OS T EO PAT H Y AU S T R A L I A M AG A ZI N E
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Adolescent idopathic scoliosis Diagnosis, treatment and management
Steering success Thank you and welcome Board members
EOI now open Get involved with the association
101 on self-care Elevating professional success
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WELCOME
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OUTGOING PRESIDENT’S MESSAGE
Steering success: Michelle Funder concludes strategic leadership at Osteopathy Australia
As I prepare to conclude my term as President of Osteopathy Australia, it’s a moment of profound reflection on the journey that brought me here. My first Board meeting took place on 10 February 2018, a date etched in my memory because just two days later, at 1:15am, my eldest daughter, Stevie, was born. I’d secretly wished for her arrival after that initial Board meeting, and fate had a way of granting my wish. Over the past six years, my role as a Board member and subsequently as President has been intertwined with significant milestones in my personal life. Stevie’s birth virtually coincided with my joining the Board, and she is now a vibrant five-year-old prep student. My third child, Gus, came into the world in February 2023, during my final year with Osteopathy Australia, and my second child, Harry, was stillborn due to a cord injury in October 2021 at 36 weeks gestation. These personal experiences have shaped my journey with Osteopathy Australia in ways I could not have foreseen. Throughout these six years, I have also navigated divorce, single parenthood and the journey of finding love again. Life’s rollercoaster has been incredible, with its ups and downs, but it has also been a source of
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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, Heath Williams Chief Executive Antony Nicholas Editor Rebekka Thompson-Jones Designer Stephanie Goh 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
inspiration and growth. Not to mention that small global pandemic that started in March 2020, three months into my presidency role! In the realm of my professional life, my business has flourished. It’s a remarkable team achievement, and I owe a tremendous debt of gratitude to my team at Beyond and the other Founding Director, Shane Bennett, who has supported me along the way. I extend heartfelt thanks to my parents, family and current partner who wholeheartedly embrace and support my pursuits. The many hats I wear as a mother, business owner and president have required an incredibly supportive team. Gratitude at the deepest level is also due to my fellow Board members and past directors with whom I’ve had the privilege of working. They are an exceptional group of people. Some continue to mentor me, and I hope these relationships continue. Special thanks go to our incredible CEO, Antony Nicholas, whose trust in me, commitment to open and honest communication, and outstanding work in placing osteopathy where it is today have been constant inspirations over the six years. The osteopathic profession will be forever grateful for everything you’ve done for us.
I share these personal reflections and express my gratitude because they underscore the importance of relationships and community. My life motto is to say “yes” to every opportunity, as each can lead to another. By giving our time, upholding integrity and doing our best, we position ourselves to meet some of the challenges we face as a profession. In 2022, I organised a meeting with past presidents, to seek their insights on inspiring future leadership in osteopathy. The resounding answer was the need to maintain our osteopathic community’s essence. The identity of osteopathy has evolved over the years, but as we move forward, we must remain agile and embrace osteopaths’ unique problemsolving abilities. Our skills extend beyond private practice and can be applied to policy advocacy, healthcare, sports teams, occupational rehab and aged care, to name a few. We have much to offer in the broader landscape of Australian healthcare. During my Board tenure, we achieved significant milestones, and I’m genuinely thrilled to witness future Osteopathy Australia Boards build on our accomplishments. (continued on page 4)
In this issue.. Welcomes & News
3 Outgoing President’s Message
5 Incoming President’s Message 6 Outgoing Director’s Message 8 Osteopathy Australia News Practice Management
16 Elevating professional wellbeing – the path to thrive in 2024 BRETT WIENER
Clinical
18 Adolescent idiopathic scoliosis DANIEL COMERFORD & KRIS LUNDINE
Research 30 The value of health research and research funding for osteopathy HR
32 Bullying in the workplace 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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WELCOME
The governance model has evolved into a highly efficient system. In 2023, I was invited to speak at a conference on chairing and CEO management, where I received a commendation for the governance structure of Osteopathy Australia. Our CEO is the Chair of AHPA – the Allied Health Professions Australia. This position means that, on a national level, our CEO often has a seat at the table on behalf of all allied health professionals. This position underscores our belief in inclusivity and diverse healthcare approaches to benefit patients. We actively promote a community of healthcare and a sense of belonging that reflects our values at Osteopathy Australia. One of my proudest accomplishments was the establishment of regular stakeholder meetings. This meeting includes our Universities, Registration and Accreditation boards. Recognising all stakeholders rarely convened in a single forum, I initiated these meetings to collectively address issues affecting our profession. The shift to virtual meetings due to the pandemic eliminated logistical barriers, and I’m delighted to leave
this legacy, fostering collaboration and shared solutions among all osteopathic stakeholders. A lesson I learnt early in my Board career was that influencing change can take time. An ongoing challenge we face as a profession is the skewed geographic distribution, with most osteopaths concentrated in Melbourne. Creating osteopathy courses outside Victoria is essential, but it’s a complex task demanding patience, collaboration and persistent effort. I’d have loved to have seen several new courses open during my time on the Board and I’m confident we have the proper structure in place for this to be a reality, but it will take time. Personally, one of my most memorable experiences was serving on the Medicare Taskforce in 2018, where we reviewed the Chronic Disease Management (CDM) program. This experience highlighted the value of Osteopathy Australia’s advocacy and policy work, often overlooked by members who may not directly see its impact. Advocacy may not always be glamorous, but it’s a crucial part of securing our profession’s future and
driving advancement and opportunities for osteopaths in all aspects of healthcare. As I conclude my tenure as President, I’m filled with gratitude for the incredible individuals and experiences that have shaped my journey. Our relationships and community are the cornerstone of our profession’s growth. Seeing someone you studied with at university at a conference or referring to an osteopath on the other side of the country – we are lucky to have this community. Moving forward, let us embrace change, maintain our unique identity, and continue to provide exceptional healthcare for all Australians. Together, we can shape a brighter future for osteopathy in Australia. I hope to see you all at the conference in Sydney in October 2024! 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.
WELCOME
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INCOMING PRESIDENT’S MESSAGE
Matt Cooper assumes leadership as President of Osteopathy Australia: a vision for education, robust research and advocacy Wishing everyone a joyful New Year! May 2024 bring prosperity and safety to all. Allow me to introduce myself; I am Matt Cooper, and I am privileged to assume the role of President of Osteopathy Australia. The responsibilities ahead are substantial, but I am eager to embrace the challenges they bring and to work towards a better future for osteopaths in this country. First and foremost, I extend my heartfelt appreciation to our outgoing president, Michelle Funder. Michelle began her journey on the Board as a director in 2018 and assumed the role of president at the beginning of 2020. Her leadership has been exemplary, setting the stage for an exciting future. Michelle, your contributions have been invaluable, and we cannot thank you enough for your tireless efforts in promoting our profession and further enhancing Osteopathy Australia’s reputation. I also wish to acknowledge outgoing Board Member Georgia Ellis, who has dedicated six years of service to our association. Her work within the research committee led to the establishment of the Osteopathy Australian Research Foundation (OARF), a significant step forward in fostering a research culture within our profession. I would also like to extend a warm welcome to our three newest directors, Tink Gee, Deanne Mitchell and Julia Biernacki. While my tenure as president begins now, many of my goals align with the strategic objectives established by our Board over the past several years. Our plan is adaptable to address the evolving needs of our profession. Our current focus is as follows: 1. Enhancing osteopathic education Our primary mission is to enrich and expand osteopathic education by introducing new courses. We will build strong partnerships with educational institutions to ensure our future
“Through outreach programs, we’ll ensure osteopathy is accessible to all Australians, regardless of background or location” osteopaths receive comprehensive, researched-based training. We aim to promote diversity and inclusivity in education, nurturing a new generation of skilled and compassionate osteopaths capable of meeting the evolving healthcare needs of our community. We firmly believe in the need for more osteopathic programs nationwide and will continue prioritising this goal.
to raising public awareness about the benefits of osteopathic care. Through outreach programs, we will ensure that osteopathy is accessible to all Australians, regardless of their background or location.
3. Advocating for osteopathy in healthcare Osteopathy is a unique and effective healthcare modality, and the broader healthcare community must recognise our distinctive contributions. We will vigorously advocate for the recognition of osteopathy within the Australian healthcare system. Collaborative efforts with other healthcare organisations will ensure that osteopathy remains integral to patient care.
5. Enhancing communication and fostering collaboration Effective communication is the lifeblood of any thriving organisation. We are committed to finding innovative ways to engage and communicate with our members, ensuring they are wellinformed, and their voices heard. We will actively seek feedback, suggestions, and ideas from our members, valuing their input as we shape the future of Osteopathy Australia. Additionally, we will remain open to collaboration with other healthcare professionals, institutions, and organisations, promoting ideasharing and collaborative partnerships. By working together and sharing our expertise, we can collectively elevate the practice of osteopathy and provide the best possible care to our patients. The future of the profession and of Osteopathy Australia fills me with optimism and excitement for the future of our profession. I look forward to working closely with Antony and the team, our esteemed members and the broader healthcare community to achieve our shared objectives. Together, we will chart the course of osteopathy in Australia and ensure that our profession continues to thrive, leaving a lasting impact on the wellbeing of our patients.
4. Expanding osteopathy’s reach Our advocacy should extend beyond the healthcare sector. We are committed
Matt Cooper, Osteopathy Australia mcooper.director@osteopathy.org.au
2. Cultivating a research culture Advancements in any healthcare profession are driven by research and evidence-based practices. During my tenure, we will emphasise the importance of research within osteopathy. To meet this goal, we will provide robust support, resources and mentorship to clinicians and academics eager to explore the scientific foundations of our practice. With the OARF now established and fostering a research-centric culture, we can continuously refine our methods, improve patient outcomes, and solidify our position within the healthcare landscape.
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WELCOME
OUTGOING DIRECTOR’S MESSAGE
Georgia Ellis’s reflections on our impactful initiatives and research achievements
Since 2018, I’ve been honoured to serve as a director on the Board of Osteopathy Australia, after being elected by my peers. I was motivated to join the Board because I wanted to collaborate on projects that promoted and advanced osteopathy while also addressing the geographical maldistribution of osteopaths across Australia. As a new Board member, I was eager to contribute and learn. Osteopathy Australia’s multifaceted efforts to continue to promote osteopathy in primary healthcare amazed me then and continues to do so today. From advocacy in Medicare, NDIS and aged care; to supporting members, CPD and education, engaging stakeholders, the association’s scope is vast. None more so than during COVID, the Board was impressed with Osteopathy Australia’s management and timely information dissemination throughout this challenging time, leading the way and keeping our members informed amid the chaos. Managing Osteopathy Australia’s finances during the pandemic was a challenging yet essential responsibility, and we ensured solid decisions were made with member’s money, thanks to robust support and advice. Over time, our Board has evolved, adopting better governance and decision-making practices, and we hope our work now is improved on again by incoming Board members.
