SIST EN 16686:2015

2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.Osteopatska zdravstvena oskrbaOsteopathische GesundheitsversorgungPrestations de soins d’ostéopathieOsteopathic healthcare provision11.020.10Zdravstvene storitve na splošnoHealth care services in generalICS:Ta slovenski standard je istoveten z:EN 16686:2015SIST EN 16686:2015en01-september-2015SIST EN 16686:2015SLOVENSKI
STANDARD



SIST EN 16686:2015



EUROPEAN STANDARD NORME EUROPÉENNE EUROPÄISCHE NORM
EN 16686
July 2015 ICS 11.020 English Version
Osteopathic healthcare provision
Prestations de soins d'ostéopathie
Osteopathische Gesundheitsversorgung This European Standard was approved by CEN on 30 April 2015.
CEN members are bound to comply with the CEN/CENELEC Internal Regulations which stipulate the conditions for giving this European Standard the status of a national standard without any alteration. Up-to-date lists and bibliographical references concerning such national standards may be obtained on application to the CEN-CENELEC Management Centre or to any CEN member.
This European Standard exists in three official versions (English, French, German). A version in any other language made by translation under the responsibility of a CEN member into its own language and notified to the CEN-CENELEC Management Centre has the same status as the official versions.
CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and United Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION EUROPÄISCHES KOMITEE FÜR NORMUNG
CEN-CENELEC Management Centre:
Avenue Marnix 17,
B-1000 Brussels © 2015 CEN All rights of exploitation in any form and by any means reserved worldwide for CEN national Members. Ref. No. EN 16686:2015 ESIST EN 16686:2015



EN 16686:2015 (E) 2 Contents Page European foreword . 4 Introduction . 5 1 Scope . 6 2 Terms and definitions . 6 3 Description of Osteopathy . 8 4 Clinical practice . 9 4.1 General . 9 4.2 Essential competencies for osteopathic practice . 9 4.3 Case History, examination and interpretation of the findings . 10 4.4 Osteopathic treatment . 10 4.5 The osteopathic profession . 11 4.5.1 General . 11 4.5.2 Continuing professional development . 11 4.5.3 Quality management . 11 5 Ethics . 12 6 Education and Training . 12 6.1 General . 12 6.2 Forms and/or categories of education . 12 6.2.1 General . 12 6.2.2 Common features of both Type I and Type II programmes . 12 6.2.3 Type I programmes . 13 6.2.4 Type II programmes . 13 6.3 Core competencies: the context of osteopathic education . 14 6.4 Osteopathic teaching, learning and assessment . 15 6.4.1 Teaching and learning . 15 6.4.2 Practical skills . 15 6.4.3 Clinical education . 16 6.4.4 Assessment . 17 6.5 General management requirements . 18 Annex A (informative)
Osteopathic models . 19 A.1 General . 19 A.2 Biomechanical Model . 19 A.3 The respiratory/circulatory model . 19 A.4 The neurological model . 19 A.5 The biopsychosocial model. 20 A.6 The bioenergetic model . 20 Annex B (normative)
Ethics for osteopaths . 21 B.1 General . 21 B.2 Acting in the patient interest . 21 B.3 Working in partnership with the patient . 21 SIST EN 16686:2015



EN 16686:2015 (E) 3 B.4 Maintaining public trust and confidence in the osteopathic profession . 22 B.5 Maintaining, respecting and protecting patient information . 22 B.6 Working in partnership with healthcare providers . 23 Annex C (informative)
Types of techniques used in osteopathic treatment . 24 C.1 General . 24 C.2 Direct techniques . 24 C.3 Indirect techniques . 24 C.4 Balancing techniques . 24 C.5 Combined techniques . 24 C.6 Reflex-based techniques . 24 C.7 Fluid techniques . 24 Annex D (informative)
A-deviations . 25 Bibliography . 35
SIST EN 16686:2015



EN 16686:2015 (E) 4 European foreword This document (EN 16686:2015) has been prepared by Technical Committee CEN/TC 414 “Project Committee - Services in osteopathy”, the secretariat of which is held by ASI. This European Standard shall be given the status of a national standard, either by publication of an identical text or by endorsement, at the latest by January 2016, and conflicting national standards shall be withdrawn at the latest by January 2016. Attention is drawn to the possibility that some of the elements of this document may be the subject of patent rights. CEN [and/or CENELEC] shall not be held responsible for identifying any or all such patent rights. Attention is drawn to the fact that in certain countries specific national regulations apply and take precedence over this European Standard. Users of this European Standard are advised to inform themselves of the applicability or non-applicability for this European Standard by their national responsible authorities. According to the CEN/CENELEC Internal Regulations, the national standards organisations of the following countries are bound to implement this European Standard: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and the United Kingdom. SIST EN 16686:2015



