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Cited by 5Musculoskeletal pain and rehabilitationOpioid Use Disorder TreatmentPrimary Care and Health Outcomes

The process and outcomes of chronic low back pain treatment provided by osteopathic and allopathic physicians: a retrospective cohort study

Open access
Licciardone, John C., Kellerlee, Joel, Joseph, Matthew, Mohammad, Moath B., Kim, Kelly G., Jain, Jyotirmaya, Aryal, Subhash·2023·Journal of Osteopathic Medicine
DOI 10.1515/jom-2023-0046
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Abstract

Context: Osteopathic physicians are trained to treat patients with musculoskeletal symptoms, to treat somatic dysfunction with osteopathic manipulative treatment (OMT), and to avoid unnecessarily prescribing drugs such as opioids. It is also generally believed that osteopathic physicians provide a unique patient-centered approach to medical care that involves effective communication and empathy. Such training and characteristics of osteopathic medical care (OMC) may enhance clinical outcomes among patients with chronic pain. Objectives: The objectives of this study were to measure and compare the process and longitudinal outcomes of chronic low back pain (CLBP) treatment provided by osteopathic and allopathic physicians and to identify mediators of the treatment effects of OMC. Methods: This retrospective cohort study was conducted utilizing adult participants with CLBP within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 2016 through December 2022. Participants having an osteopathic or allopathic physician for at least 1 month prior to registry enrollment were included and followed at quarterly intervals for up to 12 months. Physician communication and physician empathy were measured at registry enrollment. Opioid prescribing and effectiveness and safety outcomes were measured at registry enrollment and for up to 12 months and were analyzed with generalized estimating equations to compare participants treated by osteopathic vs. allopathic physicians. Multiple mediator models, including physician communication, physician empathy, opioid prescribing, and OMT, with covariate adjustments, were utilized to identify mediators of OMC treatment effects. Results: A total of 1,079 participants and 4,779 registry encounters were studied. The mean (SD) age of participants at enrollment was 52.9 (13.2) years, 796 (73.8 %) were female, and 167 (15.5 %) reported having an osteopathic physician. The mean physician communication score for osteopathic physicians was 71.2 (95 % CI, 67.6–74.7) vs. 66.2 (95 % CI, 64.8–67.7) for allopathic physicians (p=0.01). The respective mean scores for physician empathy were 41.6 (95 % CI, 39.9–43.2) vs. 38.3 (95 % CI, 37.6–39.1) (p<0.001). There was no significant difference in opioid prescribing for low back pain between osteopathic and allopathic physicians. Although participants treated by osteopathic physicians reported less severe nausea and vomiting as adverse events potentially attributable to opioids in a multivariable model, neither result was clinically relevant. OMC was associated with statistically significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and health-related quality of life (HRQOL) over 12 months. Physician empathy was a significant mediator of OMC treatment effects in each of the three outcome domains; however, physician communication, opioid prescribing, and OMT were not mediators. Conclusions: The study findings indicate that osteopathic physicians provide a patient-centered approach to CLBP treatment, particularly involving empathy, that yields significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and HRQOL over 12 months of follow-up.

AI snapshot

Written from the paper’s full text.

TL;DR

In a retrospective cohort of adults with chronic low back pain in the PRECISION registry, osteopathic medical care was associated with better 12-month outcomes for pain intensity, physical function, and health-related quality of life than allopathic medical care. Physician empathy was the only significant mediator of these osteopathic care treatment effects, while opioid prescribing did not differ significantly between groups.

