Adherence to Lumbar Radiculopathy Guidelines in Osteopathy: Diversity and Hypotheses
Hugo ROUGON, CEESO Lyon
Background
Low back pain with radicular symptoms is a common reason for osteopathic consultation. Although
frequently benign, certain symptoms may indicate serious neurological involvement requiring urgent
referral. While clinical guidelines exist, no study has evaluated osteopaths adherence to these
recommendations, despite the need for evidence based practices.
Methods
This study followed a two-phase protocol. First, a systematic literature review (PRISMA method)
identified validated physical examination components for lumbar radiculopathy. Second, a
questionnaire was developed and reviewed by 14 experts. An initial pilot test (n=41) enabled the
refinement of items based on psychometric indicators. The final version, composed of 5 questions,
was distributed to graduated osteopaths (n=75). An exploratory factor analysis (EFA) was performed;
psychometric quality was assessed with Kaiser-Meyer-Olkin index, Bartlett’s test, and McDonald’s
omega.
Results
Overall adherence to recommendations averaged 77%, but significant variability was observed across
items, with some practices receiving much lower rates of conformity. The KMO index was 0.74,
indicating good sampling adequacy. Bartlett’s test was significant (p < 0.001), validating factorability.
Internal consistency was acceptable (omega = 0.72). The EFA revealed a two-factor structure
explaining 44% of total variance. Despite high overall adherence, inter-individual variability and
moderate psychometric indices suggest unmeasured factors, such as cognitive biases or training
differences, may influence clinical reasoning.
Conclusions
Osteopaths appear to adhere to guidelines for diagnosing lumbar radiculopathy. Yet, observed
variability and limited explained variance point toward the influence of implicit cognitive
mechanisms. These findings call for broader research integrating qualitative approaches to capture
how reasoning, beliefs, and context shape adherence to evidence-based recommendations.