Browsing by Subject "Rehabilitation and Therapy"
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Item A Study to Determine Improved Compliance of Biophosphonate Treatment in Subjects with Osteoporosis(2005-02-01) Enard, April T.; Gwirtz, Patricia A.; Jimenez-Williams, Cynthia; Rubin, BernardEnard, April T. A Study to Determine Improved Compliance of Bisphosphonate Treatment in Subjects with Osteoporosis. Master of Science, February 11, 2005. The ability of patients to adhere to treatment regimens is very poor and continues to impede optimal therapy of osteoporosis. The shortcomings in treating osteoporosis are: a) noncompliance and/or lack of continued persistence of therapy, b) efficacy of therapy on bone turnover marker levels and fracture prevalence, and c) tolerability of therapy to patients. Studies have shown that interventions such as education and awareness of bone mineral density promote patient usage compliance. The slightest improvement in compliance allows further understanding of accurate efficacy of medication therapy to fractures, bone marker levels, and overall improvement of bone mass. Increased compliance/persistence allows accurate comparison of bisphosphonates to one another for effectiveness on osteoporosis patients and allows improvement opportunity in treatment modalities that can positively influence the course of osteoporosis. This phase IV study targets compliancy/persistence in bisphosphonate therapy in treatment of osteoporosis.Item An Analysis of Patient Health Outcomes in a Cardiac Rehabilitation Program(2000-12-01) Hall, Cortni K.; Antonio Rene; Raghbir Sandhu; Manuel BayonaHall, Cortni K., An Analysis of Patient Health Outcomes in a Cardiac Rehabilitation Program. Master of Public Health, Epidemiology Track, December 2000, 48 pp., 11 tables, references, 30 titles. This study analyzed the coronary risk factor and quality of life outcome results of 55 patients who participated in a 12 week, phase II cardiac rehabilitation program. Baseline and post cardiac rehabilitation data were analyzed. There was an overall improvement of the coronary risk factor variables with significant improvements in functional capacity (p=0.001), diastolic blood pressure (p=0.01), total cholesterol (p=0.017), and LDL 9p=0.01). Significant improvements in the quality of life variables included physical function (p [less than] 0.01), role-physical (p [less than] 0.01), body pain (p [less than] 0.05), vitality (p [less than] 0.05), and social (p [less than] 0.05). There was also a significant finding of improved knowledge (p [less than] 0.01) after completion of phase II cardiac rehabilitation program.Item Androgens and Cardiovascular Disease(1998-05-01) Dickerman, Rob D.; Walter J. McConathy; Thomas Yorio; Robert GracyDickerman, Rob D., Androgens and Cardiovascular Disease Doctor of Philosophy (Biomedical Sciences), May 1998; 111 pp; 10 tables, bibliography, 197 titles. Anabolic steroids are commonly used by many muscle and strength dependent athletes due to their ability to enhance the hypertrophic effects of resistance training. The use of anabolic steroids by bodybuilders appears to carry significant health risks, most commonly reported are sudden death, myocardial infarction and cardiomyopathy. To investigate the effects of anabolic steroids on cardiovascular risks, a study was designed to analyze the effects of androgens on lipoprotein levels and structure/function of the heart. For the study on lipid-related risk, twelve competitive bodybuilders were recruited for a comprehensive analysis of serum apolipoprotein A-I, B, total cholesterol, HDL-cholesterol, LDL-cholesterol, and testosterone. Serum total cholesterol, HDL- and LDL-cholesterol, apolipoproteins A-I and Be were significantly lower in androgen-users. Consistent with previous reports, androgens were associated with decreases in HDL-cholesterol and apolipoprotein A-I. However, androgens were also associated with reduced serum total cholesterol, LDL-cholesterol and apolipoprotein B. Despite the significantly higher total cholesterol/HDL-cholesterol ratio, the low levels of serum total cholesterol levels (percentile) in the androgen-users raises questions as to whether there is increased risk for cardiovascular disease and the exact role of androgens in cardiovascular risk. To investigate the effects of anabolic steroids in pathologic concentric left ventricular hypertrophy, the effects of androgens on left ventricular size and function were analyzed. Previous investigations conducted on left ventricular size and function have yielded inconclusive results. Problems existing in each of the previous investigations were small body mass, short length of myocardial exposure time to resistance training (years of training), significantly different body mass between steroid-users and steroid-free subjects and monitoring/reporting of steroid use. These problems may have contributed to the discrepancies between studies. Therefore, we selectively recruited eight competitive heavy weight drug-free bodybuilders and eight matched competitive weight bodybuilders on self-directed regimens of anabolic steroids for examination of left ventricular size and function