VCOM Research Day Program Book 2023

Medical Resident Research Cl inical

01 Ultrasound Assessment of OMT on Diaphragm Motion

Nicholas Snow, DO; Christian DeDi, OMS III; Stephanie Rathjen, OMS III; Albert J Kozar, DO, FAOASM, R-MSK; Luke Robinson, DO, DABMA Corresponding author: Nsnow01@vcom.edu

Edward Via College of Osteopathic Medicine-Virginia Campus; VCOM Sports & Osteopathic Medicine

diaphragm motion assessments were completed using multiple B-mode and M-mode US images. Measurements included static and dynamic grey scale (B-mode) morphologic diaphragm thickness, changes in superior diaphragm elevation distance during both tidal (resting) and maximal inhalation, and M-mode motion variation during both tidal (resting) breath and maximal inhalations. US images were obtained bilaterally and at both the zone of apposition and the dome of the diaphragm. Each subject underwent osteopathic screening exam utilizing the area of greatest restriction (AGR). No more than 3 regions with the greatest restrictions were treated with OMT. Then, an OMT protocol adapted from the Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) trial was used. Total time for OMT was limited to 15 minutes. Statistical analysis included sample mean and standard deviation for continuous measures, proportions to summarize categorical characteristics, and paired t-tests to measure changes in pre- and post-diaphragm measurements. Careful attention was paid to the normality assumption using a normal probability plot and adjusted with Wilcoxon

Rank Sum. Given the pilot nature of this study, we hope to demonstrate the feasibility of the methods and provide variance estimates to inform the statistical power calculation of a larger trial. Results: Data is pending but will be complete and analyzed fully for VCOM Research Day. Discussion/Conclusion: We expect a statistically significant increase in diaphragmatic motion after receipt of OMT. If the results are significant, we plan to extend the project to a prospective, randomized study in subjects with and without chronic pulmonary diseases.

Introduction/Background: Osteopathy has long sought to improve the overall health of an individual. As an essential function of life, thoracic respiratory efficiency is taught to be an important focus of Osteopathic Manual Therapy (OMT). Objective/Hypothesis: This prospective, observational pilot study aims to determine if and how much OMT can affect respiratory efficiency via changes in diaphragm motion based on ultrasound (US) measurements obtained before and after treatment. We hypothesize that OMT will increase diaphragmatic movement significantly, both at rest and with maximal effort. Methods: 10-20 “healthy” male & female volunteers were recruited. Inclusion criteria included subjects age 18-40 with at least 2 regions of somatic dysfunction on screening exam. Exclusion criteria included any chronic pain, neuromuscular, neurological, pulmonary, or sleep disorder; any prior abdominal, chest or spinal surgery; BMI>30; or current active infection. A pre-OMT and post-OMT

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