OS T EO PAT H Y AU S T R A L I A M AG A ZI N E
S PR I N G 2 0 2 3
Clinical Care Checklist General pelvic health – now available
Early career pathways
Navigating your career journey
Osteopathy and aged care
Stay up to speed with all the changes
Get curious about research
Help to build the body of evidence
Individually, we can achieve great things. But when you belong to a community swarming towards a common goal, that’s when we form our strongest line of defence, and the sky’s the limit. Guild Insurance and Osteopathy Australia have partnered for over 20 years now
to protect the future of your profession. With us, you’ll be shielded by a policy created from unmatched insight into your profession, access to risk management materials to help you reduce the risk of a claim, backing from the industry body that stands up for Australian osteopaths, and so much more.
Together, we form the network that ensures Australian osteopaths don’t have to fly solo. Get the full picture of how you can be part of something bigger by visiting guildinsurance.com.au/osteopaths or calling 1800 810 213 today.
1800 810 213 guildinsurance.com.au
Don’t go it alone Insurance issued by Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233791 and subject to terms, conditions and exclusions. This information is of a general nature. Guild Insurance supports Osteopathy Australia through the payment of referral fees. Please refer to the policy wording and policy schedule for details. OST238632 Osteo Life Magazine Ad 08/2022
WELCOME
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PRESIDENT’S MESSAGE
Welcome to the Spring edition of Osteo Life ‘Tis the season for action and excitement as the holiday season approaches! Amid the hustle and bustle of life, work, family and social commitments, finding the right balance can be tricky. So, don’t forget to take care of yourself and have some ‘pause’ moments. Thank you for your continual support into the new membership year. Renewing your membership is a show of your commitment and support to osteopathy and its place in the Australian healthcare system. We urge all our members to take full advantage of the diverse range of membership benefits over the next year to support you and help enhance your career. Exciting opportunities are continuously arising, so stay updated and simply click on our emails. At a Board level, we’ve had a very busy 12 months. By the time this edition reaches you, we would have welcomed Julia Biernacki as our new Early-Career Director, chosen by the Board. Julia will be joining us for a two-year term. We’re excited to have the early career voice represented at a Board level. This fresh perspective on our strategic outlook is invaluable,
Osteopathy Australia
T (02) 9410 0099 E info@osteopathy.org.au W www.osteopathy.org.au osteopathyaustralia
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OSTEO LIFE is the quarterly magazine for Osteopathy Australia members. For enquiries, feedback, or to contribute, contact Communications on 02 9410 0099 or comms@osteopathy.org.au. For advertising enquires, email info@osteopathy.org.au. Editorial and Education Advisory Group Toby Barker, Casey Beaumont, Amy Lawton, Melissa McDougall, Adam Nicholson, Jade Scott, Sally Tran, Heath Williams Chief Executive Antony Nicholas Editor Rebekka Thompson-Jones Sub Editor Adam Scroggy Advertising info@osteopathy.org.au Printed by Megacolour Printed on 100% recycled paper: one of our commitments to a sustainable future. OSTEO LIFE is published by Citrus Media www.citrusmedia.com.au
and we’re eagerly anticipating the positive impact this new appointment will bring. Back in September, we invited nominations for two osteopathic Director positions. One of these candidates will be dedicated to representing the interests of those working and residing outside of Victoria and/or NSW. Recognising the unique challenges faced by our colleagues in smaller states is vital, and we want to ensure their voices are well-represented on the Board – a key strategic goal. On another note, we extend our gratitude to members who attended and engaged in our member town halls. It was the first time we had run these since ‘the COVID years’. It was a wonderful opportunity to connect, listen to your needs and address your concerns. As always, we’re here for you, so don’t hesitate to reach out to me directly at mfunder.director@ osteopathy.org.au, if you have any questions or concerns. In mid-September, Antony and Stephanie represented Australia at the 10th Anniversary of Osteopaths in NZ
In this issue... News and Industry Updates 4
Osteopathy Australia news
10 Navigating the osteopathic career journey: your pathway to significance and positive impact BRETT WIENER
14 What are clinical interest groups and why do we need them?
Conference held in Christchurch. The conference theme was “The Patient Journey”. It was great to spend time with our colleagues from the NZ Osteopathic Association and I’ll be sharing my insights from the event shortly. I’m equally excited about the 11th Interdisciplinary World Congress on Low Back & Pelvic Girdle Pain National Congress based in Melbourne in early November. I had the privilege of attending this conference nine years ago in Dubai, and it had a profound impact on my clinical approach. I’m eagerly looking forward to immersing myself in the wealth of knowledge presented by the great line-up of speakers. Michelle Funder, President Osteopathy Australia mfunder.director@osteopathy.org.au
Osteopathy Australia acknowledges the Traditional Custodians and Elders of Country throughout Australia, and their connection to land, sea and community. We pay our respects to Aboriginal and Torres Strait Islander Elders, past, present and emerging.
Clinical 18 The role of osteopathy in the evolving aged care landscape LEO DEGIORGIO
20 Clinical care checklists: general pelvic health Practice Management
30 Giving new grads the best chance to succeed Research
32 It’s time to get curious about research 34 CPD Calendar Osteopathy Australia does not accept responsibility for any loss, damage, cost or expense incurred by reason of any person using or relying on the information contained in this magazine. The opinions expressed are those of the author and not Osteopathy Australia. All advertisements in this issue are paid advertisements. By registering with any company or affiliation mentioned in advertisements you will be sharing your personal information with the advertiser – please check their privacy policy. Osteopathy Australia takes no responsibility for the way personal information is used.
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NEWS
Osteopathy Australia news
OSTEOPATHY AUSTRALIA AIMS TO SUPPORT, ENHANCE AND PROMOTE THE PROFESSION. HERE’S A QUICK RECAP OF EVERYTHING OSTEO FROM THE PAST FEW MONTHS.
Notes from the Association ANTONY NICHOLAS, CHIEF EXECUTIVE, OSTEOPATHY AUSTRALIA
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he core goal of any membership organisation is to support our tribe. Openness and belonging are fundamental. We work as an osteopathic community, committed to creating an inclusive environment offering a respectful diversity of opinions. The core goal of any professional association,
especially one involved in advocacy, is integrity and having a distinct voice. To do that we have to be resilient; we must have open, honest and robust discussions and we need to focus on empowering each other and our boarder community. As I travelled around Australia talking and listening during our series of town hall meetings recently, a couple of themes were consistently raised. One was a feeling of loss for osteopathic community or a loss of connection (belonging) and the other was an increasingly negative narrative when osteopaths talked about their businesses, their practice, their osteopathy careers or why they are changing careers. We understand, now, for many individual osteopaths or for whole businesses, the recovery from the impact of COVID is still ongoing. It has been further complicated by delayed graduate completions, increasing cost of living and increasing interest rates or rents. The world is currently very dynamic and the economy grey and threatening. For most people under 35 years of age, they have never experienced an economic downturn in Australia, let alone one just after a global pandemic. All of which has reduced energies, engagement or ability to afford ‘optional’ memberships.
Over the coming months Osteopathy Australia wants to focus on the many positive, engaging and interesting things happening across our industry. We know there are hundreds of osteopaths doing dynamic, interesting and innovative forms of practice. We know there are businesses that are running supportive, engaging and fulfilling primary care clinics. We know there are osteopaths, raising awareness and challenging barriers in new careers or industries few osteopaths have worked in before. We know that although times may be tough, there are incredible opportunities for osteopaths, and we should all focus on those more. Some exciting changes are also happening with Osteopathy Australia including refreshed consumer and member websites; launching a mentorship program in collaboration with the UK and NZ; a PROMS trial to ensure researchers have a sea of data to show osteopathy’s benefits; and profiling more innovation, leadership and positive stories about how amazing osteopathy is. As always, thank you for supporting Osteopathy Australia and we look forward to improving and doing more exciting things, for you, into the future.
“The core goal of any professional association, especially one involved in advocacy, is integrity and having a distinct voice”
NEWS
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URGENT CHECK: Don’t risk registration suspension for a missed insurance payment
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We don’t want to scare people but would prefer osteopaths don’t end up at a tribunal, so please keep reading.
he Osteopathy Board of Australia (OBA) has reported a significant increase in osteopaths being non-compliant, having inadvertently missed or failed to renew their professional indemnity insurance. As a result, a record number of non-compliance cases are before independent tribunals; decisions are pending and will be made public shortly. We have been advised that it is likely some osteopaths will face registration suspension, and in all cases, individuals have to self-fund their legal defence due to lapsed insurance cover. Don’t let this happen to you. To avoid any complications, we strongly urge you to take immediate action.
If you are insured with Guild Insurance, kindly contact them at 1800 810 213 to verify the status of your insurance policy and promptly renew it if necessary. Alternatively, carefully review your certificate of currency through your online portal or by contacting Guild (or another insurance provider) directly. If you discover non-compliance, renew immediately and remember to report your non-compliance to Ahpra within seven days of discovery. Under Aphra, you also have other obligations. These include: Notifying Ahpra of changes to your principal place of practice, name or address within 30 days;
SAVE THE DATE
24 - 26 October 2024 Osteopathy Australia, Osteopaths NZ & Osteopathic International Alliance CONFERENCE - SYDNEY Details to follow
Meeting the Board’s registration standards, codes and guidelines; Maintaining recency of practice; Participating in and recording continuing professional development activities. Osteopathy Australia can help you meet some of these obligations. As a member, you can access many free CPD courses, saving you money and time looking for relevant courses. Sign up for courses today and don’t leave it until November to meet the mandatory 25 hours of CPD. If you have any queries or questions, please contact info@osteopathy.org.au
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NEWS
STAFF UPDATE
Welcoming Rebekka Thompson-Jones In her capacity as the Communications and Marketing Manager, Rebekka is looking forward to building a nimble and proficient team poised to help grow Osteopathy Australia’s brand recognition across the healthcare and community sectors. Rebekka stands as a dedicated and seasoned communications and marketing professional with demonstrated experience in formulating and executing creative communication and marketing strategies and campaigns that make an impact on a business, a brand or reputation. Rebekka’s core competencies and expertise include strategic planning, marketing communications, media relations, digital and social media, web design and content, crisis and issues communications, stakeholder
management, internal, corporate and product communications, employee engagement, product launches and event management. Rebekka’s experience spans the health, wellness, pharmaceutical, philanthropy, FMCG and entertainment sectors. Rebekka said, “I’m looking forward to working collaboratively with Osteopathy Australia members, the Board and wider team to ensure all our communications, marketing and engagement activities run as smoothly and successfully as possible; all the while promoting the high professional standards and best practice to the community.” If you have any great communications and marketing ideas, please do get in touch via comms@osteopathy.org.au
Welcoming Stephanie Santos Stephanie has recently joined the Policy Team as Policy and Advocacy Manager. She is responsible for managing the Policy Team and providing oversight to various policy and advocacy development activities. Stephanie has over 10 years of experience in the health sector across government, private and not-forprofit organisations. Stephanie is an experienced leader with strong leadership and management skills and has a background and passion for the development of health policy. Stephanie said, “Working in health policy is a niche area and is sometimes overlooked in terms of the difference rigorous policy can make to the sector. Working with a team of passionate policy professionals at Osteopathy Australia
makes all the difference to ensuring the profession has a strong voice and is recognised for all of its achievements.” Stephanie has held various roles in the health sector with HealthConsult, eHealth NSW, The Australian Health Practitioner Regulation Agency (Ahpra), The Royal Australian and New Zealand College of Ophthalmologists (RANZCO), as well as in Pharmacy and with a private Speech Pathology client. Stephanie also holds a Bachelor of Health Sciences (Major in Speech and Hearing) from the University of Sydney. Stephanie is excited to make a difference to osteopathy and work closely with the profession and the Osteopathy Australia team. She said, “I look forward to leading the Policy Team and guiding them in the right direction to produce quality results that will make a different to the Australian healthcare sector and more specifically osteopathy.”