EN 16686:2015 (E) 5 Introduction Osteopathy is a primary contact and patient-centred healthcare discipline, that emphasizes the interrelationship of structure and function of the body, facilitates the body’s innate ability to heal itself, and supports a whole-person approach to all aspects of health and healthy development, principally by the practice of manual treatment. Patients who choose osteopathic treatment have to be assured of the quality and the standard of care that they will receive. This standard is concerned with the provision of osteopathic diagnosis, treatment and care. It aspires to set a standard that provides for high quality clinical practice, education, safety and ethics for the benefit of patients. This European Standard does not supersede national legislation. SIST EN 16686:2015



EN 16686:2015 (E) 6 1 Scope This European Standard specifies the requirements and recommendations regarding the healthcare provision, facilities and equipment, education, and ethical framework for the good practice of osteopathy. 2 Terms and definitions For the purposes of this document, the following terms and definitions apply. 2.1 care interventions that are designed to maintain and improve health 2.2 case history detailed account of a patient’s health and disease status and other information provided by them 2.3 clinical record document which relates to the case history, examination, assessment, evaluation, diagnosis, treatment or care provided to a patient, and any necessary administrative information 2.4 co-morbidities concomitant but unrelated pathological or disease processes 2.5 consent acceptance by a patient of a proposed course of action to be taken by an osteopath after having been informed of relevant factors relating to it 2.6 continuing professional development
CPD means by which members of a profession maintain, improve and broaden their knowledge and skills relating to that profession 2.7 diagnosis the development by an osteopath of working hypotheses of dysfunction(s), and recognition of signs and symptoms of illness or disease using diagnostic processes of examination, assessment and evaluation Note 1 to entry: This definition is being used in this European Standard, whether or not the legislation of an individual state prevents such a term being used by an osteopath. 2.8 dysfunction area of the body with impeded biomechanical, neuroelectrical, vascular, biophysical, biochemical or cellular function which is causing a decrease in health 2.9 health state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity SIST EN 16686:2015



EN 16686:2015 (E) 7 2.10 healthcare activity carried out by a professional in the field of the health and/or well-being of the person Note 1 to entry: This definition is being used in this European Standard, whether or not the legislation of an individual state prevents such a term being used by an osteopath. 2.11 osteopath osteopath (in some circumstances and some countries referred to as an osteopathic physician or osteopathic practitioner) is an individual who has completed an appropriate education in osteopathy and continues to demonstrate the required standards 2.12 osteopathy primary contact and patient-centred healthcare discipline, that emphasizes the interrelationship of structure and function of the body, facilitates the body’s innate ability to heal itself, and supports a whole-person approach to all aspects of health and healthy development, principally by the practice of manual treatment Note 1 to entry: The terms osteopathy and osteopathic medicine are sometimes, and in some countries, used interchangeably. 2.13 patient confidentiality right of an individual to have information about them kept private 2.14 primary contact profession profession that a patient may consult directly but does not imply managing the multidisciplinary care of the patient Note 1 to entry: This definition is being used in this European Standard, whether or not the legislation of an individual state prevents such a term being used by an osteopath. 2.15 referral transfer of responsibility for care to a third-party for a particular purpose, such as additional investigation, care or treatment that is outside the referring practitioner’s competence 2.16 treatment interventions that are designed to improve, maintain and support health, relieve symptoms, or reduce dysfunction and disease SIST EN 16686:2015



EN 16686:2015 (E) 8 3 Description of Osteopathy The practice of osteopathy uses osteopathic, medical and scientific knowledge to apply the principles of osteopathy to patient diagnosis and treatment. The aim of osteopathy is to improve and support all aspects of health and healthy development. Osteopathic treatment may be preventive, curative, palliative or adjuvant. Osteopaths analyse and evaluate the structural and functional integrity of the body using critical reasoning of osteopathic principles to inform individual diagnosis and treatment of the patient. These principles are: — the human being is a dynamic functional unit, whose state of health is influenced by the body, mind and spirit; if one part is changed in the system, the balance of the whole pattern will be affected; — the body possesses self-regulatory mechanisms and is naturally self healing; the human being always tries to regain its own dynamic balance and establish homeostasis; and — structure and function are interrelated at all levels of the human being. The osteopathic approach to healthcare is patient-centred and focused on the patient’s health rather than disease-centred. Scientific rigour and evidence-informed practice are an important part of patient treatment and case management. Osteopaths use manual contact to identify and evaluate movement in all structural and functional aspects of the patient, identifying alterations of function and movement that impede health and addressing these. The highly developed sense of touch and attention to complex systems as a unit is typical of an osteopathic approach. Osteopathy is an independent healthcare discipline. Osteopaths should also cooperate with practitioners of other disciplines. Osteopathy is based on principles drawn from human physiology, anatomy, embryology and other bio-medical sciences. In consequence of the complexity of the human organism there are a number of different models that are used in osteopathy. The models set out in Annex A articulate how an osteopath seeks to influence a patient’s physiological responses. These models influence the gathering of diagnostic information and the interpretation of the significance of structural findings in the overall health of the patient. Typically a combination of models will be appropriate for an individual patient and adapted to the patient’s diagnosis, co-morbidities, other therapeutic regimens, and response to treatment. The terms osteopathy and osteopathic medicine are sometimes, and in some countries, used interchangeably. SIST EN 16686:2015