via echocardiography. Increases in left ventricular posterior wall (LVPW) and ventricular septal thickness (VST) were apparent in the steroid-user group (p [less than] 0.05). Ratio of echocardiographic findings to body mass index (BMI) revealed a significantly smaller left ventricular and diastolic dimension (LVDEd/BMI, p [less than] 0.05) in the steroid-user. The smaller LVDEd in steroid-users is coupled with a significantly disproportionate septal and posterior wall thickness in steroid-users. There was no direct evidence of diastolic dysfunction. Thus it appears from these studies that androgens alter lipoproteins leading to a questionable increased risk for cardiovascular disease and may potentiate concentric left ventricular hypertrophy without affecting cardiac function.Item Carotid Baroreflex of Leg Vasculature(2004-07-01) Keller, David Melvin; Peter A. Raven; H. Fred Downey; Patricia A. GwirtzKeller, David Melvin, Carotid Baroreflex Control of Leg Vasculature. Doctor of Philosophy (Biomedical Science), July 2004; 110 pp; 5 tables; 10 figures; bibliography. The carotid baroreflex (CBR) exerts control of arterial blood pressure primarily as a result of changes in total vascular conductance. In humans, understanding CBR control of the vasculature supplying a given vascular bed, such as the leg, remains unclear. Furthermore, it appears that metabolic attenuation of sympathetic vasoconstriction may modulate the CBR of the vasculature supplying contracting skeletal muscle during exercise. However, the balance between baroreflex-mediated vasoconstriction and the mechanisms responsible for the metabolic attenuation has not been fully elucidated. Therefore, the purpose of the investigations within this dissertation was to: i) explain CBR control of leg vascular conductance (LVC) and the relationship between changes in LVC and muscle sympathetic nerve activity at rest and during one-legged knee extension exercise, ii) examine the CBR control of the vasculature supplying an exercising leg and a non-exercising leg during exercise, and iii) demonstrate the role of the ATP-sensitive potassium channel in contributing to the metabolic attenuation of CBR-mediated vasoconstriction in the vasculature supplying contracting skeletal muscle. In the first investigation, we demonstrated: i) the stimulus response relationships for CBR control of LVC and MSNA at rest and during two intensities of one-legged knee extension exercise; ii) that CBR control of LVC was preserved during exercise; iii) that the attenuation of CBR-mediated vasoconstriction was no different between 7W and 25W exercise in the vasculature supplying an exercising leg; and iv) that the contribution of changes in LVC to CBR changes in mean arterial pressure was no different from rest to exercise in both the exercising leg and the non-exercising leg. In the second investigation, we examined the role of the ATP-sensitive potassium channel in modulating sympathetically-mediated vasoconstriction at rest and during exercise in the vasculature supplying an exercising leg and a non-exercising leg. The attenuated vasoconstrictor response to the carotid baroreceptor stimulated hypotension observed in the vasculature supplying an exercising leg was partially restored two to four hours after the oral ingestion of glyburide (5mg). This finding indicates that ATP-sensitive potassium channel activation plays a primary role in the effects of functional sympatholysis during leg exercise in humans. We further demonstrated that CBR control of MAP was not altered by oral glyburide administration in healthy subjects.Item Characterization of Health Status and Modifiable Risk Behavior of United States Adults Using Chiropractic Care as Compared to General Medical Care(2007-08-01) Ndetan, Harrison Tatandam; Sejong Bae; Karan SinghNdetan, Harrison Tatandam, B.sc., M.Sc., Characterization of Health Status and Modifiable Risk Behavior of United States Adults Using Chiropractic Care as Compared to General Medical Care. Master of Public Health (Biostatistics), August 2007; 25 pp., 8 tables, 1 appendix, 49 titles. This study characterizes typical conditions of chiropractic patients and explores how chiropractic influences modifiable behavioral risk factors in the U.S. data from the Sample Adult Core component of the 2005 National Health Interview Survey (NHIS) was analyzed using SAS9.1.2. Statistical analyses included logistic regression, chi squared, and t test analyses. There were 31,428 respondents. Males comprised 43.79%. Those who saw/talked to chiropractors (DC’s), within the past 12 months were 8.73%. Among these 21.37% did not see the general medical doctor (MD). There was no significant difference in the smoking and alcohol consumption status of respondents who saw/talked to DC’s than MDs. DC patients were more likely to be physically active [OR=1.45(1.20, 1.75)] and less likely to be obese [OR=0.74(0.59-0.92)] than MD patients. Patients with acute migraine, neck, and low back pains were more likely to see DC’s but patients with arthritis and chronic conditions were more likely to see MDs.Item Combined Chemo/Anti-Angiogenic Cancer Therapy in Lewis Lung Metastases(2002-05-01) Sinha-Datta, Anjuli; Goldfarb, Ronald H.; Agarwal, Neeraj; Mathew, Porunelloor A.Datta, Anjuli. Combined Chemo/Anti-Angiogenic Cancer Therapy in Lewis Lung Metastases. Master of Science (Microbiology and Immunology), May 2002. 