Discussion
Our secondary analysis of the Australian osteopathy PBRN data provides a novel insight into the practice characteristics of practitioners who often use exercise prescription as part of the care of patients with musculoskeletal complaints. Approximately three-quarters of Australian osteopaths often prescribe exercise in patient care. This finding is consistent with previous data for New Zealand osteopaths23 suggesting that exercise prescription is a significant component of Australasian osteopathy practice.
Our data shows Australian osteopaths who often use exercise prescription are also more likely to engage in referrals with a number of health professionals. Osteopaths who use exercise prescription often were twice as likely to send referrals to an exercise physiologist and to specialist medical practitioners. Approximately 5% of referrals from Australian osteopaths is reported to be to specialist medical practitioners.25 These findings are encouraging, and it may imply these osteopaths are more likely to use a multidisciplinary approach to their patient management with respect to exercise. Combined with the current findings, there is an increasing evidence base with respect to referrals to and from osteopaths.25,26 We are not able to comment on the nature of the referrals however these findings warrant additional exploration.
The practice of osteopathy intersects with exercise and physical activity and well-being from several perspectives. Australian osteopaths who often use exercise prescription in patient care were over five times more likely to report discussing physical activity with their patients compared to osteopaths who do not. Our results suggest that osteopaths who discuss physical activity and use of exercise prescription forms a significant part of Australian osteopathic practice. Further, these findings suggest osteopaths may be playing an important role in promoting public health messaging around physical activity for general health. However, these assertions require further research.
Our data suggests osteopaths who report often using exercise prescription were more than twice as likely to treat sport injuries and 50% more likely to use sports taping. Injuries related to sport are common presentations to Australian osteopaths with approximately half of Australian osteopaths treating sport-related injuries.27 However, exercise prescription for sport injuries in the context of osteopathy care is underexplored. Some case studies provide evidence 28,29 for its use, however there are also opportunities to develop higher level evidence to support patient outcomes and cost-effectiveness. There is evidence to support the use of sports taping for the management of musculoskeletal complaints.30-32 The increased likelihood of sports taping use by osteopaths who often use exercise prescription suggests they may be combining these modalities in patient care, however more exploration is needed.
Nutritional supplement advice was also more likely to be used by Australian osteopaths who often use exercise prescription compared to those who do not. This is a consistent finding with the chiropractic profession.33 In Australia, few adults meet the fruit and vegetable intake guidelines 34, with a dominance of excessive calorie dense, ultra-processed food intake, posing a risk for heart disease, type 2 diabetes and several cancers.35 The nature of the nutritional supplement advice provided by Australian osteopaths requires exploration, particularly whether this advice relates to specific supplements for management of musculoskeletal complaints or is more broadly applicable to overall health and wellbeing.
Previous research has shown a variety of manual therapy techniques are the dominant intervention strategy for Australian osteopaths.15,18,25 Although usage of manual therapy by Australian osteopaths is common 15,18,25, our work highlights some techniques (soft tissue techniques, trigger point therapy) are more commonly utilised by osteopaths who often use exercise prescription compared to those who do not. This association may be due to the reported effectiveness of these manual therapy techniques for various musculoskeletal conditions 36-38 or potentially patient expectation.
The cross-sectional and self-report nature of the design of the ORION survey is a limitation when interpreting the results of the study. It is known that cross-sectional self-report designs are potentially susceptible to social desirability bias 39 and recall bias 40. How practitioners defined exercise prescription when completing the questionnaire is open to interpretation and may have skewed the results. Lastly, the design of the survey does not allow for analysis of the type of exercise prescription (e.g. whether in the clinic or home) and whether osteopaths use exercise prescription for some presenting complaints only. It is probable that practitioners’ approach different conditions in different ways and this clinical reasoning would be valuable to explore.
Our analyses open up a number of opportunities for future research to develop a greater understanding of how Australian osteopaths use exercise prescription in their practice. Additional research should explore the barriers and enablers for the use of exercise prescription, the type of exercises being prescribed and for what presenting complaints, as well as the clinical reasoning for exercise prescription and outcomes from care where exercise prescription forms part of the management. This research, combined with the current work, has the potential to inform pre- and post-professional education (including professional development), and health policy.