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Penlington C, Durham J, O'Brien N, Green R. Filling in the Gaps. Making Sense of Living with Temporomandibular Disorders: A Reflexive Thematic Analysis. JDR Clin Trans Res 2024:23800844231216652. [PMID: 38166469 DOI: 10.1177/23800844231216652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Persistent, painful temporomandibular disorders (TMDs) are challenging to manage and usually require the active engagement of patients. To achieve this, it is necessary to understand the complex and multifactorial nature of persistent pain. Many dental professionals have little education about persistent pain and may prefer to offer structural management and advice. This research aims to explore how people understand their persistent TMD and how this understanding has been influenced by their treatment providers. METHODS Twenty-one people were recruited to represent a diversity of experience with persistent TMD. Interviews followed a semistructured topic guide. Themes were constructed through reflexive thematic analysis to represent how people made sense of their symptoms and the messages that they had picked up through their treatment journey. RESULTS Participants described examples of conflicting opinions and inconsistent management recommendations. They rarely recalled collaborative discussions about the nature and complexity of their symptoms and different options for treatment. This experience is represented by a single theme, "a medical merry-go-round." Subthemes of "a medical journey to nowhere-participants' frustrated attempts to find medical management that will end their pain" and "is it me?-participants' questioning their role in persisting pain" kept participants on the merry-go-round, while symptom resolution and participants' emerging development of a holistic understanding of their TMD pain provided exit points. Understanding pain holistically tended to be helpful and typically occurred despite rather than because of the advice given in routine treatment settings. CONCLUSION Participants in this study had not typically found their pain management within dental and medical settings to have helped them to construct meaning and understand their experiences of painful TMD. However, understanding symptoms holistically was experienced as beneficial. This study suggests that improved communication and signposting within services for persistent TMD may be beneficial to patients with TMD pain. KNOWLEDGE TRANSFER STATEMENT Results of this study confirm that being offered a series of anatomically based, singular-cause explanations for persisting pain symptoms had been experienced as unhelpful by the participants who had sought help for their TMD. Participants highlighted the importance of accurate and collaborative communication and of dental professionals explicitly adopting and communicating a biopsychosocial understanding of pain to their patients who have TMD. Results highlight that some people can struggle to manage persisting pain with minimal support. Signposting patients to appropriate services and resources may help them to understand more about the nature of persistent pain and methods of managing it.
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Affiliation(s)
- C Penlington
- Newcastle University Faculty of Medical Sciences, Newcastle, UK
| | - J Durham
- Newcastle University Faculty of Medical Sciences, Newcastle, UK
| | - N O'Brien
- Northumbria University Department of Psychology, Newcastle upon Tyne, Tyne and Wear, UK
| | - R Green
- Newcastle University Faculty of Medical Sciences, Newcastle, UK
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Tourny C, Zouita A, El Kababi S, Feuillet L, Saeidi A, Laher I, Weiss K, Knechtle B, Zouhal H. Endometriosis and physical activity: A narrative review. Int J Gynaecol Obstet 2023; 163:747-756. [PMID: 37345574 DOI: 10.1002/ijgo.14898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023]
Abstract
Endometriosis is a painful gynecological disorder that affects many women. Constant treatments and contraception changes affect women looking for solutions to treat and limit the problems caused by endometriosis. The current narrative review discusses the effects of physical activity on the management, pain, and quality of life in patients with endometriosis. Findings suggest that body awareness practices such as Hatha yoga, the Jacobson method, and progressive muscle relaxation reduce pain and stress and improve the quality of life associated with endometriosis. It also highlights the current knowledge gap on available evidence and future research. Moreover, care must be taken when considering patients' physical abilities and goals and avoiding intense physical activities. The forms of endometriosis and its symptoms vary from one woman to another, so it is important to perform studies with various nonmedicinal or surgical techniques. It is important to continue randomized controlled trials to obtain more data on the benefits of physical activity in women with endometriosis and also to identify what types of activities could be beneficial to combat pain symptoms and improve the daily lives of women with endometriosis.
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Affiliation(s)
- Claire Tourny
- Univ Rouen Normandie, CETAPS - UR 3832, Mont Saint Aignan, France
| | - Amira Zouita
- Higher Institute of Sport and Physical Education of Ksar-Said, Research Unit "Sports Performance, Health & Society" (UR17JS01), University of Manouba, Manouba, Tunisia
| | - Samira El Kababi
- High Institute of Nursing Professions and Health Techniques, Casablanca, Morocco
| | - Léa Feuillet
- Univ Rouen Normandie, CETAPS - UR 3832, Mont Saint Aignan, France
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Kurdistan, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Hassane Zouhal
- Univ Rennes, M2S (Laboratoire Mouvement, Sport, Santé), Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
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Tankha H, Lumley MA, Gordon A, Schubiner H, Uipi C, Wager TD, Harris J, Ashar YK. "I don't have chronic back pain anymore": Patient Experiences in Pain Reprocessing Therapy for Chronic Back Pain. THE JOURNAL OF PAIN 2023; 24:1582-1593. [PMID: 37094744 PMCID: PMC11020878 DOI: 10.1016/j.jpain.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
In a recently published randomized controlled trial, two-thirds of the patients receiving a novel psychological treatment, pain reprocessing therapy (PRT), reported elimination or near-elimination of chronic back pain. The mechanisms of PRT and related treatments remain poorly understood but are hypothesized to center on pain reappraisal, fear reduction, and exposure-potentiated extinction. Here, we investigated treatment mechanisms from the participants' perspective. A sample of 32 adults with chronic back pain who received PRT completed semi-structured posttreatment interviews about their treatment experiences. The interviews were analyzed with multiphase thematic analysis. The analyses identified 3 major themes reflecting participants' understanding of how PRT led to pain relief: 1) reappraisal to reduce fear of pain, which included guiding participants to relate to pain as a helpful indicator, overcoming pain-related fear and avoidance, and reconceptualizing pain as a "sensation;" 2) the link between pain, emotions, and, stress, which included gaining insight into these connections and resolving difficult emotions; and 3) social connections, which included patient-provider alliance, therapist belief in the treatment model, and peer models of recovery from chronic pain. Our findings support the hypothesized mechanisms of PRT centered on pain reappraisal and fear reduction, but also highlight additional processes from the participants' perspective, including a focus on emotions and relationships. This study underscores the value of qualitative research methods in illuminating the mechanisms of novel pain therapies. PERSPECTIVE: This article presents participants' perspectives on their experience engaging in a novel psychotherapy for chronic pain, PRT. Through pain reappraisal, linking pain, emotions, and stress, and connecting with their therapist and peers, many participants reported an elimination or near-elimination of their chronic back pain with therapy.