Over the past six years, the Board has invested in many great projects aligned with its strategic planning. We conducted consumer research to find the most impactful words for attracting new patients to osteopaths. From this research, we launched a new brand story, “Shake Your Pain Shadow,” and distributed compliant advertising assets to members nationwide, to help attract patients who wouldn’t typically seek osteopathic services. Additional, investments were made in upgrading the website and CRM, the creation of our education platform OsteoBrain, made it easier to deliver services to members. Recently, we’ve invested in a partnership with Converge International, provider of professional counselling services for association members, offering six free counselling sessions to any of our members. The Board and the management team also invested in employing senior research and policy officers at the Osteopathy Australia to directly support the aims of our strategic plan. As part of my role as a Board Director, I also had the privilege to chair the Research Committee. The reformed committee remodelled strategy and grants, achieving significant financial allocation of Osteopathy Australia’s members fees of more than $500,000
The Shake Your Pain Shadow campaign was a great success
to support research projects. That’s phenomenal! We developed a research grant program that supported both seeding and project grants up to $12,000 per project. We’ve just closed our fourth grant round, and have awarded a total of $200,000 through this program alone. Aside from directly funding osteopathic research, we’ve also supported 10 mid-career osteopathic researchers through the International Osteopathy Research Leadership and Capacity Building Program. We’ve invested in refreshing our national osteopathic practice-based research network (PBRN) project, ORION. Our Senior Research and Projects Officer, Shamona Eaves has been prolific in her work and her appointment has allowed us to launch so many extra projects. We launched a specific research webinar series for members; we developed and launched a Research Mentorship Program to support any grassroots clinician/researchers that wanted to know more about research and what it involves so we could support the new wave of clinician/researchers coming through. We also launched the OARF, a charitable foundation that allows people to make tax-deductible donations to support independent research projects that align with our research priorities. If that wasn’t enough, the Board allocated $100,000 of members’ fees for a Targeted Call for Research. Through extensive consultation, we have formulated a research question focused on addressing the needs of osteopaths to bolster their role in the primary healthcare system. This project may not have launched yet, but it’s on its way! This project will not only support the efficacy of osteopathic care, but also help to show that osteopathy can be part of the solution to some of Australia’s most pressing healthcare challenges. The incredible support from Osteopathy Australia, both financially and through prioritising capacity-building projects, has showcased
WELCOME
their wholehearted recognition of the importance of fostering a robust research culture for our profession’s success. My involvement in the Research Committee has been immensely rewarding, and I’m very proud of our accomplishments. Our new chair, Don Hunter, an osteopathic director from Tamworth with first-hand experience achieving his PhD, brings invaluable insights. The committee is in excellent hands, and I can’t wait to see what they do next! Another great project has been “Osteopathy in WA” – a collective initiative by Perth-based clinic owners aiming to attract osteopathic talent from the eastern states, kickstarting osteopath’s careers. Our State Mentorship Program welcomes osteopaths in their first five years from graduation, providing 12 free CPD hours led by Perth-based mentors. We’re so thrilled with the success of this program; over three years, 18 new osteopaths joined the state, boosting our numbers to a strong 72 in WA! If you’re interested in moving to Perth – check out osteopathyinwa.com for more info.
“It’s been an incredible journey, and I’m grateful for the trust the membership placed in me to advocate on their behalf” It’s been an incredible journey, and I’m grateful for the trust the membership placed in me to advocate on their behalf. I have learnt a great deal, and working alongside exceptional community leaders – intelligent, passionate and kind – has been inspiring. Our external directors, Kathryn Refshauge, Joey Calandra and Cris Massis, played pivotal roles in shaping our Board, generously sharing their time and expertise. CEO Antony Nicholas has been an amazing leader and is an asset to our profession. Outgoing President Michelle Funder’s leadership has been pivotal in our recent success, and she has been just incredible. Incoming President and Vice President Matt Cooper and Brett Wiener respectfully will make a dynamic and purposeful leadership team. Our Board operates under clear
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guidelines and a positive environment, fostering impactful work. With the new addition of osteopathic directors Tink Gee and Deanne Mitchell, and our early careers director Julia Biernacki, our team grows stronger, ensuring Osteopathy Australia’s continued success. While I am sad I am no longer able to contribute like I have been with such lovely people around me, I am excited to witness Osteopathy Australia’s next chapter! Thank you to the membership for your trust, I hope the above fills you with confidence on how much is going on behind the scenes! It has been an incredible experience. Georgia Ellis, Outgoing Director Osteopathy Australia gellis.director@osteopathy.org.au
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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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n the dynamic landscape of health professions, professional associations stand as pillars of support, providing benefits that extend beyond the traditional realms of networking and skill development. Associations, such as Osteopathy Australia, are voluntary yet play crucial roles in fortifying the careers of osteopaths and contributing significantly to the advancement of the entire profession. Notably, Osteopathy Australia is singularly dedicated to advancing the osteopathic profession.
Foremost among our responsibilities is our pivotal role in advocating for the interests of the profession on both national and state levels. Serving as the collective voice of the industry, we actively influence policies and decisions that shape the healthcare landscape. A tangible example of our impact is the recent inclusion of osteopaths as occupational rehabilitation consultants in VIC, TAS, ACT, QLD and NSW – a career option (not available less than four years ago) made possible through the lobbying and policy work directly undertaken by Osteopathy Australia staff. Your active participation or engagement contributes to the ongoing shaping of osteopathy. We also provide a valuable avenue for continuous learning and professional development. In an era of rapid policy changes, health breakthroughs and technological advancements, staying abreast of the latest developments is paramount. Through workshops, online learning and conferences, we create platforms for you to enhance your knowledge, refine your skills and adapt to emerging trends. This empowerment enables individuals to meet regulatory requirements, update their knowledge, and focus on their core aim – delivering the highest quality of care to patients. We, in partnership with you, play a pivotal role in promoting and marketing osteopathy. Through targeted promotional campaigns, we strive to raise awareness about the benefits of osteopathic care, not only among the general public but also
within the broader healthcare community. By highlighting the unique contributions and effectiveness of osteopathy, we aim to position it as an integral and respected component of the healthcare system. Moreover, we collaborate with our members to showcase their expertise and achievements, thereby fostering a positive and informed perception of osteopathy. This challenging but multifaceted approach aligns with our broader mission of advancing the profession while ensuring its prominence in the evolving healthcare landscape. Networking, both within and across disciplines, is another invaluable aspect. Building connections with peers, mentors and leaders fosters a collaborative environment where ideas are exchanged, and experiences shared. This not only cultivates a sense of community but also opens doors to new opportunities and collaborations, enriching the professional journey of health practitioners. Looking to 2024, we anticipate launching our new mentoring and near-peer platform. In my admittedly biased view, the value that professional associations offer to health professions is immeasurable. Through continuous learning, networking, and advocacy, our aim is to empower you to easily navigate the complexities of your ever-evolving field. As the healthcare sector continues to transform, the role of associations becomes increasingly crucial, guiding professionals toward success and ensuring the delivery of optimal osteopathic care to the Australian population.
“Serving as the collective voice of the industry, we actively influence policies and decisions that shape the healthcare landscape”
NEWS
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Introduction to the Advocacy and Research team In this issue of Osteo Life, we are introducing you to the Advocacy and Research team. This dynamic group of skilled professionals with diverse qualifications in health sciences, research, nursing and public health is on a mission to strategically influence the ever-evolving health landscape and secure the widespread recognition of osteopathy.
MEET THE TEAM STEPHANIE SANTOS,
KATIE BEECH
BHSc (Health Sciences and Hearing and Speech), Policy and Advocacy Manager, leads the team. She provides oversight and direction, and with over 10 years’ experience in the health sector across government, private and not-for-profit organisations, Stephanie is an experienced leader.
is our newest team member and Policy and Advocacy Officer, based remotely in Victoria. She brings over 15 years of healthcare experience and advocates for equitable access to osteopathic services. You can read more about her on page 12.
DR SHAMONA EAVES,
NATASHA OWENS,
BSc (Hons) PhD, is our Senior Research and Project Officer. Shamona runs our research activities such as our annual grant scheme. She also creates and implements new research activities like our research mentorship program, webinar series, and Outcome Measure Implementation study.
BA, MS, is our Senior Policy and Advocacy Officer with eight years’ experience working in the healthcare sector. Natasha works to raise awareness of osteopathy through stakeholder engagement and formal submissions and supports the membership with policy and professional standards advice.
You can read more about the team on our website osteopathy.org.au/about-us/our-team
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NEWS
How the team supports osteopathy WHY WE DO IT
Passion fuels the team’s mission to support you and enact positive changes to your work and operations. Our commitment to researching and advocating for the osteopathy profession aims to create an active difference for the greater good of both practitioners and patients. Our research activities aim to build a solid evidence base for osteopathy through research funding, leadership and capacity building for academics and clinicians. We also encourage osteopaths to understand the value of research in practice and its strategic role in lobbying decisionmakers and educating consumers about osteopathy. A solid evidence base will help advocate and validate the profession while building the professional standard of osteopathic care alongside other allied health professions in Australia.
CURRENT INITIATIVES AND ACHIEVEMENTS
So far, in 2023, we have made nine submissions to government and state insurance agencies and independent consulting firms. Navigating the political system is time-intensive, but we will continue to report back to you on the outcomes of each submission. A summary
Each state and territory-based Workers Compensation and Motor Accidents Scheme will routinely hold public consultations when they intend to make changes to legislation or guidelines. As such we actively respond to these to ensure that osteopaths are appropriately represented, and the changes are fair. We have responded to multiple consultations over the last year with our submissions and feedback being well-received and our suggested changes being incorporated into legislation and guidelines before release. This work has also created higher visibility for the profession, with these schemes actively contacting us for involvement and collaboration. We continue to lobby for direct referral and the expansion of diagnostic imaging. We recently submitted, in collaboration with Allied Health Professions Australia (AHPA), to the scope of practice review where we recommended that osteopaths have the expansion of rights to include reducing the costs to the Medicare Benefits Schedule (MBS) and the patient themselves by avoiding unnecessary GP consultations. This will also lessen the burden on general practice and streamline the diagnostic and management process.
“According to the Australian Institute of Health and Welfare, one in six people are estimated to be living with a disability” of each submission can be found on our website – osteopathy.org.au/ advocacy-and-lobbying/ osteopathy-australia-submissions. Through our advocacy efforts, osteopaths are recognised to be able to provide workplace rehabilitation services in Victoria, New South Wales (restrictions apply), Queensland, Tasmania and in the national Comcare scheme. We are in the process of applying for osteopaths to become eligible to provide workplace rehabilitation services within the Western Australian scheme and will continue to work in this space for more consistent recognition.
We suggested the following: The addition of referral rights for direct referral to ultrasound when preferable to plain radiology and where clinically indicated, for the spine and associated regions, as well as for a range of neuromusculoskeletal conditions such as tendon and muscle tears, ligament sprains or tears, nerve entrapments and joint effusions; The expansion of imaging referral rights to include the plain radiography of the extremities to aid in diagnosis and treatment planning.
