Objectives: This study aims to describe the characteristics of published peer-reviewed journal articles authored by naturopathic practitioners (NPs) Design: The study used bibliometric analysis of data extracted from journal articles. Settings/Location: International Subjects: Articles were included if they had at least one author with a naturopathic qualification and were published in a peer-reviewed, indexed journal. Data collection: A snowballing method was used between June 2018 and July 2019 to identify relevant articles. Outcome measures: Data related to geography, affiliation, year of publication, article type or research design, article topic, and journal were extracted from each included article. Results: Identified articles (n = 2,218) were published by NP from 22 countries between 1987 and 2019, with 80.9% published in the last 10 years. Most articles were published by NP from the America (52.5%) and Western Pacific (28.3%) World Health Organization regions. The most common type of study design or article type was reviews and meta-analyses (23.2%) and clinical trials or intervention studies (19.4%). Explicit mention of naturopathy was reported in 8.1% of articles. Almost half (48.4%) of all included articles were published in 40 journals, and 56.9% of these were published in journals ranked in the first quartile of at least one subject area. Articles focused on mental health were more likely to be conducted in Australia (odds ratio [OR] 3.3) and focused on lifestyle behavior (OR 2.5) or clinical nutrition (OR 1.6). Articles about cancer or cancer-related conditions were more likely to include lifestyle behavior (OR 2.0) and less likely to be conducted in Australia (OR 0.1) or Germany (OR 0.5). Conclusions: The international naturopathy research community has produced peer-reviewed literature for over 30 years and has demonstrated sustained commitment to codifying existing knowledge, generating new knowledge, and disseminating this knowledge to the wider clinical and research community.
Objectives: State (situational) anxiety can create suboptimal outcomes for patients across a variety of health care specializations. While anxiolytic medications reduce anxiety, problematic side effects can compromise outcomes. These challenges have spurred searches for nonpharmaceutical approaches to alleviate patient anxiety. This systematic literature review, largely following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to determine patterns and effectiveness of interventions across medical health care specialty areas, including dentistry. Methods: A systematic review was conducted, using PubMed, CINAHL, and PsycINFO databases, with search terms related to anxiety, specific interventions, and medical or dental procedures. Hand searching for additional citations was performed on the bibliographies of dissertations, meta-analyses, and systematic reviews that met article inclusion criteria. The search process yielded 48,324 articles and 257 dissertations published in English between 1974 and 2018. Each abstract was evaluated for inclusion by two reviewers, yielding 718 articles that were read and evaluated for outcomes, risk of bias, pretest and post-test, controls and quality, using a Critical Appraisal Skills Programme instrument. Of these, 408 articles, describing 501 experimental trials, were accepted for inclusion in this analysis. Results: A total of 50,343 patients were included in these experiments, with an overall success rate of 71% for reducing patient anxiety. Results are summarized by health care specialty area: surgery, oncology, cardiology, obstetrics/gynecology, dentistry, and pain/trauma, and the following diagnostic testing and intervention areas: imaging, colonoscopy, mechanical ventilation, and other. The largest number of experiments (114) was in the surgery category. The types of interventions included music, education, relaxation, cognitive behavioral therapy (CBT), massage, distraction, hypnosis, acupuncture/acupressure, social support, aromatherapy, nature sounds, natural visual stimuli, special garment, and other. The largest numbers of experiments were done with music (143) and education (130). Discussion: The following interventions were most successful, reducing anxiety in over 70% of experiments: music, CBT, relaxation, massage, acupuncture/acupressure, hypnosis, and natural sounds. Confidence in results is limited by publication bias, small sample sizes, and the lack of placebo controls. Directions for future research are discussed.
The Journal of Alternative and Complementary MedicineVol. 27, No. 10 EditorialReleasing CLARIFY: A New Guideline for Improving Yoga Research Transparency and UsefulnessSteffany Moonaz, Daryl Nault, Holger Cramer, and Lesley WardSteffany MoonazDepartment of Integrative Health Research, Maryland University of Integrative Health, Laurel, MD, USA.Search for more papers by this author, Daryl NaultDepartment of Integrative Health Research, Maryland University of Integrative Health, Laurel, MD, USA.Search for more papers by this author, Holger CramerAddress correspondence to: Holger Cramer, PhD, Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, Essen 45276, Germany E-mail Address: h.cramer@kem-med.comDepartment of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.Search for more papers by this author, and Lesley WardDepartment of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom.Search for more papers by this authorPublished Online:8 Oct 2021https://doi.org/10.1089/acm.2021.29096.hcrAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 27Issue 10Oct 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Steffany Moonaz, Daryl Nault, Holger Cramer, and Lesley Ward.Releasing CLARIFY: A New Guideline for Improving Yoga Research Transparency and Usefulness.The Journal of Alternative and Complementary Medicine.Oct 2021.807-809.http://doi.org/10.1089/acm.2021.29096.hcrPublished in Volume: 27 Issue 10: October 8, 2021Online Ahead of Print:September 21, 2021PDF download
Introduction: Complementary medicine (CM) is often used by patients and offered by physicians. The attitude of medical students toward CM in Germany has been given little research attention. The aim was to assess the attitude of medical students toward CM in general and their opinion about the importance of CM university research and teaching. Methods: An exploratory cross-sectional study among medical students at the Charite-Universitatsmedizin Berlin was performed at the beginning of the summer term 2019 using an online survey. The attitude toward CM was assessed by the Complementary and Alternative Medicine Health Belief Questionnaire (CHBQ, range 10-70, neutral at 40; a higher score indicates a more positive attitude toward CM). Furthermore, students rated their own CM use and the perceived importance of CM university research and teaching (range 1-7; a higher score indicates more agreement). The study was approved by the Charite Ethics Committee (institutional review board). Results: Out of 1256 contacted students, 349 (27.8%) students (mean age 23.7 +/- 4.3 years, 69.0% female) participated. The attitude toward CM based on the CHBQ was rather neutral (mean 44.2 +/- 10.7) and more positive among females than males (mean 46.1 +/- 10.7 vs. 40.6 +/- 9.5, p < 0.001). Medical students favored CM university research (mean 5.4 +/- 1.5) and mostly did not agree that CM is currently taught sufficiently at the university (mean 3.4 +/- 1.7). The lifetime prevalence of student's own CM use was 48.4% of respondents (79.1% females). Conclusion: Although medical students, in this sample with a high percentage of females, reported a rather neutral attitude toward CM, the authors' findings indicate that medical students promoted research and teaching in CM. Further multicenter cross-sectional studies in German and European medical universities should be undertaken to explore students' attitudes and wishes regarding the integration of CM in university teaching, research, and patient care.
