Research reportOsteopaths' professional views, identities and conceptions – A qualitative grounded theory study
Introduction
In many countries, osteopathy has undergone a process of ‘professionalisation’, which Cant and Shamar define as a “type of occupational change and formation that involves unification, standardisation, and the acquisition of external legitimacy”.1,p.197 There is evidence of the professionalisation of osteopathy in several corners of the world and different countries are at varying stages of the process. For example, in the USA the formal process of professionalisation of osteopathy first began in the early 1960s, and has resulted in the establishment of an osteopathic ‘medical’ profession which enjoys the full range of clinical practices and procedures employed by the orthodox medical profession, in addition to osteopathic manipulative therapy.2 In comparison, osteopathy in the UK and the antipodes is considered to be an emerging manual therapy profession3, 4, 5 where professionalisation has taken place since the early 1990s. Examples of strategies taken to facilitate the process of professionalisation of osteopathy in the UK and antipodes include3, 4, 5: 1) the formation of a single statutory register of osteopaths; 2) a regulatory body which sets standards of practice and training; 3) structured and externally inspected educational programmes; 4) legally protected professional title of ‘Osteopath’; and 5) measures in place to discredit those practitioners who do not practice to agreed standards. All of these strategies have provided osteopathy with unity, exclusivity and social closure which are considered to be characteristics of a profession.1
The professional status of osteopathy carries with it the requirement to be critically reflective, and to constantly self-evaluate and self-question in order to develop the knowledge base which underpins clinical practice and also to understand how osteopaths know, what they know (an epistemology of practice).6 Although a challenging process, identifying an epistemology of osteopathy through critical enquiry and research is crucial to the continued development of the osteopathic profession. A number of other healthcare professions have discussed the importance of developing an epistemology of practice, including the physiotherapy7, 8, 9, 10 and nursing professions.11, 12 Although osteopaths' professional knowledge, values and beliefs has been discussed theoretically,13, 14 and investigated in relation to specific aspects of clinical practice (e.g. prescription rights15 and chronic musculoskeletal pain16), there is little research-based knowledge of how practitioners conceive osteopathic practice and how this influences their clinical work. Developing an epistemology of osteopathy through research would allow for the identification of the tacit or non-propositional knowledge used by practitioners, as they work through the complex problems of daily practice. Research of this kind would help to understand what motivates individual practitioners' actions and decision-making when working clinically with patients. Furthermore, research which develops knowledge of what steers osteopaths' clinical actions and behaviour would facilitate clinical educators when working alongside students and also provide an understanding of the range of professional identities which could be embedded within osteopathic curricular.17 Our recent research suggests that how osteopaths conceive the nature of their practice (practice ontology) influences their clinical work and their views on knowledge (epistemology of practice knowledge), decision-making and technical skills and may help to explain the variation in clinical approaches (e.g. during treatment and management) that each osteopath takes with their patients.18, 19 How an individual practitioner's personal conception of practice develops and changes during the course of their professional life is thought to be related to how they identify with their profession, their professional values and is ultimately tied to their interactions with patients which take place during the clinical milieu.19, 20, 21 The physiotherapy literature suggests that practitioners' professional values and identities develop during their interaction and socialisation with peers during their undergraduate education and continues throughout their professional careers when interacting with professional colleagues.22 The nature of osteopaths' professional values, conceptions and identities is yet to be investigated, and how these relate to their views on the treatment and management of patients is currently unknown.
This paper explores experienced osteopaths' professional identities, views and overall conceptions of osteopathy, and the findings from this study form part of a broader theory of osteopaths' clinical decision-making and therapeutic approaches reported elsewhere.18, 19, 23
Section snippets
Study design
This qualitative study followed a constructivist grounded theory approach, with the primary researcher (OT) iterating between data collection and data analysis.24 In accordance with interpretive research,25 throughout this study, OT assumed “multiple realities; indeterminacy; facts and values as linked; truth as provisional; and social life as processual”.24,p.126 In practice this meant that during data collection the researcher explored the social worlds of participants and co-constructed
Findings
Participants expressed a range of views and perceptions in relation to many different aspects of osteopathy. These professional views are divided into five major categories:
- •
professional identity
- •
traditional osteopathic theories and principles
- •
health and disease
- •
practice skills
- •
conception of osteopathy.
