English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

To the Editor: In their article, “A Retrospective Study of Cranial Strain Patterns in Patients With Idiopathic Parkinson’s Disease” (J Am Osteopath Assoc. 2002;102:417-422), Sonia Rivera-Martinez, DO, et al hypothesize that osteopathy in the cranial field (OCF) “may contribute significantly to the management of patients with neurologic disorders.” We commend the authors for identifying an important clinical problem that may be amenable to OCF and for discussing a possible relationship between osteopathic lesions and the clinical presentation of patients with Parkinson’s disease. Evidence-based medicine ensures that we provide patients with optimal treatment based on rigorous study. Accordingly, it is important that trials contain study designs that evaluate the diagnostic and treatment regimens we offer, especially when treating patients with complex chronic illnesses such as Parkinson’s disease. The study by Rivera-Martinez et al— though inconclusive as a basis for clinical recommendations—raises important issues and should serve to promote further research into OCF techniques. However, concerns that include the study design used make this trial too preliminary to establish the effectiveness of OCF in treating patients with Parkinson’s disease. Patient encounters described in the article were extrapolated from clinical records, with inclusion criteria based on a diagnosis of Parkinson’s disease and documented findings of somatic dysfunction by osteopathic physicians competent in manipulative medicine. The range of such dysfunction makes studying discrete groups, necessary for scientific comparison and establishment of treatment protocols, a challenge. Further complicating the study of OCF is the fact that diagnostic findings regarding cranial dysfunction continue to be debated within the osteopathic medical profession. Although current studies lend credence to the concept of cranial bone mobility, the physiologic significance and clinical implications of such mobility remain to be established. A review of current medical literature reveals insufficient statistically significant correlations between cranial interventions and positive patient outcomes.1 A recent attempt to substantiate interexaminer reliability revealed a disappointing correlation between trained physicians placed at a patient’s head and feet, further compounding the dilemma of evaluating the potential effectiveness of OCF.2 Such inconsistency among osteopathic physicians proficient in the diagnosis of cranial dysfunction further distances the possibility of finding an association between Parkinson’s disease and cranial abnormalities. Parkinson’s disease is certainly a neurologic disorder; however, the spectrum of its clinical presentation suggests that that which applies to this disease is not applicable to all neurologic disorders. Although OCF may enable the identification of patterns in neurologic disorders in general, this study emphasized Parkinson’s disease; therefore, the study title and conclusions should reflect this. An additional concern regarding the study is the number of patients in the research group with diagnosed cranial dysfunction. Of those patients with documented parietal or temporal rotation—both internal and external—only 10% (n 3) met the inclusion criteria to be considered part of the research group. Forty percent (n 8) of patients with parieto-occipital rotatory dysfunction met inclusion criteria to be classified as controls. And while 15% (n 3) of control patients had frontosphenoidal dysfunction, only 33% (n 1) of patients with Parkinson’s disease had similar pathology. Although the occurrence of occipital lesions in participants with Parkinson’s disease is considered statistically significant in this study, such small study populations do not have the power to support the study’s conclusions; therefore, findings cannot be applied to the population of Parkinson’s patients. (What validity does an n of 1 have?) It is premature to use this study to suggest that “treatment of cranial findings may improve the outcome of disease progression.” Osteopathic medicine was born out of the need to protect patients from untested or As the scholarly publication of the osteopathic medical profession, JAOA—The Journal of the American Osteopathic Association encourages osteopathic physicians, faculty members at osteopathic medical colleges, students, and others—as consistent with the mission of the JAOA—to submit their comments to the JAOA. Letters to the editor are considered for publication if they have not been published elsewhere and are not simultaneously under consideration by any other publication. All accepted letters to the editor are subject to copyediting. On request, the corresponding author is responsible for providing the editor with photocopies of referenced material. When sent by mail or fax, letters must be typewritten and double-spaced. Except in rare instances, the text of a letter should not exceed 500 words and should not include any more than five references and two tables or illustrations. JAOA encourages its readers to submit letters electronically to jaoa@aoa-net.org. Letter writers must include their full professional title(s) and affiliation(s), complete address, day and evening telephone numbers, fax number(s), and e-mail address(es). Letter writers are responsible for disclosing financial associations or other possible conflicts of interest. Although JAOA cannot acknowledge the receipt of your letter, we will notify you if the letter has been accepted for publication. Rejected letters and illustrations will not be returned unless accompanied by a self-addressed stamped envelope. Address letters to: Gilbert E. D’Alonzo, Jr, DO, Editor in Chief, JAOA, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. Fax: (312) 202-8200. E-mail: jaoa@aoa-net.org.

Study raises important issues about the potential benefit of osteopathy in the cranial field to patients with Parkinson's disease