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Affiliation(s)
- Hallie Tankha
- Department of Psychology, Wayne State University, Detroit, MI
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, MI
| | | | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, MI
| | | | - Tor D. Wager
- Department of Brain and Psychological Sciences, Dartmouth College, Hanover, NH
| | - James Harris
- Division of General Internal Medicine, Department of Medicine and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - Yoni K. Ashar
- Division of General Internal Medicine, Department of Medicine and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
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Ng JY, Anagal M, Bhowmik T. Low back pain patients' perceived effectiveness of utilizing complementary and alternative medicine: a systematic review of qualitative studies. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2023; 20:47-80. [PMID: 34461012 DOI: 10.1515/jcim-2021-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The purpose of this systematic review of qualitative studies is to explore patients' perceived effectiveness of utilizing complementary and alternative medicine (CAM) for the treatment and/or management of low back pain (LBP). METHODS MEDLINE, EMBASE, AMED, and CINAHL were systematically searched from database inception until May 2020. Eligible articles included qualitative data about LBP patients' perceptions of using CAM. RESULTS Of 1,567 items, 1,542 items were excluded; the remaining 25 articles were included in this review. Three themes emerged as follows: physical benefits; mental health benefits; and negative or no perceived effectiveness of CAM on patients with LBP. CONCLUSIONS This study explores perceptions of CAM effectiveness among patients with LBP. These findings provide valuable information to CAM and non-CAM practitioners regarding the importance of individualized patient care based on their preferences, values, needs, and perspectives. Further exploration could include practitioners' perceptions of CAM and their impact on the patient-practitioner relationship.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mrinal Anagal
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Trisha Bhowmik
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Beiranvand S, Ashrafizadeh H, Sheini-Jaberi P. Investigating the Relationship between Empowerment and Chronic Pain Acceptance and the Resulting Limitations in the Elderly with Diabetes living Southwest of Iran. Pain Manag Nurs 2023; 24:130-137. [PMID: 36604195 DOI: 10.1016/j.pmn.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/23/2022] [Accepted: 12/11/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AIM Considering the importance of pain acceptance in adjusting to chronic pain among diabetic patients, this study was conducted to determine the relationship between the empowerment scale and the level of chronic pain acceptance among the elderly with diabetes and the resulting limitations. METHOD This is a descriptive-analytical study on 250 older patients (65 years and older) with diabetes. The samples were selected through random convenience sampling, performed during 2019 to 2020 in the health centers of Ahvaz, Iran. The data were collected using the demographic information checklist and standard questionnaires including chronic pain acceptance questionnaire (CPAQ), the scale of chronic pain-related limitations, and the diabetes empowerment scale-short form (DES-SF). The data were analyzed using SPSS V24. RESULTS The majority of the samples were male (56%) and the mean age of the participants was 70.96 ± 8.95 years. The results showed that the mean and standard deviation were reported to be 20.04 ± 4.63 for pain acceptance, 46.16 ± 10.85 for chronic pain-related limitations, and 27.24 ± 9.65 for the empowerment scale. According to regression coefficients, the mean score of empowerments of patients with diabetes has no significant relationship with pain acceptance (p = .199, b = -0.327) and pain-related limitations (p = .925, b = 0.004). CONCLUSIONS Based on the results of this study, the level of empowerment, pain acceptance, and pain-related limitations in the older patients with diabetes was moderate and there was no significant relationship between them. Identifying vulnerable groups in the field of chronic pain and preventive, educational and therapeutic interventions will help increase patients' self-care capacity and reduce the limitations and the disability caused by pain.
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Affiliation(s)
- Samira Beiranvand
- Nursing Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hadis Ashrafizadeh
- Nursing Department, School of Nursing, Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran
| | - Parisa Sheini-Jaberi
- Nursing Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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"Let's see what happens:"-Women's experiences of open-label placebo treatment for menopausal hot flushes in a randomized controlled trial. PLoS One 2022; 17:e0276499. [PMID: 36331921 PMCID: PMC9635716 DOI: 10.1371/journal.pone.0276499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Open-label (honestly prescribed) placebos are an ethical way to evoke placebo effects in patients. As part of a mixed-methods study, we conducted in-depth interviews with eight menopausal women who underwent and benefitted from open-label placebo treatment in a randomized-controlled trial of hot flushes. Data were analyzed using Interpretative Phenomenological Analysis. We found that the women had low expectations about the placebo treatment yet endorsed what they referred to as “hope” and openness to “see what happens”. Recording hot flushes via the symptom diary was viewed as a valuable opportunity for self-examination and appraising outcomes. Receiving relief from the placebo treatment empowered women and enhanced their sense of control and agency. In summary, participants’ initial openness towards placebos, their hopes to get better, monitoring symptoms closely, and taking the initiative to address symptoms were components of a positive open-label placebo experience.
