‘Don't focus on the finger, look at the moon’ - The importance of contextual factors for clinical practice and research

Thomson, Oliver P.; Rossettini, Giacomo

doi:10.1016/j.ijosm.2021.06.001

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…Tradition, with an emphasis on the role of the osteopath and their “listening, seeing hands” [ 38 ] is still one of the main features that characterise the way many professionals feel about themselves [ 39 ]. In confirmation of this, although Italian osteopaths are in favour of EBP, they lack basic skills in EBP and rarely engage in EBP activities [ 40 ], thus, maintaining above all a hands-on operator-dependent clinical approach [ 41 ], which is supported by some evidence [ 20 , 21 , 22 ], but at the same time has shown scientific fragilities in terms of reliability and validity considering the complexity of the phenomenon involved [ 7 , 42 , 43 , 44 , 45 , 46 , 47 ]. Osteopathic reliability can be related to perception and interpretation of the palpation which is influenced by previous experiences, type of information to collect, habitual and context-related influences, and cultural and social imprinting [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Beliefs and Use of Palpatory Findings in Osteopathic Clinical Practice: A Qualitative Descriptive Study among Italian Osteopaths

Bergna¹,

Galli²,

Todisco³

et al. 2022

Healthcare

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The Italian government has started the regulatory process of osteopathy to include it among the healthcare professions mentioning terms, such as “perceptual palpation” and “somatic dysfunction” within the professional profile. ‘Palpatory findings’ are one of the multidimensional aspects that can inform osteopathic clinical reasoning. The non-regulated educational system has led to heterogenic professionals working in Italy, thus, the aim of this study was to investigate how Italian experts use palpatory findings in their clinical practice. A total of 12 experts were selected to participate in four virtual focus groups. A qualitative inductive approach with a constructivist paradigm was chosen to describe the results. The themes that emerged were: osteopathic identity; evaluation; osteopathic diagnosis; and sharing with different recipients. Participants agreed on the peculiarity and distinctiveness of osteopathic palpation, but there was some disagreement on the clinical significance of the findings, highlighting a complex multidimensional approach to diagnosis and treatment. The results seem to reflect the history of the profession in Italy, which has evolved quickly, leading professionals to seek new paradigms blending tradition and scientific evidence. The authors suggest further investigation to verify the state of art among osteopaths not involved in research or a broader consensus of the results.

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Section: Discussionmentioning

confidence: 99%

Beliefs and Use of Palpatory Findings in Osteopathic Clinical Practice: A Qualitative Descriptive Study among Italian Osteopaths

Bergna¹,

Galli²,

Todisco³

et al. 2022

Healthcare

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“…Despite some promising clinical results for therapeutic affective touch, its effectiveness remains uncertain. Practitioners recognize that their outcomes are influenced by various sensory modalities, including non-verbal and verbal communication, which can impact a patient's recovery (31,124). It is possible that expectation-associated placebo effects contribute to reduced pain reported in sham treatments, particularly in chronic pain, through non-conscious Bayesian biases (31).…”

Section: Touch and Allostatic Regulation In Paediatrics And Neonatologymentioning

confidence: 99%

“…The intention behind therapeutic affective touch may significantly impact how practitioners establish a therapeutic alliance through their portrayal of therapeutic touch, implying an enactive component to therapeutic touch (124). By using therapeutic touch that activates CT fibres and triggers the release of oxytocin, practitioners can communicate and reassure the patient with a sense of safety about their clinical condition, as reflected by an increase in heart rate variability of preterm infants after experiencing CT-activating stroking, which helps regulate their parasympathetic nervous system (138).…”

Section: Touch Exploration Developing and Adapting Priors Through Cou...mentioning

confidence: 99%

Therapeutic touch and therapeutic alliance in pediatric care and neonatology: An active inference framework

McParlin¹,

Cerritelli

Manzotti

et al. 2023

Front. Pediatr.

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Therapeutic affective touch has been recognized as essential for survival, nurturing supportive interpersonal interactions, accelerating recovery—including reducing hospitalisations, and promoting overall health and building robust therapeutic alliances. Through the lens of active inference, we present an integrative model, combining therapeutic touch and communication, to achieve biobehavioural synchrony. This model speaks to how the brain develops a generative model required for recovery, developing successful therapeutic alliances, and regulating allostasis within paediatric manual therapy. We apply active inference to explain the neurophysiological and behavioural mechanisms that underwrite the development and maintenance of synchronous relationships through touch. This paper foregrounds the crucial role of therapeutic touch in developing a solid therapeutic alliance, the clinical effectiveness of paediatric care, and triadic synchrony between health care practitioner, caregiver, and infant in a variety of clinical situations. We start by providing a brief overview of the significance and clinical role of touch in the development of social interactions in infants; facilitating a positive therapeutic alliance and restoring homeostasis through touch to allow a more efficient process of allostatic regulation. Moreover, we explain the role of CT tactile afferents in achieving positive clinical outcomes and updating prior beliefs. We then discuss how touch is implemented in treatment sessions to promote cooperative interactions in the clinic and facilitate theory of mind. This underwrites biobehavioural synchrony, epistemic trust, empathy, and the resolution of uncertainty. The ensuing framework is underpinned by a critical application of the active inference framework to the fields of pediatrics and neonatology.

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“…Crucially, these not only include the usual exteroceptive cues that allow the patient to infer intentional stance of the therapist but, crucially proprioceptive and interoceptive (e.g., affiliative touch) evidence that pertains directly to the patient's body and its responses. Although touch is central to osteopathy and other healthcare professions such as physiotherapy, chiropractic and nursing, evidence from the field of musculoskeletal care demonstrates that other environmental elements or exteroceptive cues (aka "contextual factors") as verbal and non-verbal communication within the patient-practitioner dyad, can nonetheless shape the context aimed at updating the patient's generative model (Palese et al, 2019;Rossettini et al, 2020;Thomson and Rossettini, 2021).…”

Section: Osteopathic Care Across the Lifespanmentioning

confidence: 99%

Osteopathic Care as (En)active Inference: A Theoretical Framework for Developing an Integrative Hypothesis in Osteopathy

Esteves

Cerritelli²,

Kim

et al. 2022

Front. Psychol.

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Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under (En)active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the lived world and, crucially, the consequences of their behaviour. We argue that (En)active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic (e.g., in paediatric care) exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed.

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‘Don't focus on the finger, look at the moon’ - The importance of contextual factors for clinical practice and research

Cited by 5 publications

References 26 publications

Beliefs and Use of Palpatory Findings in Osteopathic Clinical Practice: A Qualitative Descriptive Study among Italian Osteopaths

Beliefs and Use of Palpatory Findings in Osteopathic Clinical Practice: A Qualitative Descriptive Study among Italian Osteopaths

Therapeutic touch and therapeutic alliance in pediatric care and neonatology: An active inference framework

Osteopathic Care as (En)active Inference: A Theoretical Framework for Developing an Integrative Hypothesis in Osteopathy

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