NEWS
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How we are supporting osteopathy practice under the National Disability Insurance Scheme (NDIS)
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or more than 18 months, we have been working towards formal recognition of osteopathy services under the National Disability Insurance Scheme (NDIS). Currently, osteopaths can and do provide support to some NDIS participants; many osteopaths and their clients experience significant barriers to accessing NDIS-funded osteopathy services. Osteopaths are unable to register with the National Quality and Safeguards Commission (NDIS Commission), which means that they are ineligible to provide funded support for any participants whose funding is managed by the National Disability Insurance Agency (NDIA). The work the association has undertaken to date has focused on preparing to apply for recognition with the NDIA and NDIS Commission. We are pleased to announce that we have lodged a formal application for this recognition with the National Disability Insurance Agency (NDIA). We thank the many clinicians who responded to our NDIS survey in late 2022 and the members of our NDIS Clinical Advisory Group for their contribution to the application. NDIA is currently assessing our application. Osteopathy Australia CEO Antony Nicholas recently met with senior NDIA staff to seek initial feedback on the application. Feedback suggests that our application has been well-received. While our application laid out a compelling case for osteopathy services for NDIS participants, we have been advised that the NDIA will also seek internal feedback and will be reviewing their data about osteopathy services for NDIS participants. NDIA intends to ensure that the information in our application aligns with participants’ real-world experiences of osteopathic practice. While there is no suggestion that osteopaths are practising inappropriately, the NDIA has flagged that a key focus for
them is understanding whether osteopaths are providing capacity-building support or whether their focus is more typically on health-related support that is considered the responsibility of the health system.
HOW CAN YOU SUPPORT OUR APPLICATION?
If you are not yet providing services under the NDIS, there’s nothing further that you need to do for now. We will provide additional updates as this work progresses and remain confident that osteopaths will soon have greater opportunities to support NDIS participants and participate in Australia’s disability system. If you are providing services under the NDIS, we ask that you do everything you can to ensure that the way you plan, deliver and report on NDIS services ensures NDIA criteria are met. Given the current emphasis on the sustainability of the scheme and ensuring costs are managed, all services must align with the NDIA’s understanding of reasonable and necessary; and are focused on capacity building. This typically means ensuring that the focus is on supporting the participant to achieve functional outcomes that improve their ability to engage in activities such as meal preparation, community participation or employment. The functional outcomes you are working towards should align with one or more goals set out in a participant’s plan. Your interventions should primarily focus on active, movement-based approaches and any passive approaches such as manual therapy should directly support those active therapeutic approaches and the functional outcomes you have identified in your planning with the participant. Wherever possible, we encourage you to consider whether there is evidence to suggest that the intervention you are providing leads to functional outcomes.
Pain management is generally not funded under the NDIS unless it is directly related to supporting functional outcomes associated with building participant capacity. Similarly, any services for children or adults with autism should have clearly defined functional outcomes rather than outcomes associated primarily with the disability or its symptoms. We encourage you to review the Osteopathy Australia ‘Understanding the NDIS’ webinar available to all members if you’re at all uncertain about what this means.
NEXT STEPS
Osteopathy Australia will shortly commence work to develop additional educational resources and templates to assist osteopaths working in the NDIS. Those resources will be developed to support current and future NDIS practice by osteopaths. We will provide further updates as this work progresses, including providing opportunities for feedback about what you need. If you’d like to support this work, please get in touch via the link below. We will also be continuing our engagement with the NDIA as the assessment process is completed. While we do not have a clear timeline for the completion of the review, we expect to provide further updates in upcoming Osteo Matters newsletters.
GET IN TOUCH If you’re interested in supporting further work we’ll be doing to develop member resources for NDIS practice, please send a short email to clinicalpolicy@ osteopathy.org.au expressing your interest and a short outline of the type of work you currently do with NDIS participants.
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NEWS
Graduate Certificate in Strength & Conditioning
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he Graduate Certificate in Strength & Conditioning is returning in 2024. Through a partnership between Victoria University (VU) and the Western Bulldogs the post-graduate level course combines tertiary coursework with unparalleled high-performance sport insight and experience. Learning is conducted within a hybrid style with time split between academic coursework (both online and in person at VU’s Footscray Park campus); with the industry integrated learning at the VU High Performance Center at Whitten Oval, home of the Western Bulldogs. Pathways in sport for osteopaths Osteopathy Australia recognises Victoria University as the Tertiary Provider of Choice for continuing education opportunities in exercise rehabilitation, sport science and strength and conditioning in Australia. The Graduate Certificate in Strength & Conditioning provides an industryfirst pathway for osteopaths to engage in postgraduate study in strength and conditioning and meet the requirements for Extended or Advanced Practice recognition in Sports Management. Students who successfully complete the Graduate Certificate can expect to receive: Postgraduate qualifications and eligibility to apply for Extended or Advanced Practitioner titling; Practical experience embedded in elite sport; Masterclasses from industry professionals; Career and networking opportunities. Course delivery The Graduate Certificate in Strength & Conditioning is delivered full-time over one semester. Students complete four units designed specifically to give graduates the skills and knowledge required to work in high-performance sport. Each unit is taught across a four-week period, aligned with Victoria University’s award-winning VU Block Model™. The hours are estimated to be between 10 and 15 hours a week, with the semester one intake beginning on Monday 19 February. The coursework is sport agnostic and is applicable to all athletic pursuits.
Exposure to elite sport through industry integrated practical experience Students will spend over 30 hours embedded in the high-performance department of the Western Bulldogs, gaining unparalleled understanding of elite training across all four football programs. This includes exposure to a range of athletes and disciplines within the Physical High Performance team including strength and conditioning, medical, rehabilitation and sports nutrition.
ease my way back into studying again. The VU Block Model is good for someone that might work full time or is returning to university again.” – Kate, 2023 Graduate
Extra-curricular Masterclasses Theoretical learning is complemented by a series of Masterclasses from key Western Bulldogs high-performance staff. This provides in-depth sessions on a series of topics that are unique to elite sport, explore principles of strength and conditioning in more detail, and draw on experience of senior staff. Taking learning beyond the classroom provides students invaluable opportunities to further develop industry understanding, build professional networks and future employment prospects.
Entry requirements Current course entry requirements will now readily recognise osteopathy study and industry experience. Completion of an Australian bachelor's degree (or equivalent) in a similar discipline OR; Applicants with a minimum of five years’ approved work experience will be considered for admission to this course: - Applicants applying with five years of work experience will need to demonstrate competency in several foundational skills. - Pathway units are also available to osteopaths who do not meet the work experience criteria.
Student Testimonials “I liked this way of learning – being a mature-age student, it was a great way to
“During the shadow shifts with the VFL and AFL programs I got an in-depth idea of what it’s like to be involved in a professional club. Being around coaching staff and seeing how they communicate and work collaboratively was also invaluable and helped me to understand how to act in a professional environment.” – Jett, 2023 Graduate.
Enrol today to commence study from Semester One 2024. Enquire today via education@westernbulldogs.com.au or education.westernbulldogs.com.au/osteo. For further information on fees and scholarships visit u.edu.au/courses/graduate-certificate-in-strength-and-conditioning-stsa
GRADUATE CERTIFICATE IN
STRENGTH & CONDITIONING Post-graduate qualifications coupled with elite sport experience
2024 ENROLMENTS OPEN NOW
Understanding Chronic Pain Management The benefits of saffron and PEA and their influence on the endocannabinoid system Chronic pain is on the rise and sufferers are more likely to experience psychological concerns such as depression, anxiety and sleep disturbances. PEA and saffron have the unique ability to influence the endocannabinoid system and in turn, manage chronic pain and its associated symptoms. Chronic pain is persistent pain lasting more than 3-6 months. Over the past 10 years, general practitioners have seen a 67% rise in patients experiencing chronic pain.1 Chronic pain is complex and it is often reported that chronic pain sufferers concurrently experience psychological distress and symptoms such as poor mood and sleep.1 The body is equipped with a variety of mechanisms and systems to alleviate and resolve pain, including the endocannabinoid system. Compounds, such as palmitoylethanolamide (PEA) and Crocus sativus (saffron), have the unique ability to influence the endocannabinoid system and in turn, manage chronic pain and its associated symptoms. The endocannabinoid system is involved in the modulation of pain and inflammation. Cannabinoid 1 (CB1) receptors are located within the brain and central nervous system whilst cannabinoid 2 (CB2) receptors are found primarily in peripheral tissue and cells of the immune system.5 Endocannabinoids are produced endogenously or can be supplied exogenously to manage pain. Whilst PEA is not a cannabinoid itself, it is a naturally occurring endogenous fatty acid that is produced in response to inflammation or injury. In conditions such as chronic pain, it has been noted levels have been altered, highlighting the benefit of PEA supplementation.3 PEA works through: • Enhancing tissue levels of anandamide, a cannabinoid that acts upon CB1 and CB2 receptors, providing analgesic properties.6 • An affinity to PPAR-α receptors, which reduces inflammation and the secretion of pro-inflammatory signalling molecules.6
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• An affinity to receptors GPR55 and acts to desensitise TRPV1 which is involved in the sensation of pain and heat.7 • Inhibition of mast cell degranulation and subsequent histamine release whilst controlling glial cell behaviours.3 Ultimately, PEA provides analgesic, anti-inflammatory and neuroprotective benefits. Due to its fatty nature, PEA has poor absorption. Levagen+ is considered a superior form of PEA which utilises LipiSperse® technology to increase bioavailability.6 Saffron is a notable adjunct therapy to PEA as chronic pain sufferers are more likely to experience psychological concerns such as depression, anxiety and sleep disturbances.1 Saffron has been shown to provide anti-inflammatory, antinociceptive, immunomodulatory, analgesic, antidepressant and anxiolytic effects.8 Saffron works through the following mechanisms: • Attenuates pro-inflammatory mediators such as TNF-α and IL-6.8 • Reduces eosinophils, neutrophils and lymphocytes, leading to a down-regulation of leukotrienes, prostaglandins, cytokines, ROS and NO.8,9 • Partial agonism and selective desensitisation of the TRPA1 channel.10 • Antioxidant activity reduces oxidative damage by attenuating endogenous ROS.11 • Reuptake inhibitor of dopamine, serotonin, and norepinephrine.11 For optimal patient results, choose a standardised form of Saffron such as affron®. affron® is standardised by HPLC (high performance liquid chromatography) to Lepticrosalides® and has been shown to support mood, relaxation and sleep,12 critical for chronic pain sufferers.
