Stage 2 Delivery and Evaluation of an Integrated Osteopathy, Mindfulness and Acceptance-based Programme for Patients With Persistent Pain

The OsteoMAP course is a new clinical intervention integrating Mindfulness and Acceptance-based approaches of Cognitive Behavioural Therapy with manual therapy for patients with persistent pain. In Stage 1 (in progress, June 2013 to April 2014) an intervention for individual patients of six, structured, one hour sessions was piloted by osteopaths at the British School of Osteopathy (BSO) in London with patients already attending the osteopathic clinic. In Stage 2 (awaiting ethical approval, September 2014 to May 2016) recruitment will be expanded to include NHS patients referred from, and treated in, participating GP practices in South East London. The study aims to assess whether participants report improved quality of life, well-being and engagement in personally-valued activities six months after their course ends.

Osteopathy is a low risk form of manual therapy that promotes physical functioning in the musculoskeletal system. Acceptance-based approaches promote a way of thinking that encourages acceptance of unwanted experiences (i.e. symptoms which cannot be fully resolved) by recognising that emotions, thoughts and physical sensations do not necessarily control behaviour. Chronic pain is an increasing healthcare burden with significant psychological, social and economic consequences but there is evidence that Mindfulness can be effective with a range of mental and physical health problems, including chronic pain.

This observational evaluation study includes a 'before-and-after' patient-reported outcome study with an embedded qualitative interview study and a fidelity evaluation. There is no control group or comparison with standard care. The programme was funded as a new service development, not primary research, but will generate new data from pre and post course measures using standardised self-report questionnaires at baseline and after six months. The fidelity assessment of adherence and competence will evaluate whether the course being delivered as intended, independently observed by a team from the National Council for Osteopathic Research (NCOR).

Recruitment: Posters will be placed in participating surgeries with information sheets for doctors who wish to discuss the OsteoMAP course with patients. Patients will be invited to 'opt in' by completing application forms and invited to Pre-Course Interviews to screen for eligibility and discuss the nature and potential benefits and risks of joining an experiential course. Patients will complete standardised questionnaires before their interview, either electronically on a laptop computer which submits data directly to the evaluation team via Survey Monkey, or as paper copies with stamped addressed envelopes.

Pre-Course interviews aim to explore patients' willingness to try a new approach to pain management and assess motivation and scope for change. Patients will be told about potential psychological risks, as they will be invited to think about the full impact of pain and to increase their awareness of both pleasant and painful experiences. Joint decisions will be made about whether it is appropriate for a patient to join. If it is not clear, the patient will be asked for permission to contact their doctor before a decision is made.