Fleischmann, Michael ORCID: https://orcid.org/0000-0002-2152-1193 (2025) Clinical effectiveness of the osteopathic management of non-specific neck pain: An Australian perspective. PhD thesis, Victoria University.

Abstract

This thesis explored the clinical effectiveness of osteopathic management for non-specific neck pain (NSNP) in Australia, emphasising its multifactorial, patient-centred nature. A pragmatic philosophical stance guided the investigation of real-world osteopathic practice through a sequential, multi-method approach: narrative review; secondary data analysis; cross-sectional survey; modified Delphi study; and a case series study. Six aims drove the research: 1) to explore osteopaths’ clinical profiles and treatment modalities, focusing on experience, training, and specialisation; 2) to advocate for standardised outcome measure integration; 3) to identify NSNP management guidelines and develop tailored case series guidelines; 4) to explore patient experiences; 5) to examine osteopaths’ clinical reasoning; and 6) to evaluate osteopathic treatment effectiveness for patients with NSNP. Chapter 1 establishes the research and researcher context, outlining the study's rationale and positioning. Chapter 2 examines the prevalence, burden, and management of NSNP in Australia, providing insights into osteopathic care and reviewing commonly used osteopathic techniques. Chapter 3 highlights the potential of patient-reported outcome measures (PROMs) beyond biomechanical assessments. Chapter 4’s secondary analysis of data from nationally representative practice-based research network (ORION) reveals variations in Australian osteopathic practice, noting differences between novice and experienced osteopaths in manual therapy and interdisciplinary approaches. A cross-sectional survey in Chapter 5 identifies common NSNP management strategies, including manual therapy, patient education, and exercise prescription. However, inconsistent patient reported outcome measure adoption, like the Neck Disability Index (NDI), indicated potential improvements. A modified Delphi study in Chapter 6, involving osteopathic experts, reinforces structured assessment, outcome measurement, and patient-centred approaches. Chapter 7 presents tailored case series guidelines, addressing a methodological gap. Chapter 8 applies explores these guidelines, providing insights into osteopathic decision-making and patient experiences. Chapter 9 synthesises the findings from all studies, evaluating their contribution to understanding the clinical effectiveness of osteopathic care for NSNP. This synthesis explores key themes such as practice variability, the role of outcome measures, and the implications of a multifactorial, patient-centred approach, with a strong emphasis on the therapeutic alliance. The synthesis highlights how fostering a strong therapeutic relationship, where patient engagement and shared decision-making are prioritised, is crucial for optimising clinical outcomes. It emphasises that a patient-centred approach, where the patient's individual needs and preferences are central, is essential for effective NSNP management. Osteopathic care for NSNP, as evidenced by this research, benefits from a multifactorial, patient-centred approach, encompassing psychological and social dimensions alongside biomechanical interventions. Acknowledging the inherent variability in practice, from artistic to technical conceptions of practice, and prioritising the therapeutic alliance, moving beyond purely biomechanical explanations. The systematic integration of patient-reported outcome measures (PROMs) is crucial for evaluating the multidimensional impacts of care, directly informing clinical decisions and enhancing clinical effectiveness. The findings from offer practical insights for advancing osteopathic education, practice, and ultimately, patient outcomes.

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