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Experiences of Patients Taking Conditioned Open-Label Placebos for Reduction of Postoperative Pain and Opioid Exposure After Spine Surgery. Int J Behav Med 2022:10.1007/s12529-022-10114-5. [PMID: 35915346 DOI: 10.1007/s12529-022-10114-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pain after spine surgery is difficult to manage, often requiring the use of opioid analgesics. While traditional "deceptive" or concealed placebo has been studied in trials and laboratory experiments, the acceptability and patient experience of taking honestly prescribed placebos, such as "open-label" placebo (non-deceptive placebo), or conditioned placebo (pairing placebo with another active pharmaceutical) is relatively unexamined. METHODS Qualitative thematic analysis was performed using semi-structured, post-treatment interviews with spine surgery patients (n = 18) who had received conditioned open-label placebo (COLP) during the first 2-3 weeks after surgery as part of a RCT. Interview transcripts were reviewed by 3 investigators using an immersion/crystallization approach, followed by iterative large-group discussions with additional investigators, to identify, refine, and codify emergent themes. RESULTS Patients' experiences and perceptions of COLP efficacy varied widely. Some emergent themes included the power of the mind over pain, how COLP might provide distraction from or agency over pain, bandwidth required and engagement with COLP, and its modulation of opioid tapering, as well as negative attitudes toward opioids and pill taking in general. Other themes included uncertainty about COLP efficacy, observations of how personality may relate to COLP efficacy, and a recognition of the greater impact of COLP on reduction of opioid use rather than on pain itself. Interestingly, participant uncertainty, disbelief, and skepticism were not necessarily associated with greater opioid consumption or worse pain. CONCLUSION Participants provided insights into the experience of COLP which may help to guide its future utilization to manage acute pain and tapering from opioids.
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Aday JS, Heifets BD, Pratscher SD, Bradley E, Rosen R, Woolley JD. Great Expectations: recommendations for improving the methodological rigor of psychedelic clinical trials. Psychopharmacology (Berl) 2022; 239:1989-2010. [PMID: 35359159 PMCID: PMC10184717 DOI: 10.1007/s00213-022-06123-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE Psychedelic research continues to garner significant public and scientific interest with a growing number of clinical studies examining a wide range of conditions and disorders. However, expectancy effects and effective condition masking have been raised as critical limitations to the interpretability of the research. OBJECTIVE In this article, we review the many methodological challenges of conducting psychedelic clinical trials and provide recommendations for improving the rigor of future research. RESULTS Although some challenges are shared with psychotherapy and pharmacology trials more broadly, psychedelic clinical trials have to contend with several unique sources of potential bias. The subjective effects of a high-dose psychedelic are often so pronounced that it is difficult to mask participants to their treatment condition; the significant hype from positive media coverage on the clinical potential of psychedelics influences participants' expectations for treatment benefit; and participant unmasking and treatment expectations can interact in such a way that makes psychedelic therapy highly susceptible to large placebo and nocebo effects. Specific recommendations to increase the success of masking procedures and reduce the influence of participant expectancies are discussed in the context of study development, participant recruitment and selection, incomplete disclosure of the study design, choice of active placebo condition, as well as the measurement of participant expectations and masking efficacy. CONCLUSION Incorporating the recommended design elements is intended to reduce the risk of bias in psychedelic clinical trials and thereby increases the ability to discern treatment-specific effects of psychedelic therapy.
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Affiliation(s)
- Jacob S Aday
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA.
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Steven D Pratscher
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Ellen Bradley
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Raymond Rosen
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Joshua D Woolley
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
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Eindhoven E, Lee A, Stilwell P, Mior S. I expected to be pain free: a qualitative study exploring athletes' expectations and experiences of care received by sports chiropractors. Chiropr Man Therap 2022; 30:21. [PMID: 35501876 PMCID: PMC9059405 DOI: 10.1186/s12998-022-00426-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Knowledge about patient satisfaction and experience with care they receive can guide practitioners in establishing doctor-patient relationships and improve health outcomes. Although evidence suggests high patient satisfaction with chiropractic care in general, there is limited understanding of the expectations and experiences of athletes receiving sports chiropractic care.
Objective To explore the athletes’ expectations and experiences with care received from sports chiropractors, and their perceptions of relevant areas of future research.
Methods A qualitative study was conducted through an interpretivist lens exploring the perspectives of elite and competitive athletes receiving care from sports chiropractors in Canada. Participants were purposively recruited and interviewed until saturation was reached. Two research team members independently analyzed the interview transcripts using a conventional approach to content analysis. Content was inductively coded and discussed by the research team to generate categories.
Results We interviewed 18 participants between December 2018 and March 2020, 14 were national level athletes participating in sports ranging from paddling to combat sports. Reported reasons for seeking care included acute care, injury prevention, enhancing performance and maintenance care. Generated categories were organized under topics of experience with care, expectations of care, and research agenda. Participants experienced a variety of interventions, reassurance, varying treatment times, and reported positive impact on their athletic performance. They expected musculoskeletal assessment and treatment including at and beyond the injury site, symptom improvement, good communication and expertise from the chiropractor. Some participants suggested interpersonal and interprofessional communication can be improved, in particular the level of collaboration with other members of their health care team. Overall, participants reported a high level of trust and satisfaction with care received from sports chiropractors. From our participants’ perspective, suggested areas of research should focus on injury mechanics and prevention, impact of care on performance, and interprofessional collaboration. Conclusions In general, participants were very satisfied with care. Overall, participants’ expectations and experiences aligned but changed over time. Addressing the findings of this study can be used to enhance the quality of care provided to athletes from sports chiropractors, as well as inform future research agendas. Further work assessing if athletes in other competitive levels have similar experiences and expectations is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00426-4.