REFERENCES UPON REQUEST. FOR PROFESSIONAL REFERENCE ONLY www.bioceuticals.com.au ©BioCeuticals 2023
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27/2/23 10:33 am
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INDUSTRY UPDATE
Navigating the osteopathic career journey: your pathway to significance and positive impact Embarking on a career as an osteopath is an exciting and rewarding journey filled with endless possibilities. As a budding professional in this field, you have the opportunity to make a real difference in people’s lives by providing whole-person healthcare solutions. In this article, we will explore essential early career advice for osteopaths, emphasising individual growth, diverse career pathways and the pressing need for osteopaths in rural and regional areas. THE FOUNDATION: MASTERING YOUR CRAFT
Before diving into the vast ocean of career possibilities, it’s essential to lay a strong foundation for your practice. Acquiring a comprehensive knowledge of human anatomy, biomechanics and osteopathic principles is crucial. Attend workshops, seminars and conferences regularly to stay up-to-date with the latest advancements in the field. As you delve deeper into your studies, remember that learning is a lifelong process. Approach your education with an open mind, curiosity and a willingness to evolve as an osteopath. Seeking out a high-quality mentoring program, whether that be in groups or as an individual, is an essential starting point to building those foundations. Some of the key topics/ areas you may want to dive into include: 1. Personal success foundations (Personal branding, understanding your ideal patient, understanding your why and philosophy of care and goal setting); 2. Communication standards (Diagnosis, management, compliance);
3. Effectively managing time; 4. How to build your caseload (relationships and networking); 5. Understanding and building emotional intelligence (and how it impacts patient outcomes); 6. Managing the emotional load of being a practitioner and the art of giving to others sustainably.
BUILDING YOUR NETWORK: CONNECT, COLLABORATE, AND CULTIVATE RELATIONSHIPS Building a robust professional network is key to your success as an osteopath. Attending local and national healthcare events, engage with peers, mentors and industry leaders, and making meaningful connections. Collaboration can lead to groundbreaking opportunities and foster a sense of camaraderie within the healthcare community. However, cultivating long-term referral networks/ relationships within healthcare is hard. It takes time, trust and maintenance of those relationships. Networking can be intimidating at times and rejection happens often, but
“It’s essential to stay antifragile and steadfast in your pursuit of success and significance as a healthcare practitioner”
BRETT WIENER
Brett graduated from Victoria University and completed his Masters in Applied Positive Psychology at the University of Melbourne. He has a wealth of knowledge in the science of what it means for individuals, groups and institutions to thrive. He is a director at the Sports and Spinal Group in Bayside, Melbourne. Brett is a member of the Osteopathy Australia Board. remember, even the most seasoned osteopaths were once fresh-faced graduates, nervously clutching their business cards like prized treasures. So, take a deep breath, smile, and dive into the networking pool. You’ll make a splash!
EXPLORING CAREER PATHWAYS: BEYOND THE CLINIC WALLS
A key lesson to begin: you are still an osteopath if you are not in private practice. Many osteopaths have asked questions about the attrition rate in osteopathy and make assumptions that if someone leaves private practice and moves into a new role/space, they are no longer an osteopath. This is factually incorrect!
INDUSTRY UPDATE
In the 10 years to end of 2020, there was a grand total of 3,138 osteopaths who have been registered/transitioned, of which 373 have become ‘unregistered’ (attrition). This represents 12% overall becoming unregistered in the 10 years (between 1% and 2% each year). This is below almost all other industry standards globally! Osteopathy is still the fastest growing profession after Aboriginal and Torres Strait Islander Health practitioners during the 2016-2020 period. Osteopathy numbers seem to be growing each year in all states and territories (except NT) and graduate, not overseas application numbers, are driving most of the registrant growth. While the conventional route for an osteopath involves establishing themselves in private practice, don’t be afraid to explore alternative career pathways. Your unique skills can be applied in diverse settings, including: NDIS/aged care: This is a rapidly growing space for osteopaths with greater scope for involvement in the future; Surgical equipment sales: Many osteopaths have entered this space and we look forward to featuring these in upcoming Osteo Life articles. Research and academia: If you have a passion for knowledge, consider delving into osteopathic research or academia. Contributing to scientific advancements in the field can be incredibly rewarding; Sports medicine: For the sports enthusiasts among us, sports medicine offers an exciting avenue. Collaborating with athletes and teams can put your expertise to the test, both on and off the field; Public health and community outreach: Osteopaths are in high demand in rural and regional areas, where access to healthcare is limited. Engaging in public health initiatives and community outreach can make a substantial impact in underserved regions; Corporate wellness: The corporate world is slowly awakening to the benefits of whole-person healthcare. Offering osteopathic services to companies can help improve employee well-being and productivity.
CASE STUDY Melissa McDougall,
Advanced Paediatric Osteopath (as awarded by Osteopathy Australia 2021). My interest in paediatrics started while in the UK. Like many Aussies, I travelled to London on a working holiday visa. The idea was to work a bit and travel a lot! While waiting for my GOSC exam, I arranged to observe for a day at the Osteopathic Centre for Children. During that day, I saw the early challenges of parenthood. I observed many parents express their appreciation for the help osteopathy had provided them, helping them feed, or settle their babies. They were also frustrated that osteopathy wasn’t recommended sooner. The simple things provided by the osteopaths seemed to improve the parents’ mental health and enable healthy attachment and bonding. I felt so fulfilled that day, more than any other day in practice. So, instead of travelling, I signed up on the spot for a two-year Postgraduate Diploma. I was lucky the diploma start and end date matched up with my visa! Once I returned to Australia, I wanted to help increase awareness around osteopathy for babies and children, so I started a practice called Growing Bones in 2013. For the past 15 years, I’ve maintained a large focus of the treatment of babies and children and hope to advance osteopathy in this area through research and education. What inspired you to become an Advanced Practitioner osteopath? I was chatting to Antony, the CEO for Osteopathy Australia, about research ideas when he mentioned the Advanced Practitioner Pathways. I was excited to hear Osteopathy Australia had created these to reflect the extensive learning experience an osteopath has in a particular focus area. So, I applied.
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What opportunities have opened up for you since becoming titled? And how has this benefited you and/or the osteopathic profession? As an Advanced Practitioner I don’t expect opportunities to come to me; I need to seek them out. I’m currently planning a project that looks at the role of osteopathy for plagiocephaly, using data from other Advanced Paediatric osteopaths working in private practice. I’m confident further opportunities will come from evidence-based practice. What advice do you wish you’d been given early in your career? I was very lucky to have a great mentor when I first graduated. I asked for an hour of his time per week (instead of a payrise), and this was wonderful. He taught me so many patterns of dysfunction, and I made a few mistakes and learned from them quickly under his guidance. Good mentoring is priceless. It set me up for a long, fulfilling career. What achievement are you most proud of? Totally not osteopathy-related, but having my two perfect sons, and two positive birth and breastfeeding experiences, because of excellent, early support. Why did you become an Osteopathy Australia member? I can’t understand why anyone wouldn’t be a member! We are a small profession, but a great profession. Osteopathy Australia is our voice, and so supportive to osteopaths, business owners. So I am a member for individual reasons and for the advancement of the profession as a whole. What are the particular areas within your focus area that you believe hold the most promise for patients? My goal, by the time I retire is to have osteopaths in Maternity Units in Hospitals. For two reasons: preventing plagiocephaly (now affecting 48% of babies) and improving breastfeeding outcomes for mothers who want to breastfeed. It all starts with research!
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INDUSTRY UPDATE
CASE STUDY Bronwyn La Brooy
Advanced Practitioner in Exercise Rehabilitation (Tertiary) I graduated in 2015 from RMIT University after finishing an Exercise and Sport Science degree from Deakin University in 2010. I’m currently working at City Osteopathy in Melbourne CBD (2015–current) and am also the Principal Osteopath at Burwood Osteo & Rehab (2020–current). I am a Clinical Pilates Instructor and I have extensive experience with many sporting teams over the years including managing, programming and coaching rowing at a competitive Melbournebased high school, head trainer at a VAFA Footy club, and coaching athletics and netball for junior kids. My work spans various age groups in the sporting and rehab field. I’m currently working with chronic conditions and exercise prescription for people living with MS, Parkinson’s and diabetes. What inspired you to become an Advanced Practitioner osteopath? I became an Advanced Practitioner to educate other osteopaths in different rehabilitation pathways. I wish to instil the passion I have onto other practitioners of any modality; whether they’re more experienced osteopaths than me or new graduates, everyone has the ability to learn new things from one another. I’m excited to see this change happen and be part of the process. What opportunities have opened up for you since becoming titled? And how has this benefited you and/or the osteopathic profession? Advanced Practitioner pathways have opened up more third-party clients like DVA, TAC and NDIS schemes. Clients have particularly sought out my background to help them with their rehab journey. I think this will benefit our profession by practitioners being rewarded for their professional
development and further study. To help each of us know who can help in a certain area to refer to as well. What advice do you wish you had been given early in your career? Our job can be emotionally taxing, so learn to compartmentalises emotions to ensure a healthy work-life balance. We can take on other people’s energy, so to separate yourself and start fresh when you open the door to come home is the best way to help yourself, your family and your clients by not being burnt out and exhausted too soon. What achievement are you most proud of? I’m most proud of my osteo colleagues in various practices, particularly in the CBD, and their resilience over the ever-changing landscape of COVID. Needing to pivot, rebuild and adjust every few months to new changes over the last three years has been a lot, and today the CBD is still returning to a new sense of normalcy, so I’m very proud of every practitioner who has sailed into that storm and is still practising as we come through a tough third year. Why did you become an Osteopathy Australia member? I think it’s important to have our advocacy, voices and opinions and then for that voice to be heard in larger settings. We are small compared to our physio colleagues, but we are listened to, and that’s in all parts due to the advocacy of Osteopathy Australia. For our cohort of healthcare practitioners to be taken seriously by others in the medical and health industry, having a body that represents us and that gets us further with both the general population and other third-party industries is only the surface of what Osteopathy Australia does for our profession, and one I’m happy to support. What are the areas within your focus areas that you believe hold the most promise for patients? Working with the NDIS and potential future programs like MyAgedCare holds promise, ensuring greater access to osteopathy services for those in need.
EMBRACING OPPORTUNITIES IN RURAL AND REGIONAL AREAS
The demand for osteopaths in rural and regional areas is nothing short of urgent. These communities often suffer from limited access to healthcare services, leaving the residents underserved and vulnerable. As an aspiring osteopath, you have the chance to make a substantial impact in these regions. Imagine the fulfilment of setting up amid picturesque landscapes, where your skills can improve the quality of life for countless individuals. Not only will you be offering much-needed healthcare, but you’ll also become an integral part of the community and receive high-quality mentoring for the future. Embracing rural life may mean saying goodbye to the hustle and bustle of city living. But fear not! You’ll discover that in these areas, rush-hour traffic is simply a flock of sheep crossing the road at a leisurely pace.
