The concept of function in osteopathy and conventional medicine : a comparative study

Tyreman, Stephen John (2001). The concept of function in osteopathy and conventional medicine : a comparative study. PhD thesis The Open University.



This study compares and contrasts the uses of 'function' in osteopathy and in a closely related area of conventional medicine, viz., orthopaedic surgery. Function is a fundamental concept in both; but a survey of the literature, and an initial analysis of the language used by practitioners in a sample of case studies, suggests that while orthopaedic surgeons focus on local failures of physiological function (Fphys), osteopaths are concerned with such failures in the global context of the whole body (Fglob). This is closely related to individual patients' expectations in relation to their overall ability to function (Fpt). The musculo-skeletal system, with which osteopaths are expert, is shown to be particularly significant for understanding Fphys, Fpt and Fglob. These uses of function are further analysed by drawing on the philosophical literature. This is shown to focus, like orthopaedic surgeons, mainly on biological function (Fbiol which includes Fphys). In consequence, it is argued, the philosophical literature has under-emphasised the significance of context in defining functional norms. Certain authors have recognised the importance of context for the functioning of people (i. e. as Fpt); in this thesis, by contrast, context is shown to be important in defining functional norms at all levels, including the physiological/biological. In respect of the relationship between osteopathy and conventional medicine, it is concluded that Fglob (as employed more by osteopaths) involves explaining the clinical significance of local dysfunction in the broad context of patients' activities, and Fphys (as employed more by orthopaedic surgeons) involves categorising local dysfunction in terms of referential standards. The concept of agency, although not examined in detail, emerges as the key to linking the role of context in the meaning of function statements to the intentions and self-perception of patients in clinical practice. Because of the special role of the musculo-skeletal system in enacting agency, osteopathy offers particular insights into the contextual nature of function statements.

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