Research Impact Story:
Brian F. Degenhardt, DO
Demonstrating the effectiveness of osteopathic manipulative medicine in patient care.
The mission of the Osteopathic Heritage Foundation (the Foundation) is to improve the health and quality of life in the community through education, research and service consistent with our osteopathic heritage. To advance this mission, the Foundation has prioritized investments in scientific research and professional development at leading colleges of osteopathic medicine with the goal of advancing scientific discoveries, healthcare and delivery of patient care.
In 2007, the Foundation established the Osteopathic Heritage Foundation Endowed Chair for Research in Osteopathic Diagnostic and Therapeutic Palpation – in Honor of John Auseon, DO and Boyd Bowden, DO at A.T. Still University of Health Sciences Kirksville College of Osteopathic Medicine (ATSU-KCOM). ATSU-KCOM is the founding institution of osteopathic medicine established by Andrew Taylor Still, MD, DO in 1892. The endowment is named in honor of John C. Auseon, DO and Boyd W. Bowden, II, DO both graduates of ATSU-KCOM and physicians at Doctors Hospital in Columbus, Ohio. Both Dr. Auseon and Dr. Bowden were passionate advocates for the osteopathic profession at the local, state and national level and served on the Foundation’s Board of Directors.
Brian Degenhardt, DO, assistant vice president for osteopathic research, professor in the Department of Osteopathic Manipulative Medicine, past director of the A.T. Still Research Institute and director for the Center for Osteopathic Manipulative Medicine Research, has served as the Osteopathic Heritage Foundation Endowed Chair for Research in Osteopathic Diagnostic and Therapeutic Palpation since its inception. Dr. Degenhardt oversees and directs research in the areas of palpatory diagnosis, an assessment skill used by physicians to identify medical conditions and injuries, and osteopathic manipulative medicine (OMM), a form of treatment where osteopathic physicians use manual pressure to achieve and maintain patient health. Dr. Degenhardt is an internationally recognized expert in OMM and the creator and director of DO-Touch.NET, a global practice-based research network assessing the clinical usefulness of OMM. He has authored more than 51 publications, presented 122 scientific abstracts at regional, national and international meetings, and developed the Advancing Skills in Osteopathy (ASO) Program, a continuing education program for DOs.
Dr. Degenhardt received his medical degree from the Des Moines University College of Osteopathic Medicine in 1989 and is board certified in Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine. He completed an internship at Grandview Medical Center and a residency in OMM at Northeast Regional Medical Center.
Dr. Degenhardt trains osteopathic medical students and physicians in the practice of osteopathic manipulative medicine.
Photos courtesy of A.T. Still University
Investing in the Future of Patient Care
Dr. Degenhardt’s research demonstrates the contributions of osteopathic medicine and the practice of OMM to improving patient care. By validating the effectiveness of OMM and developing innovative techniques to train the next generation of highly skilled osteopathic physicians, he is paving the way for more patients to benefit from the whole-person care at the core of osteopathic medicine.
Terri Donlin Huesman, President/CEO
Osteopathic manipulative medicine is safe and effective in relieving symptoms such as pain.
The Future of Patient Care:
Scientific evidence supporting the use of osteopathic manipulative medicine for hard-to-treat conditions, like pain, offers patients and physicians more treatment options with fewer side effects and risks.
Dr. Degenhardt spoke with Osteopathic Heritage Foundation staff about his research and the impacts of the Foundation’s investments.
What is OMM and your approach to research?
OMM is used by osteopathic physicians to promote the body’s tendency toward self-healing and homeostatic processes. Practitioners apply pressure with their hands to identify and treat structural and functional issues in the bones, joints, muscles and other soft tissues, with the goal of restoring function or removing barriers inhibiting the body from healing.
Since the beginning of the profession 130 years ago, OMM has been a key tool in the osteopathic physician’s skillset but there has been little research demonstrating its effectiveness. Our research focuses on further documenting the safety of OMM and its effectiveness in improving patient outcomes. We are building objective evidence for both the underlying principles of OMM and the way osteopathic physicians use OMM and palpation to diagnose and treat patients. The measurements, tools and processes we have developed allow us to objectify and quantify OMM techniques and create standards for an optimal range of pressure or force applied in practice. We have also created a practice-based network, DO-Touch.NET, to capture clinical outcomes of patients receiving OMM from DOs around the world.
How has your work contributed to the scientific evidence for OMM?
Most of the documented benefits of OMM have been self-reported by patients about their perception of its benefit. Although this is an important indicator of OMM’s effectiveness, it does not meet the criteria for evidence-based scientific standards, which require reproducible, validated assessment tools that can be used in different environments to collect reliable data. The measurements, tools, processes and standards we are developing fill this important gap in the research and help validate when OMM is an effective treatment.
Documenting the efficacy of OMM is important because unlike other tools at a physician’s disposal, such as imaging or biomarkers in blood tests, OMM provides the clinician with a direct way to evaluate the body’s function and assess pain. Approximately 90% of OMM patients are seeking treatment of pain, which is individualized and can be challenging to treat. OMM is an intervention that does not carry the significant side effects or downstream effects of other ways pain is currently managed, including the over-prescription of opioids and the potential for abuse.