CHALLENGES AND PERSEVERANCE: NAVIGATING THE ROAD BLOCKS No career journey is without its challenges. As an osteopath, you might face hurdles ranging from financial constraints when starting to practice to skepticism from patients unfamiliar with osteopathy. It’s essential to stay antifragile and steadfast in your pursuit of success and significance as a healthcare practitioner. Remember that each obstacle is an opportunity to grow and learn. Seek support from mentors and fellow practitioners when you encounter roadblocks, and don’t shy away from seeking guidance from other healthcare professionals. Collaboration and open communication can help you overcome hurdles and emerge stronger than ever.
MAINTAINING WORK-LIFE INTEGRATION (THERE IS NO SUCH THING AS “BALANCE”)
As you delve into your osteopathic career, it’s easy to get swept up in the excitement and dedication to your work and patients. However, it’s crucial to maintain a healthy work-life integration. Work-life integration is integrating one’s work and life to complement and support each other. It’s the process of allowing
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space for both work and your personal life so that you can feel fulfilled in both aspects. With work-life integration, you efficiently coordinate your workday schedules and personal responsibilities, ensuring personal and professional productivity and higher satisfaction. But work-life integration isn’t about finding a ‘perfect’ balance between work and life. It’s about finding a balance that works for you. It’ll look different for everyone and change over time as your circumstances change. The key is to create a balance that works for you and be flexible and adaptable as your needs change. A work-life integration approach is an evolved version of work-life balance, emphasising the integration of personal and professional responsibilities. As opposed to work-life balance, which implies scales tip in one direction or another, work-life integration suggests finding harmony. Work-life integration benefits With work-life integration, employees can give equitable attention to
all aspects of their lives without sacrificing one for the other, enhancing their wellbeing (physically, psychologically and spiritually); Achieving work-life integration is much more realistic and practical; Employees feel a sense of empowerment when in control of their own time, which in turn improves confidence and self-esteem.
BURNOUT – WHAT DOES THAT ACTUALLY MEAN? We need to bust some myths when it comes to “burnout.” It has suddenly become as common as many other buzz topics. Burnout is not boredom or laziness; it is not a psychological disease and it is certainly not an acute condition. It is an unfolding process that is very misunderstood. Burnout has been defined as an experience in response to job stressors, comprising of physical, emotional and cognitive exhaustion, progressive cynicism and inefficacy. Burnout is not one of these dimensions alone but
“The key is to create a balance that works for you and be flexible and adaptable as your needs change”
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a collection of them. The unfolding process most commonly takes place with the below four key stages: 1. An imbalance between resources and job demands (stressors); 2. The immediate, short-term physical, cognitive and emotional tension, fatigue and exhaustion (strain); 3. Several changes in attitude and behaviour, such as a tendency to treat clients in a detached and mechanical fashion; 4. A progressive reduction in self-determination (reduced feelings of mastery over your own destiny).
SO WHAT IS THE REMEDY TO GENEROSITY (OR GENERAL) BURNOUT?
Work engagement considers three core aspects: Vigour: High energy, mental resilience and a willingness to invest extra effort and persistence in one’s work; Dedication: Being strongly involved in one’s work, with a sense of purpose, enthusiasm, inspiration, pride and challenge; Absorption: Concertation, happiness with work and being deeply and fully engrossed in work – where time passes quickly and detachment from work is difficult. Contrary to those who suffer from burnout at work, engaged clinicians have a sense of energetic and effective connections with their work, and instead of stressful and demanding, they look upon their work as challenging. The early stages of an osteopath’s career are an exciting period of growth, exploration and impact. By mastering your craft, building a strong network and embracing diverse career pathways, you can chart a fulfilling professional journey. Remember the pressing need for osteopaths in rural and regional areas, where your expertise can be a beacon of hope and healing. As you navigate through challenges and embrace joyous moments, always maintain a sense of humour. Laughter can be the best medicine, both for your patients and for yourself. So, go forth with a smile and a touch of wit, and make your mark as a compassionate, skilled and innovative osteopath. The world is waiting for you.
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What are clinical interest groups and why do we need them?
Since launching our clinical interest groups just before the onset of COVID, we understand that some members may still be unfamiliar with the incredible potential of our clinical practice groups and our Extended and Advanced Practice Recognition program. This article hopes to shed light on why members should be engaging with them – not just because of the benefits to individual careers, but also the substantial benefits for the entire profession. Current clinical practice groups include: Paediatrics; Sports Management; Exercise-based Rehabilitation; Occupational Health, Work Injury Prevention, Management and Rehabilitation; Pain Management. We are also developing other areas such as women’s health, aged care and disability, but the possibilities are endless based on the desires of the profession.
WHY DID WE START SUCH GROUPS?
Clinical practice groups occur in almost every healthcare profession and have done for decades, but they did not exist in osteopathy. Under the registration standards all osteopaths are equal (i.e. registered or not), and that makes it almost impossible for consumers, other health practitioners or even other osteopaths to seek and identify experts within the profession when they have a complex patient or they consider they need to see someone with additional training and understanding. In simplest terms, that is the aim of clinical practice groups.
HOW WERE THEY DEVELOPED?
Each practice group was developed by osteopaths, for osteopaths working with Osteopathy Australia. Every clinical interest group started with an advisory group comprising osteopaths with key knowledge or training in one of the five areas identified above. We also sought input from external experts – for example, the occupation health group had an occupational physician, and the pain group had a chronic pain psychologist.
“The Extended and Advanced Practice Recognition program exists to recognise osteopaths who have gained additional tertiary qualifications or training, a high level of clinical skill and experience within a specific clinical practice area” Each of the advisory groups set about mapping and creating a Quality Practice Framework. These frameworks identify and recognise the knowledge, skills and scope of practice of osteopaths with a focus in any particular area vary depending on education, workplace requirements, clinical team requirements and relevant industry policies. The clinical practice groups are not intended to define all knowledge sets and skills possessed by these osteopaths, nor all interventions these practitioners offer. They do outline knowledge and skills that the broader health industry expects osteopaths seeking standing and recognition within a group would possess as a minimum requirement. For example, a small section of the Sport Quality Practice Framework looks like this: Injuries in the focus sport 2.7 Knowledge of prevalent, atypical and complex neuro-musculoskeletal injuries in the focus sport, including mechanisms of onset, predictors and contributing factors in play; 2.8 Knowledge of the implications of common, atypical and complex
injuries for function and performance in the focus sport; 2.9 Knowledge of injury rehabilitation approaches applied within the focus sport in accordance with current evidence informed practice; 2.10 Experience applying knowledge in 2.7-2.9 to minimise risk to players, prevent re-injury and aid timely return to sport post-injury. These frameworks are the basis for recognition but also act as a guide for any osteopath wanting to develop expertise in a particular area of practice. As such, they can act as a career and training guide. Each working group also developed processes to sit alongside the framework, including a transparent application process that helps identify and demonstrate skills and knowledge, plus criteria around independent review and assessment of each application. The system needed to stand up to scrutiny, if we want other professions, funders and government to respect the process, they needed to be transparent and credible.
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To date, many state compensation schemes have been very complimentary regarding the competency and quality practice framework model we have created. In fact, we notice recently the APA is considering transforming its current model into a similar framework.
WHAT DO THEY DO?
The Extended and Advanced Practice Recognition program exists to recognise osteopaths who have gained additional tertiary qualifications or training, a high level of clinical skill and experience within a specific clinical practice area. Beyond training or experience they demonstrate they have met the professional standards required to make an enhanced contribution to managing patient groups or clinical issues related to their advanced scope of practice. Increasingly this is an advantage to gain recognition or access to working in settings previously closed to osteopaths. Such recognition provides public acknowledgement, enhanced referral linkage, professional titling and enhanced searchability to members seeking competitive and additional career opportunities within and outside osteopathy. For instance, one
advanced osteopath considers the program’s credibility and quality practice frameworks was a major factor in her being employed within a hospital. The core over-arching aim is to create peer-osteopathy, clinical communities of practitioners who support each other and enable Osteopathy Australia to speak to and lobby for the skills of osteopaths to be recognised and progress osteopathic privileges, funding access and public awareness. Such clinical communities of osteopaths can drive policy work, develop training and other resources to support the profession, and grow networks. Extended pathway members are demonstrating an ongoing commitment to learning in that clinical practice area and many may be commencing their journey to gain Advanced Practice Recognition. Members can achieve Advanced Practice Recognition through either tertiary or vocational pathways. The tertiary pathway requires the candidate to have completed an additional university qualification within a focus area, while the vocational pathway exists for members without an additional university qualification but who can demonstrate relevant work experience, professional development,
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professional references, and reasoned case studies. Both application processes will undergo a transparent peer review conducted by a multidisciplinary review panel of health professionals. Why do osteopaths get involved? The benefits vary including: Peer and public recognition of advanced skills and scope of practice; Formal recognition and titling for professional use and profile with other professions; Enhanced employment opportunities; Opportunity to be more visible within the profession and claim more benefits; Increasing profile as a provider of quality CPD; Being a part of a network of titled Advanced Practitioner osteopaths; Opportunity to become a clinical leader within the profession.