41 pp., 17 illustrations, bibliography. The focus of my dissertation studies is an eight amino acid peptide (Å6) derived from the non-receptor binding region of urokinase plasminogen activator (uPA), which partially inhibits the binding of uPA to its receptor (uPAR). Å6 has been synthesized as a potential novel anti-cancer agent and kindly provided by Ångstrom Pharmaceuticals, Inc. (San Diego, CA). We further examined potential therapeutic properties of Å6 in vivo and in vitro. Å6 appeared to directly inhibit the invasion of Lewis lung carcinoma cells through Matrigel by approximately 40-45% compared to control. In addition, Å6 had a morphological effect resulting in thicker tubes on small vessel endothelial tube formation compared to no treatment. Interestingly, doxorubicin had similar effects when added to growing endothelial cells. Moreover, Å6 was administered alone and in combination with a standard clinically used chemotherapeutic agent, doxorubicin, in a Lewis lung carcinoma mouse model to test possible synergy between an anti-angiogenic compound (Å6) and a chemotherapeutic agent. This is the first observation that Å6 has the potential to display a direct anti-metastatic therapeutic effect for established pulmonary metastases in this model. Therefore, we believe that Å6 in combination with doxorubicin has the potential to provide better therapy to cancer patients with tumor metastases than potent chemotherapeutics agents alone, by increasing the dose of non-toxic Å6 and reducing the recommended dose of doxorubicin.Item Development of the Attitudes Toward Osteopathic Principles and Practice Scale (ATOPPS): Preliminary Results(2002-05-01) Russo, David P.Russo, David P., Development of the Attitudes Toward Osteopathic Principles and Practice Scale (ATOPPS): Preliminary Results. Master of Public Health, May 2002, 11 pp., 2 tables, bibliography, 19 titles. Little is known about how student attitudes toward osteopathic principles and practice (OPP) develop and evolve over the course of their osteopathic medical education. Interviews were conducted with osteopathic medical students, osteopathic manipulative medicine (OMM) residents, fellows, and physician specialists. These interviews were summarized in a 39-item instrument administered to 127 students at the completion of their core OMM rotation at UNTHSC-TCOM. Factor analysis of student responses to the 39 candidate items yielded two interpretable factors. 14 of the original 39 statements were eliminated and the smaller second factor was dropped. Factor 1 contained items reflecting both positive and negative attitudes toward the application OPP in patient care, medical education, and professional distinctiveness. Two internal consistency estimates of reliability were computer for the revised 25-item ATOPPS. Estimates for the split-half coefficients for part 1 were .89, for part 2 was .87; the Spearman-Brown coefficient alpha was .93Item Does Osteopathic Manipulative Treatment Improve Dyspnea and Exercise Tolerance Subjects with Stable Chronic Obstructive Pulmonary Disease?(2006-05-01) Pickett, Carolyn M.; Stoll, Scott; Cruser, des Anges; Licciardone, John C.Pickett, Carolyn M., D.O., M.S. Does Osteopathic Manipulative Treatment Improve Dyspnea and Exercise Tolerance in Subjects with Stable Chronic Obstructive Pulmonary Disease? Master of Science (Clinical Research and Education – OMM), May 2006, 54 pages, 10 tables, 4 figures, references 48 titles. Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death globally and is projected to increase. This highly prevalent and costly disease causes reduced physical and social functioning, and none of the existing medications for COPD seem to modify long-term decline in lung function. COPD patients with the severe dyspnea have more deficits in the health status and energy. Reduced functional status has been significantly correlated with health related quality of life. Osteopathic Manipulative Treatment (OMT) has been suggested for treatment of COPD as early as 1902, some research indicates that OMT may improve dyspnea and exercise tolerance, yet there are few published studies on OMT and COPD. Study goals were to increase scientific knowledge about how OMT may immediately improve dyspnea and exercise tolerance in stable COPD following exertion. This RCT was approved by the Institutional Review Board at the University of North Texas Health Science Center (UNTHSC) in Fort Worth and funded by the Osteopathic Research Center (ORC) at UNTHSC. –Hypothesis 1: A single intervention of OMT will improve dyspnea in a stable COPD subject, as measured by response to the Borg scale with exertion, when compared to no treatment. –Hypothesis: a single intervention of OMT will improve exercise tolerance in a stable COPD subject, as measured by distance walked during the six-minute walk test, when compared to no treatment. Twenty-one subjects completed the trial, 10 in the OMT group and 11 in the no-treatment group. No