The categories are discussed in turn and supported with participants' quotations from interview data which serve as evidence for the theoretical claims made in this paper. Table 3 and Fig. 1 summarise
Discussion
This study is the first of its kind to explore the professional views, identities and conceptions of osteopathy of practitioners in the UK. The findings from this study suggest that osteopaths hold different views and perceptions of their professional identity, traditional osteopathic theories and principles, health and disease and practice skills, which together help shape their overall conception of osteopathy. The diversity of views and identities amongst the practitioners in this study is
Conclusion
Osteopaths in this study held a range of views in relation to their professional practice, and were characterised by the major categories of: professional identity, traditional osteopathic theories and principles, health and disease and practice skills. Individually, these views contributed to practitioners' overall conception of osteopathy, which was characterised as either practitioner-centred, collaborative or empowerment. This diversity in professional identities and conceptions may help to
Acknowledgements
Thanks to the British College of Osteopathic Medicine, the British Naturopathic and Osteopathic Association and the Osteopathic Educational Foundation for helping to fund this doctoral research.
References (67)
- et al.
Professionalization of complementary medicine in the United Kingdom
Complement Ther Med
(1996) - et al.
Recognising practice epistemology in the health professions
- et al.
Master's level study: learning transitions towards clinical expertise in physiotherapy
Physiotherapy
(2011) Epistemology, private knowledge, and the real problems in physiotherapy
Physiotherapy
(1996)- et al.
Research and knowledge
Physiotherapy
(1998) Valuing osteopathy: what are (our) professional values and how do we teach them?
Int J Osteopath Med
(2008)- et al.
Is there a place for science in the definition of osteopathy?
Int J Osteopath Med
(2007) - et al.
Attitudes towards prescribing rights: a qualitative focus group study with UK osteopaths
Int J Osteopath Med
(2005) An exploration of the professional identity embedded within UK cardiorespiratory physiotherapy curricula
Physiotherapy
(2013)- et al.
A qualitative grounded theory study of the conceptions of practice in osteopathy: a continuum from technical rationality to professional artistry
Man Ther
(2014)
Attitudes to back pain amongst musculoskeletal practitioners: a comparison of professional groups and practice settings using the ABS-mp
Man Ther
The impact of a musculoskeletal masters course: developing clinical expertise
Man Ther
Chronic condition self-management: expectations of responsibility
Patient Educ Couns
The relation between patient-centeredness and patient empowerment: a discussion on concepts
Patient Educ Couns
Patient empowerment: myths and misconceptions
Patient Educ Couns
Conceptual models for implementing biopsychosocial theory in clinical practice
Man Ther
Professional development 1: professional socialisation and professionalisation
Physiotherapy
Professional development 2. Professional knowledge and situated learning in the workplace
Physiotherapy
Persistent back pain-why do physical therapy clinicians continue treatment? A mixed methods study of chiropractors, osteopaths and physiotherapists
Eur J Pain
The paradox of osteopathy
N Engl J Med
Capabilities for osteopathic practice volume 2012: the Osteopathic Council of New Zealand
Osteopathy code of conduct
Physiotherapy as bricolage: theorizing expert practice
Physiother Theory Pract
Nursing research
Nursing epistemology: traditions, insights, questions
Image J Nurs Sch
Will shared decision making between patients with chronic musculoskeletal pain and physiotherapists, osteopaths and chiropractors improve patient care?
Fam Pract
Clinical decision-making and therapeutic approaches in osteopathy – a qualitative grounded theory study
Man Ther
Learning to be a physiotherapist: a metasynthesis of qualitative studies
Physiother Res Int
Attitudes of novice physiotherapists to their professional role: a gender perspective
Physiother Theory Pract
Professional socialization: students' expectations of being a physiotherapist
Med Teach
Clinical decision making and therapeutic approaches of experienced osteopaths
Constructing grounded theory
Cited by (46)
Advancing osteopathic education in Canada: New offerings, new direction
2024, International Journal of Osteopathic MedicineViews from Australian osteopaths and industry stakeholders about the profession: A qualitative study
2023, International Journal of Osteopathic MedicineThe paradox of the impact of the COVID-19 pandemic on massage therapists in Australia and Canada: The reporting of a qualitative strand of a mixed methods study
2023, Journal of Bodywork and Movement TherapiesWhat's wrong with osteopathy?
2023, International Journal of Osteopathic Medicine“It's all about the story”. Osteopaths' experiences of exploring menopausal symptoms: A qualitative interview study
2023, International Journal of Osteopathic MedicineEvocations of Osteopathy's founder and questions for contemporary osteopathic professional identity: A thematic analysis
2022, International Journal of Osteopathic MedicineCitation Excerpt :Paradoxically, however, this acceptance has provoked new doubts about the identities and commitments of osteopathic professionals, from students to seasoned physicians. Important studies by Baer [3], Miller [4], Norander, Mazer, and Bates [5], and Thomson, Petty, and Moore [6], and Gevitz [1], have examined diverse aspects of osteopathic identity, from contemporary as well as historical perspectives. Each brings attention to osteopathy's unique development and the qualities that both align it with, and distinguish it from allopathic medicine and other medical developments of the 19th and early 20th centuries.