ADVANCED – TERTIARY PATHWAY
Each Advanced Practice focus area will have a Quality Practice Framework which outlines the benchmarks that an Advanced Practitioner osteopath must be able to demonstrate in their further education, the way they practice, career achievements and in feedback from
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INDUSTRY UPDATE
CASE STUDY Dr. Reena Murray Advanced Paediatric Osteopath (and IBCLC)
You can find me practising as an Advanced Paediatric Osteopath (and IBCLC) at Completely Aligned. My career is all about diving into the world of musculoskeletal health and wellness, with a strong belief in the body’s natural healing abilities. I use methods grounded in evidence to offer personalised care that truly hones in on what each patient and family needs. With almost two decades on this journey, mostly focusing on paediatrics and lactation these days, my heart is all about making sure our littlest ones thrive. I really get the importance of stepping in early to set the stage for strong childhood development – the kind that keeps giving as they grow up. Beyond my day-to-day work, I’m genuinely excited about sharing knowledge with parents and the broader healthcare community. If you’re an osteopath looking to grow, I’m here to offer guidance. With lots of families coming through our doors, there’s a perfect chance to learn and refine your skills with the support and mentoring of a seasoned practitioner. What inspired you to become an Advanced Practitioner osteopath? My pursuit of the title of Advanced Practitioner osteopath was motivated by a desire for heightened credibility and recognition within my field. This title stands as a testament to my unwavering commitment to continuous education and professional advancement. Furthermore, I envisioned this distinction as a catalyst for propelling the field of osteopathy into new fields and more integrative healthcare. Just as other specialised domains like Paediatric and Women’s Health Physiotherapy have achieved
notable distinctions, I firmly believe that osteopathy can benefit similarly from such a level of specialisation. What opportunities have opened up for you since becoming titled? Do you have an exciting story? And how has this benefited you and/or the osteopathic profession? Attaining the Advanced Paediatric osteopath title has brought forth several significant opportunities. Most notably: I secured a role initially earmarked for a Paediatric Physiotherapist at the Mater Hospital’s Helmet/ Plagiocephaly clinic. Through communication of the expertise encapsulated by an Advanced Titled Paediatric Practitioner, as outlined in the resources provided by Osteopathy Australia, I effectively demonstrated my capabilities to the neurosurgeon and secured the role; I’ve cultivated a network of esteemed and like-minded healthcare professionals both nationally and internationally, encompassing paediatricians, ENTs, GPs, dentists, speech pathologists, lactation consultants and more. This network has been instrumental in expanding the understanding and profile of our profession, as well as fostering interdisciplinary care for our mutual patients. This level of collaboration across multiple disciplines is rarely seen in private practice; The title has also facilitated the attraction of like-minded osteopaths to my practice, creating opportunities for practical training and mentorship in both paediatric osteopathy and lactation. What advice do you wish you had been given at the early stage of your career? Or what is the best bit of advice you received? Reflecting on my formative years in this profession, I recognise several pieces of advice that would have proven invaluable:
mbracing patience is crucial. E Understand that solutions might not be immediately apparent, and patients often take unique routes to healing. This complexity is intrinsic to our understanding of the human body as osteopaths. It might feel frustrating for newer graduates, but it’s also what keeps things intriguing throughout our careers! Recognise the two sides of your skill set: excelling in healthcare requires both clinical mastery and a solid grasp of the business aspects. Striking a balance between clinical expertise and developing business acumen is essential for success as a practitioner; When selecting a practice to work in, prioritise an environment and mentor who places value on your growth, invests in your development, and treats you with respect. Opting for a permanent role early in your career can offer the stability required for skill refinement, patient management and financial security. What achievement are you most proud of? Among my achievements, the establishment and steadfast management of a highly esteemed osteopathic practice stands as a significant milestone. This practice has not only served as a cornerstone within our local community for over 17 years, but has also acted as a launchpad for numerous osteopaths to elevate their skills and contribute to the evolution of our field. This significance was heightened during a period when I had to temporarily step away from practice for cancer treatment. The outpouring of support from patients I had cared for reinforced to me the depth of the therapeutic relationship, reminding me that it extends beyond a 30-minute transaction to encompass genuine care and compassion, which can be reciprocated. This lesson is especially pertinent during those moments when we as practitioners face fatigue, overwhelm, or even burnout.
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“Each practice group was developed by osteopaths, for osteopaths working with Osteopathy Australia” two health practitioner references checks. The application will specifically involve: Completion of a further university qualification related to chosen focus area (AQF Level 7 and above); Demonstration of an advanced scope of practice in healthcare as described in a CV; Demonstrated quality practice confirmed by two written referee reports conducted by two external medical or allied health professionals (non-osteopath) that the candidate has had a professional relationship with; Consistent knowledge and skills expansion through continued professional development. Each application will be reviewed by two external medical or allied health professionals who work within the focus area and hold no conflict of interest. The reviewers are provided with clear procedures and benchmarks to ensure a consistent and fair process.
ADVANCED – VOCATIONAL PATHWAY
Each Advanced Practice focus area will have a Quality Practice Framework which outlines the benchmarks that an Advanced Practitioner osteopath must be able to demonstrate in their further education, the way they practice, career achievements and in feedback from two health practitioner reference checks. The application will specifically involve: Completion of formal short, medium, or longer training courses in relation to chosen focus area; Demonstration of an advanced scope of practice in healthcare; Demonstrated quality practice confirmed by two written referee reports conducted by two external medical or allied health professionals (non-osteopath) that the candidate has had a professional relationship with; Proven ability to produce high-quality and detailed patient case studies based on real life patient scenarios
related to the candidate’s chosen focus area; Consistent knowledge and skills expansion through continued professional development. Each application will be reviewed by two external medical or allied health professionals who work within the focus area and hold no conflict of interest. The reviewers are provided with clear procedures and benchmarks to ensure a consistent and fair process.
WHAT DON’T THE CLINICAL PRACTICE GROUPS DO?
The Clinical Practice Groups don’t prevent any osteopath from seeing their patients. They don’t stop any osteopath from calling themselves an XYZ osteopath. They don’t restrict anyone’s scope of practice. We often see in social media or other forums claims that clinical interest groups are just a back door to preventing all osteopaths from treating in that clinical area, paediatrics for example. Osteopathy Australia is not the regulator,
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and Ahpra is the only body that could take such action. That has not occurred in any other profession outside medicine, so it appears unrealistic that the Osteopathy Board of Australia is going to start with osteopathy. The most likely way everyone’s scope of practice may be negatively impacted is when individuals injure patients when practising outside their current training or competency, especially if they have made advertising claims of expertise for such patients. If you speak to any Advanced Practitioner, what you quickly realise is they are engaged to grow the profession and the number of osteopaths interested in their area of clinical practice – not reduce it. They want to ensure that quality practice enhances the reputation, skill set and acceptance of osteopathy, not diminish it. In summary, the aim of the clinical practice groups and practitioner recognition is to build up the profession, acknowledge additional training, skills and experience and most importantly build practitioner-driven peer networks to provide support, mentoring, and to grow CPD, training or our policy platforms to enhance the rights and access for all osteopaths. If you are interested in becoming an Extended or Advanced Practitioner, please get in touch.
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The role of osteopathy in the evolving aged care landscape Osteopaths have been involved in providing services to aged care residents and recipients for many years now as part of multidisciplinary allied health care teams. Changes to funding of residential aged care has created new challenges for service delivery in this field. This article brings members up to date with these changes and looks to actions the profession should take to continue to contribute to the aged care workforce. BACKGROUND
The 2022 Osteopathy Australia member survey revealed 7.5% of respondents provided services in residential aged care facilities (RACF) and 5.3% provided in-home care services. In both cases, the most common services provided were pain management, assessments for musculoskeletal conditions, functional capacity and assessments for falls as well as transfer and mobility planning. In October 2022, a new funding arrangement for RACF was introduced by the Commonwealth (referred to as AN-ACC). Also, changes to the Aged Care Act mandated minimum staff time per resident to be delivered by registered nurses and personal care workers. These changes have reduced the presence of allied healthcare in residential aged care. Architects of AN-ACC recommended an average of 22 minutes’ allied healthcare per person per day to meet the needs of residents, and that funding for allied health service provision should be built in to the AN-ACC model.1 However, there is no mandated minimum average minutes for allied healthcare. Identification of allied health needs and expenses is left to the discretion of the mostly for-profit accommodation providers. As reported in the Autumn 2022 issue of Osteo Life, the Royal Commission into Aged Care Quality and Safety found that allied health services are underused and undervalued across the aged care system,2 and that aged care residents received, on average, only eight minutes per person per day of allied healthcare.3
In June 2022, the reported allied healthcare provision was 5.07 minutes per day – worse than the Royal Commission finding.4 The most recent financial data for December 2022 found that the median time for allied services has declined further to 4.6 minutes per resident per day.5 In comparison, the minutes of allied healthcare per resident provided by at home care service providers remained constant over the quarter.6
WHAT DOES THIS MEAN FOR PRACTICE?
Allied health practitioners working in residential aged care have faced significant changes in how they practise, compared to in-home care providers. A survey by Allied Health Professions Australia in December 2022 found the changes occurred swiftly for the professionals involved in residential aged care7. In summary, the changes to practice identified were: Significant reported reductions in the hours of allied healthcare provision, and anticipated further cuts to services; Providers have substituted cheaper group sessions for individual sessions meaning residents are often missing out on individual support; Many professionals said that the changes meant that they now could only respond to referrals, rather than providing proper care planning and delivery. Results from the survey indicated a combination of job insecurity,
LEO DI GIORGIO Leo Di Giorgio studied osteopathy and graduated from Victoria University in 2017 after a career as an economist and researcher. He has experience in private practice in both Melbourne and Brisbane. He is currently working at Empower Healthcare as an osteopath in the Residential Aged Care division, providing allied health clinical advice to facility operators and pain management care to residents.
deterioration in roles and concerns about the impacts on quality of care is driving allied health professionals out, with 30% of allied health professionals planning not to continue working in the sector. The discouraging state of residential aged care will give practitioners pause to consider if allied health and osteopathy has a future in this area. There are some important reasons for the profession to remain engaged with aged care.
THE DEMOGRAPHIC IMPERATIVE
The Australian Institute of Health and Welfare (AIHW) reports the number of people aged 65+ living in RACFs increased by 3.1% over five years from 30 June 2017 to 178,000.8 The growth in the Australian population aged 65+, increased 17% over the same period (to 4.4 million people).
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“Allied health practitioners working in residential aged care have faced significant changes in how they practise, compared to inhome care providers” References 1.
The AIHW identified people generally use RACFs at older ages. That is, for all admissions to RACFs in 2021-22, average age at admission was 83 for men and 85 for women.9 University of Melbourne demographers forecast Australia’s population aged 85+ is projected to increase from 534,000 in 2021 to 1.28 million persons by 2041 – an increase of 140%.10 This will drive the need for allied healthcare in RACFs regardless of government policy settings. Indeed, the larger cohort of baby boomers may force attention onto the inadequate provision of allied healthcare in the sector.
Osteopathy makes great claims to be a holistic treatment and “provide …plans … throughout your life by promoting active living and ageing.”11 If this claim is to be credible, we need to care for people in aged care settings – in facilities or in their own home. We need to ensure osteopaths who have further training and specialised work experience are recognised and encourage more osteopaths to enter this field by providing pathways to practice. We also need an evidence base to advocate for age-appropriate interventions and the benefits they provide to older Australians.
WHO IS OSTEOPATHY FOR?
WHAT NEEDS TO BE DONE?
The profession needs to ask itself “will osteopathy remain a service only accessible through private practice and generally for younger adults?”Osteopathy Australia has introduced practice recognition for osteopaths who provide treatment in workplace settings, sports settings and to paediatric patients, so it’s clear the profession wants to recognise the many populations and settings where osteopathy is of value. Therefore, it’s logical to recognise the special practice and extra skills of those osteopaths who treat older Australians in aged care settings.
Caring for older Australians can be rewarding in many ways as seen by the number of osteopaths who already work in this field. Developing this area of care requires: Extended and Advanced Practice Recognition of osteopaths in this field; A change to training and work experience placements in universities to provide undergraduates an understanding of the variety of work involved; Osteopaths encouraged to engage in research in this field.
2.
3.
4.
5. 6. 7. 8.
9. 10. 11.
12.