The Journal of Alternative and Complementary MedicineVol. 27, No. S1 EditorialFree AccessMoving Integrative Health Research from Effectiveness to Widespread DisseminationStephanie L. Taylor, Jeffery A. Dusek, and A. Rani ElwyStephanie L. TaylorAddress correspondence to: Stephanie L. Taylor, PhD, Center for the Study of Healthcare Innovation Implementation and Policy, VA Veterans Health Administration, Los Angeles, CA, USA E-mail Address: stephanie.taylor8@va.govCenter for the Study of Healthcare Innovation Implementation and Policy, VA Veterans Health Administration, Los Angeles, CA, USA.Departments of Medicine and Health Policy and Management, UCLA, Los Angeles, CA, USA.*ORCID ID (https://orcid.org/0000-0002-3266-1132).Search for more papers by this author, Jeffery A. DusekConnor Integrative Health Network, UH Cleveland Medical Center, Cleveland, OH, USA.Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA.†ORCID ID (https://orcid.org/0000-0001-9581-0564).Search for more papers by this author, and A. Rani ElwyVA Boston Healthcare System Center for Healthcare Organization and Implementation Research, Boston, MA, USA.Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.Search for more papers by this authorPublished Online:31 Mar 2021https://doi.org/10.1089/acm.2021.0080AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Stephanie L. Taylor, PhD, MPHJeffery A. Dusek, PhDA. Rani Elwy, PhDThis philanthropically backed JACM Special Issue on Effectiveness, Implementation and Dissemination Research in Integrative Health highlights how research on many complementary and integrative health (CIH) practices has moved beyond efficacy studies to progress further along the implementation and dissemination pipeline. This pipeline moves from "preimplementation" or effectiveness studies to implementation of evidenced-based integrative health approaches into practice, and eventually to widespread dissemination, which spurs sustainment.Real-world research to help the public, academic researchers, health care and policy decision makers, and other stakeholders understand the optimal uses of CIH practices has never been as important as it is today. The twin crises of increased prevalence of depression and elevated chronic pain, plus high levels of opioid use, have played key roles in the increase in patient and provider interest in nonpharmacologic approaches for health management. In addition to increased interest, the evidence of efficacy for several CIH practices has become solidly established for numerous health conditions.1–7These forces have led to significant movement toward supporting CIH deployment in health care systems, national health strategies,8 and national treatment guidelines. For example, several CIH practices have been part of the American College of Physicians (ACP) and American Academy of Family Physicians pain treatment guidelines.9–10 Three years ago, the nation's largest integrative health care system, the Veterans Health Administration (VA), deemed nine CIH practices to be medical treatment as part of their Whole Health medical transformation,11 something that no other health care system in the world has done to this degree. Globally, the World Health Organization's Traditional, Complementary, and Integrative Medicine initiative urges member nations to determine how CIH practices can be useful in meeting the WHO goal of universal health care.12Given this increased need for and interest in CIH practices, the growing number of studies demonstrating CIH practice efficacy, and growing national and international policy and health care system support, it is critical that scientists move beyond efficacy studies (for the more well-established CIH practices) to examining effectiveness, implementation, and dissemination of CIH practices in real-world clinical settings.The authors, along with John Weeks, JACM's Editor-in-Chief at the time, who codeveloped this project, would like to thank the philanthropic investors, The Institute for Integrative Health and the George Family Foundation, for funding this special issue to highlight studies of CIH practice effectiveness, implementation, and dissemination (see organizational logos). Importantly, bringing together these studies in this special issue also allows for a review of the methodological strengths in these studies, which can serve as examples for overcoming existing challenges in CIH research. The authors also would like to thank the Special Issue Advisory Team, which includes the 12 members shown hereunder, for guiding this issue. Finally, the authors would like to thank Drs. Dave Clark, Emmeline Edwards, Peter Murray, and Helene Langevin, members of National Institutes of Health National Center for Complementary and Integrative Health (NCCIH) leadership, for their excellent commentary on implementation science in CIH.Special issue advisory team memberInstitutional affiliationBrian Berman, MDPresident/Founder, Institute of Integrative Health; Professor of Family and Community Medicine and Director of the Center for Integrative Medicine, University of Maryland School of MedicineLinda E. Carlson, PhDEnbridge Research Chair in Psychosocial Oncology Professor, Department of Oncology, Cumming School, of Medicine, University of CalgaryDave Clark, DrPHProgram Director, Extramural Research, National Center for Complementary and Integrative Health, NIHLynn DeBar, PhD, MPHSenior Investigator, Kaiser Permanente Washington Health Research InstituteChristine Goertz, DC, PhDProfessor, Duke University Medical School; Chair, Board of Governors, Patient-Centers Outcomes Research InstitutePatricia Herman, ND, PhD, MSSenior Behavioral and Social Scientist RAND CorporationDonald Douglas McGeary, MDAssociate Professor, Psychiatry University of Texas Health ScienceDan Rhon, PT, DPT, DSc, OCS, FAAOMPTResearch Director, Bellin CollegeAmie Steel, ND, PhDSenior Research Fellow, Complementary and Alternative Medicine University of Technology, SydneyClaudia Witt, MD, MBAVice Dean for Interprofessionalism, University of Zurich; Professor and Chair, Institute for Complementary and Integrative Medicine; University Hospital Zurich and University Zurich, SwitzerlandStephen Zeliadt, PhD, MPHResearch Professor Health Services, School of Public Health, University of Washington; Veteran's Administration, Health Services Research and DevelopmentSuzanna Zick, ND, MPHResearch Associate Professor Co-director, Integrative Family Medicine, University of Michigan Medical SchoolThis special issue includes a wide variety of peer-reviewed articles to showcase how CIH researchers are addressing the three phases of effectiveness, implementation, and dissemination research in several countries across the world (e.g., Taiwan, Australia, Switzerland, and the United States). For example, researchers are conducting preimplementation/effectiveness phase studies of multimodel CIH programs available in the hospital or outpatient settings or are examining medical records to determine acupuncture effectiveness among patients with osteoarthritis and coronary heart disease. Other studies examine CIH implementation, with one using hybrid designs to simultaneously examine effectiveness and implementation, and another study examining the uptake of clinical guidelines recommending CIH practices. The third group of studies explores CIH practice dissemination and sustainment in usual care, with one study examining the business case for CIH practices and another demonstrating CIH practice dissemination across a large health care system.Preimplementation or Effectiveness PhaseAfter an intervention has recognized efficacy and before an intervention is ready for implementation, its effectiveness should be demonstrated. This issue presents five articles examining effectiveness, three of which examine multimodal CIH programs, such as are increasingly being explored in health care systems in response to the complexity of chronic conditions. The first, by Vitale and colleagues, examined a 4-week multimodal CIH program they developed to address risk factors of suicide. The multimodal program was an intensive (3 hours/day, 5 days/week) 4-week program comprising acupuncture, yoga, transcendental meditation, dance therapy, music therapy, emotional freedom technique, and other wellness activities. Among 126 veteran participants at risk for suicide, their program showed high engagement and improved participants' suicidal ideation, depression, and hopelessness. In a subset of veterans with history of suicidal ideation or attempt, the program also improved their pain, post-traumatic stress disorder (PTSD)/anxiety symptoms, and stress/coping.The second study examining a multimodal CIH program, by Dusek and colleagues, utilized an EPIC-based medical record to evaluate the impact of CIH practices