Adverse events

It is a patient’s right to be made as fully aware as possible of any known risks associated with a healthcare intervention, before consenting to treatment. Standard A4 of the Osteopathic Practice Standards relates to the exchange of information between patients and practitioners and the expectations associated with consent procedures.

Understanding potential risk

To gain a better understanding of any potential risk that may be associated with osteopathic care, four interlinked research projects were funded by the GOsC.
This systematic investigation of adverse events associated with osteopathic care aims to inform and guide osteopaths’ practice and enhance patient safety. Previously, almost all the available information about adverse reactions to manual therapy was based on chiropractic or physiotherapy research.

The adverse events studies

This GOsC programme of research comprised four studies.

Adverse events associated with physical interventions in osteopathy and relevant manual therapies

The research team (Dawn Carnes, Thomas Mars, Brenda Mullinger and Martin Underwood) carried out a systematic review of published literature to investigate the risks associated with manual therapy. The searches were carried out during
March 2008.

The resulting report is available here as Adverse events in manual therapy: a systematic review.

In addition, two articles based on the review were published in the journal Manual Therapy, and republished in the International Journal of Osteopathic Medicine, September 2010. They are available here by kind permission of Elsevier and can be downloaded below.

The study was undertaken as a joint collaboration between Barts and The London School of Medicine and Dentistry, University of London; the European School of Osteopathy; and Warwick Medical School.

Communicating risks of treatment and informed consent in osteopathic practice

The aim of this study was to provide guidance to osteopaths on good practice relating to communicating with patients about any risks of treatment. A wide-ranging literature review provided initial evidence and points of particular relevance for osteopathic practice were drawn out.

Some information material on risks and benefits in osteopathic practice was drafted, based on the recommendations in the literature, and this was piloted in two focus groups of osteopaths and osteopathic patients. The resulting report includes the results of the focus group pilots and each chapter of the report concludes with key messages for osteopaths.

The research team was led by Dr Janine Leach and also included Dr Anne Mandy, Matthew Hankins, Rachel Ives, Vinette Cross, Mark Cage, Kevin Lucas.

Insurance claim trends and patient complaints to the profession’s regulator

This study examined the nature and frequency of complaints made about osteopaths and insurance claims against them during the period 2004-2008. The resulting report Complaints and claims against osteopaths: a baseline study of the frequency of complaints 2004-2008 and a qualitative exploration of patients' complaints contains a number of recommendations, including measures to reduce the frequency of complaints and to help ensure patients feel supported when they complain.

The research team was led by Dr Janine Leach and also included Adam Fiske, Dr Anne Mandy, Professor Elizabeth West, Brenda Mullinger and Rachel Ives.

Investigation of osteopaths’ attitudes to managing and assessing risk in clinical settings and patients’ experiences and responses to osteopathic treatment

The aims of the Clinical Risks Osteopathy and Management (CROaM) study were to:

  • provide a description of UK osteopaths' risk assessment, and risk management
  • document reported adverse events and treatment reactions in patients
  • develop a model of practitioners' and patients' perceptions and beliefs about adverse events and treatment reactions
  • enable an evaluation of comparative risks and benefits of osteopathic treatment.

The research team was led by Steven Vogel and also included Thomas Mars,
S Keeping, T Barton, Nadine Marlin, Dr Rob Froud, Dr Sandra Eldridge,
Professor Martin Underwood and Professor Tamar Pincus.

The findings include extensive new data that is relevant to:

  • the training of osteopaths
  • the development of guidance for practitioners and strategies for minimising risk to patients, notably the assessment of the frequency and character of minor and major adverse events
  • the analysis of the patient experience.

The results are published in a full report, and a summary report is also available.