Digital health continues to be a focus of our advocacy efforts. In collaboration with AHPA, as members of the Digital Health Working Group, we are working with the Australian Digital Health Agency (ADHA) as a part of the Modernising the My Health Record program. This has included working in consultation with the ADHA to provide information on what types of information an osteopath would access and/or transmit through the My Health Record and how they would interact with other users. Further, we will work to be involved in the CSIRO’s interoperability standards development work, helping identify and justify the importance of involving allied health within this work. Having a strong presence within this space is essential to ensure that any policy, system and infrastructure changes are fit for purpose for the whole of the healthcare system to avoid leaving any profession behind. We have continued our efforts to advocate for changes to the Chronic Disease Management (CDM) program by lobbying government through prebudget submissions and under the Scope of Practice Review. We have been calling for changes to the number of services that can be accessed under the CDM to be provided based on patient need rather than being capped at a set number. Further, we advocate for the introduction of an initial consultation item number, so patients can receive the care they need with the practitioner being more accurately compensated to do so. This piece of work also allows us to draw attention to the wider role osteopaths can play within the chronic disease epidemic and GP shortage. We recently made several key recommendations to the Australian Bureau of Statistics (ABS) in response to their Australian and New Zealand Standard Classification of Occupations (ANZSCO) updates, including: That osteopathy is granted its own Unit Group classification and is recognised as a discrete profession; That the description of osteopathy and the associated task list is updated to represent the profession more accurately;
NEWS
That the ABS classifies all
allied health professionals within one Sub-Major group within the ANSZCO; That the ABS reports and releases occupation-level data so that government bodies and peak associations can use this to inform a range of policies and strategies. While much of our work cannot be quantified, this article aims to inform you about the advocacy work we have undertaken.
TRENDING TOPIC – THE NATIONAL DISABILITY INSURANCE SCHEME AND OSTEOPATHY’S VITAL ROLE
Over the last year, you would have seen communications from us about the National Disability Insurance Scheme (NDIS). You may wonder how this might impact your practice and what we are doing to help advocate for your clients. Keep reading to find out more! According to the Australian Institute of Health and Welfare (AIHW) 2022 1, one in six people are estimated to be
living with a disability. Our advocacy efforts and push for recognition within the NDIS is not just about the present – it is about laying the foundations for a future where osteopaths can significantly contribute to the wellbeing of people living with disability. The NDIS is a critical player in funding the support of people living with disabilities. Osteopaths are vital contributors to this support network, addressing musculoskeletal issues, pain management and enhancing mobility, which all play a role in one of the NDIS’s key aims of capacity building. Advocating for osteopathy to be acknowledged and having a line item within the NDIS is crucial to securing the future of osteopathy within the disability space. Osteopathy is not outlined in the NDIS Price Guide, and invoicing for plan-managed NDIS participants is under the ‘other health professionals’ category. Without recognition of the osteopathic profession by NDIA and NDIS, there is a risk that NDIS participants may not be able to access the osteopathic services they want and need. Recognition under the
TM
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NDIS opens doors, allowing osteopaths to contribute their expertise and support to a broader community.
LOOKING AHEAD
Throughout 2024, the team remains steadfast in advocating on your behalf. Change takes time, but we will keep you posted on developments that may impact you and how you practice. There are many ways for you to get involved. You can join one of our many committees, help us prepare submissions, join the Osteopathy Australia Member’s Forum, share and prepare personal letters with positive experiences, and respond to our surveys. You can contact Stephanie Santos, Policy and Advocacy Manager, at (02) 9410 0099 or ssantos@osteopathy. org.au to further discuss your interest in policy, advocacy, or research activities.
Reference
1 Australian Institute of Health and Welfare (AIHW). People with disability in Australia, summary 2022. Available from https://www.aihw. gov.au/reports/disability/people-with-disabilityin-australia/contents/summary
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NEWS
STAFF UPDATE
K
Introducing Katie Beech
atie Beech is our Policy and Advocacy officer. With a Bachelor of Nursing degree from the University of Tasmania, Katie brings over 15 years of healthcare experience across New South Wales and Victoria. As a registered nurse, she has worked in various settings,
including public and private hospitals, aged care, operating theatres, dermatology and day surgery. Beyond her healthcare roles, Katie, a former yoga studio owner, blends her expertise with a passion for the mind-body connection and holistic health. She is not only a seasoned healthcare professional, but also a versatile creator, illustrator, designer and musician. With a diverse background, Katie is well-equipped to drive policy and advocacy initiatives, bringing a wealth of experience and a multifaceted skill set to our allied health community.
A tribute to Dr Paul Whitman (Osteopath) 1963-2023 RIP
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t is with great sadness that we share the sad news with all of you who would have known Dr Paul Whitman (osteopath). Paul passed away on the 5 November 2023 after bravely fighting an aggressive nonHodgkin’s Lymphoma called Mantle Cell Lymphoma for the past two-and-a-half years. Paul began his osteopathy training in 1981 at the British School of Osteopathy, London; he was a popular and much-loved student who managed to juggle study with having fun and enjoying life but never lost sight of his determination to be the best osteopath he could be. He was confident, calm, thoughtful and not scared to be an individual. Outside of osteopathy, Paul loved golf (single-figure handicapper), tennis, skiing and sailing. After graduating in 1985, he set up practices in his hometown of East Sheen and Teddington, Greater London. However, his life was destined to be relocated to Sydney, Australia. While on a skiing trip with fellow osteopaths, Paul met and fell in love with his future wife, Lisa, who came from Australia. In 1994, Paul and Lisa moved to Sydney, and they quickly settled into a comfortable
and relaxed life, with Paul building up his osteopathic practice and passing on his extensive professional experience as a clinic tutor at the University of Western Sydney. Paul continued to excel at maintaining a perfect equilibrium between his professional and personal life. This harmonious balance was further enriched by the arrival of their two children, Al and Harry. Life in Sydney suited Paul. A quick 18 holes of golf before work or unwinding at the end of the day by taking his boat out in Sydney Harbour. Then, in February 2021, Paul got the devastating diagnosis of MCL. Despite the dreadful prognosis and facing a treatment plan that would throw everything at holding back the disease process, Paul was determined to carry on enjoying his life. He loved being an osteopath, and he kept working for as long as he possibly could. One of his biggest regrets was that the illness was going to stop him from being ‘one of those osteopaths’ who continues working well into their 80s. Paul somehow retained his dignity and humour throughout his battle against
Consumer website refresh
O
steopathy Australia’s consumer website www.whatisosteo.com – to promote osteopathy and osteopaths’ whole-body approach to managing pain – has had an upgrade. It’s now easier for consumers to use.
The website aims to demystify what you do and highlights how the profession works with GPs and other allied health professionals, ensuring that patients get the best care. Please remember to direct new patients to the website – it’s a great resource.
cancer. He was an old-school osteopath who understood the privilege we enjoy of helping others every day, just using our hands. He may be gone, but he will never be forgotten by everyone fortunate enough to call him a friend or colleague. In his final months, Paul passionately fought to improve outcomes for Australians battling Mantle Cell Lymphoma. His tireless commitment to the cancer community is evident in his legacy, “Paul’s Promise,” ensuring every Australian can receive vital treatments. Please support Paul’s memory by donating to Paul’s Promise: mycause.com.au/p/327408/pauls-promise
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NEWS
Elevate your osteopathic experience with Osteopathy Australia
Are you passionate about advancing your career in osteopathy? Osteopathy Australia invites expressions of interest for dynamic individuals to join our working groups and committees. CPD Working Group: Dive into the heart of continuing professional development. Contribute your expertise and shape the future of osteopathic education, ensuring excellence in every learning opportunity. Academic Research Committee: Unleash the power of research! Join this committee to drive innovation, foster collaboration and explore groundbreaking ideas in osteopathic academia. Your insights can spark a new era of knowledge and discovery. Aged Care Working Group: Make a difference in the lives of the elderly through osteopathic care. Join this group to influence policies, share best practices and create a positive impact on the ageing population. Communications and Marketing Working Group: Are you a maestro of communication and marketing? Join us in crafting strategies that amplify the voice of osteopathy. From social media to impactful campaigns, your skills will help us reach new heights.
Why join? • • • • •
Network with industry leaders and fellow professionals; Shape the direction of osteopathy in Australia; Contribute to meaningful initiatives; Gain unparalleled exposure in your field; Enhance your leadership skills and professional development. For more information please visit www.osteopathy.org.au/article/expressions-of-interest-now-open
“Together, we can create a stronger, more vibrant community of osteopathic professionals!” How to apply Expressions of interest close at 5pm (AEDT) on 23 February 2024. Submit your application form found at osteopathy. org.au/article/expressions-ofinterest-now-open to info@osteopathy.org.au. Include your resume and a brief statement outlining why you’re the ideal candidate for the chosen working group. Don’t miss this chance to be a driving force in shaping the future of osteopathy.
NEWS
15
Osteopathy Australia’s 2024-2025 pre-budget submission summary
I
n early 2024, Osteopathy Australia will be making a pre-budget submission to the Treasury to advocate for funding for the delivery of better health outcomes for allied health services. “Over the past few years, several commitments have been made by the Federal Government around increasing allied health involvement in the delivery of primary health care, chronic disease management, and the care and support sector, yet most of these commitments have not been accompanied by necessary budget. Osteopathy Australia urges the government to deliver on these commitments in the 2024-25 budget, and we have highlighted below some key areas needing attention.” We wanted to give you a preview of the key recommendations we have made to improve the delivery of primary health care and asked the Australian Government for: Key recommendation 1: Support trials of alternative funding mechanisms for allied health services, particularly for Medicare, Chronic Disease Management (CDM) or Department of Veteran’s Affairs;
ey recommendation 2: Support K the implementation of the New Aged Care Act through adequate funding of education, training and communication for allied health professionals; Key recommendation 3: Introduce budget measures to increase access to osteopaths and the full range of allied health services needed by aged care clients; Key recommendation 4: Allocate funding to support allied healthspecific research within governmentbased grant schemes; Key recommendation 5: Allocate funding and resources to allied health peak bodies and all allied health practitioners to provide services to support participants in the NDIS, while reducing unnecessary administrative or regulatory burdens; Key recommendation 6: Provide funding to support the smooth transition and access to My Health Record to foster understanding, engagement, crosscollaboration and ease of sharing and viewing important patient information;
ey recommendation 7: Provide K funding to support allied health integration into the Workforce Incentive Program (WIP), with a focus on allowing the WIP to fund local osteopaths working in private practice outside of GP clinics; Key recommendation 8: Implement and fund the scope of practice review to include the removal of current barriers and increase funding for osteopaths working at their full scope of practice via increased diagnostic imaging rights and direct MBS referral to a specialist; Key recommendation 9: Fund the development of an allied health workforce plan in primary care; Key recommendation 10: Ensure osteopaths and business owners receive financial support for asset write-offs, business or other incentives, including HELP write-offs, as offered in medicine or nursing. The full submission and further information will be published on our website later in the year.
