OSTEOPATHY

What is Osteopathy? Osteopathy is a complete care health profession that specializes in the treatment of the musculoskeletal system as a means to restore health and to promote wellness. Osteopaths use a combination of manual techniques (Soft Tissue Therapy, Muscle Energy Techniques, Joint Mobilization, Myofascial Release, and physical modalities (Thermal/Cold Therapy, Ultrasound Therapy) in order to bring the body back to a cohesive whole.

How did Osteopathy Begin? In the late 1800s Dr. Andrew Taylor Still, an American physician and surgeon, set out to holistically empower his patients in the healing process. Dr. Still philosophized that the human body has an innate ability to heal itself and he expanded this philosophy to six overarching tenets of "Osteopathy", a term he coined, to include the following:

The body is a unit;
Structure and function are interrelated;
The body is self-regulating;
The body is designed to defend and heal itself;
When the body’s ability to adapt is disrupted, the integrity of the internal environment is lost, and self maintenance disintegrates;

6. Rational treatment is based on these principles

Dr Andrew Still along with other family members went on to found Baker University in 1858 the first four-year university in the state of Kansas. In 1892 Dr. Still would later found the American School of Osteopathy which would later become the A.T. Still University, the world’s first osteopathic medical school. Osteopathic medical schools would increase in numbers across the USA during the early 1900s. The curriculum of these institutions would prepare their student physicians to practice, diagnosis, and provide treatment in a manner that integrates the principles of the osteopathic philosophy and in the use of Osteopathic Manipulative Techniques (OMT). Osteopathic medical school graduates (DOs) are osteopathic physicians with full, unlimited medical practice rights, who can specialize in any branch of medical care. DOs have achieved the nationally recognized academic and professional standards within his or her country which allows them to practice as medical doctors. Their key difference from medical doctors (MDs) is that they have completed education at a school that also includes training in OMT. In Bermuda the practice of Osteopathic Medicine is regulated by the Bermuda Medical Council.

What are the two branches of Osteopathy?Two branches of Osteopathy (Osteopathic Medicine & Osteopathic Manual Therapy) emerged when Dr. John Martin Littlejohn, a student of Dr. Still, founded the British School of Osteopathy in London in 1917, and subsequently the Journal of Osteopathy, which is seen to be the laying down of the scientific foundations for Osteopathy in Europe. Other persons such as Paul Gény a physiotherapist, teamed up with an English osteopath named Thomas G. Dummer, and founded the l’École française d’Ostéopathie. Their aim was to provide non-doctors the opportunity to learn osteopathic techniques. These two distinguished gentlemen are credited for advancing what is now known as European-style Osteopathy throughout Europe, Asia, Canada, and many other countries throughout the world.

How are European-style osteopaths trained and how are they different form DOs in the USA? European-style Osteopathic graduates do not prescribe pharmaceuticals or perform surgeries as do osteopathic physicians. The focus of the Osteopath is to introduce osteopathic modalities that stimulate the body's natural healing mechanisms.

How do Osteopaths perform intial assessments? European-style osteopaths are trained to assess and treat clients by taking a case history, by observing how the client’s body functions while sitting, standing and lying down, and by physically examining the client by using palpation to determine which areas of the body are healthy and which are in pain. An osteopath also observes the spine, shoulders and determines if the pelvis is symmetrical. At the initial consultation, the osteopath will devise a treatment plan for the patient, if he or she thinks that osteopathic treatment is suitable. If the osteopath determines that osteopathic treatment is not suitable for the patient, they can refer the patient back to their GP for a referral to an appropriate health profession.

To what level are Osteopaths educated? Osteopaths are educated to the four year Diploma or Bachelor's degree level, the advanced Master's degree level, and the clinical doctoral degree level.

What is the predominant form or Osteopathy practiced in the world? European-style Osteopathy is the predominant form of Osteopathy that is practiced throughout the world with the exception of the USA where osteopathic medicine is more widespread.

What is the common bond between Osteopathy and Osteopathic Medicine? Both osteopathy and osteopathic medicine incorporate current medical and scientific knowledge in applying osteopathic principles to patient care. Scientific review and evidence-informed outcomes have a high priority in patient treatment and case management.

Is Osteopathy a regulated profession worldwide? At present individual countries establish the national academic and professional standards for osteopathic physicians and osteopaths within their borders. In Bermuda Osteopathic physicians are regulated by the Bermuda Medical Council however Osteopathic Manual Therapy (OMT) / Osteopaths are not listed as regulated health professionals. BOA's aim is to establish a regulatory framework for practicing and aspiring osteopaths so as to protect the safety interests of the public going forward.

What types of conditions do osteopaths treat? Osteopaths usually treat patients who complain of headaches, bad backs, neck pain, sciatica, repetitive strain injuries (RSI), asthma, joint pain, menstrual problems and pregnancy problems. Osteopaths oftentimes treat clients suffering with chronic pain, chronic fatigue, as well as arthritis and sports injuries. Persons suffering with conditions that have developed as a result of aging also benefit from treatment by an osteopath.

