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.