on pain intensity in a real-world cohort of hospitalized patients in a large Midwestern Hospital in the United States. The authors found that post- to preintervention pain intensity scores decreased at clinically meaningful and clinically significant levels across the sample of over 3600 unique hospital admissions. Across various clinical populations (including cardiovascular, neuroscience/spine, orthopedic, and oncology), there were differences in the degree of pain relief reported. Importantly, for the first time, this team was able to account for pain medication status at the time of the CIH session. The authors found that patients who were not taking any pain medications at the time of CIH session had the same level of pain reduction as patients who were taking narcotics or nonsteroidal anti-inflammatory drugs or both. The authors conclude that future research is needed to determine optimal implementation and use of CIH practices in hospital settings.The third multimodal effectiveness study, by Abadi and colleagues, examined a peer-led group-based 9-week pilot program that aimed to teach outpatients "to become empowered to engage in their own health and well-being through mindful awareness practices, self-care strategies, and setting life goals," using whole health concepts, tools, and strategies that are now branded as such and have been implemented in many of the 170 VA medical centers in the United States. Their results showed the class reduced their perceived stress and improved their mental health, quality of life, and patient engagement.The fourth effectiveness study was a randomized trial of a trauma-sensitive yoga intervention versus a standard PTSD treatment—cognitive processing therapy (CPT), with both being delivered in an PTSD outpatient clinic to women veterans with PTSD due to military sexual trauma. Their study rationale was that CPT can be expensive relative to yoga, and women often ask for CPT treatment alternatives. The yoga intervention focused on interoception (i.e., the sense of the physiological condition of the body and "addresses themes related to establishing safety, individual choice, being in the present moment, and taking effective action"). They found the yoga intervention and CPT control groups had similar "clinically meaningful decreases in PTSD symptom severity and PTSD diagnosis" but that the yoga intervention had higher adherence.The fifth effectiveness study, by Ton and colleagues, took a different approach by conducting a nationwide matched cohort study to examine the risk of coronary heart disease among patients with and without osteoarthritis, among those who did and did not receive acupuncture, given patients with osteoarthritis are more likely to develop coronary heart disease than the general population. They used electronic records from Taiwan's National Health Insurance Research Database. Their results showed that the osteoarthritis nonacupuncture cohort had a higher risk of developing coronary heart disease than the osteoarthritis–acupuncture cohort, and the nonosteoarthritis cohort had a higher risk of developing coronary heart disease than the osteoarthritis acupuncture cohort. Given the observational nature of the study, the authors note that randomized controlled trials of patients are needed to confirm their observational findings.Implementation PhaseFour articles address CIH practice implementation. Since the field of implementation science's inception over 15 years ago,13 empirical data on 73 implementation strategies exist, and the field of CIH has not yet reached consensus on which strategies are more important.14,15 As such, it can be difficult to determine which set of strategies to study or use. Roth and colleagues offer one solution to this dilemma by describing how they applied an "implementation mapping"16 method to identify theory-driven barriers and facilitators to implementation and strategies to overcome those barriers to guide the implementation of outpatient integrative medicine group visits. The authors write that implementation mapping "is based upon and closely mirrors intervention mapping, a process for designing health behavior interventions" and "offers a systematic process for selecting the implementation strategies needed to overcome barriers to implementation by considering relevant behavioral theories and stakeholder input. Utilizing a systematic process enhances replicability, while utilizing relevant theory enhances potential to identify mechanisms of action of implementation strategies," both of which "are key to enhancing the rigor of implementation science." They used the Consolidated Framework of Implementation Research17 to guide their efforts and determined numerous implementation strategies, as well as implementation barriers and facilitators.Two studies further delve into issues of barriers and facilitators to CIH implementation. Bolton et al. examined a key health care innovation implementation factor, that of medical center leadership support. They applied Greenhalgh's Diffusion of Innovation framework18 to elicit health care leaders' reasons for providing or withholding support for CIH programs at the individual, interpersonal, organizational, and health care system levels, among 48 health care leaders at seven medical facilities that had at least three CIH programs. Their respondents provided numerous but consistent implementation themes at these levels. As such, the authors concluded that efforts to "shift individual attitudes alone may be insufficient for securing leaders' support without attention to broader organizational and system-level contextual issues."Hunter and colleagues explored the prevalence of integrative oncology programs across Australia and the barriers and facilitators to the implementation of those programs. They used a mixed-methods approach, using a survey among all public and private sector health care organizations that provide clinical care to cancer survivors and focus group interviews and an online survey of cancer survivors to further contextualize their data. Not surprisingly, they too found numerous barriers and facilitators to integrative oncology service implementation at the system and patient levels, leading the authors to conclude that implementation was "more complex than building the evidence-base and demonstrating value to justify funding" and that "providers require more guidance on clinical governance, business models, local service gaps and inter-professional collaboration."National health care policies and clinical guidelines clearly play an important role in supporting health care intervention implementation. However, clinicians often do not follow clinical guidelines for a variety of reasons. In the United States, the ACP produced the 2017 and 2020 low back pain treatment guidelines, which included recommendations for a variety of CIH practices.9–10 Given the widespread prevalence of low back pain, two very different studies were selected examining the critical issue of the degree to which physicians follow these ACP guidelines. In the first, Goertz and colleagues used a large national survey subset of patients with low back pain to examine their providers' treatment recommendations, while the second study, by Roseen and colleagues, took a qualitative approach to interview providers on their low back pain treatment recommendations. Goertz's study examined 1035 people with low back pain among a Gallup poll survey of a demographically representative sample of 12,998 U.S. adults. Among those who consulted a physician, 81% reported the physician recommended drug and nondrug therapies for low back pain. Over a third said their doctors recommended massage, acupuncture, or spinal manipulation, with 68% or more following each of those recommendations. The authors also report on respondents' use of nonpharmacologic therapies without an MD's recommendation and showed that 41% reported using yoga, stretching, or other exercises; 26% reported using massage and 19% reported using spinal manipulation.Roseen and colleagues' study used brief structured interviews with 72 primary care providers in three community-based outpatient clinics to elicit their familiarity with the ACP guidelines and how they managed patients with acute/subacute and chronic low back pain. Due to socioeconomic and racial/ethnic disparities in access to and outcomes of low back pain treatment, the authors purposely selected the clinics based on their area-level "disadvantage," to select an academic primary care group in a high-income neighborhood, a community health center serving predominantly Latinx patients, and a federally qualified health center in a low-income neighborhood. The authors found that most primary care providers reported being familiar with the