How many osteopathic treatment sessions are necessary? After the initial consultation, a patient may need to see the osteopath only once or twice more, or may need to come back for six or more treatments. At the next session, the osteopath will determine if the treatment made an improvement in the patient’s condition and based on the patient’s answer, will decide whether to continue with that specific treatment or to try a new approach.

Are some osteopaths dual or multidisciplinary practitioners? Yes, some osteopaths are health professionals in other areas such as Occupational Therapy, Physiotherapy, Naturopathy, Psychology, Allopathic Medicine, and Chiropractic. In these cases the practitioner must conduct themselves in a manner that is consistent with the licensing board of each professional body of which he or she is registered. The practitioner must clearly delineate to the client what type of treatment the practitioner is providing during a treatment session. The practitioner is permitted to provide one type of service during a treatment session and must bill the client accordingly. The practitioner must accurately document the nature of each treatment session in the client's file. Health Insurance claims can only be submitted under one discipline.

Are osteopaths bound by a code of ethics even in countries where the profession is unregulated? Yes. Osteopaths are bound by a code of ethics the world over. The universal code of ethics dictates that all practicing osteopaths uphold the highest level of committment to the client, to the public, and to the profession. BOA has established the following Code of Ethics which includes but is not limited to the specified items for practice in Bermuda:

Provide treatment at all times that is consistent with best practices for osteopathic care.
Maintain the highest standards of professional and personal conduct, and comply with all governmental jurisdictional rules and regulations.
Demonstrate absolute honesty with regard to the client’s condition when communicating with the patient and/or representatives of the client. Osteopaths shall not mislead clients into false or unjustified expectations of favourable treatment outcomes.
Provide accurate representation of the credentials, level of expertise, and scope of practice to the client and to the public.
Preserve and protect the client's confidential information, except as the client directs or consents, or the law requires otherwise.
Willingly consult and seek the talents of other health care professionals when such consultation would benefit the clients or when their clients express a desire for such consultation.
Recuse himself or herself from providing treatment when it is deemed inappropriate to do so because of a perceived or actual conflict of interest.
Provide a thorough explanation of what an osteopathic therapy session will entail to the client.
Participate in the dissemination of accurate information about the profession of Osteopathy to clients, special interest groups, government agencies, schools/learning institutions, and the public at large.

How does the BOA Regulatory Framework work to protect the public's interest? By defining the scope of practice, establishing a code of professional conduct, determining practice eligibility, identifying professional development criteria, and by publicizing each aspect of the regulatory framework BOA is able to institute a tranparent standard that meets the expectations of end users and would be osteopathic practitioners.

What does BOA recommended to be the scope of Osteopathic practice in Bermuda? BOA recommends that registered osteopaths restrict their practice to osteopathic manipulative techniques such as the Still Technique, Strain-Counterstrain Techniques, Balanced Ligamentous Technique, Soft Tissue Therapy, Muscle Energy Techniques, Muscle & Joint Mobilization Techniques, Myofascial Release Techniques, Facilitated Positional Release, Therapeutic Exercise, and the use of Physical Modalities such as Thermal/Cold Therapy, Ultrasound Therapy, Laser Therapy etc to manage their clients health concerns. BOA STRONGLY ADVOCATES AGAINST THE USE OF HIGH VELOCITY LOW AMPLITUDE THRUST (HVLA-T) AND SPINAL MANIPULATION in clinical management. As it pertains to children five years old and under, BOA takes the view that this area of Pediatric Osteopathy requires advanced training which goes well beyond the typical training of a regular Osteopathy program. Osteopaths who wish to treat infants and children in this age group category must provide proof that they have obtained specialized and advanced expertise in this area before proceeding with treatment. Failure to do so is considered by BOA to be a violation of its established Code of Conduct and could lead to the practitioner's registration being revoked.

What are the standards of practice that BOA seeks to enforce? BOA enforces the Osteopathic philosophical standards of excellence in four areas:

1) Evidence-Based Scope of Practice (EBP)- Practice standards in Osteopathy are the baseline for quality osteopathic care, holding registrants accountable for delivering consistent, high quality health care services. These standards ensure that the best available research evidence with respect to what works in the treatment process, clinical expertise (clinical judgment and experience) and client preferences and values are readily identified and applied to each patient's unique health state and diagnosis for maximum intervention benefit. This standard also safeguards the practitioner and the client by clearly defining what is considered to be within the realm and domain of osteopathic care in Bermuda.

