This statement is for health professionals, third party funders and policy makers. It gives an overview of osteopathic practice and its place within the Australian healthcare system.
This statement has been developed by the Australian Osteopathic Association (AOA) in alignment with The Osteopathic Service Descriptors, The Capabilities for Osteopathic Practice, the Code of Conduct for Registered Health Practitioners and the World Health Organisation Benchmark Statement on Osteopathic Education. The statement is further influenced by broader health policies, legislation, regulation and health workforce debate.
Osteopaths are committed to effective, patient-centred healthcare. As the scientific understanding of health and disease evolves, this Scope of Practice Statement will require on-going revision.
An Overview of Osteopathy
Osteopaths are autonomous primary contact practitioners who treat patients from across the life span. 90% of patients access osteopathic care without a referral. Osteopaths have a professional focus on conditions affecting the neuro- musculoskeletal system and the management of pain.
Osteopathy is a system of diagnosis and treatment that recognises the following principles:
- the body is one unit of function;
- the body has self-regulating mechanisms;
- structure and function are reciprocally inter-related; and
- therapeutic management is applied with an understanding of these principles and a thorough knowledge of clinical sciences.
These osteopathic principles, in conjunction with current medical knowledge, inform the care given to patients. Scientific plausibility and evidence-informed reasoning are fundamental to diagnosis, treatment and case management.
Osteopaths follow these principles of patient care:
- The patient is the focus for healthcare.
- The patient has the primary responsibility for their own health.
- Effective treatment is founded on these principles and:- incorporates evidence informed guidelines,
– optimises the patients natural healing capacity,
– seeks to address the primary cause of disease, and
– emphasises health maintenance and disease prevention.
The osteopathic approach to healthcare provides therapeutic management and rehabilitation to address specific injury, trauma and/or disease, as well as preventative care to enhance health and wellbeing. Osteopaths support the use of pharmaceutical interventions where clinically indicated.
The emphasis on the neuro-musculoskeletal system as integral to the body’s function, a person’s health and to patient care is a defining characteristic
Osteopaths acknowledge the uniqueness of each patient and seek to optimise their health and wellbeing.
Modern osteopathic practice is informed and improved by the integration of relevant practice guidelines . The AOA is committed to educating members on current best practice.
Regulation, Education and Continuing Professional Development
Osteopathy is one of 14 government regulated professions under the Australian Health Practitioner Regulation Agency (AHPRA). Within AHPRA, the Osteopathy Board of Australia (OBA) protects the public by ensuring that only osteopaths who are suitably trained and qualified can register, and by ensuring that they practise in a competent, safe and ethical manner.
To these ends the OBA publishes codes and guidelines, approves standards for university courses, handles complaints, and conducts disciplinary hearings. Other requirements include criminal background checks, English language proficiency, and professional indemnity insurance.
All osteopaths in Australia complete a minimum of five years training at an accredited university. These university graduates hold either a double Bachelors or Master qualification. Upon graduation, osteopaths are required by law to be registered.
Registration requires continuing professional development. This must meet a minimum standard set by the OBA and have a clinical focus relevant to a practitioner’s area of practice
Scope of Practice
The AOA endorses a broad scope of practice for the profession. Narrowly defined scope restricts opportunities and innovation for individuals, the profession and the health system. Osteopathic scope is not defined by legislation in Australia.
It is therefore the responsibility of the profession to define and develop its scope of practice.
Many professions have skills, qualities and attributes in common. This scope of practice in osteopathy necessarily overlaps with other professions’ scopes.
Within the broader professional scope of practice, individual osteopaths will develop their own personal/professional scope. The personal scope is for the individual to establish, having in mind the particular priorities that attach to:
- Education and qualifications,
- Geography and demography,
- Areas of clinical interest,
- Patients’ unique health needs, and
- Service requirements of Medicare and third party funders.
Osteopathy is a system of health care. It integrates an understanding of clinical diagnosis and assessment with the knowledge of the inter-relationship of the neuro-musculoskeletal system with other body systems.
Osteopathy is holistic in the sense that health and disease are multi-factorial and an osteopath considers a patient in the relevant enviro-biopsychosocial context. This applies equally for prevention, diagnosis or therapeutic management. Osteopaths recognise the importance of providing lifestyle and general health advice including dietary and exercise prescription.
The practice of osteopathy requires broad diagnostic competencies. Osteopaths use standard clinical processes in history taking and examination, such as orthopaedic special tests, neurological examinations and systems reviews. Laboratory tests or imaging may be requested where clinically indicated. A differential diagnosis is required to determine if the patient’s presentation is appropriate for osteopathic management. Osteopaths recognise that whilst there may well be a musculoskeletal component in many patient presentations, osteopathic care may not be indicated or the principal modality in all cases. If patients’ needs are best met by other healthcare service providers, a referral will be made.
Osteopaths combine a highly developed sense of palpatory awareness with an understanding of functional anatomy and biomechanics, where the osteopath identifies and seeks to normalise strain patterns in the tissues. This gives an emergent quality to practice as often there is a diagnostic / therapeutic continuum where assessment and treatment coincide.
This emergent aspect of practice gives a distinctive characteristic to osteopathy which may contrast with modalities where a formulaic approach is common. This is an important aspect of the patient-centred system of osteopathic healthcare.
Advanced Standing and Credentialling
Individual osteopaths pursue a diversity of clinical interests and may develop advanced standing in particular areas of practice. Advanced practice requires that osteopaths obtain further education or training in order to expand their areas of practice.
The AOA recognises that the osteopathic profession is diversifying and that a growing number of clinical interest areas are vital for development and expanded scope of practice.
The AOA supports this clinical diversification of osteopathy by developing credentialling processes that allow recognition of advanced standing in particular areas of practice. The AOA supports a system of credentialling that is transparent, accountable and effective in recognising experience and training. The AOA acknowledges the principles for credentialling outlined by the Australian Commission on Safety and Quality.
In order for osteopaths to undertake advanced or broader extended roles within healthcare; legislative, regulatory, funding and systemic barriers will need to be addressed. Scope of practice is dynamic. Some areas of clinical interest that may be seen as advanced now, in the future will be standard practice.
Osteopathy Within the Healthcare System
Osteopaths mainly work in primary health care settings, including osteopathic or multi-disciplinary clinics or in association with general practitioners. Some osteopaths work within specialist pain management services, elderly care facilities or occupational health settings.
Osteopaths may apply their professional knowledge in a wide range of non- clinical settings such as universities, research, healthcare management and health education.
Osteopaths understand the wider healthcare environment and the role of the primary care practitioner within the healthcare system. Likewise, better patient outcomes and more cohesive multidisciplinary care rely on other health professionals understanding the role and competencies of osteopaths.
Osteopathy is a global profession. However, regulation, education and the role of osteopaths vary greatly from country to country. These range from osteopathic physicians or surgeons working in hospitals or general practice in the USA; to allied health practitioners in countries like Australia, New Zealand or the United Kingdom; to complimentary therapists working in countries lacking regulation and/or accredited education standards. The Osteopathic International Alliance gives an indication of this diversity.
The AOA is committed to ensuring that the Scope of Practice in Osteopathy remains congruent with the national health priorities and the strategic direction of Australian healthcare policy.
For further information, please contact:
PO Box 5044
Chatswood West NSW 1515
Phone 1800 467 836