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Affiliation(s)
- Evan Eindhoven
- Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON, M2H 3J1, Canada.
| | - Alex Lee
- Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON, M2H 3J1, Canada
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Silvano Mior
- Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON, M2H 3J1, Canada.,Institute for Disability and Rehabilitation Research at, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
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Chronic Kidney Disease of Uncertain Etiology in Sri Lanka: Curing between Medicine and Traditional Culture. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic Kidney Disease of unknown origin (CKDu) has appeared across Sri Lanka’s North Central Province (NCP) since the 1990s as an epidemic, unexplained by conventional associated risk factors. During the past few decades, a large number of studies attempted to determine the unknown etiology of CKDu. Despite these investigations, no concrete conclusions were developed, though a number of contradictory hypotheses emerged. The present ethnographic study was carried out in two endemic areas, labelled as “CKDu hotspots”, and illuminates how curing takes place between biomedicine and traditional cultural practices. Our ethnographic study thoroughly scrutinized three decades of lived experience, lay-perceptions and local discourses on CKDu. We used a qualitative study design with a transcendental phenomenological approach and employed a mixture of ethnographic methods. Data collection techniques included participant observation, in-depth interviews, focus group discussions and key informant interviews. Data was analysed by using an interpretive thematic analysis model. Findings revealed that lay people have constructed a popular discourse on CKDu, and we explored their views on the origin, etiology and prevalence of CKDu in their locality over the past few decades. Patients’ narratives revealed that there were currently a number of gaps in service delivery. These were mainly due to distant relationships between healthcare providers and CKDu patients. Lay people in affected communities were marginalized throughout the investigation process to determine the unknown etiology, their involvement marginalized to merely acting as objects for scientific instigation. The affected communities strongly believed that CKDu was a recent phenomenon resulting from the mismanagement of the natural environment due to social and lifestyle changes. These findings highlight local dynamics of healthcare seeking behaviours which demand complementary medicine system, particularly given the number of limitations in the biomedical system. Empirical evidence generated from this study suggests a conceptual shift to an ethno-medical model to address CKDu. Improving cultural competency and communication skills among healthcare providers in public health are crucial in order to apply a “bio-psychosocial perspective” in healthcare delivery system and bridging the gap between hospital and the community.
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Rose CM, Atler KE, Dickman Portz J, Andrews AP, Schmid AA. Participant-perceived occupational outcomes after two years of yoga for chronic pain. Br J Occup Ther 2021. [DOI: 10.1177/0308022620985779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The study aim was to investigate the perceived impact and experience of long-term involvement in community-based group yoga for people with chronic pain. Methods Eleven participants, who previously completed an 8-week yoga intervention and continued attending yoga at a community pain clinic for 2 years, participated in the study. A mixed-methods approach was employed. Canadian Occupational Performance Measure data were collected during the 8-week yoga study (baseline) and after 2 years of yoga (follow-up). Baseline and follow-up Canadian Occupational Performance Measure data were compared to measure change in perceived occupational performance and satisfaction. Individual qualitative interviews were conducted to explore participants’ perceived impact and experience of long-term yoga involvement. Canadian Occupational Performance Measure data were analyzed using Wilcoxon signed-rank tests, and qualitative interviews were analyzed using an inductive approach. Findings Canadian Occupational Performance Measure scores significantly improved between baseline and follow-up. Three main themes emerged from qualitative interviews: (a) Occupational shift from “existing” to “living,” (b) The change process is “progressive,” and (c) Yoga is “a positive thing I do in my life.” Conclusion Long-term involvement in community-based group yoga may improve and sustain occupational performance and satisfaction. Occupational therapists may consider yoga as a tool to promote occupational gains in people with chronic pain.
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Affiliation(s)
- Caroline M Rose
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Karen E Atler
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | | | - Alexandra P Andrews
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
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McNelly AP, Eaves ER, Christine Gardner J, Wetzel WS, Sutliffe JT. A Qualitative Exploration of Pregnancy Experience With a Nutrient-Dense, Plant-Rich Dietary Pattern: A Pilot Study. Am J Lifestyle Med 2021; 16:390-398. [DOI: 10.1177/15598276211040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: A nutrient-dense, plant-rich diet may be promising as a nutrition intervention for pregnant women for a number of factors. Factors include the possibility of a decreased risk for gestational diabetes, excess weight gain, and preeclampsia. Little is known about the experience of following this type of dietary pattern while pregnant and what barriers are present that should be addressed in a large-scale intervention. Methods: Qualitative interviews were used to understand the personal experience of women who aimed to eat a nutrient-dense plant-rich diet while pregnant. Semi-structured interviews were conducted from June to August 2020. Results: Three main themes regarding a nutrient-dense plant-rich diet emerged. First, family and social influence played an important role. Second, women who had a previous pregnancy felt they had fewer pregnancy symptoms on this diet. Last, the participants may have experienced a reduced milk supply on this dietary plan. Conclusion: Future research should consider family context as a factor in adherence to a nutrient-dense plant-rich dietary pattern, investigate the possible associations between nutrient-dense plant-rich dietary patterns and reduced nausea and vomiting in early pregnancy, and determine whether nutrient-dense, plant-rich dietary patterns contribute to a reduction in milk production for women who experience over-engorgement.
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Affiliation(s)
- Allison P. McNelly
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Emery R. Eaves
- Department of Anthropology, Northern Arizona University, Flagstaff, AZ, USA
| | | | - Wendy S. Wetzel
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Jay T. Sutliffe
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
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Unsgaard-Tøndel M, Søderstrøm S. Therapeutic Alliance: Patients' Expectations Before and Experiences After Physical Therapy for Low Back Pain-A Qualitative Study With 6-Month Follow-Up. Phys Ther 2021; 101:6330887. [PMID: 34339506 PMCID: PMC8632789 DOI: 10.1093/ptj/pzab187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to explore patients' expectations before and experiences after physical therapy for low back pain. METHODS Qualitative in-depth, semi-structured interviews with patients attending physical therapy were performed before, immediately after, and 6 months after treatment. Data were analyzed from a hermeneutical perspective with decontextualization, recontextualization, and identification of themes. RESULTS Patients' pretreatment expectations to physical therapy focused around exercises and a body-oriented diagnosis. After treatment, reassurance, active listening with explanations, and personally adapted strategies for self-managing pain and regaining control over everyday activity were expressed as decisive for a meaningful therapeutic alliance. CONCLUSION Expectations before treatment focused on exercises and diagnosis. Empathetic and personally adapted education aimed at empowerment was experienced as a meaningful aspect of the therapeutic alliance after treatment. The therapeutic alliance provided a basis to integrate knowledge on the complexity of pain. IMPACT Our findings indicate that patients emphasize physical therapists' interactional and pedagogical skills as meaningful aspects of the therapeutic alliance, which has implications for clinical practice and training physical therapist students.