significant differences were found in the Borg scale or 6MWT following OMT. This study is limited by a small sample size and single OMT intervention design; however, it does demonstrate the feasibility of this research at this institution and may lead to a larger, more definitive and funded clinical trial.Item Effects of Cervical Manipulation on Cardiac Autonomic Control(2006-05-01) Giles, Paul David; Michael Smith; Scott Stoll; Walter WitryolGiles, Paul David, Effects of Cervical Manipulation on Cardiac Autonomic Control. Master of Science (Clinical Research and Education – OMM), May 2006, pp, 1 table, 8 figures, references. Objective: Osteopathic Manipulative Medicine treatment (OMT) regimes often focus on treating the Autonomic Nervous System (ANS) in addition to biomechanics. Techniques focused on the upper cervical spine are theorized to affect the function of the vagus nerve and thereby influence the parasympathetic branch of the ANS. This study was conducted to observe the effect of upper cervical spine manipulation on cardiac autonomic control as measured by heart rate variability (HRV). Methods: Nineteen healthy, young adult subjects were randomly assigned an order in which they would undergo three different experimental protocols: OMT, Sham, and a time control. Six minutes of electrocardiographic data was collected before and after each intervention to be analyzed by power spectral analysis. Results: All baseline data for each protocol and all parameters studied were the same. The OMT protocol and all parameters studied were the same. The OMT protocol caused a change in the standard deviation of the normal-to-normal (SDNN) intervals (0.121 +/- 0.0822 sec, p=0.005) and the change in the high frequency HRV was different from the changes caused by other interventions (p=0.038). Conclusions: This preliminary data supports the hypothesis that under cervical spine manipulation affects the parasympathetic nervous system; however, more data on more subjects needs to be collected in order to clarify some points, and to reach statistical significance in certain measures.Item Effects of Osteopathic Manipulative Treatment on Symptom Severity and Functional Status in Carpal Tunnel Syndrome(2005-05-01) Meyer, Patricia M.Meyer, Patricia M, Effects of Osteopathic Manipulative Treatment on Symptom Severity and Functional Status in Carpal Tunnel Syndrome. Master of Science (Clinical Research and Education), May, 2005, 55pp., 7 tables, 54 figures, bibliography 44. Carpal tunnel syndrome (CTS) is symptoms like paresthesias and weakness caused by compression of the median nerve. It affects up to 10% of the adult population in the U.S. with medical costs exceeding $2 billion annually. The goal of this study is to evaluate the benefits of Osteopathic Manipulative Treatment (OMT) on the symptom severity and daily functioning of subjects with CTS. The OMT group was compared to a ultrasound placebo group. Outcome measures include symptom severity, functional status scores, and strength measures. Subjects receive six treatments with measures taken at three points in the study. Thirty-two subjects were used in the study analysis. The OMT group had significantly improved symptom severity and functional status scores over time. These scores were not significantly different from the changes in the ultrasound group. While outcome measures show trends toward improvement with OMT, they are not significantly different from placebo.Item Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit(1997-06-01) Brittain, Paul D.; John LicciardoneBrittain, Paul D., Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit Master of Public Health (Biomedical Sciences), June, 1997, 75 pp., 12 tables, bibliography, 16 titles. The primary purpose of this study was to determine the efficacy of osteopathic manipulative treatment (OMT) in improving clinical outcomes in patients who had undergone a surgical procedure for either a hip fracture or osteoarthritis affecting the hip or knee. OMT treatment subjects were recruited from an inpatient rehabilitation unit housed with an osteopathic hospital. OMT subjects received a standard course of OMT throughout their stay in the rehabilitation unit. Clinical outcomes were assessed principally through the administration of the Functional Independence Measure (FIM), a standard disability measure, to study subjects on admission to and discharge from the rehabilitation unit. Mean FIM score charges were compared between the OMT and a control group of similar patients. Receipt of OMT was associated with shorter length-of-stay, higher total FIM score change, and greater improvement on FIM locomotion items. These findings suggest that OMT is a beneficial therapy for this population of patients.Item Elimination of Post-Exercise Hypotension Impairs Plasma Volume Recovery(1996-12-01) Hayes, Patrick M.; Peter B. RavenHayes, Patrick M., Elimination of Post-Exercise Hypotension Impairs Plasma Volume Recovery. Master of Science (Biomedical Sciences), December, 1996, 18 pp., 2 tables, 5 figures, bibliography, 20 titles. The aim of this study was to test the hypothesis that plasma volume (PV) recovery following exercise was facilitated