Assessing the feasibility of osteopathy and psycho-education based therapy application in managing stress

Brief description of the Intervention (s) and steps in the therapy application: The therapy package composed of two components; application of general osteopathic techniques and administration of stress management education. After initial consultation and participants agreeing to proceed, participants were invited to the osteopathic teaching clinic (Unitec, Mount Albert campus), a general health screen was taken for each participant, which was adopted from the John Hopkins Medical School case history (John Hopkins Medicine, n.d.). This included gathering information regarding height, weight, heart rate and blood pressure. Following initial health screening and PSS-10 score (self-report of stress), eligible participants with acceptable health status and PSS-10 scores >14 were enrolled in the study. The therapy package was applied in two consecutive days, each session lasting up to 1 hour and 15 minutes. The steps for the two mutually agreed and scheduled consecutive sessions are detailed below. Session one (1 to 1.25 hours) 1. Participants were given PIS and on arrival 2. Participants then completed the Consent Form 3. Rinsing of participant’s mouth with water five minutes before sample collection 4. Pre-intervention collection of saliva sample (Timepoint 1), for assessing biomarkers. Samples stored in collection chilly box for transportation and then stored in the -80°C freezer until processed. 5. Completion of self report stress questionnaires: modified Self report stress questionnaires (POMS and PSS-10). 6. Completion of adapted case history including blood pressure (BP) and heart rate (HR) measurement. 7. Application of the 10 selected general osteopathic techniques (GOT). Description of GOT is provided below after the two sessions description. 8. Delivery of scripted stress management education and handing out of associated pamphlet. 9. Completion of POMS and PSS-10 Questionnaire – post-treatment (Timepoint 2). 10. Collection of saliva samples – post-treatment (Timepoint 2). Participants were not asked to rinse their mouth post intervention. At the end of the first session, the participants were asked routine health safety questions to ensure they were not or had not experienced any adverse effects of the treatment (e.g. questions regarding their current mood and/or whether they had any aches or pains). They were advised to contact the student researcher if they had any questions or experienced any effects from the treatment, such as feeling light-headed or headache. They were also advised to drink water throughout the day. Session two (50-minutes to 1 hour) Session two followed the same procedure and steps as session 1 (except first two steps). This session took place 24 hours after the initial session and included the following steps: 1. Rinsing of the participant’s mouth with water five minutes before sample collection 2. Collection of pre-intervention saliva samples (Timepoint 3) 3. Completion of pre-intervention stress questionnaires (POMS and PSS-10) 4. Application of the GOT and stress management education; the procedures were same as those administered during session one. 5. Completion of post-intervention self report stress questionnaires (POMS and PSS-10) 6. Collection of post-treatment saliva samples (Time point 4). Participants were not asked to rinse their mouth post intervention. After the second session, participants were asked the 'routine health safety questions'. Participants with remaining high-stress levels (>19) were advised to consult their general health practitioner. All participants were given the chance to ask any final questions about the study, which included the collection of participant's feedback on every aspect of the therapy package (e.g. collection of saliva sample, GOT therapy, stress management package etc.). The session booking sheet was used to check the attendance (adherence) of participants to both sessions. They were also asked to leave their contact email to receive a summary of the study results. Therapy delivered by: Two Master of Osteopathy research students who were professionally trained by clinicians and clinic tutors. These lead (student) researchers were experienced and competent in delivering these techniques in to patients in the Unitec's Osteopathy teaching Clinic. These students were supervised by two post-graduate research supervisors and an Osteopath (Clinic tutor). Mode of administration - one-on one. Each participant was booked for the private sessions, no group activity or therapy application was undertaken. Brief description of General osteopathic techniques: Each participant was asked to lie supine on the treatment plinth they received the GOT routine applied to 10 different areas. These areas included the hip, sacroiliac joint, lumbar spine, thoracic spine and ribcage, glenohumeral joint, scapulothoracic joint, cervical spine, upper thoracic ribs, cervical spine and cranium region. The techniques included soft tissue massage, rhythmic joint articulation, myofascial release, gentle harmonics, muscle inhibition, and rib-raising. The student researcher individually tailored the application of each technique. The length of time spent on performing each technique depended on the researcher's perception of tissue change. This included the feeling of the joint or area "relaxing" as the technique was applied to the area. This perception of tissue change was determined by the feeling of softness of the tissues, if they became more mobile and/or if they were more pliable to stretch. Then the student researcher moved on to the next area. Seven joint articulations and three soft tissue techniques were applied to the participant for a maximum of 30 minutes. Overall, the duration of each session varied between participants (range: 50 minutes to 1.25 hours; mean 60.7, SD 6.85). The sessions were flexible depending on the participant's perceived comfort level. Stress management education and pamphlet: The stress management and education pamphlet aimed to provide the participant with tools to help them identify stressors and manage their stress in everyday life. The stress management education used for this project included a scripted discussion about tools aimed to reduce tension and promote an overall sense of wellbeing. Stress management education was delivered after the GOT treatment. The participant was asked to slowly get up and off the treatment table at their own pace, and sit comfortably in a chair before receiving a 5-10 minute scripted session based on the Brief Cognitive-Behavioural Education Program (B-CBE) (Chiang et al., 2016) by the student researcher. The way the education script was delivered followed a pragmatic real-life setting, whereby the student researcher chose how to best deliver the information depending on the participant’s mood during the session. This led to the duration of delivery varying between 5-10 minutes. Also, a pamphlet was given to the participant to take home and read in their own time. This contained information such as a basic and clear definition of stress, ways to identify stressors and some strategies to cope with, manage and overcome stress. These included sleep, exercise, visualisation, deep breathing, socialising, keeping a journal and creating a schedule. Participants were advised to try some of these strategies in their daily life. Location of therapy administration: Unitec Osteopathy clinic, Carrington Rd,Unitec Gate 4, Building 61, Mount Albert, Auckland 1025