ACP guidelines, but none advised patients with acute low back pain to use the ACP-recommended nonpharmacologic treatments. For patients with chronic low back pain, 85% of physicians did recommend these treatments, but most recommended physical therapy with few recommending the CIH therapies.Many researchers now simultaneously examine both the effectiveness and implementation of interventions using hybrid study designs.19 One such study in this special issue conducted by Siebenhuener and colleagues examined both effectiveness (patient symptoms) and implementation (adherence) outcomes of a mindfulness and relaxation app they developed and tested among cancer patients. They found that the app reduced participants' distress and several other patient-reported outcomes. However, they discovered that participants' adherence to the app was stronger among those whose distress was at moderate levels or in whom distress increased, while their adherence was reduced among those whose distress improved. To interpret this interesting finding, they posit that their app's effectiveness (a reduction in distress) actually led people to use it less.Dissemination or Sustainment PhaseFarmer and colleagues conducted the first in-depth survey of the dissemination of CIH programs across all medical centers in the United States' largest integrated health care system, the VA. They examined the delivery of 27 CIH and other nonpharmacologic therapies, assessing the type of departments in which they were located and the types of providers delivering them, the visit format, and geographic variations in availability. They found CIH provision in the VA to be widespread, with over 1500 CIH programs being available in 2017–2018. Sites offered an average of 5 CIH practices and 63 sites offered 10 or more such practices. The authors found the five most common CIH practices were relaxation techniques, mindfulness, guided imagery, yoga, and meditation. Importantly, all five of these practices fall under a general "mind–body" category. Given the rise in patients' interest in nonpharmacologic options to manage their health, the authors concluded that the VA "is well-positioned to meet that demand."A key part of sustaining any evidence-based treatment is building the business case for its use. The above-mentioned Taiwan-based study conducted by Ton and colleagues on the effectiveness of acupuncture also examined the costs associated with its use. Understanding the cost implications of any CIH use is essential for building the business case for its sustainment in health care.20 They examined the average daily hospitalization and outpatient care expenditures of diagnosed osteoarthritis and nonosteoarthritis patients for up to 5 years. They found that patients with osteoarthritis who were treated with acupuncture had lower medical expenditures than either the osteoarthritis nonacupuncture or nonosteoarthritis cohorts.Finally, the commentary by NCCIH's leadership provides thoughtful and significant instructional guidance on dissemination and implementation science studies. The commentary begins by stating that NCCIH supports "the full continuum of the biomedical research pipeline, whereby a complementary health intervention moves from basic and mechanistic research, through efficacy trials, through dissemination and implementation." Not explicitly mentioned, but what is required from this perspective, is a continued evaluation of effectiveness or preimplementation research after the efficacy research has been conducted but before the dissemination and implementation research (Fig 1.). The authors then stress the importance of conducting CIH implementation and dissemination studies, and especially studies using implementation science.FIG. 1. NCCIH framework for clinical research. NCCIH, National Center for Complementary and Integrative Health.A goal of conducting dissemination and implementation studies, the authors write, can be "to decrease the time between establishing the evidence base of interventions and the widespread uptake and adoption of these interventions." The authors clarify that "dissemination research asks, are the relevant clinicians and target population aware of the novel evidence-based intervention(s)," and "implementation science focuses on, how can these novel evidence-based intervention(s) be more widely and rapidly used in practice?" while implementation science studies are those that "that test strategies to address implementation at multiple ecological levels is a high priority to NCCIH." Informative instructional guidance is provided on the nature of implementation science for researchers who are less familiar with this field, offering that it (1) "assesses more than just barriers and facilitators," (2) "evaluates specific implementation strategies and characterizes the extent that the intervention is modified within the context of the implementation strategy and health care delivery setting," and (3) addresses the question, "how can these novel evidence-based intervention(s) be more widely and rapidly used in practice?" The commentary includes informative sections on definitions, the level of evidence needed to begin considering implementing an intervention, how to differentiate implementation science from implementation and dissemination, methods/measures to use, implementation science frameworks, study designs, and apply it all to the field of CIH practices. The NCCIH commentary concludes by noting NCCIH's future directions and intention to support implementation science among its portfolio of funded research.Indeed, NCCIH's desire to support future implementation science is made explicit in language below which is taken from the draft of the 2021–2015 NCCIH Strategic Plan (https://files.nccih.nih.gov/nccih-strategic-plan-2021-2025-draft.pdf). "Research has shown that nonopioid pain management interventions can be effective for treating acute and chronic pain. More support is needed to assess the impact of evidence-based health care strategies and clinical practices and procedures when they are included in health care systems. Pragmatic and implementation trials could identify strategies to most effectively implement evidence-based interventions and pain management guidelines." The authors wholeheartedly affirm NCCIH's future direction.This JACM Special Issue on Effectiveness, Implementation and Dissemination Research in Integrative Health has provided an opportunity for the field of integrative health research to highlight key studies within the effectiveness, implementation, and dissemination domains of research. It also emphasizes the variety of study designs, methods, measures, and outcomes being assessed across each of these domains. An area of focus for those involved in this research is to coalesce around the optimal ways of conducting CIH effectiveness, implementation, and dissemination research, to move the field forward while also ensuring a high standard of methodological rigor in this research. The work of researchers, who are part of coalitions all using the same outcome measures in studies of integrative health interventions (such as those in the NIH-DoD-VA Pain Management Collaboratory21 or the BraveNet Practice-Based Research Network22), should be shared and widely used. This sharing can encourage a consistent use of outcome measures, the formation of a community of practice of researchers looking to move the needle on the effectiveness of CIH, implementation of evidence-based CIH therapies in routine care settings, and dissemination of best practices widely to ensure sustainment. The overall goal of all CIH effectiveness, implementation, or dissemination research is to improve health of the population. The authors hope you will agree that highlighting these studies and their methodological strengths in this special issue is an important step in that direction.FundingThe authors note again the philanthropic support from the George Family Foundation and from The Institute for Integrative Health that made this special issue possible and has allowed it to be published in open access in perpetuity.References1. Nahin RL, Boineau R, Khalsa PS, et al. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clin Proc 2016;91:1292–1306. Crossref, Medline, Google Scholar2. Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: A systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2017;166:493–505. Crossref, Medline, Google Scholar3. Polusny MA, Erbes CR, Thuras P, et al. Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: A randomized clinical trial. JAMA 2015;314:456–465. Crossref, Medline, Google Scholar4. Morone NE, Greco CM, Moore CG, et al. A mind-body program for older adults with chronic low back pain: A randomized clinical trial. JAMA Intern Med 2016;176:329–337. Crossref, Medline, Google Scholar5. Skelly AC, Chou R, Dettori JR, et al. Noninvasive nonpharmacological treatment for chronic pain: A systematic review update [homepage on the Internet]. Agency for Healthcare Research and Quality (US). 