by post-exercise hypotension. Seven volunteers performed 2 bouts of cycling exercise for 60 minutes followed by 90 minutes of seated recovery without intervention (trial 1) or with phenylephrine infusion (PE) started at 10 minutes of recovery (trial 2). Blood samples were taken throughout the protocol at specific times, and were analyzed to measure hematocrit (Hct), hemoglobin (Hb), protein content and electrolyte levels. Plasma volume was measured using the Evans Blue Dye dilution technique and estimates of changes from resting values were then calculated from Hct and Hb values. While PV approached baseline levels at 30 minutes into recovery in trial 1, the change in PV remained significantly below control values with PE. We concluded that the diminished gain in the change in total proteins (significant increase without PE, no difference from control with PE) contributed to the impaired recovery of PV observed in trial 2, and that this difference in protein shift is attributable to the elimination of post-exercise hypotension.Item Endurox R4® & Gatorade®: Effects of Recovery Drinks After Prolonged Glycogen-Depleting Exercise(1999-06-01) Williams, Michael Brandon; Raven, Peter B.; Smith, Michael; Shi, XiangrongWilliams, Michael B., Endurox R4® & Gatorade®: Effects of Recovery Drinks After Prolonged Glycogen-Depletion Exercise. Master of Science (Biomedical Sciences, Integrative Physiology), June, 1999, 73 pp., 2 tables, 18 figures, references. Purpose: Eight high-fit (bicycle Vo2max=62.4 ± 1.10 ml·kg-1·min-1) male cyclists, aged 28.4±1.65 yrs, performed a two-hour endurance bicycle exercise to achieve depletion of skeletal muscle and liver glycogen. During recovery, Endurox R4 Recovery Drink®, or Gatorade®, was ingested to investigate their relative restorative capacities to enable further exercise. Methods: Each subject performed two days of testing: one for each drink presented in random order. On each testing day, the twelve-hour fasted subject performed a two-hour cycling exercise bout at 75% VO2max followed by one to three five-minute sprints at 85% VO2max. At the end of the exercise blood glucose concentrations were 3.98±0.138 mmol/L. A four hour recovery period ensued in which the subject was given 24-ounces of the recovery drink. A performance test at 85% VO2max to exhaustion was then conducted. Ventilatory responses were collected breath-to-breath, while venous blood samples were measured for oxidation products, glucose and insulin concentrations. Results: The recovery phase showed significant increases in both plasma glucose and serum insulin following Endurox R4 Recovery Drink® ingestion as compared to Gatorade®. There was a significant increase in time to exhaustion (+55%) following Endurox R4 Recovery Drink® during the performance ride compared to Gatorade®. Final oxidation products following Endurox R4 Recovery Drink® ingestion were significantly decreased as compared to Gatorade® ingestion, in that Thiobarbituric Acid Reactive Substrates (T-BARS) were significantly decreased. Conclusions: These data indicate that the Endurox R4 Recovery Drink®, when compared to Gatorade®, significantly enhanced recovery from glycogen-depleting exercise. In addition, Endurox R4 Recovery® Drink decreased the formation of final oxidation products, when compared to Gatorade®.Item Examining the Theoretical Constructs of Motivational Interviewing: Applying Self-Determination Theory to Physical Activity Among Heart Failure Patients(2008-05-01) Spranger, Catherine Borski; Shawn Jeffries; Sejong Bae; Claudia CogginSpranger, Catherine Borski, Examining the Theoretical Constructs of Motivational Interviewing: Applying Self-Determination Theory to Physical Activity Among Heart Failure Patients. Doctor of Public Health (Social and Behavioral Sciences), May, 2008, 90 pp., 8 tables, reference list, 61 titles. Effective management of heart failure (HF) is one of the major challenges facing health care providers today due to the complexity of a number of inter-related health and self-care behaviors. One health behavior that is important in the management of HF is physical activity. Motivational Interviewing (MI) has been shown to be an effective counseling style engaging individuals to both adopt and maintain physical activity; however, the literature is lacking in this area among HF patients. One underlying theoretical basis of MI that has been proposed is Self-Determination Theory (SDT). The purpose of this pilot study was to explore the relationships between physical activity and the SDT constructs of autonomous motivation, perceived competence, and autonomy support. The sample consisted of 26 HF patients in a heart failure clinic in north central Texas. Participants completed an interviewer-administered questionnaire examining various psychological constructs, as well as, assessing their levels of physical activity during a typical week during the preceding month. The finding of this study lend some support to better understanding the relationships between specific SDT constructs and physical activity. Likewise the findings demonstrated the importance of motivation-related variables to understanding how to motivate HF