Key findings

  • Among 1,079 participants and 4,779 registry encounters, 167 (15.5%) reported having an osteopathic physician. Osteopathic physicians had higher mean physician communication scores (71.2 vs. 66.2; p=0.01) and higher mean physician empathy scores (41.6 vs. 38.3; p<0.001).
  • Over 12 months, participants treated by osteopathic physicians reported lower mean low back pain intensity (5.14 vs. 5.83; p<0.001), lower mean back-related disability (11.50 vs. 13.95; p<0.001), and lower mean HRQOL deficits (55.55 vs. 57.47; p<0.001). Univariable effect sizes were clinically relevant (d=0.27 for HRQOL to d=0.38 for physical function); in multivariable analyses, HRQOL did not reach the clinical relevance threshold.
  • Opioid prescribing for low back pain did not differ significantly: unadjusted OR 0.75 (95% CI, 0.53–1.06; p=0.10), adjusted OR 0.76 (95% CI, 0.54–1.08; p=0.12), with RR=0.81 for both, below the clinically relevant threshold.
  • In mediation analysis (n=801), physician empathy was the only significant mediator in all three effectiveness domains, accounting for 13.0%, 20.1%, and 31.0% of the osteopathic care total treatment effect for low back pain intensity, back-related disability, and HRQOL deficits, respectively. Physician communication, opioid prescribing, and OMT were not significant mediators.

Methods

  • Retrospective cohort study using adults with chronic low back pain from the PRECISION registry (April 2016–December 2022). Participants had low back pain for at least 3 months and a treating physician for at least 1 month before enrollment; those with physician crossover were excluded. Follow-up occurred at quarterly intervals for up to 12 months.
  • Measures included physician communication (Communication Behavior Questionnaire) and physician empathy (Consultation and Relational Empathy measure) at enrollment; opioid prescribing and OMT at enrollment and quarterly encounters; and primary effectiveness outcomes of low back pain intensity (numerical rating scale), physical function (Roland-Morris Disability Questionnaire), and HRQOL (PROMIS SPADE cluster). Safety outcomes were secondary.
  • Generalized estimating equations compared osteopathic vs. allopathic physician groups over 12 months, with OR/RR and Cohen’s d for clinical relevance. Multivariable models adjusted for age, gender, race, ethnicity, and general health. Multiple mediator models used PROCESS with 50,000 bootstrap resamples and included physician communication, physician empathy, opioid prescribing, and OMT as potential mediators.

Limitations

  • The authors state that participants were not randomized to osteopathic vs. allopathic medical care, so baseline differences existed, most notably current comorbidities; they attempted to mitigate this with multivariable adjustment.
  • The authors state that OMT use may have been misclassified if spinal manipulation was provided by chiropractors, physical therapists, or other manual therapy providers rather than osteopathic physicians.
  • The authors state that mediation analyses required complete data, reducing the sample from 1,079 to 801 participants, which may have limited detection of smaller mediation effects from opioid prescribing or OMT. Evident from the text: the observational design cannot establish causality, and physician type was limited to DO vs. MD, excluding other low back pain treatment providers.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1515/jom-2023-0046

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

16 of 25 cited sources checked · 16 supported · 0 flagged

  • Premisecitation
    § Abstract

    Osteopathic physicians provided a disproportionately large volume of medical visits for low back pain compared with allopathic physicians.

    “Indeed, data from the National Ambulatory Medical Care Survey demonstrated that osteopathic physicians provided a disproportionately large volume of medical visits for low back pain and prescribed nonsteroidal anti-inflammatory drugs less frequently than allopathic physicians [5].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Licciardone, JC. The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States. Osteopath Med Prim Care 2008;2:11. https://doi.org/10.1186/1750-4732-2-11. source
  • Premisecitation
    § Abstract

    Osteopathic physicians prescribed nonsteroidal anti-inflammatory drugs less frequently than allopathic physicians.

    “Indeed, data from the National Ambulatory Medical Care Survey demonstrated that osteopathic physicians provided a disproportionately large volume of medical visits for low back pain and prescribed nonsteroidal anti-inflammatory drugs less frequently than allopathic physicians [5].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Licciardone, JC. The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States. Osteopath Med Prim Care 2008;2:11. https://doi.org/10.1186/1750-4732-2-11. source
  • Interpretationcitation
    § Discussion

    The finding that physician empathy mediates the OMC total treatment effect corroborates prior findings involving longitudinal OMC outcomes and patient perceptions of osteopathic physician empathy.