SAVE THE DATE
25 - 26 OCTOBER 2024 OSTEOPATHY CONFERENCE - SYDNEY Novotel Sydney Central / Sydney Central Hotel 169/179 Thomas St, Haymarket NSW
16
PRACTICE MANAGEMENT
Elevating professional wellbeing – the path to thrive in 2024 In the dynamic realm of allied health, the pursuit of professional wellbeing stands as the cornerstone of our success. It’s important to delve into the essential aspects that fortify our journey toward excellence and wellbeing, emphasising continuous learning, human-centred design, and the unwavering adherence to professional values. The term “self-care” can be counterintuitive because it may inadvertently suggest detachment from responsibilities or a temporary escape from challenges, rather than emphasising the importance of integrating self-care practices into our daily lives. It’s crucial to recognise that true self-care involves actions that not only rejuvenate but also empower individuals to navigate life’s demands more effectively and, ultimately, facilitates helping others and improved performance. Rather than superficial self-care practices, why not commit to the below throughout 2024?
weights, painting, strumming your guitar, or delving into a thrilling novel, these moments are not mere indulgences but vital doses of rejuvenation. Embracing these passions isn’t just about pleasure; it’s a conscious choice to nurture your wellbeing, fortify your spirit and elevate your effectiveness as an osteopath.
FIND YOUR FLOW IN WORK-LIFE INTEGRATION
The heart of effective osteopathic care lies in understanding the needs of those we serve. Adopt a human-centred design approach – immerse yourself in the user experience, observe patient interactions within the system and apply human factors and ergonomics principles. By placing emphasis on usability and patient-centred care, we craft environments and treatment plans that resonate deeply with those seeking our skillset.
Gone are the days of segregating work from life! Embrace the fluid dance of work-life integration. There is no such thing as work-life balance as it is genuinely impossible to separate our professional and personal lives. They are one in the same. Amid the busy schedule of an osteopath, finding solace in the rhythmic cadence of your favourite workout routine becomes a non-negotiable. Carving out time to hit the gym, dance to your favourite tunes, or take a revitalising jog in the park becomes as essential as any appointment in your calendar. Beyond the clinic walls, there’s an oasis – a haven where you immerse yourself in what ignites your soul – where you are at your absolute best. Whether it’s swimming in the ocean, lifting heavy
CONTINUOUS LEARNING: THE LIFELONG ODYSSEY
The quest for mastery never ceases. Embrace the ethos of lifelong learning. Engage in continuous professional development, explore innovative techniques, and stay abreast of the latest advancements in the field. From attending workshops to pursuing advanced certifications, nurturing your knowledge base is the key to refining your craft.
HUMAN-CENTRED DESIGN: EMPATHY IN PRACTICE
UPHOLDING PROFESSIONAL OATHS AND VALUES
As custodians of health and wellbeing, our commitment to professional values fuels our purpose. Let the oaths we’ve sworn echo in our practice – integrity, empathy and a profound dedication to the welfare of our patients. By upholding these values, we honour our profession
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. and inspire confidence in those who entrust us with their care.
FOSTERING A CULTURE OF REFLECTION AND IMPROVEMENT
Pause, reflect, and refine. Embrace a culture that encourages introspection and improvement. Regularly assess your methodologies, seek feedback and adapt strategies to optimise patient outcomes. The ability to introspect and evolve distinguishes exceptional practitioners from the rest. In the symphony of nurturing our own wellbeing, one profound note resonates – the act of giving to others. As osteopaths, our dedication to healing extends beyond clinical walls. It’s in the moments of lending an empathetic ear, offering guidance, or simply sharing a comforting smile that we discover the immense power of giving. In giving, we receive a sense of purpose, fulfillment, and a profound connection to human experience. It’s through these proactive, generous acts that our own wellbeing flourishes. So, as we journey forward into 2024, let us remember: the greatest gift we give ourselves is the joy of giving to others.
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CLINICAL
Adolescent idiopathic scoliosis In this article, we’ll look at the diagnosis and management of patients with adolescent idiopathic scoliosis (AIS), helping practitioners to be better prepared in a clinical setting. INTRODUCTION
Scoliosis is a three-dimensional medical condition where the spine deviates in all three planes of spinal motion (sagittal, coronal and axial). In the coronal plane the deviation of the spine must be greater than 10 degrees when measured by the Cobb angle method and display a level of spinal rotation on the x-ray image. There are many aetiologies for scoliosis. Idiopathic scoliosis is the most common in the general population with these patients not having any underlying disease process causing their scoliosis. Current best evidence is strongly suggestive of an underlying genetic cause of idiopathic scoliosis, but the exact mechanism has not been determined. Other aetiologies include congenital vertebral malformations and underlying neuromuscular or syndromic conditions affecting musculoskeletal development. Scoliosis most frequently presents in association with the adolescent growth spurt, hence the term adolescent idiopathic scoliosis (AIS). Early onset scoliosis denotes any progressive scoliosis occurring before the age of 10 and is sometimes broken down into infantile (before age 3) and juvenile (age 3-10) scoliosis. Growth is the primary driving force behind scoliosis progression in most cases. For this reason, early onset scoliosis has the potential for severe spinal deformity in young children given the growth potential of these patients. This article will focus on the diagnosis and management of patients with AIS.
For children and adolescents, referrals may be time sensitive due to rapid growth spurts at different ages and the magnitude of the spinal curvature. The aim is to intervene with evidence-based treatments such as bracing or scoliosis specific exercise with the focus to reduce the need for possible surgical intervention. Osteopaths and other allied health practitioners can be particularly helpful in the diagnosis and early management of scoliosis. The aim of this article is to better prepare practitioners for basic diagnosis and management of AIS.
STRUCTURAL AND FUNCTIONAL SCOLIOSIS
This article will focus on idiopathic scoliosis, but it is important to be able to differentiate between both structural and functional / postural curvatures. A structural curve originates in the spine and a functional curve elsewhere in the body, such as leg discrepancy. A functional scoliosis can normally be affected by changing the patients’ position, i.e. observing the patient in a standing position then asking them to sit and making the same visual observation of the curve. If the functional scoliosis is caused by a leg length discrepancy, there should be a visible difference in the presentation of the curve while the patient is seated, or accommodating for the leg length discrepancy by placing the required heel raise under the shorter limb. In most cases when
“Osteopaths and other allied health practitioners can be particularly helpful in diagnosis and early management of scoliosis”
DANIEL COMERFORD (OSTEOPATH) Daniel graduated from RMIT and also completed a Masters in Exercise Rehabilitation at Victoria University. Daniel has undertaken extensive training in the field of Scoliosis Management in Germany and the USA in both bracing and scoliosis specific exercise (Schroth Method). He has qualified as a Schroth Best Practice Instructor and delivers courses in the Schroth Method to practitioners and patients. Daniel is the Australian distributor for the Cheneau Gensingen Brace and fits patients locally and distributes around the country.
MR. KRISTOPHER M LUNDINE, MD MSC FRCSC FRACS Many thanks to Kris Lundine for his invaluable input into the contribution of this article and his counsel into the surgery section.
performing an Adam’s Forward Bend Test to measure the Angle of Trunk Rotation (ATR) you will find there is little to no trunk rotation.
DIAGNOSTIC INDICATORS
There are numerous tests and observations that lead to a diagnosis of scoliosis. The list in this article is by no means an exhaustive one but should allow for basic diagnosis and when a referral is required. It is important to remember that many of these findings when determining skeletal age can vary from the ranges stated. Therefore if one of the parameters falls outside of the stated
CLINICAL
thresholds it doesn’t mean referral or treatment isn’t required. Gender The ratio of scoliosis that requires treatment (bracing or surgery) between females and males is approximately 9:1, in smaller curves the ratio has been cited as closer to approximately 1:1. There are a number of possible theories as to why the prevalence is greater in females than males, including a more rapid change in axial growth during female pubescent growth spurt, and higher rates of osteopenia.1,2,3
Age The current age of the patient and the age of known onset of the scoliosis is extremely important to ascertain early on in the case history. The age of the patient will assist in identifying how much growth they have remaining, which is important for understanding the risk of progression. Red flags There are a number of red flags to consider when a patient presents with scoliosis. Though 80-90% of curves are
19
idiopathic, secondary causes of scoliosis should be ruled out.9 With the presentation of the below signs and/or symptoms should be considered non-idiopathic and immediate referral to a paediatric spinal specialist for further investigation including MRI is required: midline skin defects; spina bifida; meningomyelocele; cafe-au-lait spots; foot deformities such as cavovarus; asymmetric abdominal reflexes;
20
CLINICAL
SCOLIOSIS IS CLASSIFIED INTO DIFFERENT CATEGORIES, DEPENDENT ON THE AGE OF ONSET INFANTILE 0-3 YEARS4 • • • • •
•
• •
•
Aetiology remains unknown Incidence is rare it represents only 1% of all idiopathic scoliosis cases 60% are male Curve is typically in the thoracic region and laterally bends to the left MRI scans are normal in idiopathic scoliosis (e.g. no detectable abnormalities such as spinal cord tumours) Treatment is normally observational and many of these curves spontaneously resolve. Reported rates vary between 18-92% Curves which show signs of progression are either braced or casted Some cases can progress to surgery and these are complex cases for surgeons as they aim to reduce progression but not adversely affect the child’s growth rate Curves that decrease with observation are likely to remain dormant during subsequent growth spurts
• • •
•
Comprises approximately 10-15% of all idiopathic cases Boys may be more affected in this age group Commonly an MRI is required in this age group as those with a curve greater than 20 degrees, 20% may have an underlying spinal condition Bracing is generally used to manage these curves but those that have curves greater than 30 deg, approximately 95% end up progressing to surgically indicated levels
severe pain (night pain); sudden rapid progression in a previously stable curve; abnormal neurologic findings.
FURTHER CLINICAL AND RADIOLOGICAL EVALUATIONS FOR GROWTH PREDICTION
ADOLESCENT 10 – SKELETAL MATURITY6
JUVENILE 4-10 YEARS5
Spinal growth is often the primary driving force behind scoliosis progression. Several clinical and radiographic methods can be utilised to help predict growth. Historically, Tanner staging was used to track a patients’ progress through pubertal development. This has become less commonly used in most clinical practices. Menarche can be a very useful marker of skeletal maturation in adolescent
•
•
• •
Most common cause is idiopathic and adolescent idiopathic scoliosis represents the largest population of idiopathic curves across all age groups Ongoing research continues into the cause of idiopathic curves. This includes genetic research but there is still no identifiable causes Approximately 30% of patients will have some family history of scoliosis Though many patients may present with back pain, scoliosis does not generally cause pain or neurological symptoms
females. Tracking a patient’s height over time and mapping this according to growth charts based on population based normative values is useful if the clinician has been seeing the patient for several years and if they have access to normative values for that patient’s gender and ethnicity. Radiographic markers frequently used to predict growth include pelvis (Risser sign and closure of the tri-radiate cartilage), hand (Sanders Classification), elbow and proximal humerus. All of these methods have a high degree of variability and are by no means perfect at predicting a patient’s peak growth velocity or remaining growth. A good clinician will use a combination of clinical and radiographic markers to most reliably predict growth.