patients to both initiate physical activity and maintain a regular physical activity regimen.Item Immediate Effects of Osteopathic Manipulative Treatments on Immune Function in a Healthy Population: A Pilot Study(2006-05-01) John, Janice Thomas; Scott Stoll; Jerry Simecka; Barbara AtkinsonJanice Thomas, D.O., M.S. Immediate Effects of Osteopathic Manipulative Treatments on Immune Function in a Healthy Population: A Pilot Study. Master of Science (Clinical Research and Education – OMM), May 2006, 75 pp, 3 tables, 5 figures, 66 references, 24 titles. Objectives: The purpose of this pilot study was to investigate the immediate effects of Osteopathic Manipulative Treatment (OMT) on immune function in a healthy population. Methods: This was a randomized, blinded and controlled clinical trial. 50 healthy individuals, ages 18 to 40, were recruited. Subjects were randomly assigned to one of two groups: OMT or Rest (control). Blood and saliva samples were collected pre and post-intervention (thirty minutes of OMT or Rest). Samples were analyzed for a CBC, salivary IgA, and various lymphocyte populations. Results: This study successfully demonstrated the feasibility of this protocol. No statistically significant differences in outcome measures were identified between the two groups, nor were any apparent trends identified. Conclusion: This study established a framework for future research investigating the effects OMT on acute and chronic infection, chronic pain, and immunocompromised populations in human and/or animal populations.Item Inhibitory Rib-Raising and Microneurographic Measurement of Sympathetic Nervous System Activity(2007-05-01) Kinzler, Damien W.; Michael Smith; Russell Gamber; Hollis KingThe clinical effectiveness of osteopathic manipulative therapy (OMT) techniques that are designed to address the autonomic nervous system (ANS) are untested to current research standards. As the concept of “autonomic imbalance” is frequently ascribed as the etiology of various pathologic conditions, it is paramount to undertake basic research into not only efficacy but also possible mechanistic actions and origins. Osteopathic physicians often utilize treatment regimens and techniques for which the given mechanism of action is simply attributed to “balancing the autonomics”. This intuitive concept may finally be at the threshold where enough basic science exists to justify clinical investigations. Osteopathic manual manipulative techniques have shown effectiveness in the treatment of various musculoskeletal conditions and have been shown to lower perceived pain; supporting the use of manual therapy as an effective treatment modality. A brief review yields the following within just the last four years: Eisenhart showed positive range-of-motion outcomes after ankle sprain in the emergency department. Biondi reviews the usefulness of cervical manipulation for tension headache and McReynolds demonstrated an equivalent decrease in acute neck with OMT versus intramuscular ketolac in an emergency department setting, although the dosing was not maximal. German researchers have shown effectiveness in chronic epicondylopathia humeri radialis and research has led to the demonstration of lowered post-operative pain in hip or knee arthroplasty. There has also been decreased post-operative pain medication reported in hysterectomy when compared with a control group. OMT has demonstrated a decrease in fibromyalgia symptoms when used with standard care over standard care alone. Low back pain, perhaps the most extensively studied diagnosis in which OMT has been evaluated, has reported numerous positive outcomes including lower levels of narcotic use and decreased pain in both double-blinded and meta-analysis studies, although there is still considerable debate within this area. There has also been favorable outcomes associated with the management of gain in Parkinson’s disease and preliminary work has shown the efficacy in treatment of carpal tunnel syndrome. Most of the aforementioned musculoskeletal conditions are not amenable to traditional therapies and have a high-cost burden on the economy. Traditional treatments generally have a “wait and see” approach combined with analgesics which may not cause harm, but hampers quality of life and income in the interim. The cost effectiveness of OMT is still in the preliminary stages, but there is evidence supporting a superior cost benefit ratio when compared to standard care and since many of these conditions have no other proven treatment modality available patients will often try anything over nothing. The evaluation of OMT addressing clear autonomic dysfunction is limited. This study closes a small part of that gap by examining the proposed physiologic mechanism of OMT and its’ interaction with the ANS. Small studies have documented changes, namely heart rate variability, in autonomic processes in healthy individuals while other, older studies have found benefit in clinical variables. With few exceptions however, most of these studies lacked a particular technique protocol. Operators were free to use whatever intervention that they chose and most of these studies were not performed under rigorous