Eagar K, Westera A, Snoek M, Kobel C, Loggie C & R Gordon, ‘How Australian residential aged care staffing levels compare with international and national benchmarks’, Centre for Health Service Development, AHSRI, University of Wollongong, 2019 https://agedcare.royalcommission.gov.au/ publications/Documents/research-paper-1.pdf , 33-35; Eagar K, McNamee J, Gordon R, Snoek M, Kobel C, Westera A, Duncan C, Samsa P, Loggie C, Rankin N & K Quinsey, ANACC: A national classification and funding model for residential aged care: Synthesis and consolidated recommendations. The Resource Utilisation and Classification Study: Report 6, Australian Health Services Research Institute, University of Wollongong, 2019, 8-10. See also https://www. australianageingagenda.com.au/clinical/alliedhealth/allied-health-a-real-loser-in-budget/ . Royal Commission into Aged Care Quality and Safety, Final Report Volume 2 The current system, 2021, 83. Eagar K, Westera A, Snoek M, Kobel C, Loggie C & R Gordon, ‘How Australian residential aged care staffing levels compare with international and national benchmarks’, Centre for Health Service Development, AHSRI, University of Wollongong, 2019 https:// agedcare.royalcommission.gov.au/publications/ Documents/research-paper-1.pdf , 2. https://www.stewartbrown.com.au/ news-articles/26-aged-care/266-2022-10stewartbrown-aged-care-financial-performancesurvey-sector-report-june-2022 . https://www.health.gov.au/resources/ publications/quarterly-financial-snapshot-of-theaged-care-sector-quarter-2-2022-23-october-todecember-2022 , 13-14 Ibid., 25-26 Allied Health Professions Australia, MEDIA RELEASE: Allied health in residential aged care from bad to worse since Royal Commission, 2 December 2022 https://www.aihw.gov.au/reports/older-people/ older-australians/contents/aged-care#People Ibid. https://www.abc.net.au/news/2022-10-23/ population-predictions-over-65s-to-increase-by2-million/101348994# https://whatisosteo.com/body-map/howosteopaths-can-help-you/
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Clinical Care Checklists (part 3)
As an osteopath, you are likely to treat a wide range of patients including those who are embarking on their pregnancy journey, those who are currently pregnant or who are in the postnatal period. As such, it’s essential to be aware of the complexities, concerns and potential difficulties that comes with treating these unique patients for the best health outcomes.
To assist in this the Women’s Health Clinical Interest Group has produced six clinical care checklists as practical resources that outline some of the major red and yellow flags and concerns that need to be central considerations when treating patients who are planning pregnancy, are pregnant or in the postnatal period. Each checklist covers a range of biopsychosocial considerations, details on thorough history taking and referral pathways to assist osteopaths who have had limited experience with this subpopulation. They highlight that these
patients should not be treated in isolation to their pregnancy experience and that a practitioner should understand their own limitations and personal scope of practice when treating these patients. The checklists have been designed to be used as practical educational and training tools, not only demonstrating major areas of concern but also highlighting areas where additional training and education could be undertaken or when external referral should be taken. In this article we’ll feature the sixth checklist that covers general pelvic health.
Each checklist and additional resources will be available for viewing and download on the Osteopathy Australia website under the article Identifying Red and Yellow flags in pre-pregnancy, pregnancy, the post-natal period and general pelvic health – Clinical Care Checklists as well as a CPD webinar from the checklist creators providing more in-depth descriptions and clinical case studies from their experience. Many thanks to Briony Chase, Lorrae Griffiths, Melissa Arnts, Rebecca Lovett, Daniela Aiello and Elizabeth Johns for their help.
General Pelvic Health Clinical Care Checklist General assessment domains for questioning Occupation and nature of working activities
Lifestyle activities
Exercise and nature of exercise undertaken
Concerns/flags to be attentive to and why
Referral pathway options AND/OR management strategies
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Hours per week;
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Refer to GP;
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Heavy weights (increased intra-abdominal pressure with lifting can increased risk of prolapse and/or haemorrhoids);
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Gynaecologist;
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Occupational therapist;
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Ask patient and seek to educate them on general workplace ergonomics, safe lifting strategies and tools/lifts/hoists that may be useful.
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Long hours standing (can worsen prolapse);
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Elite athlete (may cause amenorrhea);
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Radiation/exposure to chemicals;
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High stress environments or high expectations may lead to anxiety and stress, exacerbating pelvic floor hypertonicity and constipation.
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Children at home, family structure (mental load);
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Refer to GP;
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Duties in the household;
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Psych/counsellor.
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Support systems;
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All contribute to treatment plan and potential increased risk factors to other pelvic health concerns.
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Question the type, frequency, and duration of exercise;
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Refer to exercise physiologist (EP), physio, GP, osteo, psychologist/counsellor, personal trainer;
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Heavy weights (leading to altered menstruation and increased intra-abdominal pressures);
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Educating patients on safe lifting techniques;
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Change or recent addition to exercise;
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Amount of exercise:
WHO daily exercise recommendations: https://www.who.int/news-room/fact-sheets/ detail/physical-activity
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I s it excessive, leading to amenorrhea or as part of an eating disorder;
- Sedentary habits, leading to high BMI (which effects hormones, menstruation and fertility); - High impact sports or those which increase intra-abdominal and pelvic pressures (may affect pelvic floor function, incontinence and prolapse).
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General assessment domains for questioning Health history
Concerns/flags to be attentive to and why
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High BMI/low BMI (impacts menstruation and fertility);
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Smoker;
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Reproductive history: -
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Referral pathway options AND/OR management strategies •
Refer to GP, gynaecologist
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General education regarding diet and exercise
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Referral to websites and programs to help patients quit smoking: https://www.quit.org.au/
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Education on importance of contraceptives and those available https://www.betterhealth.vic.gov.au/health/ healthyliving/contraception-choices
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Education of normal symptoms and body changes with menarche and menopause. Facebook pages and support groups: https://www.betterhealth.vic.gov.au/health/ healthyliving/puberty
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Menopause: https://www.healthdirect.gov.au/menopause
Age of menarche;
- Menstruation: cycle length, flow, cramping, extrapelvic symptoms; Changes to menstrual cycle;
- Sexual activity; - Use of contraceptives, type and length of use; - Pregnancies: •
GTPAL:
•
G = Gravidity (number of pregnancies overall
•
T = Term (number of pregnancies carried to 37+ weeks)
•
P = Preterm (number of pregnancies carried 20-36 weeks
•
A = Abortions (and losses prior to 20 weeks)
•
Living children.
•
Method of conception;
•
Birthing history: -
21
Weeks’ gestation;
- Vaginal or C-section; - Planned or emergency C-section (if emergency, why); - Tearing (degree, direction and after care); - Duration of labour; - Position while delivering - Pharmaceutical interventions; - Complications (parent and child); - APGAR score.
Mental health history
•
History of STIs;
•
Menopause symptoms;
•
Date of last menstrual period;
•
Pelvic floor injury/falls/trauma/surgery;
•
Gastro-intestinal conditions;
•
Urinary conditions, incontinence and recurrent UTIs;
•
Osteoporosis;
•
Amenorrhoea;
•
Cervical cancer screening checks (pap smears) Cone biopsy;
•
Hormonal imbalance/conditions.
•
Post-natal depression;
•
Refer to GP
•
Depression;
•
Psychologist/counsellor
•
Anxiety;
•
•
Eating disorders.
Have an understanding of the patient’s personal support system and known coping strategies will increase management and rapport.
•
Life line: https://www.lifeline.org.au/
•
Beyond Blue: https://www.beyondblue.org.au/
•
Butterfly Foundation: https://butterfly.org.au/get-support/helpline/
•
Eating Disorders Victoria: https://www.eatingdisorders.org.au/
•
There are many apps now available to help with meditation and mindfulness: Moodkit, talkspace, Headspace, iBreathe, MindShift CBT and Calm
22
CLINICAL
General assessment domains for questioning Medication/ supplements
Concerns/flags to be attentive to and why
•
Referral pathway options AND/OR management strategies
Hormone replacement therapy
•
Refer to GP;
- Duration and dosage;
•
Gynaecologist;
- Topical vs oral;
•
Referral for DEXA scans if bone density is a concern;
•
If unsure of medication interactions, side effects or contra-indications, refer to the TGA website: https://www.tga.gov.au/
- Oestrogen only or oestrogen and progesterone.
Contraceptives
Nutrition/diet
Other health professionals seen
Clinical issue to explore (biological) Accesses medical gynaecological checks for general pelvic health
Hysterectomy status
•
Iron supplements/infusions;
•
Naturopathic remedies;
•
Vitamin D and calcium for one health;
•
Prenatal vitamins (if planning to conceive);
•
Long term corticosteroid use (effecting bone density);
•
Chemotherapy or radiation;
•
Hormone therapy (non-sex hormones);
•
Dermatological medications (common medications such as Roaccutane are teratogens).
•
OCO and COCP;
•
Refer to GP;
•
Implanon;
•
Gynaecologist;
•
IUD/marina – removed before pregnancy or check for pain/irritation (pelvic);
•
Educate the patient on the role of contraceptives in preventing pregnancies and STIs;
•
Mini pill;
•
Diaphragm;
•
Condoms.
•
Poor diet;
•
Referral to dietitian, GP, naturopath/nutritionist.
•
Constipation -straining increases risk of prolapse and haemorrhoids.
•
Pelvic/women’s health physio;
•
Gynaecologist;
•
GP.
Concerns/flags to be attentive to and why
Referral pathway options AND/OR management strategies
•
Post-partum checks;
•
Refer to GP;
•
Regular cervical cancer screen test (Pap smear) – GP/ gynae visits;
•
Gynaecologist;
•
Govt website for mammograms and cancer screening tests available through Medicare: https://www.canceraustralia.gov.au/awareness/ screening
•
Refer to GP as appropriate;
•
Gynaecologist;
•
Early removal of ovaries increases risk of osteoporosis and therefore DEXA scans are recommended at an earlier age;
•
Support groups/Facebook pages for patients who undergo oophorectomy and menopause at an early age.
•
STI screens;
•
Mammograms.
•
Total hysterectomy – where the uterus and cervix are removed;
•
Subtotal (partial) hysterectomy – where the uterus is removed, but the cervix is left in place;
•
Hysterectomy and Bilateral Salpingo-Oophorectomy – were the uterus, fallopian tubes and ovaries removed;
•
Reason for all;
•
Any problems since (pain, bowel, bladder issues);
•
Ongoing treatment;
•
Subsequent menopause/osteoporosis.
CLINICAL
Clinical issue to explore (biological) Abdominal or pelvic surgical history
Pudendal neuralgia
Concerns/flags to be attentive to and why •
Laparoscopy – endometriosis, fibroids, ovarian cysts, leiomyoma, adhesions;
•
Urinary or digestive (bowel) related surgeries (can lead to trauma to pelvic floor and cavity);
•
IVF related;
•
Pelvic organ prolapse – type;
•
D&C – miscarriage, fertility, termination;
•
Hysterectomy;
•
Pelvic floor – perineal tear/repair;
•
C-section birth;
•
Mesh.
•
Risk factors:
Referral pathway options AND/OR management strategies •
Refer to GP as appropriate;
•
Gynaecologist;
•
Psychologist/counsellor – counselling for trauma related or distressing experiences;
•
Pelvic floor physio or osteo for assessment.