What scientific discoveries about OMM have been made through your work at the A.T. Still Research Institute?
For OMM research and practice to be reproducible, the assessments need to be standardized. This poses a challenge because the primary tool used in OMM is a physician’s hands. Our most important discoveries are related to what physicians perceive when they diagnose and treat patients.
To assess what physicians perceive when they use their hands to diagnose and treat patients, we measured the amount of force physicians apply during OMM. We discovered that although physicians think they are applying the same amount of pressure with each hand, they usually apply more force with the dominant hand. The tools and measures we have developed provide objective feedback physicians can use to help them learn to apply the same amount of pressure with each hand. These measures can also be used in randomized controlled clinical studies to compare treatments within patient populations. This type of research is the gold standard for evidence-based research and is essential in documenting the benefits of OMM in patient care.
We have also developed a way to measure physician precision in observing the degree of asymmetry in the skeletal system during patient exams. Skeletal system symmetry is considered an indicator of function and health. Asymmetry, or a difference in the position of bone landmarks between the sides of the body, can be an indicator of disease or injury. We have measured the degree of asymmetry physicians can observe when evaluating patients, which helps enhance the accuracy of clinical decision making and applying OMM.
How does your research in OMM benefit patient care?
Our practice-based research network, DO-Touch.NET, collects information from practicing physicians on how OMM is used in actual patient care situations and the results achieved. This data indicates 83% of patients receiving OMM report improvement in symptoms and the improvement is sustained over a one-week follow-up period. It also demonstrates a smaller proportion of people, 20-25%, experience increased pain within 24 hours of treatment but it usually subsides within three days. This is helpful for understanding how various conditions respond to OMM and when there are potential side effects of treatment.
The practice of OMM is truly personalized medicine. It combines the physician’s skill with the unique experiences of each patient to effectively diagnose and treat dysfunction and pain. When a physician can feel or observe a place of pain or discomfort during the practice of OMM, it builds a trusting, caring and empathetic connection between the physician and the patient, although these characteristics are more difficult to measure than symmetry and force. By demonstrating the safety and efficacy of OMM, our work encourages more DOs and patients to explore this as a treatment option.
How does conducting this research at the founding college of osteopathic medicine and the profession’s focus on treating the whole person influence your work?
Since the inception of the endowment 12 years ago, we have been striving to validate the reported benefit of OMM, a foundational element of osteopathic medical training. Enhancing the ability of osteopathic physicians in practice and demonstrating the effectiveness of OMM at the first college of osteopathic medicine, founded by A.T. Still himself, just makes sense. The tools and practices we developed have made OMM a measurable skill to be evaluated and refined, which is transformational. In my own practice, these measures have changed the way I practice and improved results for my patients.
How has the Osteopathic Heritage Foundation’s funding investment helped you impact osteopathic medical education?
The endowment is helping to create a culture shift in the osteopathic profession. We are gathering reliable evidence of OMM’s benefit to patient care, validating and standardizing techniques previously supported only by anecdotal evidence. In the past, OMM was often overlooked or dismissed because of our inability to rigorously measure its outcomes. Our research is changing this and leading to new interest and support for OMM as a safe and effective treatment in pain management and other disease processes.
Funding from the Foundation has allowed us to establish the research lab and purchase the equipment needed to train providers and assess skills in the practice of OMM. As a result, we now have the capacity to train and evaluate the OMM skills of 360 medical students each year and to refine the OMM skills of practicing physicians. Our lab is developing students to be clinician-scientists who closely monitor the care offered and outcomes achieved in practice, and based on those insights, strive to improve the quality of patient care offered within healthcare.
What is next for your research?
Now is an important time for the rapidly growing osteopathic profession to provide evidence demonstrating how OMM impacts and improves patient care. In osteopathic medical education, we are creating measurements, tools, processes and standards to provide the next generation of physicians with a higher level of scientifically documented OMM skills.
Through our provider research network, DO-Touch.NET, we continue to develop opportunities for practicing physicians to contribute to OMM utilization research. It is a goal to get more physicians engaged in this process and to monitor outcomes at a larger scale. Another goal is to build strategic relationships with research intensive institutions and funding agencies such as the National Institutes of Health (NIH), to increase recognition of OMM as a valuable clinical treatment tool warranting funding for large-scale clinical trials.
Lastly, we have created the International Consortium on Manual Therapies (ICMT) as a space where manual therapy practitioners, such as DOs, chiropractors, massage therapists, physical therapists and others, can come together to advance the practice and science of manual therapies like OMM. In June 2022, we hosted our inaugural conference, bringing together more than 180 manual therapy professionals from eight countries. Osteopathic physicians have an opportunity to be leaders in creating a collaborative, supportive and respectful environment where manual therapy professionals can work together in science for the benefit of patient care.
Brian F. Degenhardt, DO
Assistant Vice President for Osteopathic Research, Professor in the Department of Osteopathic Manipulative Medicine
Photo courtesy of A.T. Still University
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