An Enactive-Ecological Model to Guide Patient-Centered Osteopathic Care

Area of Science:

• Osteopathic manipulative medicine
• Clinical reasoning
• Embodied cognition

Background:

• Osteopaths frequently encounter complex clinical presentations requiring advanced clinical reasoning.
• Understanding the patient's lived experience and its impact on their life is crucial for effective osteopathic care.
• Existing frameworks may not fully capture the nuances of osteopathic practice.

Purpose of the Study:

• To present a clinically based interpretation of the (En)active inference framework for osteopathic care.
• To explore how (En)active inference can address complexity and clinical uncertainty in osteopathy.
• To highlight the role of therapeutic alliance, touch, and hands-on care within this framework.

Main Methods:

• Conceptual interpretation of (En)active inference applied to osteopathic practice.
• Analysis of patient-practitioner interaction through the lens of active inference.
• Consideration of the ecological niche of osteopathic care.

Main Results:

• Active inference facilitates disambiguation of unobservable patient mental states through perceptual cues.
• Touch and hands-on care enhance therapeutic alliance, mental state alignment, and biobehavioral synchrony.
• The osteopath-patient dyad enables ecological niche construction, potentially reducing prediction errors and minimizing free energy.

Conclusions:

• The (En)active inference framework offers a valuable model for understanding and enhancing person-centered osteopathic care.
• Integrating enactivism and active inference can improve how osteopaths manage clinical complexity and uncertainty.
• This framework emphasizes the therapeutic potential of the osteopath-patient relationship, including the role of touch.