    “This not only corroborates prior findings involving longitudinal OMC outcomes [7,29,30] and patient perceptions of osteopathic physician empathy [15], but now directly links the latter with better outcomes among patients with CLBP.”
    Quote in the paperSubstantial claim4 of 4 sources checked
    • cites [7] Licciardone, JC, Aryal, S. Patient-centered care or osteopathic manipulative treatment as mediators of clinical outcomes in patients with chronic low back pain. J Osteopath Med 2021;121:795–804. https://doi.org/10.1515/jom-2021-0113. source
    • cites [29] Licciardone, JC. Preventing progression from chronic to widespread pain and its impact on health-related quality of life: a historical cohort study of osteopathic medical care. J Osteopath Med 2022;122:21–9. https://doi.org/10.1515/jom-2021-0105. source
    • cites [30] Licciardone, JC, Moore, S, Fix, K, Gowen Blair, L, Ta, K. Osteopathic manipulative treatment of patients with chronic low back pain in the United States: a retrospective cohort study. J Osteopath Med 2023;123:259–67. https://doi.org/10.1515/jom-2022-0212. source
    • cites [15] Licciardone, JC, Schmitt, ME, Aryal, S. Osteopathic and allopathic physician interpersonal manner, empathy, and communication style and clinical status of their patients: a pain registry-based Study. J Am Osteopath Assoc 2019;119:499–510. https://doi.org/10.7556/jaoa.2019.092. source
  • Premisecitation
    § Discussion

    Patients with CLBP often express a desire for physician interactions that involve listening and showing empathy.

    “In particular, patients with CLBP often express a desire for physician interactions that involve listening and showing empathy in such various ways as getting to know them, understanding how pain affects their lives, and not feeling rushed through their office visits [33].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [33] Evers, S, Hsu, C, Sherman, KJ, Balderson, B, Hawkes, R, Brewer, G, et al.. Patient perspectives on communication with primary care physicians about chronic low back pain. Perm J 2017;21:16–177. https://doi.org/10.7812/tpp/16-177. source
  • Premisecitation
    § Discussion

    Previous research did not find physician empathy to be a significant mediator of the OMC total treatment effect.

    “Previous research did not find physician empathy to be a significant mediator of the OMC total treatment effect [7].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [7] Licciardone, JC, Aryal, S. Patient-centered care or osteopathic manipulative treatment as mediators of clinical outcomes in patients with chronic low back pain. J Osteopath Med 2021;121:795–804. https://doi.org/10.1515/jom-2021-0113. source
  • Classified as probably not a substantial claim. 29
  • May combine two claims. 9
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Abstract

    Previous research found that OMT was a significant mediator of the pain reduction reported by patients with CLBP treated by osteopathic physicians.

    “Previous research found that OMT was a significant mediator of the pain reduction reported by patients with CLBP treated by osteopathic physicians [7].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] Licciardone, JC, Aryal, S. Patient-centered care or osteopathic manipulative treatment as mediators of clinical outcomes in patients with chronic low back pain. J Osteopath Med 2021;121:795–804. https://doi.org/10.1515/jom-2021-0113. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Abstract

    Emerging evidence indicates that patients with low back pain view osteopathic physicians as more empathic than their allopathic counterparts.

    “Emerging evidence indicates that patients with low back pain view osteopathic physicians as more empathic than their allopathic counterparts [15].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Licciardone, JC, Schmitt, ME, Aryal, S. Osteopathic and allopathic physician interpersonal manner, empathy, and communication style and clinical status of their patients: a pain registry-based Study. J Am Osteopath Assoc 2019;119:499–510. https://doi.org/10.7556/jaoa.2019.092. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Abstract

    Physician empathy is strongly associated with satisfaction with pain care.

    “Physician empathy is another aspect of the patientphysician relationship that is strongly associated with satisfaction with pain care [13,14].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [13] Walsh, S, O’Neill, A, Hannigan, A, Harmon, D. Patient-rated physician empathy and patient satisfaction during pain clinic consultations. Ir J Med Sci 2019;188:1379–84. https://doi.org/10.1007/s11845-019-01999-5. source
    • cites [14] Licciardone, JC, Patel, S, Kandukuri, P, Beeton, G, Nyalakonda, R, Aryal, S. Patient satisfaction with medical care for chronic low back pain: a pain research registry study. Ann Fam Med 2023;21:125–31. https://doi.org/10.1370/afm.2949. source

  • Classified as probably not a substantial claim.