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Affiliation(s)
- Monica Unsgaard-Tøndel
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway,Department of Physical Therapy, Trondheim Municipality, Trondheim, Norway,Address all correspondence to Dr Unsgaard-Tøndel at:
| | - Sylvia Søderstrøm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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Arandia IR, Di Paolo EA. Placebo From an Enactive Perspective. Front Psychol 2021; 12:660118. [PMID: 34149551 PMCID: PMC8206487 DOI: 10.3389/fpsyg.2021.660118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Due to their complexity and variability, placebo effects remain controversial. We suggest this is also due to a set of problematic assumptions (dualism, reductionism, individualism, passivity). We critically assess current explanations and empirical evidence and propose an alternative theoretical framework—the enactive approach to life and mind—based on recent developments in embodied cognitive science. We review core enactive concepts such as autonomy, agency, and sense-making. Following these ideas, we propose a move from binary distinctions (e.g., conscious vs. non-conscious) to the more workable categories of reflective and pre-reflective activity. We introduce an ontology of individuation, following the work of Gilbert Simondon, that allow us to see placebo interventions not as originating causal chains, but as modulators and triggers in the regulation of tensions between ongoing embodied and interpersonal processes. We describe these interrelated processes involving looping effects through three intertwined dimensions of embodiment: organic, sensorimotor, and intersubjective. Finally, we defend the need to investigate therapeutic interactions in terms of participatory sense-making, going beyond the identification of individual social traits (e.g., empathy, trust) that contribute to placebo effects. We discuss resonances and differences between the enactive proposal, popular explanations such as expectations and conditioning, and other approaches based on meaning responses and phenomenological/ecological ideas.
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Affiliation(s)
- Iñigo R Arandia
- IAS-Research Center for Life, Mind and Society, University of the Basque Country, Leioa, Spain.,ISAAC Lab, Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Ezequiel A Di Paolo
- IAS-Research Center for Life, Mind and Society, University of the Basque Country, Leioa, Spain.,Ikerbasque-Basque Foundation for Science, Bilbao, Spain.,Center for Computational Neuroscience and Robotics, University of Sussex, Brighton, United Kingdom
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15
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Stensland M. Managing the Incurable: Older Pain Clinic Patients' Experiences of Managing Treatment-Resistant Chronic Low Back Pain. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:405-422. [PMID: 33719939 DOI: 10.1080/01634372.2021.1898073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Chronic low back pain (CLBP) is a highly prevalent disabling condition among older adults, and treatment remains a challenge. Limited research has qualitatively examined late-life CLBP and its management. Study objective was to examine how older adults experience pain management approaches for CLBP. Guided by van Manen's phenomenological method, 21 pain clinic patients (66-83) completed semi-structured interviews. Under the main theme "Managing the incurable," four subthemes emerged: (a) A quest for relief; (b) Spinal procedures offer temporary relief yet ongoing disappointment; (c) The apprehension of medication (d) Making things work for me. Social work practice implications are discussed.
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Affiliation(s)
- Meredith Stensland
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center of San Antonio, San Antonio, Texas, USA
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16
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Bishop F, Al-Abbadey M, Roberts L, MacPherson H, Stuart B, Carnes D, Fawkes C, Yardley L, Bradbury K. Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study. BMJ Open 2021; 11:e044831. [PMID: 34006548 PMCID: PMC8130743 DOI: 10.1136/bmjopen-2020-044831] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Contextual components of treatment previously associated with patient outcomes include the environment, therapeutic relationship and expectancies. Questions remain about which components are most important, how they influence outcomes and comparative effects across treatment approaches. We aimed to identify significant and strong contextual predictors of patient outcomes, test for psychological mediators and compare effects across three treatment approaches. DESIGN Prospective cohort study with patient-reported and practitioner-reported questionnaire data (online or paper) collected at first consultation, 2 weeks and 3 months. SETTING Physiotherapy, osteopathy and acupuncture clinics throughout the UK. PARTICIPANTS 166 practitioners (65 physiotherapists, 46 osteopaths, 55 acupuncturists) were recruited via their professional organisations. Practitioners recruited 960 adult patients seeking treatment for low back pain (LBP). PRIMARY AND SECONDARY OUTCOMES The primary outcome was back-related disability. Secondary outcomes were pain and well-being. Contextual components measured were: therapeutic alliance; patient satisfaction with appointment systems, access, facilities; patients' treatment beliefs including outcome expectancies; practitioners' attitudes to LBP and practitioners' patient-specific outcome expectancies. The hypothesised mediators measured were: patient self-efficacy for pain management; patient perceptions of LBP and psychosocial distress. RESULTS After controlling for baseline and potential confounders, statistically significant predictors of reduced back-related disability were: all three dimensions of stronger therapeutic alliance (goal, task and bond); higher patient satisfaction with appointment systems; reduced patient-perceived treatment credibility and increased practitioner-rated outcome expectancies. Therapeutic alliance over task (ηp2=0.10, 95% CI 0.07 to 0.14) and practitioner-rated outcome expectancies (ηp2=0.08, 95% CI 0.05 to 0.11) demonstrated the largest effect sizes. Patients' self-efficacy, LBP perceptions and psychosocial distress partially mediated these relationships. There were no interactions with treatment approach. CONCLUSIONS Enhancing contextual components in musculoskeletal healthcare could improve patient outcomes. Interventions should focus on helping practitioners and patients forge effective therapeutic alliances with strong affective bonds and agreement on treatment goals and how to achieve them.