testing methods with a randomized design. The technique that was evaluated (inhibitory rib-raising) has a documented history from the origins of osteopathic medicine in the United States, and is currently taught to students in osteopathic medical schools as part of their medical education curriculum. Rib-raising is most often taught to enhance the mechanical motion of the ribs, but other paradigms utilize this technique to either enhance or inhibit sympathetic nervous system (SNS) activity. The evaluation of inhibitory rib-raising or its’ proposed mechanism of action has never been rigorously scrutinized to modern scientific standards. The current study was designed to address that gap with both direct and indirect measurement of SNS variable in healthy individuals with the hypothesis that there would be a time-dependent, graded reduction in measured sympathetic nervous system activity (MSNA) in healthy individuals undergoing cold-pressor stimulus.Item Interexaminer Reliability of Somatic Palpatory Findings Associated with Chronic Low Back Pain(2002-05-01) Russo, David P.; Scott Stoll; John C. Licciardone; Russell GamberRusso, David P., Interexaminer Reliability of Somatic Palpatory Findings Associated with Chronic Low Back Pain. Master of Science, May 2002, 15 pp., 1 table, 1 figure, bibliography, 26 titles. Osteopathic physicians rely on specific clinical palpatory tests to diagnose somatic dysfunction of the neuromusculoskeletal system. The purpose of this study is to compare the interexaminer reliability of six common osteopathic clinical tests to severity ratings of somatic dysfunction in six body regions. Ten trained and clinically supervised predoctoral osteopathic manipulative medicine fellows collected palpatory data using the Standardized Outpatient Osteopathic Soap Note Form (SNF) and recorded findings for six pre-selected osteopathic clinical diagnostic tests as part of a randomized controlled trial of osteopathic manipulative treatment for chronic low back pain. Kappa coefficients were used to assess overall examiner agreement for the osteopathic clinical tests. Intraclass correlational coefficients (ICC) and Chronbach’s alpha were used to assess examiner agreement for the severity ratings. Kappa values for the six clinical tests ranged from 0 to 0.32. The single item ICC was 0.32, average item ICC was .74, and the coefficient alpha for internal consistency of the six body region scores was 0.80. These results indicate that diagnostic impressions of somatic dysfunction severity may be more reliable than outcomes from isolated osteopathic clinical tests.Item Line-of-Duty Injury or Illness Incidence in an Air National Guard Unit(2001-05-01) Lorich, Michael F.; Muriel Marshall; Sharon Clark; Antonio ReneLorich, Michael F., Line-of-Duty Injury or Illness Incidence in an Air National Guard Unit. Master of Public Health, DO/MPH track, May 2001, 31 p.p., 3 tables, 4 illustrations, reference list, addendum. Line-of-duty injuries or illnesses (LODs) suffered by members of Air National Guard units may demonstrate the status of unit safety, unit readiness and deployability, a potentially significant area of unit expenditures, and areas of needed health promotion. This descriptive pilot study was conducted at the unit commander’s request to determine an apparent doubling of the prevailing incidence of LODs over a recent quarterly period. Tracking of injuries and injured individuals was problematic. The vast majority of LODs were musculoskeletal in nature. Decreased fitness level (Identified as elevated body mass index (BMI)) among males and increased age were related to increased LODs. Recommendations were given to improve tracking, identify individuals at increased risk, provide pre-training assessment, and institute health promotion focused on musculoskeletal injuries.Item Long Term Compliance and Withdrawal Rates in Gynecologic Oncology Clinical Research Studies(2003-12-01) Kersey, Jen Kelley; Robert Kaman; LaChelle Arredondo; Robin NewmanOncology is an area of study that is greatly affected by time. Patients with cancer need safe and effective treatment immediately. For some, current treatments have not worked to eliminate their disease. Their recurrent condition reinforces the need for safer and more effective treatment. This treatment must not only destroy the cancerous cells, but it must also allow for the continuation of their lives. This life can be measured by time and quality. Ideally, both would be maximized for proper treatment, yet current science has not found this model cure. For some regimens, quality of life could be maximized at the expense of quantity of life and vice versa. Both the patient and the healthcare provider should evaluate the balance of expectations. The potential of each life should be maximized for length and quality. The investigator/physician must do everything in their power to ensure that the patient’s needs are met medically. In treatment involving recurrent cancer patients, time is of the essence. Therapy, in every form, must be given immediately to extend and improve their remaining lives. If QOL assessments can predict the outcome of retention, acknowledgement of the