    Premisecitation
    § Discussion

    Prior research has shown that patients with CLBP report osteopathic physicians being more empathic than allopathic physicians.

    “prior research has shown that patients with CLBP report osteopathic physicians being more empathic than allopathic physicians [15].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] Licciardone, JC, Schmitt, ME, Aryal, S. Osteopathic and allopathic physician interpersonal manner, empathy, and communication style and clinical status of their patients: a pain registry-based Study. J Am Osteopath Assoc 2019;119:499–510. https://doi.org/10.7556/jaoa.2019.092. source

  • May combine two claims.

    Interpretationcitation
    § Discussion

    A stronger patient-physician alliance may enhance adherence to treatment recommendations, thereby promoting better outcomes as observed in this study.

    “which may enhance adherence to treatment recommendations [34], and thereby promote better outcomes as observed in our study.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [34] Dorflinger, L, Kerns, RD, Auerbach, SM. Providers’ roles in enhancing patients’ adherence to pain self management. Transl Behav Med 2013;3:39–46. https://doi.org/10.1007/s13142-012-0158-z. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    In the previous study, OMT was identified as a mediator of the OMC total treatment effect for one of three clinical outcomes (low back pain intensity).

    “Parenthetically, it should be noted that OMT was identified as a mediator of the OMC total treatment effect for one of three clinical outcomes (i.e., low back pain intensity) in the previous study [7], but not in this study.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] Licciardone, JC, Aryal, S. Patient-centered care or osteopathic manipulative treatment as mediators of clinical outcomes in patients with chronic low back pain. J Osteopath Med 2021;121:795–804. https://doi.org/10.1515/jom-2021-0113. source

  • May combine two claims.

    Study design and conductcitation
    § Discussion

    The number of participants included was about twice as great as in the previous study, thereby increasing statistical power to detect significant mediation effects.

    “Finally, the number of participants included was about twice as great as in the previous study [7], thereby increasing statistical power to detect significant mediation effects [31].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [7] Licciardone, JC, Aryal, S. Patient-centered care or osteopathic manipulative treatment as mediators of clinical outcomes in patients with chronic low back pain. J Osteopath Med 2021;121:795–804. https://doi.org/10.1515/jom-2021-0113. source
    • cites [31] Fritz, MS, Mackinnon, DP. Required sample size to detect the mediated effect. Psychol Sci 2007;18:233–9. https://doi.org/10.1111/j.1467-9280.2007.01882.x. source

  • Classified as probably not a substantial claim.

    Premisecitation
    § Discussion

    Physician empathy has been associated with a stronger patient-physician alliance.

    “Physician empathy has been associated with a stronger patient-physician alliance, which may enhance adherence to treatment recommendations [34], and thereby promote better outcomes as observed in our study.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [34] Dorflinger, L, Kerns, RD, Auerbach, SM. Providers’ roles in enhancing patients’ adherence to pain self management. Transl Behav Med 2013;3:39–46. https://doi.org/10.1007/s13142-012-0158-z. source

  • May combine two claims.

    Findingown data
    § Abstract

    In a multivariable model, participants treated by osteopathic physicians reported less severe nausea as an adverse event potentially attributable to opioids, but this result was not clinically relevant.

    “Although participants treated by osteopathic physicians reported less severe nausea and vomiting as adverse events potentially attributable to opioids in a multivariable model, neither result was clinically relevant.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The type of treating physician reported by participants accurately reflects whether their physician was osteopathic or allopathic.

  • The quote only partly states this claim.

    Findingown data
    § Effectiveness outcomes

    The univariable difference in low back pain intensity between osteopathic and allopathic physician groups was clinically relevant.