EN 16686:2015 (E) 9 4 Clinical practice 4.1 General Osteopathy is focused on the patient’s health rather than being disease-centred. Osteopaths shall have an understanding of osteopathic and non-osteopathic models of health and disease and how these inform a critical consideration of practical patient care and management. They shall have a critical awareness of relevant research and of principles and practice of relevant healthcare approaches for adequate referral, cooperation and adjuvant treatment. 4.2 Essential competencies for osteopathic practice Osteopaths share a set of core competencies that guide them in the diagnosis, management and treatment of their patients and form the foundation for the osteopathic approach to healthcare. The following are essential competencies for osteopathic practice which sould be included in all training programmes (see 6.3 below): a) osteopathic history, principles, and approach to healthcare; b) basic sciences relevant to osteopathic practice; c) diagnosis and treatment planning; d) knowledge of the mechanisms of action of manual therapeutic interventions and the biochemical, cellular and gross anatomical response to treatment; e) ability to appraise medical and scientific literature critically and incorporate relevant and contemporary information into practice; f) competency in the palpatory and clinical skills necessary to diagnose dysfunctions of the body, with an emphasis on osteopathic diagnosis (see Annex A); g) competency in a broad range of osteopathic skills; h) proficiency in physical examination and the understanding of relevant tests and data, including diagnostic imaging and laboratory results; i) understanding and expertise in diagnosis and osteopathic treatment using the osteopathic models (see Annex A) and evaluation of the outcomes; j) thorough knowledge of the indications for osteopathic treatment, and contraindications to specific osteopathic techniques; k) ethical and legal aspects of healthcare; l) a basic knowledge of commonly used conventional medicine and Complementary and Alternative Medicine; m) a knowledge of practice, financial and data management, and regulation relevant to osteopathic practice; and n) self awareness and the ability to be self-critical, and to be able to respond positively to feedback from patients and peers. SIST EN 16686:2015



EN 16686:2015 (E) 10 4.3 Case History, examination and interpretation of the findings Osteopaths shall take a case history of the patient and analyse the patient’s presenting complaint. They shall be able to interpret verbal and non-verbal information. This information shall be individually recorded and stored safely. Confidentiality shall be maintained at all times. Osteopaths shall give patients the information they need and in a way they can understand and benefit from. There should be an explanation of benefits and risks and as a result, consent given by the patient for the treatment/procedure. Osteopaths shall formulate and record a diagnosis or rationale for care or referral, based on the osteopathic evaluation and the case history. The diagnosis and rationale for care shall be kept under review while caring for the patient. Osteopaths shall select an appropriate course of action based on a rational decision-making process which includes a critical consideration of limits of competence, the likely effects of osteopathic treatment, relevant research and the patient’s wishes. Osteopaths shall demonstrate a detailed knowledge and understanding of human structure and function, with great emphasis on functional interrelation of all the systems of the body. This shall be sufficient to recognize, identify and differentiate between normal and abnormal structures and processes in the living body. Osteopaths consider and recognize through an understanding of the models (see Annex A) and principles that the presenting problem may be caused by underlying health concerns. Osteopaths shall conduct an effective assessment and undertake a thorough, sensitive and appropriately detailed evaluation. As well as using clinical skills to evaluate a patient, osteopaths shall also be able to determine whether further investigations are necessary. Osteopaths shall have a knowledge and understanding of human disease and dysfunction sufficient to inform clinical judgement and to diagnose and to recognize disorders not suitable for specific osteopathic techniques. 4.4 Osteopathic treatment Osteopaths shall generate accurate, contemporaneous clinical records of the outcomes of the patient evaluation and treatment process. Osteopaths shall be able to justify how osteopathic treatment is applied to the patient. Osteopaths shall select, use and modify a wide range of osteopathic techniques and patient management approaches. Osteopaths shall assess the effect of treatment during and after its application, where possible. The purpose of osteopathic treatment may be preventive, curative, palliative or adjuvant. Osteopaths shall endeavour to help the patient regain as much of their natural structural integrity and function as possible. Osteopaths shall guide the patient to an understanding of the significance of the potential effect of the treatment and enhance the patient’s understanding and commitment to individual exercise, preventive measures, adapting lifestyle and diet, as well as making use of healthcare disciplines, as appropriate. Osteopaths shall make clear the importance of these aspects and self-care activities for the patient’s health. This includes explanation of its potential benefits, risks and limitations. Osteopaths shall help patients to make informed choices about their personal healthcare maintenance. The osteopath shall educate the patient in the understanding of their disorders and how to manage their conditions or prevent recurrence. SIST EN 16686:2015