DE NOVO SCOLIOSIS7,8 • •
• •
Rarely presents before the age of 40 Patients have no prior history of spinal curvature. De Novo means “New” Females more likely than males Is secondary to advanced degenerative changes
Risser The Risser sign is very important in calculating the risk of progression of a scoliosis, as it is a sign of skeletal maturity. The lower the Risser score the higher the risk of progression of a scoliosis (as skeletal growth is still occurring). The majority of a female’s growth occurs during Risser 0-2.10,11,12 While statistically the Risser score is associated with chronological age, variations are regularly observed. Calculation of scoliosis risk progression should not be made on magnitude of curve and age alone; Risser sign must always be considered.13 0 – no epiphysis present 1 – 25% of the epiphysis present 2 – 50% of the epiphysis present 3 – 75% of the epiphysis present
CLINICAL
DIAGNOSTIC INDICATORS – EXAMPLES Gender: Female Age: 12 years old Adolescent Idiopathic Presentation Presenting posture: The appearance of the patient’s posture may not appear instantly obvious that she has scoliosis. The patient has a double major curve, commonly referred to as an S-curve. This curve type’s postural presentation can present a little more inconspicuously than a single thoracic curve. The image right identifies a number of the observable postural variations: 1. Right shoulder is higher than the left; 2. W inging of the right scapular is observed, also trunk rotation of the thoracic spine to the right; 3. Soft tissue fold through the right loin/lumbar region; 4. Left rotation of the lumbar spine; 5. Upward tilt of the pelvis to the right. Below is a patient with a single right thoracic curve. With single curves the postural presentation is normally more evident. As can be seen below, the patient’s trunk translates to the right relative to the pelvis.
21
22
CLINICAL
4 – 100% of the epiphysis present 5 – Fusion of epiphysis to the ilium Menarche Skeletal maturity was once thought to be achieved at two years after the onset of menarche. A number of studies have shown this not to be accurate and residual growth may continue afterwards.11 For example, Patient AB (see Case Study below) at the initial presentation was yet to commence menarche. This indicates that she has significant growth remaining. Imaging Plain film x-ray is required in the diagnosis of a scoliosis. This is in the form of a full spine image, which includes all four regions, cervical spine, thoracic spine, lumbar spine and pelvis in the one image. Having the whole spine in one image allows for accurate measurement of the curve(s). If sectional x-rays are taken it may be difficult to measure curves that may start or end in a different region of the spine. More commonly EOS x-rays are ordered by orthopaedic surgeons, osteopaths, physiotherapists and chiropractors working in the field of scoliosis. They are available in a number of major cities in Australia and offer the benefits of: low dose of radiation;15 ability to create 3D reconstructions;15 ability to conduct whole body imaging;15 high reproducibility in measuring various parameters of alignment and faster imaging time;15 can take full spine and full skeletal images. Cobb angle With EOS imaging, many radiology clinics will provide Cobb angle measurement of the size of the curve(s). When ordering plain film x-rays it is uncommon for the provider to supply measurements. This may be requested retrospectively, though it is encouraged that a practitioner take the time to learn how to measure a Cobb angle. There are numerous resources on the web that can show how this is performed. Measurements can now be easily measured using the iPhone as well.16 If unsure on how to measure, referral is suggested.
“The Risser sign is very important in calculating the risk of progression of a scoliosis, as it is a sign of skeletal maturity. The lower the Risser score, the higher the risk of progression of a scoliosis (as skeletal growth is still occurring). The majority of a female’s growth occurs during Risser 0-2” CASE STUDY (Patient: AB)
Risser – 0 Triradiate cartilage is not fully closed on the patient. It is the epiphyseal growth plate between the ilium, ischium and pubis that forms the acetabulum.14 Once the triradiate cartilage closes, the next stage is the presentation of the iliac crest apophysis.
Example of an epiphysis present from a later EOS scan of the same patient. Note risser 2 of the left iliac as the epiphysis covers 50% of the iliac crest.
CLINICAL
Sanders score Estimated bone age can be performed by ordering an x-ray of the left hand and wrist. The Sanders score is commonly used in clinical settings. It uses a scale of 1-8 – the Sanders maturity scale considers level 1 to be slow growth in early adolescence whereas 8 is categorised as full skeletal maturity.18 Tanner staging method Tanner staging is a measurement of the physical development based on the breast, genitals and pubic hair development. In females this can be easily measured by observation of breast development. This can be observed while the patient is wearing a singlet or bra. Tanner stage 2 to 3 normally occurs after the onset of pubertal growth spurt which coincides with the acceleration in axial growth and likely progression of scoliosis.21 Scoliometer A scoliometer is a bubble inclinometer used to measure the angle of trunk rotation (ATR). It is used during Adam’s forward bend test and can be used to identify possible curvatures and the requirement for imaging. Some studies created22,23 formulas to predict the Cobb angle using ATR measurements. Application generally has been suggested that angles 5 degrees or less are considered insignificant and may not require follow up. Angles of 6 – 9 degrees require follow up and radiological evaluation. ATR needs to be complemented with the use of other diagnostic tests prior to ordering imaging.24 As the correlation between Cobb angle and ATR is only 0.65 in right convex curves.25
REFERRAL GUIDELINES AND INDICATED TREATMENT OPTIONS
The International Society on Scoliosis Orthopaedic and Rehabilitation
23
Cobb angle: Patient Example From Cobb angle measurements the patient at presentation had a 35 degree right thoracic curve from T4-T10 with the apex at T8 and a 31 degree left lumbar curve from T10-L3 with the apex at L1. This presentation is consistent with a double major curve presentation. There are many different curve classification systems, the most common system used by orthopaedic surgeons is the Lenke.17 This curve would be classified as a Lenke Type 3.
35
31
(Patient: AB)
I
April 2007 Prior To Bracing
II III Sanders score19
IV V
Treatment (SOSORT) guidelines are used to inform decision making when determining required treatment, specifically curve magnitude and Risser score.26 As previously mentioned, variations can occur and age may not correlate closely to Risser. Most studies have been performed on American and European
“Angles of 6-9 degrees require follow-up and angles of 10 degrees or above require radiological evaluation. ATR needs to be complemented with other diagnostic tests”
Female image of Tanner staging22
populations and variations have been noted in Asian populations.27 In 1984, Lonstein developed one of the early prediction models based on observational studies of untreated scoliosis.28 This was further updated by Weiss and SOSORT committee in 2006.29 and the SOSORT guidelines most current version being published in 2016.30 This current version has been formed on the consensus of leading world experts based on the available research and their expert opinions.
O
24
CLINICAL
Table 2 to the right indicates the type of treatment:30 Obs = Observation. The number relates to the number of months between follow up; PSSE = Physiotherapy Scoliosis Specific Exercise. Referring to Schroth, SEAS and other available scoliosis specific exercise methods; NTRB = Night Time Rigid Bracing; SIR = Special Inpatient Rehabilitation. Patients spend a number of weeks in a specialised rehabilitation facility learning and practicing scoliosis specific exercises; SSB = Scoliosis Soft Braces such as Spine Cor; HTRB = Half Time Rigid Bracing; PTRB = Part Time Rigid Bracing – 12–20 hrs per day of brace wear; FTRB = Full Time Rigid Bracing – 20-24 hrs per day or wearing of a cast; TTRB = Total Time Rigid Bracing; Su = Surgery. The guidelines in Table 3 (opposite page) can be used to determine the best evidencebased treatment options that could be considered for the patient based on age, curve magnitude and presence of pain. For example, patient AB’s largest curve is 35 degrees therefore is considered moderate and risser 0. Therefore, the minimum suggested treatment is Half Time Rigid Bracing up to Full Time Rigid Bracing.
TREATMENT OPTIONS Bracing Bracing has been around for decades and there is a large choice for patients both worldwide and locally in Australia. While many practitioners and brace manufacturers anecdotally understand the outcomes of brace treatment, Weinstein’s 2013 “BrAIST” Study31 was the first randomised control trial that proved that bracing was effective in reducing the progression to surgically indicated levels. Boston Braces were used in the study and are widely available in Australia today. Commonly used in European countries is a Chéneau Style brace32,33 that is becoming more popular in Australia. This brace is available in private clinics and a number of children’s hospitals now use it as their primary brace to treat scoliosis. The primary purpose of bracing in adolescent idiopathic scoliosis is the prevention of curve progression, particularly into the surgical range. For this reason, the main indication for bracing is a curve with a Cobb angle of between 20-45 degrees in a child with at least 1 year of growth remaining. Theoretical advantages of different brace styles have been proposed but current best evidence shows that the most important factor in brace efficacy is brace compliance. A brace worn for less than 12 hours per day has been shown to be equivalent to not wearing a brace at all.31
TABLE 2: PRACTICAL APPROACH SCHEME (PAS) FOR AN EVIDENCEBASED CLINICAL PRACTICE APPROACH TO IDIOPATHIC SCOLIOSIS (STRENGTH OF EVIDENCE VI–STRENGTH OF RECOMMENDATION B)30 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Obs 36 Obs 12 Obs 8 Obs 6 Obs 3 PSSE NTRB SIR SSB HTRB PTRB FTRB TTRB Su
Scoliosis specific exercise There are many different approaches to scoliosis-specific exercise such as: Lyon Approach; Schroth Best Practice (Schroth);34 Katharina Schroth Asklepios (Schroth);35 Scientific Exercise Approach to Scoliosis (SEAS);36 Barcelona Scoliosis Physical Therapy School approach (BSPTS); Dobomed Approach; The Side Shift Approach; Functional Individual Therapy of Scoliosis approach (FITS).