    “These univariable results were clinically relevant, with d scores ranging from 0.27 for HRQOL to 0.38 for physical function.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Abstract

    In a multivariable model, participants treated by osteopathic physicians reported less severe vomiting as an adverse event potentially attributable to opioids, but this result was not clinically relevant.

    “Although participants treated by osteopathic physicians reported less severe nausea and vomiting as adverse events potentially attributable to opioids in a multivariable model, neither result was clinically relevant.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The type of treating physician reported by participants accurately reflects whether their physician was osteopathic or allopathic.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning
    § Safety outcomes

    To minimize potential reporting bias among opioid users, safety items asked participants about each symptom generally rather than asking them to assign attribution to a particular drug or medical condition, blinding participants to the purpose of these items.

    “To minimize potential reporting bias among opioid users, these items asked participants about each symptom generally rather than asking them to assign attribution to a particular drug or medical condition (i.e., participants were blinded to the purpose of these items).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Measures of the patient-physician relationship

    The Communication Behavior Questionnaire was developed and validated as a measure of patient preferences regarding physician communications pertaining to low back pain.

    “The Communication Behavior Questionnaire was developed and validated as a measure of patient preferences regarding physician communications pertaining to low back pain [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Farin, E, Gramm, L, Schmidt, E. Taking into account patients’ communication preferences: instrument development and results in chronic back pain patients. Patient Educ Counsel 2012;86:41–8. https://doi.org/10.1016/j.pec.2011.04.012. source

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Treating physician for low back pain

    Participants who reported having an osteopathic physician at enrollment and then having an allopathic physician at a subsequent encounter, or vice versa, were considered to have physician crossover and were excluded from the study.

    “Participants who reported having an osteopathic physician at enrollment and then having an allopathic physician at a subsequent encounter (or vice versa) were considered to have physician crossover and were excluded from the study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation
    § Abstract

    Holistic and patient-centered approaches have been recognized as potentially unique aspects of osteopathic medical care.

    “Holistic and patient-centered approaches have also been recognized as potentially unique aspects of osteopathic medical care (OMC) [6,8].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] American Medical Association. AOA and AMA stand against misrepresentation of osteopathic physicians. Published 2020 https://www.ama-assn.org/press-center/ama-statements/aoa-and-ama-stand-against-misrepresentation-osteopathic-physicians [Accessed 20 February 2023].

      Not checked in the free run.

    • cites [8] Howell, JD. The paradox of osteopathy. N Engl J Med 1999;341:1465–8. https://doi.org/10.1056/nejm199911043411910. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Abstract

    The American Medical Association has acknowledged that the distinctive training of osteopathic physicians may enable them to treat such conditions as chronic low back pain without resorting to opioids or other pharmacological treatment.

    “The American Medical Association has acknowledged that the distinctive training of osteopathic physicians may enable them to treat such conditions as chronic low back pain (CLBP) without resorting to opioids or other pharmacological treatment [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] American Medical Association. AOA and AMA stand against misrepresentation of osteopathic physicians. Published 2020 https://www.ama-assn.org/press-center/ama-statements/aoa-and-ama-stand-against-misrepresentation-osteopathic-physicians [Accessed 20 February 2023].

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Statistical analysis

    Multivariable analyses utilized participant age, gender, race, ethnicity, and general health to control for potential confounding.

    “The aforementioned univariable analyses were repeated as multivariable analyses utilizing participant age, gender, race, ethnicity, and general health (measured as the sum of current comorbidities reported at registry enrollment) to control for potential confounding.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Measures of the patient-physician relationship

    The Consultation and Relational Empathy measure was developed and validated as a process measure of empathy during physician encounters for primary care.

    “The Consultation and Relational Empathy measure was developed and validated as a process measure of empathy during physician encounters for primary care [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Mercer, SW, Maxwell, M, Heaney, D, Watt, GC. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract 2004;21:699–705. https://doi.org/10.1093/fampra/cmh621. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Additional information

    This study was approved by the North Texas Institutional Review Board (protocol 2015-169).

