Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession.
OBJECTIVE
To determine whether osteopathic manipulative treatment (OMT), a key identifiable feature of osteopathic medicine, is becoming a "lost art" in the profession, and whether the long-term evolution of osteopathic medicine into mainstream medicine and particularly specialization has had a similar impact on the use of OMT by family practitioners and specialists.


METHODS
In April 1998, a two-page questionnaire was mailed to 3,000 randomly selected osteopathic physicians in the United States to assess factors affecting their use of OMT. Descriptive statistics, linear regression analyses, and analysis of variance techniques were used to test for differences.


RESULTS
The response rate was 33.2%. Over 50% of the responding osteopathic physicians used OMT on less than 5% of their patients, and analysis of variance revealed OMT use was significantly affected by practice type, graduation date, and family physicians versus specialists. For specialists, 58% of the variance regression was attributed to barriers to use, practice protocol, attitudes, and training, whereas for family physicians, 43% of the variance regression was attributed to barriers to use, practice protocol, and attitudes. More important, the eventual level of OMT use was related to whether postgraduate training had been undertaken in osteopathic, allopathic, or mixed staff facilities, particularly for osteopathic specialists.


CONCLUSIONS
The evidence supports the assertion that OMT is becoming a lost art among osteopathic practitioners. Osteopathic as well as allopathic medical educators and policymakers should address the impact of the diminished use of OMT on both U.S. health care and the unique identifying practices associated with the osteopathic profession.
Johnson
S M
SM
Department of Family and Community Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, 48824-1316, USA.
Kurtz
M E
ME
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D004501:Education, Medical; D005194:Family Practice / Q000193:education / Q000458:organization & administration*; D005260:Female; D005544:Forecasting; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D008349:Manipulation, Orthopedic / Q000706:statistics & numerical data*; D008511:Medicine / Q000458:organization & administration*; D008875:Middle Aged; D010021:Osteopathic Medicine / Q000193:education / Q000458:organization & administration*; D010686:Philosophy, Medical; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013038:Specialization; D011795:Surveys and Questionnaires; D014481:United States