title: Can laypersons be trained to effectively deliver osteopathic manual therapy to patients with HIV?: a pilot study.
abstract: BACKGROUND
  Osteopathic manipulative treatment (OMT) may provide added benefits to standard human immunodeficiency virus (HIV) and AIDS treatments. However, lack of access to trained OMT providers is a potential barrier to the widespread use of OMT in the management of HIV and AIDS.
  
  
  OBJECTIVE
  To determine the best time to measure the short-term impact of a brief OMT protocol on white blood cell counts in individuals with HIV and AIDS. Also, to explore recruiting and training laypersons to administer select osteopathic manual techniques.
  
  
  METHODS
  Participants were HIV-positive men aged between 18 and 65 years who had not undergone antiretroviral therapy in the past 12 months, had CD4(+) lymphocyte counts of 200 to 700 cells/mm(3), and had viral load levels of less than 100,000 copies/mL. Participants were randomly assigned to an OMT group or a control group; those in the OMT group recruited a layperson for training in osteopathic manual therapy. Participants in the OMT group received a 15-minute OMT protocol consisting of myofascial release of the thoracic inlet, pectoral traction, rib raising, thoracic pump, and abdominal pump. Participants in the control group engaged in conversation with the researcher for 15 minutes. Between-group differences for each white blood cell type were examined at varying time intervals after the protocols. Laypersons were trained to administer thoracic and abdominal pump techniques. They were tested by multiple choice examinations and by an independent rater for fidelity of administration.
  
  
  RESULTS
  Twenty-one participants met the eligibility criteria. Of those, 18 returned for their study visit (OMT group, n=9; control group, n=9). An optimal time interval for measurement of white blood cell changes across the 5 cell types was not determined. However, P values for the 30-minute interval were consistently below 0.18 for neutrophils, eosinophils, and monocytes. Nine laypersons were trained in osteopathic manual therapy, 5 of whom scored 100% on initial completion of the multiple-choice examination; the remaining 4 laypersons scored 80% on the first try and 100% on the second try. All laypersons appropriately administered the manual therapy protocol.
  
  
  CONCLUSIONS
  It is feasible to recruit and train laypersons to administer selected osteopathic manual therapy techniques with fidelity. Longitudinal studies on this concept are needed to examine patient outcomes and to evaluate the retention and fidelity of laypersons over time.
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine, Miami, FL 33137-3200, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Newberry
authors.forename: G Stephen
authors.initials: GS
authors.lastname: Bowen
authors.forename: Kristina
authors.initials: K
authors.lastname: Trubey
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D004804:Eosinophils; D015658:HIV Infections; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D026301:Manipulation, Osteopathic / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009000:Monocytes; D009504:Neutrophils; D010865:Pilot Projects; D013997:Time Factors; D014481:United States; D055815:Young Adult