2020. Online document at: www.ncbi.nlm.nih.gov/books/NBK556229/, Accessed July 31, 2020. Google Scholar6. Stahl JE, Dossett ML, LaJoie AS, et al. Relaxation response and resiliency training and its effect on healthcare resource utilization. PLoS One 2015;10:e0140212. Crossref, Medline, Google Scholar7. Cherkin DC, Herman PM. Cognitive and mind-body therapies for chronic low back pain and neck pain: Effectiveness and value. JAMA Intern Med 2018;178:556–557. Crossref, Medline, Google Scholar8. Department of Health and Human Services. National pain strategy: A comprehensive population health-level strategy for pain [homepage on the Internet]. Online document at: https://www.iprcc.nih.gov/sites/default/files/documents/NationalPainStrategy_508C.pdf. Google Scholar9. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166:514–530. Crossref, Medline, Google Scholar10. Qaseem A, McLean RM, O'Gurek D, et al. Nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults: A clinical guideline from the American College of Physicians and American Academy of Family Physicians. Ann Intern Med 2020;173:739–748. Crossref, Medline, Google Scholar11. U.S. Department of Veterans Affairs. Expanding the VA Whole Health System—Whole Health [homepage on the Internet]. Online document at: https://www.va.gov/WHOLEHEALTH/features/Expanding_the_VA_Whole_Health_System.asp Google Scholar12. World Health Organization. WHO Traditional Medicine Strategy: 2014–2023 [homepage on the Internet]. Online document at: https://www.who.int/medicines/publications/traditional/trm_strategy14_23/en/. Google Scholar13. Eccles MP, Mittman BS. Welcome to implementation science. Implementation Sci 2006;1:1–3. Crossref, Google Scholar14. Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the expert recommendations for implementing change (ERIC) project. Implement Sci 2015;10:21. Crossref, Medline, Google Scholar15. Waltz TJ, Powell BJ, Fernández ME, et al. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci 2019;14:42. Crossref, Medline, Google Scholar16. Fernandez ME, ten Hoor GA, van Lieshout S, et al. Implementation mapping: using intervention mapping to develop implementation strategies. Front Public Health 2019;7:158. Crossref, Medline, Google Scholar17. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Sci 2009;4. https://doi.org/10.1186/1748-5908-4-50. Crossref, Google Scholar18. Greenhalgh T, Robert G, Macfarlane F, et al. Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q 2004;82:581–629. Crossref, Medline, Google Scholar19. Curran GM, Bauer M, Mittman B, et al. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 2012;50:217–226. Crossref, Medline, Google Scholar20. Eisman AB, Kilbourne AM, Dopp AR, et al. Economic evaluation in implementation science: Making the business case for implementation strategies. Psychiatry Res 2020;283. https://doi.org/10.1016/j.psychres.2019.06.008. Crossref, Medline, Google Scholar21. Kerns RD, Brandt CA, Peduzzi P, et al. NIH-DoD-VA pain management collaboratory. Pain Med 2020;20:2336–2345. Crossref, Google Scholar22. Dusek JA, Abrams DI, Roberts R, et al. Patients receiving integrative medicine effectiveness registry (PRIMIER) of the BraveNet practice-based research network: study protocol. BMC Complement Altern Med 2016;16:53. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited byLooking Back Ahead: 12 Months of "Advancing Whole Health" Holger Cramer9 January 2023 | Journal of Integrative and Complementary Medicine, Vol. 29, No. 1The Impact of Individualized Complementary and Integrative Health Interventions Provided in Clinical Settings on Quality of Life: A Systematic Review of Practice-Based Research Natalie L. Dyer, Jessica Surdam, Roshini Srinivasan, Ankita Agarwal, and Jeffery A. Dusek10 August 2022 | Journal of Integrative and Complementary Medicine, Vol. 28, No. 8 Volume 27Issue S1Mar 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Stephanie L. Taylor, Jeffery A. Dusek, and A. Rani Elwy.Moving Integrative Health Research from Effectiveness to Widespread Dissemination.The Journal of Alternative and Complementary Medicine.Mar 2021.S-1-S-6.http://doi.org/10.1089/acm.2021.0080Published in Volume: 27 Issue S1: March 31, 2021PDF download
The Journal of Alternative and Complementary MedicineVol. 27, No. 4 EditorialFree AccessTaking a Closer Look at Methodological Quality: JACM Partners with Cochrane Complementary MedicineHolger Cramer and L. Susan WielandHolger CramerAddress correspondence to: Holger Cramer, PhD, Research Director, Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany E-mail Address: H.Cramer@kem-med.comDepartment of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.Search for more papers by this author and L. Susan WielandCochrane Complementary Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.Search for more papers by this authorPublished Online:15 Apr 2021https://doi.org/10.1089/acm.2021.29092.hcrAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Rigor and ReproducibilityTwo cornerstones of scientific advancement are methodological rigor and reproducibility of scientific findings. Although it may not seem immediately obvious, these two pillars are highly interdependent.1According to the US National Institutes of Health, methodological rigor in design and realization of scientific studies is “the strict application of the scientific method to ensure robust and unbiased experimental design, methodology, analysis, interpretation and reporting of results.”2 Lack of methodological rigor can have many causes: fortunately, probably the rarest cause is deliberate scientific misconduct, i.e. the purposeful production or falsification of data. However, in times of increased pressure to publish and increasing competition for research funds, the importance of scientific misconduct should not be underestimated, as it is the reason for more than two thirds of the retractions of scientific papers. Since 1975, the number of retractions due to scientific misconduct has increased tenfold (with the USA and Germany clearly taking the top positions in retractions because of fraud).3 Much more dangerous than conscious fraud, however, because it is more blurred and often not recognized as such even by the scientists concerned, is an unconscious lack of scientific rigor: due to a lack of methodological training or to cognitive bias, cherry-picking is practiced, and results are interpreted or selected in conformity to a preferred hypothesis. Or the work is simply not done precisely and conscientiously enough— either out of inexperience or out of carelessness, precisely because experience teaches that it almost always works out well. But only almost always.4The consequences of lack of scientific rigor, whether deliberate or negligent, are manifold and, especially in clinical research, are a potential threat to public health if the implementation of a therapeutic method is based on biased efficacy and safety data.In addition, however, lack of rigor is also one of the most important threats to reproducibility. Replication of research findings is a basic requirement for making generally applicable treatment recommendations. Without independent replications, individual research results cannot be detached from their specific context; they only allow statements related to the location and time, where and when they were obtained. And, in health research, related to the respective therapists and patients.5 Unfortunately, the independent replication of study results, although essential for therapy decisions, is valued much less than supposedly groundbreaking new findings. What replication would ever have made it to the front pages of major newspapers? And grants also are much more likely to be awarded for “new ideas” than for replications. And so this valuable scientific tool is underutilized.5,6 However, if these supposed breakthrough results are the consequence of a lack of methodological rigor, then an attempt at replication is essential, as it can refute the biased results. If it is lacking, this leads to wrong decisions— and to public health hazards.There are unfortunately still people for whom traditional, complementary, alternative, and integrative medicine (TCIM) research and methodological rigor is an oxymoron, i.e. a pairing of two mutually exclusive terms. Wikipedia (not a scientific source, of course, but often the first access to medical information for the public) lumps together traditional, complementary, alternative, and integrative medicine, defining them all as “any practice that aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested, untestable, or proven ineffective” and claiming that “they reside outside medical science, and rely on pseudoscience.”7 In the further explanation it is listed as the main point of difference to conventional medicine that TCIM cannot or will not be tested by means of scientific studies.JACM Partners with Cochrane Complementary MedicineFrom this it becomes clear that methodological rigor is at least as important in TCIM as it is in biomedicine: in the latter it is tacitly assumed, in the former it is just as tacitly denied. Thus, to overcome this prejudice, TCIM studies must be at least as rigorous as conventional medical ones. JACM has always stood for methodological rigor; in the future, we will focus on and communicate it even more explicitly.An important building block in this methodology initiative is the journal's brand-new partnership with Cochrane Complementary Medicine starting with this issue. Cochrane probably stands for methodological rigor like no other organization. Since Cochrane was founded in 1993 as the Cochrane Collaboration, it has been in the forefront of quality and innovation in systematic reviews and meta-analyses, with regard not only to technical standards but also to standards for transparency and the identification and reduction of methodological bias. Systematic reviews, the comprehensive identification, critical assessment and summarizing of information on a specific research question, and optionally included meta-analyses, the statistical combining of information from separate but similar studies, are an increasingly widely used and trusted method to understand and convey the overall evidence on a particular health question.8Cochrane itself is an international non-profit organization focused on the preparation of high-quality systematic reviews to inform health decision-making, with over 13,000 members and 50,000 supporters from more than 130 countries as of 2018.9 The organization consists of Cochrane Review Groups that produce Cochrane reviews, Methods Groups that develop the methods for Cochrane reviews, Geographic Groups that provide a hub for Cochrane activities in different geographic areas, and Fields that support Cochrane in topic areas that cross multiple health conditions. The main product of Cochrane is the Cochrane Library, an online repository of databases the most relevant of which is the Cochrane Database of Systematic Reviews, a continuously updated database containing the full text of all Cochrane systematic reviews and Cochrane protocols (i.e., pre-specified procedures) for systematic reviews.The Cochrane Complementary Medicine Field was founded in 1996, shortly after the founding of the initial Cochrane Review Groups, to support Cochrane efforts in ensuring the completeness, relevance, quality and accessibility of systematic review evidence on TCIM. For example, Cochrane Complementary Medicine promotes the assessment and improvement of methods for controlled trials and systematic reviews in TCIM, facilitates the identification and availability of difficult-to-find controlled trials in TCIM, develops and delivers educational workshops on the preparation and interpretation of Cochrane evidence, and supports the production and dissemination of individual Cochrane reviews in acupuncture, yoga, and other TCIM modalities.10 The Field also promotes the dissemination of Cochrane review evidence to interested audiences through multiple venues, including summaries and commentaries in TCIM journals.This issue marks the introduction of a regular Cochrane Column, consisting of summaries of the most recent Cochrane evidence relevant to our audience. The goal of these synopses of Cochrane reviews is to provide insight into the current focus and findings of Cochrane reviews in TCIM and related whole-person topic areas, together with a link to the Cochrane review for more detailed information. They provide quick and immediate access to the results of relevant reviews. In addition, they serve as a cornerstone in JACM's new methodology initiative: Cochrane reviews not only offer the highest methodological standard of systematic reviews, they also contain particularly sophisticated methods for assessing the quality and risk of bias in the original papers they contain, and for assessing the overall confidence in the review findings. They thus help to separate the wheat from the chaff.JACM is proud to partner with Cochrane Complementary Medicine to strengthen methodological rigor in the field - but also to demonstrate the methodological quality that many TCIM studies now have.References1. National Institutes of Health. Rigor and reproducibility. Online document at: www.nih.gov/research-training/rigor-reproducibility, accessed March 24, 2021. Google Scholar2. National Institutes of Health. Guidance: rigor and reproducibility in grant applications. Online document at: https://grants.nih.gov/policy/reproducibility/guidance.htm, accessed March 24, 2021. Google Scholar3. Fang FC, Steen RG, Casadevall A. Misconduct accounts for the majority of retracted scientific publications. Proc Natl Acad Sci USA. 2012;10917028–33. Google Scholar4. Hofseth LJ. Getting rigorous with scientific rigor. Carcinogenesis. 2018;39:21–25. Crossref, Medline, Google Scholar5. Schmidt S. Shall we really do it again? The powerful concept of replication is neglected in the social sciences. Rev Gen Psychol. 2009;13:90–100. Crossref, Google Scholar6. Ioannidis JPA. Why most clinical research is not useful. PLoS Med. 2016;13:e1002049. Crossref, Medline, Google Scholar7. Wikipedia. Alternative medicine. Online document at: https://en.wikipedia.org/wiki/Alternative_medicine, accessed March 24, 2021. Google Scholar8. Ahn E, Kang H. Introduction to systematic review and meta-analysis. Korean J Anesthesiol. 2018;71:103–112. Crossref, Medline, Google Scholar9. Chandler J, Cumpston M, Thomas J, Higgins JPT, Deeks JJ, Clarke MJ. Chapter I: Introduction. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, eds. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Online document at: www.training.cochrane.org/handbook, accessed April 1, 2021. Google Scholar10. Cochrane Complementary Medicine. Online document at: https://cam.cochrane.org, accessed April 1, 2021. Google ScholarFiguresReferencesRelatedDetailsCited byLooking Back Ahead: 12 Months of “Advancing Whole Health” Holger Cramer9 January 2023 | Journal of Integrative and Complementary Medicine, Vol. 29, No. 1In the Same Boat: The Evidence Base of (the Whole of) Medicine Holger Cramer8 September 2022 | Journal of Integrative and Complementary Medicine, Vol. 28, No. 9 Volume 27Issue 4Apr 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Holger Cramer and L. Susan Wieland.Taking a Closer Look at Methodological Quality: JACM Partners with Cochrane Complementary Medicine.The Journal of Alternative and Complementary Medicine.Apr 2021.285-286.http://doi.org/10.1089/acm.2021.29092.hcrPublished in Volume: 27 Issue 4: April 15, 2021PDF download
Objective: We evaluated digital consultations at a University Hospital in Switzerland within an integrative medicine outpatient setting. Patients' and treatment providers' (physicians and therapists) evaluated digital conversation-based consultations as well as the digital delivery of practical exercises. Methods: Digital consultations between March 15, 2020 and April 30, 2020 were identified. Between June and July 2020, patients and treatment providers completed online questionnaires addressing challenges and advantages of their digital consultations. Both groups documented their satisfaction and working alliance (Working Alliance Inventory). In addition, semistructured qualitative interviews with treatment providers were conducted. Findings: A total of 82 online surveys (response rate 47%) about the digital consultations were available for analyses, with 60 patients correctly identifying at least one treatment provider, and 9 interviews were performed. Patients and treatment providers overall evaluated the new setting of digital consultation as feasible and an efficient consultation format. Interestingly, the working alliance was rated as good. Technical problems were mentioned as the main challenge and the delivery of practical exercises in digital consultations was seen more challenging than having digital conversation-based consultations. Conclusion: Digital consultations were established with overall positive evaluations and with a good working alliance between patients and providers. For the delivery of practical exercises it might be required to develop more innovative digital settings to overcome shortcomings of the digital format. Hybrid settings that combine the best of both settings could be a good option for future in postpandemic times.