•
Refer to physio, osteo
- Prolonged 2nd stage labour; - Instrumental delivery; - High birth weight;
•
Neuromuscular treatment;
-
Lifestyle changes;
Pain specialist -
Pulsed radio frequency;
- Pelvic surgery;
-
Nerve block;
-
Nerve release surgery.
- Endometriosis (can have lesions on the nerve);
•
-
- Large episiotomy or tear;
- Cycling.
23
•
Support groups/Facebook pages.
•
Refer to pelvic floor physio or pelvic floor trained osteo;
•
Refer to gynae/GP if incontinence or prolapse is considered as a complication of pelvic floor weakness;
•
Pelvic floor exercises (find good online resources to refer patient to) and training tools such as Perifit;
•
Personal trainer, Pilate’s instructor or exercise physiologist that specialise in pelvic floor training.
Signs: - Burning, electric shock, shooting, aching, itch or a raw feeling in the clitoris, labia, vagina, anus and/ or rectum; - Painful penetration – dyspareunia; - Anismus; - Vulva pain; - Vaginismus; - Recurrent UTIs; - Pain with sitting; - Obstructive defecation; - Incontinence; - Relieved with sitting on the toilet.
Pelvic floor weakness
•
Symptoms: - Stress urinary incontinence; - Urinary urgency with or without leakage; - Bowel incontinence; - Lower back pain; - Prolapse; - Tampons/menstrual cups that dislodge; - Recurrent UTIs and/or thrush infections; - Vaginismus; - Reduced vaginal and/or clitoral sensation; - Difficulty/inability to orgasm;
•
Causes: - Increased BMI; - Age related, post-menopause, atrophic vaginitis; - Vaginal childbirth (especially with intervention, episiotomy or tearing); - Chronic constipation (straining); - Heavy lifting; - Chronic coughing.
24
CLINICAL
Clinical issue to explore (biological) Pelvic organ prolapse
Pelvic floor pain, tightness
Concerns/flags to be attentive to and why •
Prolapse:
•
Heavy or dragging – vagina;
•
Referral pathway options AND/OR management strategies •
If prolapse is suspected, always refer to GP or a trained professional for proper examination;
Lump feeling;
•
Pelvic floor physio or gynae, osteo(mild);
•
Lump bulging out;
•
•
Pain with intercourse;
Discuss use of pessaries, referral to pelvic floor physio to have one fitted:
Bladder – incomplete emptying, incontinence, or weak stream;
•
•
https://www.safetyandquality.gov.au/sites/ default/files/migrated/Treatment-Options-POPConsumer-Info.pdf
•
Recurrent UTI;
•
•
Difficulty emptying bowel;
If secondary to chronic cough or constipation, these symptoms must be addressed;
•
Better after lying down, worse at end of day;
•
•
Lower back and/or pelvic pain;
If caused by atrophic vaginitis, use of topical oestrogen cream can decrease discomfort;
•
Causes:
•
•
Childbirth;
•
Long term constipation;
If prolapse extends external to the vagina with coughing/strain, physiotherapy/ pelvic muscle training is not recommended, and pessary or surgery should be considered;
•
Heavy weightlifting;
•
Support groups/Facebook pages.
•
Persistent cough;
•
Levator Ani Avulsion;
•
Atrophic vaginitis;
•
Types:
•
Bladder, AKA anterior or;
•
Cystocele;
•
Uterine;
•
Bowel, AKA posterior or rectocele;
•
Vaginal;
•
Intestinal, AKA enterocele.
•
Symptoms:
•
Refer to physio/osteo with women’s health experience;
•
Pain specialist:
- Pelvic floor myalgia •
Core exercises make it worse;
•
Feels like a ball in pelvic floor.
- Dyspareunia; - Painful urination; - Constipation;
•
The cause of pelvic floor hypertonicity should always be address/reduced/treated;
•
Psychologist/counsellor for cases of sexual abuse, PTSD, stress or anxiety. Lifeline, support groups, books, websites, Facebook pages;
•
Osteopathic treatment should include:
- Pelvic pain; - Urinary frequency/urgency; - Urinary hesitancy or incomplete emptying; - Lower back pain; - Vulvodynia;
- Difficulty/inability to orgasm •
Causes: - Increased weightlifting/pelvic floor exercises; - Ignoring urge to urinate/defecate; - High stress/anxiety; - Endometriosis; - IBS or frequent abdominal pain; - Pudendal neuralgia; - Scar tissue; - History of sexual abuse/PTSD.
-
Pelvic and hip soft tissue techniques;
-
Stretches for pelvis and hips;
-
Education on toilet ergonomics;
- Breathing techniques and education (pressure dynamics).
- Vaginismus; - Reduced vaginal and/or clitoral sensation;
Botox;
•
Pelvic floor physio (or internal trained osteopaths) to release the pelvic floor internally and possible recommendation of vaginal dilators.
CLINICAL
Clinical issue to explore (biological) Pelvic girdle pain
Concerns/flags to be attentive to and why •
•
Defined as pain between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joint (SIJ), which may radiate to the thighs and hips. PGP can occur in conjunction with or separately to pain in the pubic symphysis;
Referral pathway options AND/OR management strategies •
- Ergonomic advice/aids •
Difficulty with stairs; Pain lying on side or back;
•
Pain with opening legs;
Pain specialist: - PRP, PRF injections
- Weight-bearing is time-limited (20 minutes);
•
Refer to osteo, physio, EP - Serola SIJ/PS belt
Symptoms:
•
25
- Typical signs •
Pain location;
•
Tenderness of SIJ and/or PS.
- Pain provocation tests; - Pubic symphysis; - LDL tenderness; - Faber; - Gaenslen’s:
•
•
Single leg stance difficult +/- pain at SIJ or PS;
•
ifficulty lifting straight leg (active straight D leg raise);
Biopsychosocial – emotion, fear, sleep, can be distressing; - Relationship strain; - Personal identity;
Urinary history, including (re) current UTIs
Bowel health (outside of allergies/ intolerances)
•
Urgency with or without leakage;
•
Refer to GP;
•
Stress urinary incontinence;
•
Urologist;
•
Urinary frequency - >5-7 x daily;
•
Osteo, physio (for MSK aspect)
•
Nocturia - more than once over night;
•
Support groups/Facebook pages
•
Urinary hesitancy and decreased urine flow;
•
•
Incomplete voiding of bladder;
Continence Foundation of Australia: https://www.continence.org.au/
•
Bladder pressure;
•
Recurrent UTI without culture can be pudendal neuralgia not UTI or hypertonic pelvic floor;
•
Irritable bladder;
•
Increase urgency;
•
Stress incontinence;
•
Urinary hesitancy;
•
Painful urination;
•
Discoloured, cloudy, strong smelling or sediment in urine.
•
SIBO (small intestine bacterial overgrowth);
•
Refer to GP and gastroenterologist;
•
Chron’s disease;
•
Osteopathic management (for constipation):
•
Ulcerative colitis;
•
Constipation;
•
Haemorrhoids;
•
Fissures;
•
IBS;
•
Refer to Bristol stool chart;
•
Chronic pelvic pain is often associated with gastrointestinal symptoms.
- techniques supporting gut mobility and motility;
•
-
Toilet ergonomics;
-
Dietary advice.
Exercise Support groups/Facebook pages, websites to refer patients to for more info.
26
CLINICAL
Clinical issue to explore (biological) Reproductive conditions (acute)
Concerns/flags to be attentive to and why
Referral pathway options AND/OR management strategies
*****CAN BE LIFE THREATENING*****
•
Refer immediately to ER. Laparoscopic surgery is likely required.
•
If a patient reports multiple symptoms, primary referral should be to a GP for a pelvic US and blood test. If something is found, then further follow-up with a gynaecologist is required;
•
Osteo/physio/acupuncture
•
Pelvic pain is considered acute if present for less than three months.
•
Signs/Symptoms:
•
Reproductive conditions (Chronic)
-
+ve rebound test;
-
Shoulder pain;
-
Increased respiratory rate;
-
Hypotension;
-
Tachycardia;
-
Vaginal bleeding (not menstrual);
-
Fever;
-
Vomiting/nausea;
-
Abdominal tenderness;
-
Palpable mass;
-
History of or known ovarian cysts.
Conditions: -
Ruptured ectopic pregnancy;
-
Miscarriage;
-
Ruptured ovarian cyst;
-
Ovarian torsion;
-
Infection;
-
Fibroid rupture;
-
Abscess/fistula formation.
•
Rule out other organs: appendicitis, GI infection, diverticulitis, abscess, hernia, kidney stone and/or UTI.
•
Signs/symptoms (keeping in mind that many of these symptoms in isolation or moderation can be normal):
•
-
Excessive pain with menstruation (cyclic pain);
-
Ovulation pain;
-
Excessive bleeding;
-
Clotting in menstrual blood;
-
Dark/old blood;
-
Secondary anaemia;
-
Dyspareunia;
•
Neuromuscular component.
Gynae management may include: -
Laparoscopy or transvaginal surgery;
-
Continuous oestrogen suppression;
-
Observation.
•
When discussing long term management, always consider the patients family planning;
•
Referral to support groups, charity foundations, websites and general education:
-
No change to pain levels with OCP;
-
Overweight/struggling to lose weight;
-
Hirsutism (hairy);
-
Acne on back;
-
https://www.jeanhailes.org.au/
-
GIT symptoms with menstruation;
-
https://www.endometriosisaustralia.org/
-
Amenorrhoea;
-
Spotting (mid cycle);
-
Excessive discharge
- https://www.hormones-australia.org.au/ endocrine-diseases/polycystic-ovariansyndrome-pcos/
Common conditions:. -
Endometriosis;
-
Polycystic ovary syndrome (PCOS);
-
Adenomyosis;
-
Endometrial hyperplasia;
-
Fibroids/polyps;
-
Ovarian cysts.
CLINICAL
Clinical issue to explore (biological) Sexual health
Concerns/flags to be attentive to and why •
Referral pathway options AND/OR management strategies
Dyspareunia
•
Refer to gynaecologist/GP;
- Pain with penetration during sexual activity with or without pain with other types of penetration e.g., tampon;
•
Pain specialist;
•
Osteo, physio (women’s health experience);
•
Psychologist/councillor if symptoms are emotionally driven;
•
Support groups/Facebook pages, websites to refer patients to for more info.
•
Refer to gynaecologist/GP;
•
Pain specialist;
•
Osteo, physio (women’s health experience).
- Pain with thrusting; - Burning or ache; - Throbbing lasting for hours after intercourse; - Pain with orgasms. •
Maybe due to PF tension, hormones, episiotomy / perineal scar, endometriosis, emotions, fear;
•
Vaginismus: - Involuntary spasm of pelvic floor muscles making it difficult or impossible to have vaginal penetration.
•
Important to address the emotional component – fear-based thinking, support form partner;
•
Sexual arousal disorder: - Unable to become aroused or maintain arousal.
•
Risk factor: - Depression and/or anxiety; - Hormonal disfunction; - Pelvic floor dysfunction; - Endometriosis; - Previous trauma – physical, sexual and/or emotional; - Emotional stress; - Lichen Sclerosus.