TABLE 1: CLASSIFICATIONS OF IDIOPATHIC SCOLIOSIS30 Chronological (SoE: V) Age at diagnosis (years.months)
Topographic (SoE: V)
Angular (SoE: VI) Cobb degrees
Apex from
to
Infantile
0–2
Low
Up to 20
Cervical
–
Disc C6–7
Juvenile
3–9
Moderate
21–35
Cervicothoracic
C7
T1
Adolescent
10–17
Moderate to severe
36–40
Thoracic
Disc T1–2
Disc T11–12
Adult
18+
Severe
41–50
Thoraciclumbar
T12
L1
Severe to very severe
51–55
Lumbar
Very severe
56 or more
Disc L1–2
CLINICAL
25
TABLE 3: STRENGTH OF TREATMENTS SCHEME (STS) (STRENGTH OF EVIDENCE V–STRENGTH OF RECOMMENDATION B): IT REPORTS ALL THE POSSIBLE TREATMENTS THAT CAN BE PROPOSED FOR IDIOPATHIC SCOLIOSIS GRADUATED FROM THE LESS TO THE MOST DEMANDING (BOTH IN TERMS OF BURDEN ON THE PATIENT, AND POSSIBLE EFFICACY)30 Low Min
Moderate Max
Min
Max
Severe Min
Max
Infantile
Obs3
Obs3
Obs3
TTRB
TTRB
Su
Juvenile
Obs3
PSSE
PSSE
FTRB
HTRB
Su
Risser 0
Obs6
SSB
HTRB
FTRB
TTRB
Su
Risser 1
Obs6
SSB
PSSE
FTRB
FTRB
Su
Risser 2
Obs6
SSB
PSSE
FTRB
FTRB
Su
Risser 3
Obs6
SSB
PSSE
FTRB
FTRB
Su
Risser 4
Obs12
SIR
PSSE
FTRB
FTRB
Su
Nothing
PSSE
Obs12
SIR
Obs6
Su
No pain
Nothing
PSSE
PSSE
SIR
Obs12
HTRB
Pain
PSSE
SSB
PSSE
HTRB
PSSE
Su
No pain
Nothing
PSSE
Obs36
PSSE
Obs12
HTRB
Pain
PSSE
SSB
PSSE
HTRB
PSSE
Su
trunk decompensation
Obs6
SSB
PSSE
PTRB
PSSE
Su
Adolescent
Adult up to 25 y Adult
Elderly
26
CLINICAL
PATIENT EXAMPLE The patient was braced with a Germany Chéneau Style brace called a Chéneau-Gensingen. In total due to growth she wore three separate braces. Each of the braces were worn for 23 hours per day. First Brace
First Brace
17/04/2017
26/04/2017
23/05/2017
03/05/2017
(Patient: AB) Comparing initial EOS with in-brace EOS
26
35
31
April 2007 Prior To Bracing
17
19
19
20
October 2017 1st Brace
May 2018 2nd Brace
20
12
October 2019 3rd Brace
14
April 2020
Night-Time Wear
Out of brace EOS’ performed after wearing each brace for approximately 6 months. The last image is at the last stage of weaning from the brace after completing nighttime wear only.
The common features of Scoliosis Specific Exercise (SSE) are:37 3-Dimensional self-correction of the curvature; Training of activities of daily living. How to move in ways that favour the curves correction; Stabilisation of the corrected posture. Within the overall care model, approaches include not just exercise therapy but also:36 Scoliosis-specific education; Observation or surveillance; Psychological support and intervention; Bracing and surgery.
These exercise methods are currently applied to both adult and adolescent patients. Initially, some of the older methods such as Schroth were developed to manage the pain in adult populations with scoliosis.
Scoliosis specific exercises can serve as a useful adjunct for patients also undergoing brace therapy for scoliosis. Wearing a brace for prolonged periods likely has a negative impact on patients’ core strength. A guided exercise program can be helpful to maintain postural strength during the months and/or years often involved in brace treatment. There has been one RCT that has shown a greater improvement in curvature when bracing and scoliosis specific exercise are combined in treatment of adolescents.35 Surgery Surgery is generally indicated in curves with magnitudes greater than 45-50 degrees.38 Curves larger than this have an increased risk of ongoing progression even after skeletal maturity. Larger curve magnitudes have the potential for greater surgical risk. Long-term studies of patients with adolescent idiopathic scoliosis have not shown a deleterious effect on pulmonary function.38 This is not the case with early onset scoliosis when curves tend to be more severe and have the potential for greater impact on chest wall and lung development.40 The current gold-standard surgical treatment for AIS is spinal fusion with segmental instrumentation.41 This can be achieved through either a posterior or anterior approach to the spine. Posterior spinal fusion has become the most common procedure with the advent of the pedicle screw and the ability to access the entire spine from the occiput to the pelvis through this single approach. Anterior spinal fusion is still commonly used in some centres for selective fusions of single curves, but it is not possible to access the entire length of the spine through a single anterior approach.42
“I suggest that manual therapy can be used on patients that are experiencing pain, though it should not be in lieu of the recommended treatments within the SOSORT guidelines”
CLINICAL
Spinal fusion has long been the preferred surgical option for patients near to or at skeletal maturity. Non-fusion techniques to achieve deformity correction but allow ongoing spine growth have been used traditionally for early onset scoliosis when patients still have a large amount of spine growth remaining that plays an important role in chest wall and lung development. More recently, growth modulation techniques such as vertebral spinal tethering (VBT), magnetically controlled growing rods, ApiFix and sublaminar polyester bands43, spinal fusion continues to be the most prevalent and enduring procedure to date.44 In spinal fusion surgery, metal implants are connected to the spine then to either one or two rods, this allows for the spine to be held in a
corrected position until the vertebrae are fused.44 Revision rates for surgery vary from technique to technique, one study45 found between 2 and 5 year follow-up for VBT showed 21% revision rate, where spinal fusion surgery reports revision figures around 4-5%.46,47 Overall, the natural history of most AIS late into adulthood is quite good. The rate of back pain requiring consultation with a healthcare professional is greater than the general population.48 AIS has also been shown to not result in longterm pulmonary impairment and has no effect on all-cause mortality later in life.49
OSTEOPATHIC TREATMENT OPTIONS
Manual therapy is a complementary conservative treatment regularly utilised by patients with scoliosis.50
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While it may assist in reducing pain reported by the patient, there is no evidence that it affects the radiological presentation of the curve.51 Therefore, it is suggested that manual therapy can be used on patients who are experiencing pain, though it should not be in lieu of the recommended treatments within the SOSORT guidelines. It is important to note that pain is not a normal presentation in adolescent idiopathic scoliosis. The most important role osteopaths can play in the management and treatment of a scoliosis is early detection, appropriate imaging and appropriate referral where necessary. Osteopaths have a role to play in the delivery of scoliosis specific exercise though further training is required.
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CLINICAL
References 1. Thomas JJ, Stans AA, Milbrandt TA, Kremers HM, Shaughnessy WJ, Larson AN. Trends in Incidence of Adolescent Idiopathic Scoliosis: A Modern US Population-based Study. J Pediatr Orthop. 2021 Jul 1;41(6):327–32.
17. Slattery C, Verma K. Classifications in brief: the lenke classification for adolescent idiopathic scoliosis. Clin Orthop Relat Res. 2018 Nov;476(11):2271–6. 18. Tools to Assess Skeletal Maturity | Gillette Children’s [Internet]. [cited 2023 Jul 16]. Available from: https:// www.gillettechildrens.org/for-medical-professionals/ partners-in-care/tools-to-assess-skeletal-maturity
2. Reamy BV, Slakey JB. Adolescent idiopathic scoliosis: review and current concepts. Am Fam Physician. 2001 Jul 1;64(1):111–6.
19. Monitoring Scoliosis [Internet]. [cited 2023 Jul 16]. Available from: https://www.scoliosis.gen.nz/ monitoring-scoliosis
3. Zhang H, Guo C, Tang M, Liu S, Li J, Guo Q, et al. Prevalence of scoliosis among primary and middle school students in Mainland China: a systematic review and meta-analysis. Spine. 2015 Jan 1;40(1):41–9.
20. Mueller NT. Early Puberty: Adulthood Metabolic Consequences & Childhood Nutritional Determinants. UNIVERSITY OF MINNESOTA. 2013 Nov 8;
4. Infantile Scoliosis | Scoliosis Research Society [Internet]. [cited 2022 Jan 8]. Available from: https:// www.srs.org/professionals/online-education-andresources/conditions-and-treatments/infantile-scoliosis 5. Juvenile Scoliosis | Scoliosis Research Society [Internet]. [cited 2022 Jan 9]. Available from: https:// www.srs.org/professionals/online-education-andresources/conditions-and-treatments/juvenile-scoliosis 6. Adolescent Idiopathic Scoliosis | Scoliosis Research Society [Internet]. [cited 2022 Jan 8]. Available from: https://www.srs.org/professionals/online-educationand-resources/conditions-and-treatments/adolescentidiopathic-scoliosis 7. Tsutsui S, Yoshimura N, Watanuki A, Yamada H, Nagata K, Ishimoto Y, et al. Risk Factors and Natural History of De Novo Degenerative Lumbar Scoliosis in a Community-Based Cohort: The Miyama Study. Spine Deform. 2013 Jul;1(4):287–92. 8. McAviney J, Roberts C, Sullivan B, Alevras AJ, Graham PL, Brown BT. The prevalence of adult de novo scoliosis: A systematic review and meta-analysis. Eur Spine J. 2020 Dec;29(12):2960–9. 9. Choudhry MN, Ahmad Z, Verma R. Adolescent Idiopathic Scoliosis. Open Orthop J. 2016 May 30;10:143–54. 10. Minnella S, Donzelli S, Zaina F, Negrini S. Risser stages, menarche and their correlations with other growth parameters in a cohort of 3,553 Italian adolescent idiopathic scoliosis patients. Scoliosis. 2013 Jun;8(S1). 11. Negrini S, Donzelli S, Lusini M, Minnella S, Zaina F. Two year post-menarche rule for bracing: myth or reality? Scoliosis. 2013 Sep;8(S2). 12. Ryan PM, Puttler EG, Stotler WM, Ferguson RL. Role of the triradiate cartilage in predicting curve progression in adolescent idiopathic scoliosis. J Pediatr Orthop. 2007 Sep;27(6):671–6. 13. Dimeglio A, Canavese F. Progression or not progression? How to deal with adolescent idiopathic scoliosis during puberty. J Child Orthop. 2013 Feb;7(1):43–9. 14. Ponseti IV. Growth and development of the acetabulum in the normal child. Anatomical, histological, and roentgenographic studies. J Bone Joint Surg Am. 1978 Jul;60(5):575–85. 15. Garg B, Mehta N, Bansal T, Malhotra R. EOS® imaging: Concept and current applications in spinal disorders. J Clin Orthop Trauma. 2020 Oct;11(5):786–93. 16. Shaw M, Adam CJ, Izatt MT, Licina P, Askin GN. Use of the iPhone for Cobb angle measurement in scoliosis. Eur Spine J. 2012 Jun;21(6):1062–8.
