Osteopathy is a science that is aimed at primary and preventive healthcare and takes a global approach to the individual, emphasizing the relationship between structure and function. It is a primary contact healthcare profession, and so osteopaths' basic and continuing training must guarantee patient safety. The standards of education of osteopaths and their implementation vary significantly worldwide. Although some countries have raised the level of training to a university degree, gaps still exist. Higher education standards provide more complete, rigorous, and evidence-based training, significantly improving the quality of consultations. The authors aim to show how evidence-based practice can be a useful methodology not only for clinical practice but also in undergraduate training, improving patient safety and reducing the risk of adverse events. They focus on the cooperation of osteopathy with other health areas. Sources of evidence applied to osteopathy are provided, and the importance of continuous professional development and remote learning are discussed.
TopIntroduction
Context of Osteopathy
Osteopathy is a science that studies somatic dysfunctions, applies differential diagnosis, and using manual techniques contributes to the individual's regeneration. It is aimed at primary and preventive health care, emphasizing the interrelationship between structure and function, considering a global approach to the individual. For this approach, the complete integration of the patient in their sociocultural context and emotional component is essential because, for the osteopath, structural changes can have different origins (Chila, 2012; WHO, 2010).
For training professionals in this area, the development of competencies in the three domains of knowledge is essential: knowing how to know, knowing how to do, and knowing how to be. The osteopath is a health professional who must master a thorough knowledge of Anatomy, Physiology, Neurology, Pathophysiology, Biomechanics, as well as many other components so that during the appointment, in front of the patients and their symptoms will be able to rule out conditions that offer contraindications to the treatment and that may require differentiated clinical care. In the presence of these scenarios, the osteopath must know how to refer the patient to the medical specialty most suitable to the clinical condition, contributing to an early diagnosis and a better provision of health care (Portaria No207-B/2014, 2014).
Osteopathy is sometimes a primary contact healthcare profession so it is crucial to ensure the professional´s basic and continuing training so that the patient's safety is always guaranteed (WHO, 2010; Portaria No207-B/2014, 2014).
Education
The standards of education, training and practice of osteopaths are very diverse, varying significantly across different countries. The regulation of this profession has been implemented at different stages and speeds, which means that we have places, such as the USA, where Osteopathy is considered a medical specialty in opposition to other places, such as several European countries, where training is considered vocational nature (Luciani et al., 2015).
In addition to this difference, there are courses with more than 4200 hours and others with less than 1000 contact hours. This reality compromises the quality of the service provided by osteopaths, and it is urgent to standardize the training of these professionals (WHO, 2010; Hempstead et al, 2018; Ward & Retz, 1998; Luciani et al., 2015).
Countries of reference for the practice of Osteopathy, such as the United Kingdom, Australia, New Zealand, Finland and, Portugal, have raised the level of osteopaths training to a higher education degree (Leach et al., 2019). This higher education standards, allows for a more complete, rigorous, and evidence-based training, which contributes to a significant improvement in the quality of appointments provided by these professionals. This seems to be the right path for all countries that have not yet achieved such high standards (Luciani et al., 2018).
Evidence-Based Practice (EBP)
EBP is an approach based on the best existing scientific evidence, to guide health professionals in clinical practice and decision-making, integrating critical thinking and clinical experience with the patient's preferences and values (Kyriakoulis et al.,2016; Straus et al., 2019).
It is a very useful methodology not only for the osteopath´s clinical practice but also as a pilar for their undergraduate training. Teaching is conducted using clinical exercises to develop the student's autonomy for making clinical decisions. The curricula of osteopath training courses should include clinical training methods using real cases so students can in a monitored way learn clinical performance strategies aimed above all for patient´s safety.