The Journal of Alternative and Complementary MedicineVol. 27, No. 8 CommentaryMoving the Complementary and Integrative Health Research Field Toward Whole Person HealthHelene M. LangevinHelene M. LangevinAddress correspondence to: Helene M. Langevin, MD, National Center for Complementary and Integrative Health, National Institutes of Health, 31 Center Drive, Room 2B11, Bethesda, MD, USA E-mail Address: helene.langevin@nih.govNational Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA.Search for more papers by this authorPublished Online:16 Aug 2021https://doi.org/10.1089/acm.2021.0255AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byConscious connected breathing with breath retention intervention in adults with chronic low back pain: protocol for a randomized controlled pilot study24 January 2023 | Pilot and Feasibility Studies, Vol. 9, No. 1Women's Experience of Living with Vulvodynia Pain: Why They Participated in a Randomized Controlled Trial of Acupuncture Allissa A. Desloge, Crystal L. Patil, Jennifer E. Glayzer, Marie L. Suarez, William H. Kobak, Monya Meinel, Alana D. Steffen, Larisa A. Burke, Yingwei Yao, Miho Takayama, Hiroyoshi Yajima, Ted J. Kaptchuk, Nobuari Takakura, David C. Foster, Diana J. Wilkie, and Judith M. Schlaeger9 January 2023 | Journal of Integrative and Complementary Medicine, Vol. 29, No. 1Integrating ayurvedic medicine into cancer research programs part 2: Ayurvedic herbs and research opportunitiesJournal of Ayurveda and Integrative Medicine, Vol. 4Towards Whole Health Toxicology: In-Silico Prediction of Diseases Sensitive to Multi-Chemical Exposures8 December 2022 | Toxics, Vol. 10, No. 12Similarities between Ashi acupoints and myofascial trigger points: Exploring the relationship between body surface treatment points2 November 2022 | Frontiers in Neuroscience, Vol. 16Social Prescribing: Bringing the Community (Back) into Medicine Holger Cramer11 April 2022 | Journal of Integrative and Complementary Medicine, Vol. 28, No. 4We're Still the Blue Journal—Introducing Journal of Integrative and Complementary Medicine Holger Cramer16 August 2021 | The Journal of Alternative and Complementary Medicine, Vol. 27, No. 8 Volume 27Issue 8Aug 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Helene M. Langevin.Moving the Complementary and Integrative Health Research Field Toward Whole Person Health.The Journal of Alternative and Complementary Medicine.Aug 2021.623-626.http://doi.org/10.1089/acm.2021.0255Published in Volume: 27 Issue 8: August 16, 2021Online Ahead of Print:August 4, 2021PDF download
Objectives: Aromatherapy has become popular in pain control in recent years compared with other complementary methods. Lavender (Lavandula angustifolia Miller) is a fragrant essential oil used in aromatherapy for its antibacterial, antifungal, muscle-relaxing, and analgesic effects. The smell of lavender oil, known for its soothing effect on adults, has not been adequately investigated in regards to pain control in premature infants. The purpose of our study was to assign the effect of the scent of lavender oil on pain in preterm infants during heel lancing. Design: A double-blind randomized controlled clinical study. Settings/Location: The study was conducted in a third-level neonatal intensive care unit of Bezmialem Vakif University Hospital from March 2019 to November 2019. It consisted of two groups. Subjects: Sixty-one premature babies (24-37 weeks of gestation) were enrolled in the study. Interventions: Heel stick sampling for metabolic screening was used for both study groups. The interventions were performed by two experienced nurses. Heart rate, oxygen saturation, and the baby's facial expression were recorded by a camera 3 min before the intervention, during the sampling, and 3 min after the procedure. After collecting the data, the head researcher and the assistant researcher separately watched the videos and scored them by using the Premature Infant Pain Profile-Revised (PIPP-R). Outcome measures: The difference of pain scores (PIIP-R) between two groups. Results: There was a statistically significant difference between the two groups in terms of PIPP-R scores during and after the sampling (p = 0.008 and p = 0.03 respectively). The PIPP-R scores at the beginning of the procedure were not found to be significantly different between the groups (p > 0.05). Conclusions: Inhalation of lavender scent is effective in pain control in premature infants. It is safe and low cost; it does not interfere with medical care.
The Journal of Alternative and Complementary MedicineVol. 27, No. 6 Osher CollaborativeMassage Therapy in the Time of COVID-19Carolyn Tague, Dianne Seppelfrick, and Adrien MacKenzieCarolyn TagueAddress correspondence to: Carolyn Tague, MA, CMT, Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94115, USA E-mail Address: [email protected]Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, USA.Search for more papers by this author, Dianne SeppelfrickOsher Center for Integrative Medicine, Northwestern University, Chicago, IL, USA.Search for more papers by this author, and Adrien MacKenzieOsher Center for Integrative Medicine, Vanderbilt University, Nashville, TN, USA.Search for more papers by this authorPublished Online:16 Jun 2021https://doi.org/10.1089/acm.2021.0045AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byExplaining the Impact of the COVID-19 Pandemic on Massage Therapists in Australia and Canada: A Mixed Methods Study Sarah Fogarty, Phillipa Hay, Felicia Calleri, Lisa Fiddes, Rebecca Barnett, and Amanda Baskwill16 August 2023 | Journal of Integrative and Complementary Medicine, Vol. 0, No. 0Impact of the COVID-19 Pandemic on the Professional Identity of Massage Therapists: The Reporting of a Quantitative Strand of a Mixed-Methods Study Sarah Fogarty, Phillipa Hay, Felicia Calleri, Lisa Fiddes, Rebecca Barnett, and Amanda Baskwill11 February 2022 | Journal of Integrative and Complementary Medicine, Vol. 28, No. 2 Volume 27Issue 6Jun 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Carolyn Tague, Dianne Seppelfrick, and Adrien MacKenzie.Massage Therapy in the Time of COVID-19.The Journal of Alternative and Complementary Medicine.Jun 2021.467-472.http://doi.org/10.1089/acm.2021.0045Published in Volume: 27 Issue 6: June 16, 2021Online Ahead of Print:March 31, 2021PDF download
Introduction: Insomnia affects up to half of the U.S. population, and due to limitations of current treatments, there is a growing interest in mind-body practices to reduce insomnia. To understand how a guided meditation practice, Yoga Nidra, may affect relaxation and align with current descriptions of nonpharmaceutical practices that could improve sleep, qualitative and quantitative methods were used to explore participant experience of a single Yoga Nidra practice, administered in a group setting. Methods: Current insomnia (Insomnia Severity Index), sleep practices, and mood (positive and negative affect schedule [PANAS]) were measured at intake. After 30 min of Yoga Nidra practice, the PANAS was readministered. In a focus group that followed, participants discussed their experience before, during, and after the practice and the likelihood of repeating it. Six groups were conducted. All interested adults were welcome to join. Results: In the final sample of 33 individuals (79% female), 80% of participants reported insomnia at intake and 45% reported a regular mind-body practice, supporting the prevalence of insomnia in the society as well as the interest in mind-body practices. After the Yoga Nidra intervention, mean negative affect decreased 5.6 ± 4.5 points, a 31% decrease from baseline, and positive affect decreased 3.5 ± 9.7 points, a 13% decrease. Three major themes were identified from focus group discussions: response to the practice (relaxation, perceived sleep, and sense withdrawal); factors that affect engagement (delivery method and intrapersonal factors); and potential as a clinical intervention (for conditions including sleep, anxiety, and pain). Conclusion: Yoga Nidra appeared tolerable within the sample, and descriptions suggest it may be useful for enhancing relaxation, facilitating sleep, easing anxiety, and reducing pain. Results from this study will inform the design of future studies of Yoga Nidra for insomnia and related conditions.