21. Renshaw TS. Idiopathic scoliosis in children. Curr Opin Pediatr. 1993 Aug;5(4):407–12. 22. Ma H-H, Tai C-L, Chen L-H, Niu C-C, Chen W-J, Lai P-L. Application of two-parameter scoliometer values for predicting scoliotic Cobb angle. Biomed Eng Online. 2017 Dec 4;16(1):136. 23. Korovessis PG, Stamatakis MV. Prediction of scoliotic cobb angle with the use of the scoliometer. Spine. 1996 Jul 15;21(14):1661–6. 24. Horne JP, Flannery R, Usman S. Adolescent idiopathic scoliosis: diagnosis and management. Am Fam Physician. 2014 Feb 1;89(3):193–8. 25. Samuelsson L, Norén L. Trunk rotation in scoliosis. The influence of curve type and direction in 150 children. Acta Orthop Scand. 1997 Jun;68(3):273–6. 26. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6399566/ 27. Modi HN, Modi CH, Suh SW, Yang J-H, Hong J-Y. Correlation and comparison of Risser sign versus bone age determination (TW3) between children with and without scoliosis in Korean population. J Orthop Surg Res. 2009 Sep 20;4:36. 28. Lonstein JE, Carlson JM. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am. 1984 Sep;66(7):1061–71. 29. SOSORT guideline committee, Weiss H-R, Negrini S, Rigo M, Kotwicki T, Hawes MC, et al. Indications for conservative management of scoliosis (guidelines). Scoliosis. 2006 May 8;1:5. 30. Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. 31. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013 Oct 17;369(16):1512–21. 32. Kuroki H. Brace treatment for adolescent idiopathic scoliosis. J Clin Med. 2018 Jun 4;7(6).
scoliosis: how many patients require treatment to prevent one deterioration? - results from a randomized controlled trial - “SOSORT 2017 Award Winner”. Scoliosis Spinal Disord. 2017 Nov 14;12:26. 36. Romano M, Negrini A, Parzini S, Tavernaro M, Zaina F, Donzelli S, et al. SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis. 2015 Feb 5;10:3. 37. Berdishevsky H, Lebel VA, Bettany-Saltikov J, Rigo M, Lebel A, Hennes A, et al. Physiotherapy scoliosisspecific exercises - a comprehensive review of seven major schools. Scoliosis Spinal Disord. 2016 Aug 4;11:20. 38. Maruyama T, Takeshita K. Surgical treatment of scoliosis: a review of techniques currently applied. Scoliosis. 2008 Apr 18;3:6. 39. Akazawa T, Kotani T, Sakuma T, Nakayama K, Iijima Y, Torii Y, et al. Pulmonary Function Improves in Patients with Adolescent Idiopathic Scoliosis who Undergo Posterior Spinal Fusion Regardless of Thoracoplasty: A Mid-Term Follow-Up. Spine Surg Relat Res. 2021;5(1):22–7. 40. Fletcher ND, Bruce RW. Early onset scoliosis: current concepts and controversies. Curr Rev Musculoskelet Med. 2012 Jun;5(2):102–10. 41. Fougère AT. Minimally invasive surgery for adolescent idiopathic scoliosis: anterior and posterior techniques. JHNSS. 2018 Jul 18;3(2). 42. Fischer CR, Kim Y. Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy. Eur Spine J. 2011 Jul;20(7):1048–57. 43. Cheung ZB, Selverian S, Cho BH, Ball CJ, KangWook Cho S. Idiopathic scoliosis in children and adolescents: emerging techniques in surgical treatment. World Neurosurg. 2019 Oct;130:e737–42. 44. Treating Scoliosis | Scoliosis Research Society [Internet]. [cited 2022 Jan 10]. Available from: https:// www.srs.org/patients-and-families/conditions-andtreatments/adolescents/treating-scoliosis 45. Hoernschemeyer DG, Boeyer ME, Robertson ME, Loftis CM, Worley JR, Tweedy NM, et al. Anterior Vertebral Body Tethering for Adolescent Scoliosis with Growth Remaining: A Retrospective Review of 2 to 5-Year Postoperative Results. J Bone Joint Surg Am. 2020 Jul 1;102(13):1169–76. 46. Campos M, Dolan L, Weinstein S. Unanticipated revision surgery in adolescent idiopathic scoliosis. Spine. 2012 May 20;37(12):1048–53. 47. Luhmann SJ, Lenke LG, Bridwell KH, Schootman M. Revision surgery after primary spine fusion for idiopathic scoliosis. Spine. 2009 Sep 15;34(20):2191–7. 48. Janicki JA, Alman B. Scoliosis: Review of diagnosis and treatment. Paediatr Child Health. 2007 Nov;12(9):771–6.
33. Kaelin AJ. Adolescent idiopathic scoliosis: indications for bracing and conservative treatments. Ann Transl Med. 2020 Jan;8(2):28.
49. Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003 Feb 5;289(5):559–67.
34. Kuru T, Yeldan İ, Dereli EE, Özdinçler AR, Dikici F, Çolak İ. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil. 2016 Feb;30(2):181–90.
50. Huang Q, Zhang L, Li Z, Kong L. Manual therapy for idiopathic scoliosis: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020 Aug 21;99(34):e21782.
35. Schreiber S, Parent EC, Hill DL, Hedden DM, Moreau MJ, Southon SC. Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic
51. Romano M, Negrini S. Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review. Scoliosis. 2008 Jan 22;3:2.
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30
RESEARCH
The value of health research and research funding for osteopathy It’s time to get curious about research. Here, we look at Osteopathy Australia’s body of evidence and the importance of CPD, grants programs and pain education in the efforts to pave the way for better patient outcomes. Research at Osteopathy Australia goes beyond clinic walls, shaping policies, educating the public about osteopathy, and influencing the future of education. In recent years, we’ve pushed for osteopaths’ involvement in research through initiatives like an annual grants program, promoting outcome measures, and webinars guiding clinicians in CPD-worthy webinar series, “Life as a Clinician Scientist” (part 1 and 2). In this Osteo Life issue, we spotlight our own body of evidence. We ask you in 2024 to get curious about research. Osteopathy Australia Grant Recipient Project: Pain knowledge, attitudes, and beliefs of Australian osteopaths before and after completing a tailored pain education e-module. Chief Investigator: Dr Kylie Fitzgerald Institution: University of Melbourne Grant type: Seeding Grant Grant Round: 2020-21 NEXT STEPS: THE JOURNEY TO ENHANCING PAIN EDUCATION FOR OSTEOPATHS Kylie Fitzgerald (Osteopath, Senior Lecturer in Medical Education, The University of Melbourne), Brett Vaughan (Osteopath, Lecturer in Clinical Education, The University of Melbourne), Michael Fleischmann (Osteopath, Lecturer in Osteopathy, RMIT University), Azharuddin Fazalbhoy (Osteopath, Senior Lecturer in Osteopathy, RMIT University). Data from Australian osteopathic practice highlights that low back, neck and thoracic spine pain are the most prevalent complaints we see in practice. Therefore, comprehensive knowledge and
skills in pain assessment and management approaches for acute, recurrent and persistent disabling pain conditions are required. However, many of us did not receive specific pain education during our pre-professional training, necessitating further education and upskilling through continuing professional development (CPD). Osteopathy Australia has recognised the importance of CPD as both a requirement for ongoing registration and to support members in upskilling in key areas of practice that are rapidly evolving, including pain assessment and management. Together with Osteopathy Australia membership expert groups, developing and disseminating professionspecific pain education to members was prioritised. The aim was to improve outcomes for our patients with acute, recurrent and persistent disabling pain conditions. Osteopathy Australia invited an expert allied health pain consultant to
develop the Osteopathy Australia Pain Management e-module. The e-module was designed to enhance our capabilities and capacity to assess and manage patients presenting with pain. The project was awarded a research grant in 2021 to evaluate the outcomes of the Osteopathy Australia Pain Management e-module. We utilised validated questionnaires to investigate shifts in learners’ pain knowledge, attitudes and beliefs towards persistent pain from undertaking the e-module. The outcomes of this evaluation would inform a review of the module’s value and forge future actions for pain education in osteopathy. This project was made possible through a collaborative effort between Osteopathy Australia and RMIT University, and we thank both organisations for their contributions and facilitation of the project. To encourage members to undertake the e-module, Osteopathy Australia
RESEARCH
offered the e-module at a substantial discount (>80%) for several months. The marketing team developed a series of communications inviting osteopaths to complete the e-module and participate in the project between 1 September 2021 and 28 February 2022. Throughout the six-month evaluation period, enrolments in the Osteopathy Australia Pain Management e-learning module were low. Even with the incentives through substantial discounts, only 57 members (accounting for <0.2% of Osteopathy Australia members) enrolled in the module. Of these enrollees, 38 successfully completed the e-module, representing a completion rate of 66%. Of these, 44 members accessed the survey, with 27 providing consent to participate and 17 choosing not to participate. Among the consenting respondents, nine members completed the pre- and post-module questionnaires, resulting in a response rate of 15.7%. We analysed the responses of these nine members who completed pre- and post-questionnaires. The first measure we used was the Neurophysiology of Pain Questionnaire (NPQ). NPQ was devised to assess how individuals conceptualise the biological mechanisms underpinning their pain. We found there was no significant difference in the total NPQ score. While this suggests there was no measurable improvement in the participants’ understanding of pain neurophysiology after completing the e-module, it’s important to emphasise the sample size is too small to enable meaningful interpretation. The second measure that evaluates shifts in attitudes and beliefs towards persistent pain (PABS-PT) also did not exhibit a significant improvement pre- and post-module completion. We found some promising findings when we separated this measure into two components – one sampling biomedical beliefs and attitudes and the other sampling biopsychosocial beliefs and attitudes. There was a decrease in the scores of the Biomedical subscale, indicating a reduction in the belief that biomedical factors alone are the cause of chronic pain. There was no improvement in the understanding that biopsychosocial factors play a substantial role in chronic pain. Again, the low
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“Osteopathy Australia has recognised the importance of CPD as both a requirement for ongoing registration and to support members in upskilling in key areas of practice that are rapidly evolving, including pain assessment and management” sample size limits the interpretation of these findings. The reliability of the questionnaire analysis is also affected by the sample size limitation. The engagement of our profession with the e-module and this project raise some interesting questions for Osteopathy Australia members to consider – maybe the delivery method (online and self-directed) could be reconsidered to align with members’ preferences. E-modules are more convenient and generally less expensive than live workshops. Still, perhaps members would be more likely to engage with the chance to come together with the osteopathy community for learning opportunities? We can also consider that the Australian osteopathy population is highest in Victoria, with most residing within metropolitan Melbourne during the COVID-19 lockdowns and restrictions. This project commenced within the sixth lockdown in Melbourne, and potentially, the impacts of repeated lockdowns
and restrictions on people’s health and wellbeing, coupled with telehealth/ Zoom fatigue, may offer an additional consideration for low engagement with e-learning during this time. It is also worth considering if osteopaths currently working in practice in Australia believe they already have the knowledge and skills to appropriately assess and manage acute, recurrent and persistent disabling pain presentations? Considering these findings, one of our recommendations to Osteopathy Australia could be to develop a survey for members to gauge their interest in learning about chronic pain and, if so, how. If there is an expressed interest, it is crucial to determine the preferred mode of CPD for members, whether blended learning, face-to-face workshops, participation in Osteopathy Australia conferences, or other alternatives. Osteopathy Australia is paving the way for better patient outcomes through its continued efforts to support its members through professional development.
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HR
Bullying in the workplace
Managing and preventing bullying in the workplace is critical to the overall health and wellbeing of a team. In the unfortunate event where bullying does occur, business owners and employers have a range of legal and employment obligations to take into consideration to not only ensure a procedurally fair and respectful process is provided to staff, but to also ensure the physical and psychological safety of all employees.