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Affiliation(s)
- Felicity Bishop
- Department of Psychology, University of Southampton, Southampton, UK
| | - Miznah Al-Abbadey
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Lisa Roberts
- Health Sciences, University of Southampton, Southampton, UK
- Therapy Services, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Dawn Carnes
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Carol Fawkes
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
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17
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Plank A, Rushton A, Ping Y, Mei R, Falla D, Heneghan NR. Exploring expectations and perceptions of different manual therapy techniques in chronic low back pain: a qualitative study. BMC Musculoskelet Disord 2021; 22:444. [PMID: 33990196 PMCID: PMC8122532 DOI: 10.1186/s12891-021-04251-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) prevalence has steadily increased over the last two decades. Manual therapy (MT) is recommended within a multimodal management approach to improve pain and disability although evidence investigating the patients' experience of MT is scarce. OBJECTIVE To explore expectations and perceptions of MT techniques in people with CLBP. METHODS A qualitative study embedded sequential to an experimental trial using semi-structured interviews (SSI) explored participants' experiences of thrust, non-thrust and sham technique. Purposive sampling enabled variance in age and CLBP duration. An evidence informed topic guide was used. Data were analysed using thematic analysis (TA). Respondent validation and peer debriefing enhanced trustworthiness. The Consolidating Criteria for Reporting Qualitative Studies (COREQ) reported methodological rigour. FINDINGS Ten participants (50% male) with a mean age of 29.1 years (Standard Deviation (SD): 7.9, range: 19-43), a mean pain intensity of 4.5 on a Numeric Rating Scale (NRS) 0-10 (SD: 1.5, range: 2-7), a mean Oswestry Disability Score (ODI) of 9 (SD: 4.6, range: 2-17) and a mean Tampa Scale of Kinesiophobia (TSK) score of 38.6 (SD: 4.8, range: 30-45) participated. Four themes were identified: understanding of pain; forming expectations; perception of care; re-evaluation of body awareness and management. Understanding of CLBP is formed by an individuals' pain perception and exchange with social environment. This, combined with communication with physiotherapist influenced expectations regarding the MT technique. CONCLUSION Expectations for MT were formed by an individual's social environment and previous experience. A treatment technique is perceived as positive if its characteristics are aligned with the individual's understanding of pain and if care is delivered in an informative and reassuring manner.
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Affiliation(s)
- A Plank
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - A Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,School of Physical Therapy, Western University, London, Ontario, Canada
| | - Y Ping
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - R Mei
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - N R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
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18
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Connor JP, Bernstein C, Kilgore K, Rist PM, Osypiuk K, Kowalski M, Wayne PM. Perceptions of Chiropractic Care Among Women With Migraine: A Qualitative Substudy Using a Grounded-Theory Framework. J Manipulative Physiol Ther 2021; 44:154-163. [PMID: 33431279 DOI: 10.1016/j.jmpt.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize expectations, attitudes, and experiences of individuals with migraine who were randomly assigned to receive chiropractic care delivered within a randomized controlled trial in a hospital-based integrative care center. METHODS This qualitative substudy was conducted as a part of a 2-arm pilot pragmatic randomized controlled trial investigating a multimodal model of chiropractic care for women with episodic migraine (4-13 migraines per month). Women were randomly assigned to chiropractic care (10 sessions over 14 weeks) plus enhanced usual care vs enhanced usual care alone. Semistructured interviews were conducted at baseline and 14-week follow-up with 15 randomly selected participants from the 29 participants randomized to the chiropractic group. Qualitative analysis was performed by 2 independent reviewers using a constant comparative method of analysis for generating grounded theory. RESULTS Integrating baseline and follow-up interviews, 3 themes emerged: over the course of treatment with chiropractic care, participants became more aware of the role of musculoskeletal tension, pain, and posture in triggering migraine; participants revised their prior conceptions of chiropractic care beyond spinal manipulation; and participants viewed the chiropractor-patient relationship as an essential and valuable component to effectively managing their migraines. CONCLUSION In this qualitative study, women with episodic migraine after receiving comprehensive chiropractic care described chiropractic as a multimodal intervention where they learned about musculoskeletal contributions to migraine, discovered new ways to affect their symptoms, and developed a collaborative patient-practitioner relationship. The results of this study provide insights into perceptions of chiropractic care among women with migraine and suggestions for future trials.
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Affiliation(s)
- Julie P Connor
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.
| | - Carolyn Bernstein
- Osher Clinical Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts; John Graham Headache Center, Department of Neurology, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen Kilgore
- School of Special Education, School Psychology & Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kamila Osypiuk
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew Kowalski
- Osher Clinical Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
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Tangkiatkumjai M, Boardman H, Walker DM. Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review. BMC Complement Med Ther 2020; 20:363. [PMID: 33228697 PMCID: PMC7686746 DOI: 10.1186/s12906-020-03157-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine similarities and differences in the reasons for using or not using complementary and alternative medicine (CAM) amongst general and condition-specific populations, and amongst populations in each region of the globe. METHODS A literature search was performed on Pubmed, ScienceDirect and EMBASE. KEYWORDS 'herbal medicine' OR 'herbal and dietary supplement' OR 'complementary and alternative medicine' AND 'reason' OR 'attitude'. Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a 'risk of bias' assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ2 tests to identify the main factors related to reasons for CAM usage. RESULTS 231 publications were included. Reasons for CAM use amongst general and condition-specific populations were similar. The top three reasons for CAM use were: (1) having an expectation of benefits of CAM (84% of publications), (2) dissatisfaction with conventional medicine (37%) and (3) the perceived safety of CAM (37%). Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations (p < 0.05). Affordability, easy access to CAM and tradition were significant factors amongst African populations (p < 0.05). Negative attitudes towards CAM and satisfaction with conventional medicine (CM) were the main reasons for non-use (p < 0.05). CONCLUSIONS Dissatisfaction with CM and positive attitudes toward CAM, motivate people to use CAM. In contrast, satisfaction with CM and negative attitudes towards CAM are the main reasons for non-use.