Chronic pelvic pain
•
27
Persistent pain in the area of the umbilicus to pelvis and groin for at least three months;
•
Pain can be constant, intermittent, dull ache or sharp pain;
•
Generally, has associated bowel, urinary or reproductive;symptoms;
•
Vulvodynia;
•
Vestibulodynia;
•
Clitorodynia;
•
Bladder pain;
•
Genital pain;
•
Dyspareunia;
•
Coccyx pain;
•
Abdominal pain;
•
SIJ pain;
•
Pelvic girdle pain.
28
CLINICAL
Clinical issue to screen (psychosocial) Stress levels
Trauma
Concerns/flags to be attentive to and why •
•
Rushing women’s syndrome.
•
The pelvis is a very sensitive and personal area, especially around the topic of trauma. Pelvic trauma can include, crush and musculoskeletal injuries, surgical trauma, episiotomy, tearing from previous births and sexual abuse;
•
•
Family or support network, family care supports
High levels of stress increase resting muscle tone and can cause hypertonicity to the pelvic floor. This may lead to dyspareunia, urge incontinence, and constipation;
Patients may be uncomfortable discussing these topics, as well as uncomfortable being touched around the pelvis: full informed consent should be given prior to placing your hands on any patient; If discussion of this area is clearly quite uncomfortable for the patient, do not force it. Explain to them why you are asking these questions and let them share as much as they want. Developing rapport is vital in these situations;
Referral pathway options AND/OR management strategies •
Refer to GP;
•
Psychologist;
•
Referral to websites and apps for tracking stress, guided meditation and simple stress management strategies.
•
Refer patient to their GP for onwards referral;
•
Obstetrician/gynaecologist;
•
Sexual abuse: police and/or mental health professional;
•
Referral to psychologist or mental health professional;
•
During osteopathic treatment, be sure to take extra care with hand placement, informed consent and explanation of techniques prior to touching the patient.
•
Support groups: -
lifeline: https://www.lifeline.org.au/
•
Childhood trauma (physical, mental, sexual and/or neglect);
•
Birth trauma;
•
Sexual trauma.
•
Is the patient safe in their home?
•
•
Are they supported by their partner with conditions affecting intimacy.
Provide evidence informed information resources and support services that they can access;
•
Connecting patient with social support where required;
•
Referral to psychologist, social or welfare worker;
•
Other contacts: -
Police;
- Family violence organisations (safe steps 1800015188 – VIC); •
1800 RESPECT - National
The Orange Door -
https://www.orangedoor.vic.gov.au/
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https://www.whiteribbon.org.au
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30
PRACTICE MANAGEMENT
Giving new grads the best chance to succeed
Integrating new graduates into the workplace can be both exciting and challenging. This article explores best practices for engaging and supporting them, including employment choices, induction programs, and valuable tips for employers and employees.
New graduates can be a boon for a practice, bringing in new energy and a keen drive to learn. However, it can also be incredibly overwhelming as they begin a new professional career and settle into their first job. To get the best results, it’s important that employers facilitate their entry into the workplace as smoothly as possible. This article will explore some best-practice tips for engaging new graduates.
EMPLOYEE OR CONTRACTOR?
A question that often pops up is whether it’s best to engage a new graduate osteopath as an employee, or as an independent contractor. There are benefits being engaged as either – however, generally speaking we recommend that new graduate employees be engaged as employees instead of contractors. A new employee is new to practising, and generally requires additional mentoring and training beyond just what they received during their study. Employment acts as an important safety net to allow a new graduate to thrive. Alternatively, an independent contractor operates as their own business and assumes the risk for the services they provide. If a new graduate is engaged as a contractor, there can be risk of sham contracting where the business is required to provide them additional support and mentoring while they settle in.
INDUCTION PERIODS
All employees should receive an induction program. This induction is designed to provide new employees with all the
necessary information they need to excel in their new role. Typically, an induction might include: A welcome to the workplace; Organising computer access, security passes, email signatures, and key contact details where necessary; Information on the business’ HR and work (occupational) health and safety policies and procedures; Providing an induction checklist for the first three to six months of employment. New graduates will generally require a more thorough induction program than the one an experienced osteopath would receive. It’s important to remember that this is often their first role in their professional field, and while this may mean a little bit of extra support, nurturing employees now can pay dividends in the future. Throughout the entire induction period, an employee should feel comfortable enough to approach their employer about any questions or concerns they may have, and an employer should regularly check in with the employee to see how they are settling in.
A QUICK COMMENT ON PROBATION PERIODS
During a probation period, it’s correct that there’s less risk from an employment law perspective if an employer wants to swiftly move towards termination of employment. Typically, the employee won’t have access to unfair dismissal. However, we would advise against being too quick to pull the trigger on new employees. In the first instance, it establishes a bad precedent – that rather than working with an employee to help them improve, they may be subject
to termination or other disciplinary measures without notice. Rather than termination, some performance issues can be resolved through a softer approach – implementing training systems and organising regular check-ins with employees. This provides a built-in platform to highlight any concerns you might have with their performance so far, and to work together with them to fix these issues. As a general rule, its best to save termination as a last resort.
TIPS FOR EMPLOYERS
Make yourself available for new employees to ask questions; Try to provide structure for new employees to succeed; Consider bonding activities to help the employee settle in.
TIPS FOR EMPLOYEES
Make sure you understand your job description and the expectations of your role; Get to know your colleagues – they can help with settling in and providing pointers to succeed; Don’t be afraid to ask questions if you’re unsure; Lastly, you were hired for a reason! Be confident that you have the ability to succeed in the role and that your employer recognises this.
For more assistance, please contact the Osteopathy Australia HR Service on 1300 143 602, or via email at HRHotline@osteopathy.org.au. Alternatively, a suite of dedicated resources for members is also available at www.osteopathy.org.au 24 hours a day, seven days a week.
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32
RESEARCH
It’s time to get curious about research
The significance of research reverberates beyond the clinic walls. At Osteopathy Australia we recognise the strategic power research holds – it’s key in influencing policies, educating a discerning public about the merits of osteopathy, and moulding the future of osteopathic education. Over the last few years, Osteopathy Australia has been working hard to encourage practising osteopaths to engage in research. A few of our initiatives have included running an annual research grants program, promoting the use of outcome measures in clinical practice and the development of a series of webinars for clinicians who are wanting to learn more about how they can get involved with research. These webinars explain the pathways open to novice and prospective researchers in osteopathic practice in academia and those working as part of a multidisciplinary team. If you haven’t ready included them in your CPD, we urge you to watch Life as a Clinician Scientist (parts 1 and 2). Over the next few issues of Osteo Life, we will be shining the spotlight on our own osteopathic body of evidence and as members, we ask you to get curious about research. Osteopathy Australia Grant Recipient Project: Exploring the health-seeking narratives of refugee women living with chronic pain. Chief Investigator: Dr Areni Altun Institution: Monash University Grant type: Seeding Grant Grant Round: 2020-21 Chronic pain has been long recognised as a defining feature among the wide range of health-related problems exhibited in women belonging to refugee backgrounds. The Osteopathy Australia Research Grant was used to help explore the health-seeking narratives of refugee women and the factors that influence their care for chronic pain in Australia. Our qualitative study was set in Melbourne, Victoria where recruitment began by approaching Iraqi Assyrian refugee community leaders, acting as key informants, through pre-existing
“The Osteopathy Australia Research Grant was used to help explore the health-seeking narratives of refugee women and the factors that influence their care for chronic pain in Australia” partnerships with settlement services. We used purposive sampling and a snowballing approach to identify eligible participants. Analysis was grounded in phenomenology and involved reflexive thematic analysis which was used to identify meaningful patterns and organising these into themes. Ten Assyrian refugee women aged between 19 to 85 and who identified as having chronic pain were included in our study. We conducted semi-structured, in-depth interviews lasting between 30 to 90 minutes in English or in Arabic with an interpreter present. From our interviews we found that culture and their role as the family caregiver heavily influenced their experiences seeking healthcare in Australia. Five key themes that emerged from our research included: 1) Trust in health care systems; 2) Accessibility to care; 3) Perceptions of pain; 4) Support seeking mechanisms; and 5) Health knowledge. These themes played a significant role in shaping and forming their models of thought around accessing care and their struggles with chronic pain. Refugee women arriving in Australia are confronted with social and cultural conditions and health systems that were radically different to their past experiences. This study provides rich insights into the health needs of refugee women, and highlights a need for an evidence base for better patient advocacy around chronic pain management and practice protocols to support refugee
women resettling in Australia. This research also highlights the importance of a patient-centred approach and the need for health care providers such as osteopaths, to consider cultural competence in clinical practice and ensure effective communication strategies exist to bridge any language and cultural barriers. Osteopaths and other healthcare providers are encouraged to consider these findings to create safe and supportive environments, to engage in active listening, and incorporate culturally informed practices into their clinical care. Our research findings have been disseminated through publication in the peer-reviewed journal International Journal for Equity in Health. The article can be found at https://equityhealthj. biomedcentral.com/articles/10.1186/ s12939-023-01891-w. The publication aimed to raise awareness among healthcare professionals, particularly those working in primary and allied healthcare, about the unique challenges faced by refugee women seeking care for chronic pain. The study has also been presented at the largest primary care conference in North America; NAPCRG, and at the Australasian Association for Academic Primary Care conference. This research offers insights into the health and sociocultural experiences of refugee women seeking care for chronic pain which may help inform practice protocols and reduce health inequalities in populations that are systematically marginalised.
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CPD CALENDAR
CPD calendar
As the year draws to a close, key dates for your diary throughout the upcoming months. NOVEMBER
8 NOVEMBER – 7:30 PM ADST
Minimising your social media risks. Explore the risks of using social media on a person’s professional reputation. 18 NOVEMBER – 7:30 PM ADST
Introduction to the Graduate certificate in Strength & Conditioning run in partnership between VU and the Western Bulldogs. 29 NOVEMBER – 7:30 PM ADST
A guide for osteopaths on how to comply with Ahpra advertising guidelines when it comes to promoting your business. 30 NOVEMBER
The 2022/2023 CPD cycle ends. You must have completed and kept record of
25 hours of CPD activities, including four hours on mandatory topics. Keep track of hours on your online CPD record on your member dashboard. Continuing professional development (CPD) is how health practitioners maintain, improve and broaden their knowledge, expertise and competence, and develop the personal and professional qualities required throughout their professional lives. As a practising osteopath, it is a legal requirement to fulfil 25 hours of CPD and at least four hours of your annual CPD hours must cover mandatory topics. All CPD activities must be recorded. As an Osteopathy Australia member you can access free or low-cost CPD resources. The CPD programs are customised for members and save you time and money, no need to look
TM
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elsewhere for relevant osteo-centric CPD or mandatory topic hours. Your Osteopathy Australia membership makes sourcing CPD a one-stop shop. You have full access to plenty of free webinars, free modules, free eLearning platform, free podcasts. What’s more, you can record you CPD hours via your dashboard – which comes in handy if audited by Ahpra.
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