Clinical Integration and Case Management
Core concepts
Integration means combining the osteopathic structural examination with conventional workup into a single plan: problem list, differential, treatment goals, modality selection, frequency, reassessment intervals, and referral criteria. Know how to sequence care - address the most limiting restriction first, layer techniques, and reassess objectively.
Building the plan
State the diagnosis, the somatic dysfunction findings, the treatment approach with rationale, expected response, and what would trigger a change in course. Include self-care, activity guidance, and coordination with other clinicians. Document medical necessity through measurable change in findings and function.
Traps
- Listing techniques without linking them to findings.
- No defined reassessment point, so progress cannot be judged.
- Failing to refer when response is absent or red flags appear.
- Fragmented plans that ignore psychosocial and occupational factors.
- Overlooking medication interactions or comorbidities that alter technique choice.
Rule of thumb
Every plan needs a "what if it does not work" branch; if you cannot state the next step, the plan is incomplete.
Worked example
A patient with subacute low back pain and a single restricted lumbosacral segment receives muscle energy and soft tissue work twice weekly for two weeks, with a defined functional goal (tolerance for sitting) and a reassessment at the end of that period; lack of change triggers imaging and referral.