A workforce survey of Australian osteopathy: analysis of a nationally-representative sample of osteopaths from the Osteopathy Research and Innovation Network (ORION) project

The Osteopathy Research and Innovation Network (ORION) project is the first national PBRN of osteopaths in Australia (http://​www.​orion-arccim.​com/) and the recruitment of this project was conducted from July to December 2016. The ORION recruitment invitation pack included an online practitioner questionnaire (accessed via SurveyGizmo™) as well as a consent form relating to joining the ORION PBRN database.

Osteopathy Australia (OA) is a national professional organization representing more than 85% of registered osteopaths in Australia. The invitation pack was distributed to all registered osteopaths via OA networks for OA members and via osteopathy-related conferences/events and the ORION website for non-OA members. Participants were directed to the ORION website (containing the online practitioner questionnaire) and recruitment emails enclosed embedded links directly to the questionnaire. Several email reminders were circulated following the initial invitation pack. The ORION project is designed and conducted by senior researchers at the Faculty of Health, University of Technology Sydney independent of OA who funded the project. This project has been approved by the UTS Human Ethics Committee (approval # 2014000759).

Participants were invited to complete the online practitioner questionnaire and provide consent to be an ongoing member of the ORION PBRN project. The analyses presented in this article report data gathered from all participants who completed the questionnaire regardless of whether the participant provided consent or did not provide consent to be an ongoing member of the ORION PBRN database.

A questionnaire with 27 items was administered to registered osteopaths in Australia (Additional file 1). The questionnaire examined osteopathic practitioner characteristics, practice characteristics, clinical management, and research engagement. Participants were questioned about their age, gender, highest osteopathy professional qualification, years in private osteopathy practice, professional organization membership, and roles they have been involved in as an osteopath in the previous 12 months. With regards to practice characteristics the participants were questioned regarding their average patient care hours per week, average patient visits per week, number of practice locations, other health professionals working in the same practice location, professional referral relationships (sending and receiving referrals separately), State/Territory of practice, practice location (urban, rural, remote), use of diagnostic imaging and reason(s), techniques used to assist in clinical diagnosis, use of electronic records and specified software(s) for electronic records, and frequency of using eHealth system, HICAPs and Medicare Easyclaim. Osteopathic clinical management measures consisted of the frequency of discussion with patients in their care/management plan such as diet/nutrition, physical activity/fitness, and medication, frequency of treating patients with a broad range of conditions (including musculoskeletal disorders and non-musculoskeletal disorders), broader patient subgroups (such as older people, people with sports-related injuries, and people with work-related injuries) of those treated, a wide range of techniques/methods (such as strain, soft tissue, and functional techniques) employed in patient management, and perceptions regarding a variety of osteopathy practice issues (such as prescribing rights, expanded referral rights to medical specialists, and expanded diagnostic imaging rights). In addition, the ORION participants were asked about their perceptions relating to a number of issues around osteopathy research.

All data were imported into the statistical software Stata 14. Variables regarding the frequency of osteopaths’ clinical practice and management (response options: never, rarely, sometimes, often) were re-categorised as ‘often’ and ‘never/rarely/sometimes’. Dichotomous and categorical variables are presented in frequencies and percentages and continuous variables are shown in means and standard deviations.

The average age of participants was 38.0 (SD = 10.9) years, with 58.1% being female. The average number of years in private osteopathy practice was 11.4 (SD = 9.0) years. More than half (68.7%) of the osteopaths held a Masters degree related to the osteopathy profession, while 21.6% of participants held a Bachelor or double Bachelor degree related to the osteopathy profession and only 0.5% had a PhD related to the osteopathy profession. In addition to private practice, the respondents also report being involved in other roles as an osteopath in the last 12 months, including volunteer work (16.0%), clinical supervision (15.1%), university teaching (11.7%), professional organisations (10.8%), and research (5.4%).

The respondents spent an average of 28.3 (SD = 11.8) hours per week on patient care and facilitated an average of 37.0 (SD = 18.2) patient visits per week (only 791 participants provided information on the patient visits per week). Most osteopaths report practicing in one location (65.0%), but of those who practice in more than one location, 85.4% practice in two locations and 12.3% practice in three locations. A total of 829 (83.7%) osteopaths practice in a multi-practitioner location, with 64.8% working with another osteopath, 50.5% working with a massage therapist, 19.5% working with a naturopath, 19.3% working with a psychologist or counsellor, and 19.0% working with an acupuncturist in the same practice location. General practitioners (GPs) are the most common health professional to whom osteopaths send referrals (88.5%) as well as the most common health professional from whom the osteopaths report receiving referrals (89.3%), followed by massage therapists (sending: 67.6%; receiving: 76.0%), another osteopath (sending: 51.0%; receiving: 61.9%) and podiatrists (sending: 65.6%; receiving: 47.5%) (Table 1).

The majority of respondents are working in (State/Territory) Victoria (56.4%), followed by New South Wales (26.5%), Queensland (9.0%), Western Australia (3.2%), Tasmania (2.2%), South Australia (1.8%), Australian Capital Territory (1.7%), and the Northern Territory (0.2%). The majority of osteopaths (81.8%) report practicing in an urban area, with only 18.2% practicing in a rural or remote area. More than half (55.9%) of all the osteopaths ‘sometimes’ or ‘often’ refer their patients for diagnostic imaging, and investigation of suspected diagnosis, potential fractures, and unknown pathologies are the most common reasons for the use of diagnostic imaging. In terms of the techniques used to assist in clinical diagnosis, orthopaedic testing (97.6%) and neurological testing (92.5%) are the most frequent options reported amongst the osteopaths. Electronic patient records are commonly used amongst the participants with 73.2% of all the osteopaths using electronic records for initial history, 76.2% for subsequent patient visits, and 74.1% for examination findings.

The osteopaths typically discuss a number of topics as part of their care/management plans with the patients (Table 2). The most often discussed topics are physical activity/fitness (89.4%), occupational health and safety (51.2%), and stress management (49.4%). People with sports-related injuries (50.6%), people with work-related injuries (36.2%), and pregnant women (34.7%) are the patient subgroups most often consulting the participants. In terms of conditions presented by patients, musculoskeletal disorders are the most frequently treated by the respondents with low back pain (98.7%), neck pain (98.0%), thoracic pain (91.7%) and headache disorders (90.1%) the most common musculoskeletal conditions presented by patients to the respondents (Table 2).

The osteopaths report employing a wide range of techniques and methods in their patient management (Table 3), including soft tissue techniques (85.7%), muscle energy techniques (79.5%), and exercise prescription (74.0%). In terms of the future directions of osteopathy, most of the respondents report they would like to see expanded diagnostic imaging rights (83.0%) and expanded referral rights to a number of specialists including sports medicine specialists (79.8%), orthopaedic surgeons (70.9%), and rheumatologists (63.5%).

A majority (74.9%) of respondents report that evidence from research has a moderate to high impact upon their current osteopathy practice (Table 4). The majority of participants consider osteopathy research as useful in: helping patients understand the benefits of osteopathy for their health (84.1%); helping GPs and other conventional health professionals understand the role of osteopathy in health care (93.9%); and providing scientific evidence for what they do as an osteopath (87.3%).