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Affiliation(s)
- Mayuree Tangkiatkumjai
- Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhonnayok, 26120 Thailand
| | - Helen Boardman
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Dawn-Marie Walker
- School of Health Sciences, University of Southampton, Southampton, UK
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Pan Y, Meister R, Löwe B, Kaptchuk TJ, Buhling KJ, Nestoriuc Y. Open-label placebos for menopausal hot flushes: a randomized controlled trial. Sci Rep 2020; 10:20090. [PMID: 33208855 PMCID: PMC7674475 DOI: 10.1038/s41598-020-77255-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
This study investigated the efficacy of an open-label placebo (OLP) treatment for menopausal hot flushes. Women with at least five moderate or severe hot flushes per day were allocated to receive four weeks of OLP for twice a day or no-treatment. Intention-to-treat analyses included n = 100 women. In comparison to no-treatment, OLP reduced the log-transformed hot flush composite score (frequency × intensity) (mean difference in change: − 0.32, 95% CI [− 0.43; − 0.21], p < 0.001, Cohen’s d = 0.86), hot flush frequency (− 1.12 [− 1.81; − 0.43], p = 0.02, Cohen’s d = 0.51), and improved overall menopause-related quality of life (− 2.53 [− 4.17; − 0.89], p = 0.02, Cohen’s d = 0.49). Twelve (24%) (vs. three [6%]) patients had 50% lesser hot flushes. Problem rating of hot flushes and subdomains of quality of life did not improve. After four weeks, the OLP group was further divided via randomization to continue or discontinue the treatment. Benefits were maintained at week 8 (log-transformed score: − 0.04 [− 0.06; 0.14], p = 0.45). There was no difference between taking placebos for 8 or 4 weeks (log-transformed score: 0.04 [− 0.17; 0.25], p = 0.73). Results indicate that open-label placebos may be an effective, safe alternative for menopausal hot flushes.
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Affiliation(s)
- Yiqi Pan
- Department of Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany. .,Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Ramona Meister
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ted J Kaptchuk
- Program in Placebo Studies and the Therapeutic Encounter (PiPS), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Kai J Buhling
- Department of Gynecological Endocrinology, Clinic of Gynecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Mohamed Mohamed WJ, Joseph L, Canby G, Paungmali A, Sitilertpisan P, Pirunsan U. Are patient expectations associated with treatment outcomes in individuals with chronic low back pain? A systematic review of randomised controlled trials. Int J Clin Pract 2020; 74:e13680. [PMID: 33166045 DOI: 10.1111/ijcp.13680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022] Open
Abstract
AIM The importance of patient expectations (PEs) on treatment outcomes is poorly understood in clinical practice. The aim of this review is to investigate the evidence behind association between pre-treatment PEs and treatment outcomes such as pain intensity (PI), level of function (LF) and health-related quality of life (HRQoL) among individuals with chronic low back pain (CLBP). METHODS A systematic search was conducted for randomised controlled trials published between 1946 and May 2019 across major databases using the key MeSH terminologies. The association between PEs and PI, LF and HRQoL were extracted and categorised into positive, negative or no association for analysing the data. A descriptive synthesis was conducted and the association between PEs and PI, LF and HRQoL were reported. RESULTS Among the total of seven trials, two trials demonstrated a positive association between PEs and PI in short (≤6 weeks) and long term (>6 months), while another two trials demonstrated no association at medium term (>6 weeks-≤6 months). About four trials demonstrated a positive significant association between PEs and LF, 2 at medium and 2 at long terms. The only available trial demonstrated no association between PEs and HRQoL at medium term. CONCLUSION PEs is associated with PI at short and long terms. Also, evidence suggests association between PEs and LF at medium and long terms. Currently, there is no evidence of association between PEs and HRQoL. Further studies with valid tools to measure PE are warranted among individuals with CLBP.
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Affiliation(s)
| | - Leonard Joseph
- School of Health Science, University of Brighton, East Sussex, UK
| | - Guy Canby
- School of Health Science, University of Brighton, East Sussex, UK
| | - Aatit Paungmali
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Patraporn Sitilertpisan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Ubon Pirunsan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
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Véron C, Genevay S, Knafou Bastard M, Fleury A, Cedraschi C. Psychomotor therapy as a treatment of chronic spinal pain: A qualitative study. Complement Ther Med 2020; 56:102590. [PMID: 33197665 DOI: 10.1016/j.ctim.2020.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/28/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Psychomotor therapy is an innovative complementary approach that enhances the mind-body connection. It could have a positive effect on chronic pain syndromes but has not yet been specifically studied for spinal pain. We thus aimed to explore the experiences of chronic spinal pain patients with psychomotor therapy. DESIGN We conducted a qualitative study using semi-structured interviews. 17 patients with chronic spinal pain were recruited from a multidisciplinary spinal pain program in a rehabilitation hospital in Switzerland. Participants received psychomotor therapy as part of this care. All interviews were transcribed and thematic analysis was performed. SETTING Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland. RESULTS Four themes emerged from thematic analysis: 1) Connecting body and mind; 2) Passive individualized care; 3) Effect on mobility and well-being versus pain; and 4) Need for further care. Participants particularly appreciated the person-centered approach, relaxation and link between body and mind in the psychomotor therapy sessions. They shared positive effects of psychomotor therapy on mobility, kinesiophobia and overall well-being, rather than on pain. Finally, they would have liked more follow-up care at the end of the program. CONCLUSIONS Experiences reported by patients in this study suggest that psychomotor therapy could be a promising complementary therapy for chronic spinal pain within a biopsychosocial approach. To better understand the benefits of psychomotor therapy for chronic spinal pain, further research is needed and should consider patient-reported outcome measures such as well-being, fear-avoidance belief and disability.
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Affiliation(s)
- Claudia Véron
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | - Stéphane Genevay
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | - Maud Knafou Bastard
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | - Adrien Fleury
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland; Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.
