"I do it my way" - Italian osteopaths' beliefs and attitudes about five osteopathic models: A qualitative study

Background: Recent debates inside the osteopathic community have underlined the need to revise and to implement osteopathic traditional clinical concepts in relation to the process of clinical reasoning. Nevertheless, clinical reasoning has to be based on models and evidence to enhance the quality and to maximise the effectiveness of the therapeutic act. Among models, the five osteopathic models (OMs) are supposed to guide osteopathic clinical reasoning. However, there is a lack of studies on how OMs characterise clinical practice. Objectives: The primary purpose of this study was to explore Italian osteopaths' attitudes and beliefs toward the five OMs and their application in clinical reasoning and practice. Methods: 19 Italian professional osteopaths with clinical and educational experience formed the purposive sample of this qualitative study. Data were collected through recorded semi-structured interviews, transcribed verbatim and coded by using elements of a constructivist grounded theory approach. Results: Three main themes were identified: 1) Ambiguity of the professional identity; 2) OMs: an enigma of clinical reasoning, 3) Osteopathic knowledge paths: evolutionary on-going trajectories. Conclusion: The results of the present study suggest a heterogenic theoretical and practical conceptualisation of OMs within the Italian osteopathic field, identifying a gap between knowledge and tradition. This study may contribute to reducing this gap promoting a framework to clarify current understanding of the OMs in order to guide the profession towards the definition of an updated osteopathic paradigm.