EN 16686:2015 (E) 11 Osteopaths shall be able to recognize adverse reactions to osteopathic treatment and to initiate appropriate responses, including referral when appropriate. Osteopaths shall endeavour to work in partnership with healthcare professionals and patients, as effective interaction of all involved provides optimal care. Osteopathic practice facilities shall meet the need of the patients for confidentiality and optimal cooperation in the treatment process. They shall be hygienic, safe and conducive to the delivery of high-quality healthcare, and adhere to national health and safety standards. 4.5 The osteopathic profession 4.5.1 General Osteopathy is recognized as distinct from healthcare disciplines that utilize manual techniques and is not limited to the spinal thrust techniques often associated with manual medicine. To avoid isolation as practitioners, osteopaths are recommended to seek cooperation with other practitioners and to join a national osteopathic association or register, or where no such body exists, work with colleagues to form an association or register. Osteopathic organizations are recommended to work in cooperation with others to promote high standards of osteopathy. 4.5.2 Continuing professional development Osteopaths shall maintain and develop their knowledge and skills of osteopathic treatment and science through continuing professional development. Continuing professional development shall maintain, improve and broaden the osteopathic knowledge and skills of the graduated osteopaths and develop the personal qualities required in their professional lives. Subject to national legal regulations a requirement shall be put in place to ensure the continued formation of the osteopath in practice. 4.5.3 Quality management Osteopaths and their national osteopathic associations are encouraged to develop systems of quality management in accordance with appropriate recognized European quality standards. In the absence of existing national quality standards, osteopathic quality standards shall include: a) access to the practice premises; b) the consultation/treatment room; c) provision of waiting areas and other facilities for patients; d) information provided to patients about their treatment and care, including its price and any reimbursement mechanisms; e) hygiene and cleanliness procedures, for personnel, premises, facilities and equipment; f) systems and processes in place for managing emergency situations; g) security and confidentiality of patient information and other data; h) communication with patients including appointments and reception procedures; SIST EN 16686:2015



EN 16686:2015 (E) 12 i) assessment of patient satisfaction; and j) continuous improvement processes within the practice. 5 Ethics The osteopath shall provide services with high standards of ethical and professional behaviour. Annex B provides the principles of ethics for osteopaths. The osteopath shall observe these principles in their interactions with patients, prospective patients and other osteopaths and healthcare professionals. 6
Education and Training 6.1 General An osteopath shall have reached a level of knowledge and skills through education and training that meets the following characteristics. 6.2 Forms and/or categories of education 6.2.1 General Regulating the practice of osteopathy and preventing practice by unqualified practitioners requires a proper system of training, examination and licensing. Benchmarks for training have to take into consideration the subsequent items: a) contents of the training; b) methods of the training; c) to whom the training is to be provided and by whom; d) the roles and responsibilities of the future practitioner; and e) the level of education required in order to participate in osteopathic training. There are two types of training depending on prior training and clinical experience of trainees: f) Type I training programmes are aimed at those with little or no prior healthcare training, but who have completed high school education or equivalent; and g) Type II training programmes are aimed at those with prior training as healthcare professionals. 6.2.2 Common features of both Type I and Type II programmes Osteopathic manual treatment is a distinctive component of osteopathy. It requires both cognitive and sensomotoric skills, and knowledge, and the development of these clinical and manual skills require time and practice. Osteopathic skills and physical examination training shall be delivered via direct contact. Other academic curricular content may be delivered in various training formats. SIST EN 16686:2015



EN 16686:2015 (E) 13 Both Type I and Type II programmes shall be externally validated or assessed, with independent and expert osteopathic input. Providers of osteopathic education and training shall ensure, through documented information, that clinical and academic staff have appropriate professional and educational knowledge, skills and experience, maintained with continuous professional development. Supervised osteopathic clinical practice is an essential component of the training of osteopaths, which may take place in several formats. The majority of clinical training shall take place in an osteopathic environment. Suitable formats include: a) in a dedicated osteopathic teaching clinic, where high-quality clinical support and teaching can be provided; b) in medical hospitals or in healthcare establishments, where students are able
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