Beliefs and Use of Palpatory Findings in Osteopathic Clinical Practice: a Qualitative Descriptive Study among Italian Osteopaths

Abstract

ABSTRACT
The Italian government has started the regulatory process of osteopathy to include it among the healthcare professions mentioning terms, such as “perceptual palpation” and “somatic dysfunction” within the professional profile. ‘Palpatory findings’ are one of the multidimensional aspects that can inform osteopathic clinical reasoning. The non-regulated educational system has led to heterogenic professionals working in Italy, thus, the aim of this study was to investigate how Italian experts use palpatory findings in their clinical practice. A total of 12 experts were selected to participate in four virtual focus groups. A qualitative inductive approach with a constructivist paradigm was chosen to describe the results. The themes that emerged were: osteopathic identity; evaluation; osteopathic diagnosis; and sharing with different recipients. Participants agreed on the peculiarity and distinctiveness of osteopathic palpation, but there was some disagreement on the clinical significance of the findings, highlighting a complex multidimensional approach to diagnosis and treatment. The results seem to reflect the history of the profession in Italy, which has evolved quickly, leading professionals to seek new paradigms blending tradition and scientific evidence. The authors suggest further investigation to verify the state of art among osteopaths not involved in research or a broader consensus of the results.

CONCLUSIONS:
This qualitative research shows that expert Italian osteopaths use PFs in clinical practice with a mixed hands-on and hands-off approach. Osteopathic distinctive manual assessment is maintained by integrating it in the context of person-centred care and making use of the best available information gathered from the scientific literature. The profession placed in the healthcare setting will have to fit into a multidisciplinary context by sharing its peculiarities with other professions using an understandable language.
Furthermore, it appears that professional identity is facing a transitional phase in which one looks to the future not yet sure what to leave behind in one’s past. In this landscape that seems to show uncertainty, the profession has a great opportunity as tradition and evidence coexist. The ability to maintain tradition in a context of informed EBP could represent the innovation of osteopathic professional identity.
In order to improve consistency, plausibility, generalizability, relevance, and expected applicability of PFs in clinical practice, osteopathic practitioners, researchers, and educators could participate in an International Consensus Conference using the results of this study.