School of Osteopathic Medicine. Today I'll be presenting on perceptions of osteopathic medicine in a rural clinic in Peru. A little bit of background before we begin. Iquitos, Peru is the capital of the poorest region of this country where unfortunately many patients struggle to afford medications and treatments. Additionally, specialized treatment is not always realistic due to the remoteness and geographical isolation from Lima of this region. OMT has been shown to benefit patient outcomes and reduce pain. Additionally, OMT may be beneficial in remote and underserved areas. A point of note is that there are currently no doctor of osteopathic training programs in Peru. There have been previous studies aiming to introduce OMT to medical professionals or medical students in this country. However, there has been no studies to examine the patient experience. Each year WVSOM's chapter of DoCare International charters a global health outreach trip to Iquitos and this year's trip students and physicians sought to survey patients to understand and assess the knowledge and perceptions of OMT in Iquitos, Peru. A couple of goals of this study were to identify existing knowledge, identify how this field of medicine is perceived by patients at the OMT clinic, as well as to identify any knowledge gaps to address in future trips. Moving on to the methods, this was a survey of 51 patients offered to any patient over the age of 18 referred with musculoskeletal complaints to the OMT clinic in Iquitos in March of 2024. Materials were offered in American English or Peruvian Spanish. There was no blinding or randomization. Due to the nature of the survey and the fact that there was no collection of identifying data, study was deemed exempt from IRB approval. Surveys were administered by six WVSOM students in Spanish with an interpreter available as needed. There was a log kept to track if patients received OMT or not and inclusion criteria was anyone over the age of 18. Exclusion criteria for the study was anyone who didn't want to participate, anyone who was unable to complete the survey for reasons of poor eyesight or anything along those lines, as well as anyone who was younger than 18 was excluded. Since the study was IRB exempt, patients were presented with a cover letter in lieu of informed consent and gave verbal consent to participate. If patients did not wish to participate, they continued to their appointment receiving standard of care. If patients chose to participate, they began by filling out the pre-survey which asked questions about demographics like age, gender, and occupation, which were categories created based on categories from the previous Peruvian census. We also asked about pain location using a diagram and pain severity on a scale from 0 to 10. Two questions on the pre-survey were prior to today, have you ever heard of OMT? And if so, what is your current impression of OMT? After this, the patients moved on to completing the EQ5D, which was a validated survey we obtained permission to use in Peruvian Spanish. This assessed for mobility, self-care, usual activities, pain and discomfort, anxiety and depression, as well as overall health. Following the completion of the EQ5D, patients moved on to their appointment where they received standard of care. All patients saw one provider who was an osteopathic physician with 33 years of experience. All patients received either direct or indirect techniques, OMT techniques, or more acute orthopedic treatment based on their structural exam. The post-survey after their appointment included a pain severity scale readjusting their pain, as well as patients were given a definition of OMT and then asked the following questions. Did you receive OMT today? Was the pain that you arrived with improved during today's visit? What is your current impression of OMT? Would you receive OMT again in the future if available? And would you recommend OMT to others? Beginning with the analysis, the pain locations were categorized using ICD-10 codes for somatic dysfunction regions, and a diagram was created with location cutoffs for uniformity. SAS 9.4 was used to analyze the data, and due to normality issues in the data, non-parametric tests were used to analyze the outcomes, like Wilcoxon 2-sample test and Wilcoxon signed rank test. 13 out of 51 patients incorrectly completed the post-treatment portion of the survey, which didn't apply to them, and these results were disregarded. Responses were then converted to a Likert type scale, and Wilcoxon signed rank test was used to determine statistical significance. Beginning the results, 33 of 51 patients received OMT, and 18 out of 51 did not. Majority of participants in the study were older and self-employed. Of those that received OMT, patients were statistically likely to agree their pain improved and that they would return for additional treatments. This group also responded favorably to OMT and said they definitely would recommend OMT. In general, those who received OMT had a reduction statistically significantly greater than non-OMT recipients. A little bit of the IQ5D results, majority of participants reported at least slight afflictions in all categories and 100% had at least slight pain or discomfort. The self-reported average of overall health score was a 61.25 out of 100. A little bit of the study conclusions, the primary findings were that most participants had not previously heard of OMT prior to their appointment, but most had a favorable opinion of OMT after their appointment. Some secondary findings that we found was that there was a significant reduction in pain for a small sample following OMT application, as well as a general lack of understanding, being that patients believed that they received OMT when they did not. Another limitation was that there were differences in health literacy and cultural nuances. Future efforts of this project will be to address limitations as well as to introduce an educational component to increase patient understanding. Additionally, we hope to collect more comprehensive data on patient's complaint to better analyze pain reduction by region or type of treatment. Thank you for listening.

osteopathic medicine

Iquitos Peru

osteopathic manipulative treatment

patient perceptions

pain reduction