OSCAR Project
OSCAR: a single case experimental design study of osteopathic treatment options
Single case experimental design (SCED) methodology, which uses repeated measurements of a small number of patients, is a useful way to assess the effectiveness of different treatment options. The Osteopathic Single Case Research (OSCAR) project is the first time SCED methodology has been implemented in osteopathic practice in the UK.
The project evaluated the effectiveness of standard osteopathic treatment compared with biopsychosocial-informed management for non-specific low back pain. It also assessed the feasibility of conducting rigorous practice-based research in real clinical settings. By combining the tracking of individual patient outcomes with practitioner education evaluation, the project aimed to bridge the gap between research evidence and clinical practice.
Research goals
The primary goals of the project were to compare outcomes between standard osteopathic treatment and biopsychosocial-informed management for non-specific low back pain, and to assess the feasibility of implementing SCED methodology in osteopathic practice.
However, it also provided opportunities to evaluate the effectiveness of a biopsychosocial pain management e-learning course for osteopaths, to develop a framework for practice-based research that will bridge evidence and clinical implementation, and to track individual patient responses to osteopathic care.
Team and collaborators
The project’s principal investigator was Dr Jerry Draper-Rodi, of Health Sciences University, UCO School of Osteopathy. He was supported by a core team from the UCO School of Osteopathy within Health Sciences University consisting of Prof Hilary Abbey, Dr Kevin Brownhill and Prof Steven Vogel. Dr Kimberly J. Vannest, PhD (University of Vermont) was an external collaborator, supporting on methods review.
Key findings / progress
The OSCAR project generated notable clinical outcomes, including:
- Significant daily improvements in pain (NPRS -0.07/day, p<0.001) and function (PSFS -0.12/day, p<0.001) during treatment
- Treatment-phase reductions exceeded established Minimal Important Change thresholds for both measures
- Pain reduction of 1.96-2.94 points over treatment period (exceeds 2-point MIC for NPRS)
- Function improvement of 2.52-3.78 points over treatment period (exceeds 2-point MIC for PSFS)
- Sustained improvements maintained during 12-week follow-up period
However, the methodological achievements were also notable. The project successfully demonstrated that SCED methodology is feasible within osteopathic practice, with 9 out of 11 recruited patients providing sufficient data for analysis. Robust statistical modelling used linear mixed effects and the project demonstrated a novel integration of practitioner education with patient outcomes.
Funding and support
Primary funding for the project came from the Osteopathic Foundation (grant number URNLG007), with institutional support from Health Sciences University.
Impact and applications
For those in clinical practice, the OSCAR project provides a valuable evidence-based framework for individual patient monitoring within osteopathic care, and a model for integrating research into routine clinical practice. It also demonstrates the effectiveness of osteopathic treatment for chronic low back pain.
In terms of professional development, the project establishes a methodology for the evaluation of practitioner education. It also supports evidence-informed healthcare requirements for osteopaths and contributes to the growing culture of standardised data collection in osteopathic practice.
Useful innovations for research include being the UK’s first SCED implementation in osteopathic practice. The project provides a novel approach to combine individual patient tracking with group-level analysis, and a framework for future practice-based research in manual therapy professions.
The project’s applications for healthcare policy include that it aligns with WHO guidelines advocating biopsychosocial approaches for chronic musculoskeletal conditions, and supports professional standards for evidence-based osteopathic care.
Media and publications
Journal publications:
- Main study results manuscript (current document – submitted/in preparation)
- Protocol published: Draper-Rodi, J., Abbey, H., Brownhill, K. and Vogel, S., 2023. OSCAR (Osteopathic Single CAse Research)–Assessing the effect of standard and biopsychosocial osteopathic management for patients with non-specific low back pain: Protocol for a Single Case Experimental Design (SCED). International Journal of Osteopathic Medicine, 48, p.100660.
https://www.sciencedirect.com/science/article/pii/S1746068923000044
Related publications by the team:
- Draper-Rodi J, Vogel S, Bishop A. ‘Effects of an e-learning programme on osteopaths’ back pain attitudes: a mixed methods feasibility study’ – Pilot and Feasibility Studies, 2021
- Draper-Rodi J, Vogel S, Bishop A. ‘Design and development of an e-learning programme: An illustrative commentary’ – International Journal of Osteopathic Medicine, 2018
Conference proceedings:
- Poster at The Society for Back Pain Research (SBPR) 2024 Annual General Meeting: “Innovation in Research and Management of Spine Pain”, Aberdeen, Scotland, 13–14 June 2024: Draper-Rodi, J., Abbey, H., Brownhill, K. and Vogel, S., 2024, August. STANDARD AND BIOPSYCHOSOCIAL OSTEOPATHIC MANAGEMENT FOR PATIENTS WITH NON-SPECIFIC LOW BACK PAIN (THE OSCAR STUDY): A SINGLE-CASE EXPERIMENTAL DESIGN. In Orthopaedic Proceedings (Vol. 106, No. SUPP_15, pp. 4-4). Bone & Joint.
- Special poster and presentation at The Society for Back Pain Research (SBPR) Annual General Meeting, ‘PANNING FOR GOLD’ 50+ Anniversary Meeting, Coventry, England, 30 June – 1 July 2022. Draper-Rodi, J., Abbey, H., Brownhill, K. and Vogel, S., 2022, October. OSCAR (OSTEOPATHIC SINGLE CASE RESEARCH)–ASSESSING THE EFFECTS OF STANDARD AND BIOPSYCHOSOCIALLY INFORMED OSTEOPATHIC MANAGEMENT FOR PATIENTS WITH NON-SPECIFIC LOW BACK PAIN: PROTOCOL FOR A SINGLE CASE EXPERIMENTAL DESIGN (SCED). In Orthopaedic Proceedings (Vol. 104, No. SUPP_9, pp. 34-34). Bone & Joint.
Trial Registration: NCT05120921
Get involved
Opportunities for students include research methodology training in SCED design, data analysis experience with complex time-series data and mixed methods research training combining quantitative and qualitative approaches.
For researchers, opportunities exist to collaborate in the development of SCED methodology, participate in the practice-based research network and contribute to research on the biopsychosocial approach within manual therapy.
If you’re an osteopath, the team would welcome your participation in future SCED trials and membership of the new research network through NCOR. There are opportunities for professional development via the biopsychosocial pain management e-learning course, and support can be provided for the implementation of Patient Reported Outcome Measures (PROM).
Academic institutions can benefit from research collaboration opportunities, SCED methodology training and implementation and practice-based research development partnerships.
Contact information:
- Principal Investigator: Jerry.draper-rodi@hsu.ac.uk
- Institution: Health Sciences University, UCO School of Osteopathy, 275 Borough High Street, London SE1 1JE, UK