Objectives: qigong, a traditional Chinese mind-body exercise, has been shown to improve balance and gait in several neurological conditions; however, community-delivered qigong has never been assessed for people with multiple sclerosis (MS). The authors assessed the feasibility of community qigong classes for people with MS and explored outcomes of balance, gait, and quality of life (QOL). Design: Twenty adults with MS were randomly assigned to 10 weeks of community qigong classes or wait-list control. Settings/Location: Portland, Oregon. Subjects: People with MS. Intervention: Community qigong classes. Outcome measures: Feasibility criteria included recruitment, retention, adherence, and ability to participate in qigong movements. Secondary outcome measures included physical tests of mobility, gait, and balance and participant-reported mobility, depression, anxiety, fatigue, and QOL. Results: Recruitment of eligible and interested people with MS was feasible. Retention in the trial was 60%. Completers attended a mean of 7 of 10 classes. All completers participated with no or minor modifications to qigong movements. Exploratory within-group analyses showed trends toward improved mental health, QOL, and reduced fatigue and depression. Several participants spontaneously reported improved energy, flexibility, sleep, and mobility. Conclusions: Community qigong may be a feasible form of exercise for people with MS. To improve retention and capture potential effects of qigong on physical function and quality of life, future studies might consider pragmatic trials with tiered level classes, simpler forms of qigong, and/or refined inclusion criteria (CTR#: NCT04585659).
Background: In April 2017, the American College of Physicians (ACP) published a clinical practice guideline for low back pain (LBP) recommending nonpharmacologic treatments as first-line therapy for acute, subacute, and chronic LBP. Objective: To assess primary care provider (PCP)-reported initial treatment recommendations for LBP following guideline release. Design: Cross-sectional structured interviews. Participants: Convenience sample of 72 PCPs from 3 community-based outpatient clinics in high- or low-income neighborhoods. Approach: PCPs were interviewed about their familiarity with the ACP guideline, and how they initially manage patients with acute/subacute and chronic LBP. Treatment responses were coded as patient education, nonpharmacologic, pharmacologic, or medical specialty referral. PCPs were also asked about their comfort referring patients to nonpharmacologic treatment providers, and about barriers to referring. Responses were assessed using content analysis. Differences in responses were assessed using descriptive statistics. Key results: Interviews were completed between December 2017 and March 2018. Of 72 participating PCPs (50% male; mean years of practice = 13.8), over three-fourths indicated being familiar with the ACP guideline (76%-87% at 3 clinics). For acute LBP, PCPs typically provided advice to stay active (81%) and pharmacologic management (97%; primarily nonsteroidal anti-inflammatory drugs). For chronic LBP, PCPs were more likely to recommend nonpharmacologic treatments than for acute LBP (85% vs. 0%, p < 0.001). The most common nonpharmacologic treatments recommended for chronic LBP were physical therapy (78%), chiropractic care (21%), massage therapy (18%), and acupuncture (17%) (each compared with 0% for acute LBP, all p < 0.001). The cost of nonpharmacologic treatments was perceived as a barrier. However, PCPs working in low-income neighborhood clinics were as likely to recommend nonpharmacologic approaches as those from a high-income neighborhood clinic. Conclusions: While most PCPs indicated they were familiar with the ACP guideline for LBP, nonpharmacologic treatments were not recommended for patients with acute symptoms. Further dissemination and implementation of the ACP guideline are needed.
Objective: To examine the evidence for efficacy of phosphatidylserine for symptoms of attention-deficit/hyperactivity disorder (ADHD) in children. Methods: Medline, Cochrane Library, and ClinicalTrials.gov were searched from inception through August 2020. Studies of any design that assessed phosphatidylserine supplementation for children aged ≤18 years with a diagnosis of ADHD were included in the systematic review; only randomized clinical trials were included in the meta-analysis. Standardized mean differences and 95% confidence intervals (CIs) were calculated, and the heterogeneity of the studies was estimated using I2. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Results: Four studies met the inclusion criteria for the narrative review (n = 344) and three for the meta-analysis (n = 216). Results of the meta-analysis showed a statistically significant effect of 200-300 mg/day of phosphatidylserine on symptoms of inattention relative to placebo (effect size [ES] 0.36; 95% CI: 0.07 to 0.64; p = 0.01). The effects of phosphatidylserine on overall symptoms of ADHD (ES 0.76; 95% CI: -0.07 to 1.60; p = 0.07) and hyperactivity-impulsivity (ES 0.24; 95% CI: -0.04 to 0.53; p = 0.09) were not statistically significant. Conclusions: Preliminary evidence suggests that phosphatidylserine may be effective for reducing symptoms of inattention in children with ADHD, although the quality of the evidence is low and additional research in this area is warranted.
Introduction: Sexual minority (SM; lesbian, gay, bisexual) older adults age 50+ experience a higher prevalence of chronic disease and disability, as well as a poorer physical and mental health status, compared with their heterosexual peers. Many adults use complementary and integrative therapies, particularly mind-body therapies, as health-enhancing approaches and to support well-being. However, no study to date has examined the use of mind-body therapies among SM older adults. Materials and Methods: Data were from the 2017 National Health Interview Survey. Descriptive and summary statistics were calculated to describe use of mind-body therapies by SM older adults (aged 50+). The authors also tested associations between use of mind-body therapies and health and well-being among SM older adults and compared associations with their non-SM counterparts. Results: SM older adults reported higher usage (36%) of mind-body therapies compared with heterosexual adults (22%), with lesbian women reporting the highest use (39.4%). Having a SM identity was associated with mind-body therapy use; SM older adults were 57% more likely to use a mind-body therapy. Conclusion: Mind-body therapies may be a useful tool for SM older adults to enhance their health and well-being. Future qualitative research is needed to investigate more deeply the reasons SM older adults use mind-body therapies. To advance the health and well-being of SM older adults, the authors also need intervention studies that explore the effectiveness of mind-body interventions and the possible need for tailoring these to the unique needs of this population.