subject’s well-being can allow for greater insight into the physical and emotional effects of the experimental treatment. The use of this information can help future generations of cancer patients by providing data that describes the therapy. The study of “Long Term Subject Compliance and Withdrawal Rates in Gynecologic Oncology Clinical Research Studies” is necessary for the evaluation of QOL assessments to subject retention, patient care practices in research and private practice may be affected through incorporation of the QOL assessment. There are many benefits that may result if significance is found in this study. The main objective of the QOL assessment is to observe the QOL of the subject in relation to the effect of the treatment on the individual. If subject retention can be predicted from the evaluation of QOL assessments, future clinical research studies, in gynecologic oncology and beyond, may modify their protocols to include the assessments. Improved subject retention will ultimately improve the accuracy of data collection. Improved accuracy will help evaluate the outcomes of treatment for cancer patients. If the QOL assessment shows a correlation to subject retention, the survey could be used as a tool, not only to assess the patient’s well being, but also to predict withdrawal. This project could identify “at-risk” factors of the subject population. Subjects who are at-risk for withdrawal should be followed closely. Excluding subjects that meet the clinical protocol would be unethical. To protect the validity of the study and ensure ethical measures are taken, those subjects that have factors associated with drop-out should be enrolled in the study and monitored closely. The survey may give insight to the types of ancillary or palliative care that may be needed during the patient’s fight with cancer. This research hopes to identify that quality of life assessments are an integral dimension of the research practice. The care of the patient rests in the hands of the physicians providing treatment. They are responsible for the needs and best interest of the patients. Wide discrepancies between the rating of specific outcomes of treatment by the patient and physician have been noted in current literature. This study may help show that the patient driven quality of life assessment is an important aspect of patient care, and should be integrated as a common tool for the care of gynecologic oncology patients. The use of this tool outside of the research setting should also be explored. Future studies in quality of life, beyond that of gynecologic oncology, may be investigated. This study hopes to initiate further research for the quality of life assessment because the QOL assessment gives data regarding well-being from the patient’s perspective. Future studies should also research the confounding factors that may influence subject withdrawal. These additional collaborative factors may contribute to compliance or those “at-risk” for drop out. By maximizing subject retention and protecting subject safety, healthcare research can provide results that reflect the true investigational question.Item Mechanisms of Right Ventricular Oxygen Supply/Demand Balance in the Concious Dog(2000-06-01) Hart, Bradley; H. Fred Downey; Patricia A. Gwirtz; James L. CaffreyHart, Bradley Joe. Mechanisms of Right Ventricular Oxygen Supply/Demand Balance in the Conscious Dog Doctor of Philosophy (Biomedical Sciences), August,2000, 119 pp, 4 tables, 13 figures, references, 79 titles. No data exist in the literature describing the myocardial oxygen supply/demand relationship of the right ventricle in a conscious, anaesthetized animal. A novel technique developed in our laboratory enables us to collect right ventricular (RV) venous blood samples from conscious dogs to determine RV myocardial oxygen consumption (MVO2). RV oxygen supply/demand balance was examined in conscious dogs, chronically instrumented to measure right coronary blood flow (RCBF), segmental shortening (%SS) and RV pressure (RVP) during increases and decreases in RV myocardial oxygen demand. Right ventricular MVO2 and O2 extraction (O2E2) were determined; RCBF, RVP, dP/dt, and %SS were recorded concomitantly. Acute increases in RV MVO2 were accomplished by atrial pacing (200 beats/min), increasing RV afterload by 65%, infusion of isoproterenol (0.1 μg/kg/min, i.v.), and by conducting a submaximal exercise routine (70-75% of maximum VO2). An acute decrease in RV MVO2 was created by propranolol administration (1 mg bolus, i.c.). During acute increases in RV MVO2, the extraction reserve is utilized primarily; flow is not affected in the absence of direct vasodilatory effects of the intervention. A decrease in RV oxygen demand is associated with a further increase in the RV extraction reserve. Since RV O2E increases linearly with increases in RV MVO2, these data show that changes in RV venous O2 tension can occur with little or no change in RCBF. LC resistance is very sensitive to alterations in LC venous pO2; therefore, there appear to be significant differences between the left and right ventricles concerning the matching of oxygen supply with myocardial oxygen demand.