In this article the Osteopathy HR Advisory Service will outline both an employer’s and employee’s obligations in accordance with the Fair Work Act 2019 and relevant work (occupational health and safety (WHS) legislation. The article will also discuss best practice principles that should be considered when managing workplace bullying. Please note that this article references employee (as well as contractors, apprentices, volunteers and any other individuals on the premises)
WHAT IS BULLYING?
A common misconception of bullying is that it encompasses one-off incidents or issues. While these one-off incidents are still to be taken seriously and addressed accordingly, it is important to note that bullying is defined as repeated and unreasonable behaviour which poses a threat to the health and safety of employees. Some examples of this type of behaviour, whether intentional or unintentional, include but are not limited to: Verbally abusing another individual in the workplace; Behaving in an aggressive or intimidating manner towards others; Humiliating individuals in front of others; Social isolation; Deliberately withholding information from other individuals; Spreading rumours about others; Unreasonable management action and unreasonable performance standards.
WHAT IS NOT CONSIDERED TO BE WORKPLACE BULLYING? Reasonable management action is often misunderstood as a form of bullying, but it’s important to clarify that employers (and any manager or supervisor) have the authority to take management
“Bullying is defined as repeated and unreasonable behaviour which poses a threat to the health and safety of employees” action to direct and oversee how work is conducted. Managers and supervisors are also within their rights to assign tasks and provide feedback on employee performance, as long as these actions are carried out lawfully and in a reasonable manner, and also taking the particular circumstances into account. Examples of reasonable management action include but are not limited to: Setting reasonable performance goals, standards and deadlines; Rostering and allocating working hours where the requirements are reasonable; Transferring a worker for operational reasons; Deciding not to select a worker for promotion where a reasonable process is followed; Informing a worker about inappropriate behaviour in an objective and confidential way; Taking disciplinary action, including suspension or terminating employment.
WHAT ARE THE WORK, HEALTH AND SAFETY CONSIDERATIONS?
Everyone within the workplace has a work, health and safety (WHS) duty to facilitate a safe workplace and ensure that workplace bullying does not occur. It is important to keep it mind that WHS obligations don’t just fall under the onus of the employer, but the employee or contractor as well. Employers carry the primary duty of care as mandated by the Model WHS Acts, and in Victoria, the Occupational Health and Safety Act 2004 contains similar
provisions. Their primary responsibility is to ensure, to the extent reasonably practical, the protection of all stakeholders from health and safety risks associated with the work. This duty includes maintaining a work environment free from health and safety hazards, establishing and upholding safe work systems and ongoing monitoring of the health and safety of workers. Training should also be provided to workers as to how to promote and maintain safety in the workplace. On the other hand, employees also share the responsibility of taking reasonable care for their own health and safety while at work, and the health and safety of others. Participating in bullying conduct or failing to take action to prevent or eliminate it, is a breach of these WHS obligations. Overall, WHS is a collaborative effort which requires active participation from both parties to establish a safe work environment and mitigate instances of bullying.
WHAT TO DO IF AN EMPLOYEE IS BEING BULLIED WITHIN THE WORKPLACE? Where an employee is bullied at work, it is important for them to know that they are not alone, and there are support networks such as colleagues, professionals and family or friends. If the situation is safe enough, an employee can consider respectfully confronting the bully and attempting to resolve the issue between themselves. Employers should take proactive steps by engaging with the affected
HR
employee to gather more information. If circumstances allow, employers can consider mediating the situation. However, depending on the seriousness of the matter, it might be advisable to encourage the employee to file a formal complaint. Employers should remain mindful that some employees may be reluctant to file a formal bullying complaint, often out of fear that doing so could make the situation worse. It’s essential for employers to reassure the employee that the paramount concern is ensuring their ongoing health and wellbeing, and assure them that any investigation will be conducted impartially and confidentially. When a formal complaint is made, it’s important that there is: A well-documented record of events from the onset of the issue, including specific dates, locations and any available witnesses; Familiarity from all parties with the procedures detailed in the organisation’s anti-bullying or harassment policy.
WHAT HAPPENS AFTER A FORMAL COMPLAINT IS MADE?
Employers need to conduct a workplace investigation given the seriousness of the allegation and situation. The person in charge of the investigation should be an impartial third party. This may be the employer or another senior employee – or, if the complaint is made against the employer, an external investigator may be needed to ensure the investigation is conducted appropriately. The investigation should involve meeting with all relevant parties needed to assess the complaint, including witnesses and where necessary, allow them the chance to respond to any accusations made against them. Throughout, it’s crucial to exercise discretion when sharing information to avoid the spread of rumours and misinformation, as this could potentially compromise the integrity of the investigation and cause harm to any parties in the investigation. Once the investigation has finalised, the investigator will need to determine, on the balance of probabilities, whether or not bullying did occur. This can be
in a report that summarises the content and results of the investigation and recommends strategies to address the situation, as any actions that may need to be taken to appropriately discipline the accused if bullying has been established. Depending on the severity, this could even involve the termination of their employment. If the bullying is not as serious, a formal warning is possible. Other steps can include external training, or a review of company policies and processes that may heighten the risk of bullying behaviour in the workplace. Finally, a letter should be sent to both the complainant and the accused with the result of the investigation, what actions will be undertaken and an explanation for the reasons behind any decisions that were made to rectify the situation, before anything is implemented.
WHAT IF BULLYING STILL CONTINUES OR IS NOT PROPERLY MANAGED?
In cases where bullying persists following the investigation process or when the initial management of bullying proves inadequate, employees should be aware that there are further avenues for recourse. As a final resort, they can consider applying for a Stop Bullying Order through the Fair Work Commission (FWC). Upon the submission of an application, the FWC will conduct an independent investigation to establish whether
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bullying behaviour is occurring in the workplace. If bullying is confirmed, the FWC may issue any necessary orders aimed at stopping it.
IN SUMMARY
It is vital for both employers and employees to understand the seriousness of workplace bullying and recognise their shared responsibility in establishing a safe working environment. Where bullying arises, employers should take care in their approach to ensure it is managed properly. This may of course warrant for a workplace investigation to be conducted. These proactive measures will not only ensure regulatory compliance but will also help prevent potential complications in the future. If you have any questions about this article, 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. Disclaimer
The material contained in this publication is general comment and is not intended as advice on any particular matter. No reader should act or fail to act on the basis of any material contained herein. The material contained in this publication should not be relied on as a substitute for legal or professional advice on any particular matter. Wentworth Advantage Pty Ltd, expressly disclaim all and any liability to any persons whatsoever in respect of anything done or omitted to be done by any such person in reliance whether in whole or in part upon any of the contents of this publication. Without limiting the generality of this disclaimer, no author or editor shall have any responsibility for any other author or editor. For further information please contact Wentworth Advantage Pty Ltd. © Wentworth Advantage Pty Ltd 2023
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CPD CALENDAR
CPD calendar
Key dates for your diary throughout the coming months. UPCOMING WEBINARS 7 FEBRUARY 2024 – 7:30PM AEDT
Endo for Osteos: Our role in whole person treatment This webinar will help osteopaths understand the important role they can play in helping people manage endometriosis. You will learn what endometriosis is, when to suspect endo and where osteopathy can help within your patient’s endo team. Presenter: Sarah Dryburgh Register: https://us02web.zoom.us/ webinar/register/WN_YeE9ad7oSZMeJFTO6689w
6 MARCH 2024 – 7:30PM AEDT
The Marketing Eco-System So many business owners have a scattered approach to marketing, which means that they are not getting a great return from their efforts. The Marketing Eco-System™ is the one framework every business must have to make sure all their marketing strategies are working hand-in-hand. Presenter: Basic Bananas Register: https://us02web.zoom. us/webinar/register/WN_Jvm_ nPA5TVGmZcFiqNnTgg
E-LEARNING
AVAILABLE NOW
Common clinical presentations for 6–7-year-olds Register: CPD Hub
AVAILABLE NOW
8–9 years of age physical and cognitive development Register: CPD Hub AVAILABLE FROM LATE FEBRUARY
Introduction to the National Disability Insurance Scheme (NDIS Module 1 of 3) Register: CPD Hub AVAILABLE FROM MID-MARCH
Working with people with disability (NDIS Module 2 of 3) Register: CPD Hub AVAILABLE FROM LATE MARCH
Understanding osteopathic NDIS practice (NDIS Module 3 of 3) Register: CPD Hub
ADVERTORIAL
Is free software really free? When it comes to software, there are many seemingly free products out there – a quick browse on your phone’s app store shows how prolific they are! But be cautious. While the companies producing this kind of software aren’t charging you, they’re nonetheless making money from you using their product. How is that possible when you’re not paying? Sometimes the base product won’t cost you anything, but most additional functionality is pay-as-you-go – this could mean that using the software might incur higher costs than you’d initially anticipated. Far more concerning, however, is the software that makes its money from advertising to you or even monetising your data. It can be hard to know when this is happening and it might not be obvious from the terms and conditions when you sign up. It’s also worth keeping in mind that privacy policies and terms of service can change, so it’s a good idea to periodically check to make sure you’re up to date with the latest information. This is the business model behind many free products. For example, Google states
that they don’t allow advertisers to access data from your free-to-use calendar or your Gmail. However, they also acknowledge that their targeted ads are based on your online activity while you’re logged into your Google account. Always remember the infamous internet saying: if you’re not paying for it, you’re not the customer; you’re the product being sold!
Make an informed choice We’re not suggesting you never use free software – there are times when it might be the right choice for you. But we think you should find out how the companies behind the software are making their money, and make sure you’re okay with their methods. As a custodian of healthcare information, you should make an informed choice when selecting software for your business. Data security is always important, and never more so than when you work in healthcare. You’re trusted with storing and securing sensitive patient records, so you’ll want to know that any software you use in your osteopathy practice will protect this. Make sure you understand exactly what
happens to the information you put into any software you use, and be certain that you own it and can get it back when needed. Lastly, it’s worth checking your legal obligations around data storage and making sure that all software you use is compliant with any regulations in your local area.
Why Cliniko isn’t free Cliniko isn’t free, but we think that our software is worth paying for and we aim to add more value to your osteopathy practice than what we cost. Charging a fee allows us to be self-funded, which means that we have control over the direction of Cliniko and we’re not compelled to compromise our values to please investors.
Free trial for Members With Cliniko, you can be certain that your data is safe and protected and that we’ll always act with integrity. If you’d like to try it out, sign up for a 90-day trial by visiting cliniko.com/oa-member!
Not all security is equal. Power Diary’s Practice Management Software is ISO 27001 Certified
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Choose Power Diary, the Most L ved and Most Secure Practice Management Software Why does ISO 27001 Certification matter for your practice? • Externally audited systems and processes that adhere to the highest global security standards • Continually evolving intelligence to stay ahead of potential threats • Sleep soundly knowing that your clients’ data is protected
Security that’s Audited. Verified. Certified.
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