Assessing the feasibility of applying a combined osteopathy and psychoeducation therapy (OsteoPeCT) and its inuence on levels of psychological and physiological stress in adult participants with moderate stress: A pilot study

Background: There is mounting evidence suggesting a relationship between stress and adverse health outcomes. Stress is a multidimensional phenomenon requiring a multimodal approach. While there is some evidence indicating a positive effect of massage therapy, there is limited research regarding the impact of related approaches such as general osteopathic techniques (GOTs). Further, research examining the feasibility and effectiveness of combining GOTs with psychoeducation in the management of stress is lacking. The present pilot study aimed to assess the feasibility of applying a therapy package consisting of GOTs and brief psychoeducation and its inuence on moderate stress in a convenience sample. Methods: A pilot uncontrolled trial with mixed pragmatic and exploratory design was conducted. The therapy package comprised of ten GOTs and ten minutes of scripted psychoeducation (OsteoPeCT) was applied in two sessions over two consecutive days to 18 adult participants with moderate stress. Feedback from participants and challenges experienced by both participants and researchers were recorded. The effects of OsteoPeCT were assessed by measuring pre-and post- intervention scores of self-reported perceived stress (Perceived Stress Scale-10, PSS-10; Prole of Mood Scale, POMS) and salivary levels of physiological stress biomarkers (cortisol; secretory immunoglobulin A, sIgA and interleukin-6, IL-6). Results: All aspects related to the application of OsteoPeCT (participant recruitment, participant retention, therapy application, administration of health screen and self-reported perceived stress questionnaires, and the collection of saliva samples for biomarker analysis) were feasible. A total of 18 participants were enrolled. The timing of sessions on consecutive days was reported to be challenging. While a measurable decrease in perceived stress (PSS-10) and in mood scores (Tense, Fatigue, Depression, Anger) were noted post therapy (OsteoPeCT) application, physiological stress markers were unaffected. Diurnal variations of these biomarkers may need further consideration. Conclusion: The application of OsteoPeCT was feasible, well received with some benecial inuence on perceived stress indicating that an integration of psychoeducation and osteopathic care may confer benets to patients. Future investigations with adapted protocols and larger sample size is warranted to assess effectiveness.


Abstract
Background: There is mounting evidence suggesting a relationship between stress and adverse health outcomes. Stress is a multidimensional phenomenon requiring a multimodal approach. While there is some evidence indicating a positive effect of massage therapy, there is limited research regarding the impact of related approaches such as general osteopathic techniques (GOTs). Further, research examining the feasibility and effectiveness of combining GOTs with psychoeducation in the management of stress is lacking. The present pilot study aimed to assess the feasibility of applying a therapy package consisting of GOTs and brief psychoeducation and its in uence on moderate stress in a convenience sample.
Methods: A pilot uncontrolled trial with mixed pragmatic and exploratory design was conducted. The therapy package comprised of ten GOTs and ten minutes of scripted psychoeducation (OsteoPeCT) was applied in two sessions over two consecutive days to 18 adult participants with moderate stress. Feedback from participants and challenges experienced by both participants and researchers were recorded. The effects of OsteoPeCT were assessed by measuring preand post-intervention scores of self-reported perceived stress (Perceived Stress Scale-10, PSS-10; Pro le of Mood Scale, POMS) and salivary levels of physiological stress biomarkers (cortisol; secretory immunoglobulin A, sIgA and interleukin-6, IL-6).
Results: All aspects related to the application of OsteoPeCT (participant recruitment, participant retention, therapy application, administration of health screen and self-reported perceived stress questionnaires, and the collection of saliva samples for biomarker analysis) were feasible. A total of 18 participants were enrolled. The timing of sessions on consecutive days was reported to be challenging. While a measurable decrease in perceived stress (PSS-10) and in mood scores (Tense, Fatigue, Depression, Anger) were noted post therapy (OsteoPeCT) application, physiological stress markers were unaffected. Diurnal variations of these biomarkers may need further consideration.
Conclusion: The application of OsteoPeCT was feasible, well received with some bene cial in uence on perceived stress indicating that an integration of psychoeducation and osteopathic care may confer bene ts to patients. Future investigations with adapted protocols and larger sample size is warranted to assess effectiveness. Time of the therapy session 8-10 am Participants were required to attend each consecutive session at 8-9:30 am to achieve consistency and reliability with the selected salivary biomarkers, as these biomarkers show diurnal variation.
Early morning appointments on two consecutive sessions proved di cult for participants with early morning weekday commitments.

Therapy sessions
Approximately one hour, on two consecutive days (Monday and Tuesday) As the intervention only ran for two days, having the two sessions 24 hours apart lasting approximately 1 hour was chosen for consistency.
Arranging/organising two consecutive days were di cult for some participants in light of their daily life commitments, i.e. work. Furthermore, peak hour tra c and the clinic's location off a busy main road added to di culties. Osteopath researcher made an error in scoring, which led to the inclusion of three participants who scored <14.
Data analysis and interpretation.
Three participants (#1, #2, #4) were included in the study although scored <14 PSS-10 due to nature and aim of the study. This icl Therapy sessions Feasibility regarding the timing of the sessions and consecutive days.
Timing -8-10 am decided to avoid diurnal variation observed in the selected biomarkers.
Two consecutive days of the week: The study was run as part of the student osteopaths' research for their Masters, alongside completing clinical hours, which is a compulsory component for their studies.
The two available dates were mid-working week, which became di cult for the student researchers to liaise with their participants. In addition, due to the selection of the times (8-10 am) the participants encountered challenges with arriving on-time (between 5-20 minutes late).
It took nine minutes to collect and ll two cryotubes with saliva for participant #5 at TP1. It took between 5-7 minutes to collect saliva from participants #4 and #10 at TP1. Participant #4 had a coffee at 6:30 am that morning. Participant #12 could not produce any saliva.
Participants who could not produce saliva as easily appeared more stressed and agitated. Not producing enough saliva may have caused participants to feel tense, further increasing stress levels.