2) Code of Conduct for Practice- The BOA Code of Conduct enables BOA to define and clarify the professional responsibilities for present and future BOA registrants. In order to earn and maintain the confidence and respect of recipients of osteopathic care, colleagues, employers, students, and the public, it is vital that BOA registrants act in a professional manner consistent with the Practice Standards and responsibilities set forth in the Code of Conduct. Specific principles of this code require registrants to:

Always act in the best interest of all clients by conducting oneself in a safe, lawful, ethical, respectful, non threatening, and confidential manner
Always obtain the client's consent before conducting a physical examination
Always have an another adult such as a parent present when providing osteopathic care to children under the age of 18 years
Refrain from providing osteopathic treatment while one’s ability to practice is impaired due to chemicals (i.e., legal and/or illegal) drug or alcohol abuse
Use evidence-based research to inform practice methodologies
Remain within the scope of Osteopathy when providing osteopathic care and clearly delineate to the client the areas of crossover if an osteopath is a dual or multidisciplinary practitioner

3) Education and Training- BOA ensures that all osteopaths practicing in the Bermuda have been educated to the required standards. Students of osteopathy who wish to practice in Bermuda must successfully complete a course that gives them a qualification 'recognized' by BOA, if they want to register and practice as an osteopath in Bermuda. BOA recognizes the following accredited osteopathy training institutions:
• Buenos Aires School of Osteopathy (Argentina)
• Instituto Argentina de Osteopatía (Argentina)
• Osterreiches Osteopathie Kolleg (Austria)
• RMIT University (Australia)
• Southern Cross University (Australia)
• University of Western Sydney (Australia)
• Victoria University (Australia)
• Chiropractic and Osteopathic College of Australasia (Australia)
• Escola Brasileira De Osteopatia
• National Academy of Osteopathy (Canada & its other locations)
• Collège d'Études Ostéopathiques (Canada)
• Centre Ostéopathique du Québec (Canada)
• Canadian College of Osteopathy (Canada)
• Canadian Academy of Osteopathy and Holistic Health Sciences (Canada)
• Southern Ontario College of Osteopathy (Canada)
• The Osteopathic College of Ontario (Canada)
• British College of Osteopathic Medicine (England)
• University College of Osteopathy (formerly British School of Osteopathy England)
• College of Osteopaths (England)
• European School of Osteopathy (England)
• London School of Osteopathy (England)
• London College of Osteopathy & Health Sciences (Canada)
• National Academy of Osteopathy (England)
• London College of Osteopathic Medicine (England)
• Oxford Brookes University (England)
• Centre Europeen d'Enseignement Superieur de l'Osteopathie (France)
• Institut de Formation en Ostéopathie du Grand-Avignon (France)
• Osterreiches Osteopathie Kolleg (Germany)
• Deutsches Osteopathie Kolleg (Germany)
• Istituto Superiore di Osteopatia - Milano (Italy) • Unitec (New Zealand)
• Russian School of Osteopathic Medicine (Russia)
• National Academy of Osteopathy (South Korea)
• Swiss International College of Osteopathy (Switzerland)
• Madrid School of Osteopathy (Spain)
• National University of Medical Sciences (Spain)
• College of Natural Health Sciences-Bermuda
• Universitat Autonoma de Barcelona (Spain)

4) Continued Professional Development- In order to remain registered with BOA osteopaths must keep their skills and knowledge up-to-date by engaging in continuing professional development activities (CPD). Eligible registrants will be required to renew registration every three years, during which time a total of 90 hours of continuing education units (CEUs) must be obtained. Registrants must log a minimum of 30 hours each year with BOA in order to maintain an 'Active Status' with respect to their registration leading up to the renewal period.

What are the specific eligibility requirements prospective registrants must meet in order to register with BOA? BOA registration criteria is as follows:

The registrant must successfully complete an osteopathy course of study from any of the above accredited institutions
The registrant must write the BOBE Registration Exam and achieve a passing score of 80% or higher in order to be registered. Registrants who have successfully passed the IOEB Exam may obtain registration through reciprocity
The registrant must not have been convicted of any of the following: crimes of a sexual nature, domestic violence, armed robbery, child abuse/neglect, elder abuse/neglect, assault, assault with a deadly weapon, possession of firearms or bladed weapons, and/or manslaughter/murder
The registrant must not have been suspended, disciplined, or fired from a place of employment due to reported child abuse/neglect, elder abuse/neglect, and/or sexual harassment/misconduct
The registrant must not have been charged with any of the above offenses within twelve months of the date of submitting an application to register.

How does BOA enforce the standards of practice? BOA enforces standards of practice by:

Requiring all osteopaths who wish to practice in Bermuda to register and renew registration every three years in accordance with the renewal CEU requirements
Fielding complaints of malfeasance, nonfeasance, and misfeasance lodged by any persons in the public who believes that they have not received treatment that is consistent with the standards of osteopathic care set by BOA.
Affording registered osteopaths due process by way of an official tribunal in the event that he or she has been accused of wrong doing, provided sub standard care, breached client confidentiality, caused harm intentional harm, and/or withheld care without justifiable cause
Suspending, reprimanding, censuring, and revoking registration if the osteopath is found to be culpable of that which he or she has been accused
Depending on the severity of the matter and the outcome of the tribunal BOA may refer the matter to the Ministry of Health and the Department of Public Prosecutions in the pursuit of justice

How often are the BOBE Registration Exams offered? The BOBE Registration Exam will be offered three times per year during the months of February, July, and November as of January 2019.

Is there a BOBE study guide? Yes. BOA will make availabe the BOBE Study Guide to eligible applicants.

What is the projected rate of growth of osteopath personnel in Bermuda? The projected growth rate for osteopathic personnel is expected to be similar to that of other developed countries where there are aging populations and progressive healthcare systems in place, which will be between 5.7 - 6.2% by the year 2025.