    “This study was approved by the North Texas Institutional Review Board (protocol 2015-169); ClinicalTrials registry number: NCT04853732.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning
    § Discussion

    The study utilized participants in a national pain research registry, rendering the results more generalizable to patients with CLBP throughout the United States.

    “First, it utilized participants in a national pain research registry, thereby rendering the results more generalizable to patients with CLBP throughout the United States.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Discussion

    The digital research platform utilized by the registry provided electronic data capture and precluded missing data during any encounters undertaken by participants.

    “Second, the digital research platform utilized by the registry provided electronic data capture and precluded missing data during any encounters that were undertaken by participants.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Discussion

    OMT use was based on a composite measure requiring participant reporting of the use of spinal manipulation and current treatment for low back pain by an osteopathic physician.

    “Second, OMT use was based on a composite measure requiring participant reporting of the use of spinal manipulation and current treatment for low back pain by an osteopathic physician.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Mediation analysis

    Of the mediation analysis participants, 121 (15.1%) were treated by osteopathic physicians and 680 (84.9%) by allopathic physicians.

    “There were 121 (15.1 %) participants treated by osteopathic physicians and 680 (84.9 %) participants treated by allopathic physicians.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Discussion

    Adjustment for additional participant demographic characteristics and general health was performed in the mediation analyses.

    “Second, adjustment for additional participant demographic characteristics and general health was also performed in the mediation analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning
    § Conclusions

    These findings support the claim that osteopathic physicians offer a unique, patient-centered approach to medical care that enhances clinical outcomes.

    “These findings support the claim that osteopathic physicians offer a unique, patient-centered approach to medical care that enhances clinical outcomes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The mediation analyses assume no unmeasured confounding of the mediator-outcome relationships.
    • Rests on an assumption: The OMC total treatment effect can be interpreted as a causal effect of osteopathic medical care.
    • Rests on an assumption: Physician empathy measured at registry enrollment is a valid and stable measure of the physician's empathy over the 12-month follow-up.

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Mediation analysis

    A total of 801 participants were included in the mediation analysis.

    “A total of 801 participants were included in the mediation analysis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Discussion

    The mediation analyses required complete data for all participants.

    “Third, the mediation analyses required complete data for all participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Discussion

    The registry routinely collected data that facilitated mediation analyses involving four possible mediators and five potential confounders.

    “Finally, the registry routinely collected data that facilitated mediation analyses involving four possible mediators and five potential confounders.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § Discussion

    The complete-data requirement reduced the sample size from 1,079 to 801 participants.

    “This reduced the sample size from 1,079 to 801 participants.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Discussion

    A more comprehensive multiple mediator model for each outcome was utilized, including potentially four mediators.

    “First, a more comprehensive multiple mediator model for each outcome was utilized, including potentially four mediators.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Additional information

    All participants provided informed consent prior to entering the study.

    “All participants in this study provided informed consent prior to entering the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § Discussion

    OMT may have been misclassified if spinal manipulation was provided by chiropractors, physical therapists, or other manual therapy providers rather than by osteopathic physicians.

    “However, OMT may have been misclassified if spinal manipulation was provided by chiropractors, physical therapists, or other manual therapy providers rather than by osteopathic physicians.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    There is evidence of a neural basis for empathy derived from brain studies involving functional magnetic resonance imaging (MRI), particularly within the anterior insula and anterior cingulate cortex.

    “There is also evidence of a neural basis for empathy derived from brain studies involving functional magnetic resonance imaging (MRI), particularly within the anterior insula and anterior cingulate cortex [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Bernhardt, BC, Singer, T. The neural basis of empathy. Annu Rev Neurosci 2012;35:1–23. https://doi.org/10.1146/annurev-neuro-062111-150536. source

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Discussion

    The results were adjusted for participant age, gender, race, ethnicity, and general health.

    “The results were adjusted for participant age, gender, race, ethnicity, and general health.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Additional information

    The study was registered with ClinicalTrials registry number NCT04853732.

    “ClinicalTrials registry number: NCT04853732.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Such studies have demonstrated consistency in activations in parts of the pain network elicited by first-hand pain experience and vicariously felt pain.

    “Such studies have demonstrated consistency in activations in parts of the pain network elicited by first-hand pain experience (e.g., by the patient) and vicariously felt pain (e.g., by the physician).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Bernhardt, BC, Singer, T. The neural basis of empathy. Annu Rev Neurosci 2012;35:1–23. https://doi.org/10.1146/annurev-neuro-062111-150536. source
36 of 36

  • The paper relies on this without support.

    Osteopathic physicians are trained to treat patients with musculoskeletal symptoms, to treat somatic dysfunction with osteopathic manipulative treatment, and to avoid unnecessarily prescribing drugs such as opioids.

    “Osteopathic physicians are trained to treat patients with musculoskeletal symptoms, to treat somatic dysfunction with osteopathic manipulative treatment (OMT), and to avoid unnecessarily prescribing drugs such as opioids.”

  • The paper relies on this without support.

    The type of treating physician reported by participants accurately reflects whether their physician was osteopathic or allopathic.

    “The registry collected treating physician data at enrollment and each quarterly encounter utilizing an item wherein participants were offered the response options”

  • The paper relies on this without support.

    The multiple mediator model's causal ordering and no-unmeasured-confounding assumptions hold.

    “A comprehensive multiple mediator model was utilized to further assess any significant difference in effectiveness outcomes reported by participants treated by osteopathic vs. allopathic physicians.”

  • The paper relies on this without support.

    The mediation analyses assume no unmeasured confounding of the mediator-outcome relationships.

    “The results were adjusted for participant age, gender, race, ethnicity, and general health.”

  • The paper relies on this without support.

    The OMC total treatment effect can be interpreted as a causal effect of osteopathic medical care.

    “participants were not randomized to OMC or allopathic medical care.”

  • The paper relies on this without support.

    Physician empathy measured at registry enrollment is a valid and stable measure of the physician's empathy over the 12-month follow-up.

    “Physician communication and physician empathy were measured at registry enrollment with the Communication Behavior Questionnaire and Consultation and Relational Empathy measure, respectively.”
6 of 6

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. American Osteopathic Association. Osteopathic medical profession report, 2020–2021. Chicago, IL: American Osteopathic Association; 2021:1–12 pp. https://osteopathic.org/wp-content/uploads/OMP-Report-2020-21.pdf [Accessed 17 May 2023].
  2. American Medical Association. AOA and AMA stand against misrepresentation of osteopathic physicians. Published 2020 https://www.ama-assn.org/press-center/ama-statements/aoa-and-ama-stand-against-misrepresentation-osteopathic-physicians [Accessed 20 February 2023].

Cited by

Sorted by citations

Related

Authors
Licciardone, J. C., Kellerlee, J., Joseph, M., Mohammad, M. B., Kim, K. G., Jain, J., & Aryal, S.
Affiliations
  • University of North Texas Health Science Center (US)
  • University of Pennsylvania (US)
Corresponding author
Licciardone, John C.
ORCID
Venue
Journal of Osteopathic Medicine
Publisher
Walter de Gruyter GmbH
Published
2023-05-25
Volume
123
Issue
8
Pages
385-394
ISSN
2702-3648 (ISSN-L)
DOI
10.1515/jom-2023-0046
OpenAlex
W4377965383
Semantic Scholar
78c33979de8179b1b6de62fcdeedc43194a75fd6
Cited by
5
References
32
Citations by year
2026: 3 · 2025: 1 · 2024: 1
FWCI
0.64
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Osteopathic Medicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
chronic low back pain, osteopathic medicine, osteopathic manipulative treatment, allopathic physicians, physician communication, physician empathy, opioid prescribing, treatment outcomes, patient-centered care, musculoskeletal pain management, patient satisfaction, patient-reported outcomes, patient satisfaction with physician
MeSH terms
Adult, Analgesics, Opioid, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Quality of Life, Retrospective Studies, Low Back Pain, Osteopathic Physicians

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-23.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-23.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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