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Chen AT, Flaherty MG, Threats M. Attitudes, Provider and Treatment Selection of Complementary and Integrative Health among Individuals with Pain-Related Conditions. Complement Ther Med 2020; 51:102410. [PMID: 32507427 DOI: 10.1016/j.ctim.2020.102410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/03/2020] [Accepted: 04/10/2020] [Indexed: 11/15/2022] Open
Abstract
Complementary and integrative therapies are used by people to address many conditions, including pain-related conditions. There has been concern about the quality of online health information, including information pertaining to complementary and integrative health (CIH). In this qualitative interview study, we sought to investigate how individuals interact with CIH-related information online and how this might affect their subsequent behavior. We conducted semi-structured interviews with 14 individuals with chronic pain conditions. We report findings based on three main themes: individuals' beliefs about CIH; approach to CIH, including how people view provider information and personalize their CIH use strategy; and factors that affect trust in the information encountered. Overall, study participants believed there was value in CIH therapies and that treatments were effective. Many described experiences that had influenced their views of complementary therapies over time. We also found that individuals form impressions of CIH providers based on structural and personal characteristics, particularly cost and proximity, that are conveyed in information to which they are exposed. These findings have various implications. First, over time individuals with chronic pain conditions develop their own beliefs and attitudes, which play a role in their selection of providers and modalities relating to CIH. Health care providers should consider how people view information relating to, and make decisions about, CIH therapies and work collaboratively with patients to develop effective health management strategies. Information services should also consider patients' perspectives in developing websites and other informational materials.
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Affiliation(s)
- Annie T Chen
- Biomedical Informatics and Medical Education, University of Washington School of Medicine, UW Medicine South Lake Union, 850 Republican Street, Box 358047, Seattle, WA 98109, United States.
| | - Mary Grace Flaherty
- School of Information and Library Science, University of North Carolina at Chapel Hill, 216 Lenoir Drive, CB #3360, 100 Manning Hall, Chapel Hill, NC, 27599-3360, United States.
| | - Megan Threats
- School of Information and Library Science, University of North Carolina at Chapel Hill, 216 Lenoir Drive, CB #3360, 100 Manning Hall, Chapel Hill, NC, 27599-3360, United States.
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25
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Herman PM, Edgington SE, Ryan GW, Coulter ID. Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care. J Altern Complement Med 2019; 25:1015-1025. [PMID: 31453711 DOI: 10.1089/acm.2019.0247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: The treatment goals of patients successfully using ongoing provider-based care for chronic spinal pain can help inform health policy related to this care. Design: Multinomial logistical hierarchical linear models were used to examine the characteristics of patients with different treatment goals for their ongoing care. Settings/Location: Observational data from a large national sample of patients from 125 chiropractic clinics clustered in 6 U.S. regions. Subjects: Patients with nonwork-injury-related nonspecific chronic low-back pain (CLBP) and chronic neck pain (CNP). Interventions: All were receiving ongoing chiropractic care. Outcome measures: Primary outcomes were patient endorsement of one of four goals for their treatment. Explanatory variables included pain characteristics, pain beliefs, goals for mobility/flexibility, demographics, and other psychological variables. Results: Across our sample of 1614 patients (885 with CLBP and 729 with CNP) just under one-third endorsed a treatment goal of having their pain go away permanently (cure). The rest had goals of preventing their pain from coming back (22% CLBP, 16% CNP); preventing their pain from getting worse (14% CLBP, 12% CNP); or temporarily relieving their pain (31% CLBP, 41% CNP). In univariate analysis across these goals, patients differed significantly on almost all variables. In the multinomial logistic models, a goal of cure was associated with shorter pain duration and more belief in a medical cure; a goal of preventing pain from coming back was associated with lower pain levels; and those with goals of preventing their pain from getting worse or temporarily relieving pain were similar, including in having their pain longer. Conclusions: Although much of health policy follows a curative model, the majority of these CLBP and CNP patients have goals of pain management (using ongoing care) rather than "cure" (care with a specific end) for their chiropractic care. This information could be useful in crafting policy for patients facing provider-based nonpharmacologic care for chronic pain.
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Pan Y, Meister R, Löwe B, Winkelmann A, Kaptchuk TJ, Buhling KJ, Nestoriuc Y. Non-concealed placebo treatment for menopausal hot flushes: Study protocol of a randomized-controlled trial. Trials 2019; 20:508. [PMID: 31420050 PMCID: PMC6697911 DOI: 10.1186/s13063-019-3575-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2019] [Indexed: 12/31/2022] Open
Abstract
Background Beneficial effects of placebos are high in double-blind hot flush trials. Studies in various conditions suggest that honestly prescribed placebos may elicit symptom improvement. Objective To determine whether open label placebo (OLP) treatment is efficacious in alleviating hot flushes among peri- and postmenopausal women. Methods/design In this assessor-blinded, randomized-controlled trial, n = 100 women experiencing five or more daily hot flushes of at least moderate severity and bothersomeness are assigned 1:1 to a 4-week OLP treatment or no treatment. To explore the duration and maintenance of placebo effects, the OLP group is randomized a second time to either discontinue or continue the OLP treatment for another 4 weeks. All participants receive a briefing about placebo effects and study visits at baseline, post-treatment (4 weeks), and follow-up (8 weeks, OLP group only). Qualitative interviews about subjective experiences with the OLP treatment are conducted. Primary outcomes are differences between the OLP and the no-treatment group in the hot flush composite score (frequency × severity), and bothersomeness of hot flushes as assessed with the Hot Flush Rating Scale at post-treatment. Secondary outcomes include hot flush frequency, health-related quality of life, global improvement, and the number of responders at post-treatment. Data are analyzed by fitting (generalized) linear mixed models. An exploratory analysis of maintenance and duration is performed including follow-up data. Discussion This trial will contribute to the evaluation of OLP treatments in clinical practice and further our understanding about the magnitude of placebo effects in hot flush treatments. Trial registration Clinicaltrials.gov, NCT03838523. Retrospectively registered on February 12th, 2019. The first patient was enrolled on October 10th, 2018.
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Affiliation(s)
- Yiqi Pan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Anne Winkelmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ted J Kaptchuk
- Program in Placebo Studies and the Therapeutic Encounter (PiPS), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Kai J Buhling
- Clinic for Gynecology, Department of Gynecological Endocrinology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Clinical Psychology, Helmut-Schmidt-University / University of the Federal Armed Forces Hamburg, Holstenhofweg 85, 22043, Hamburg, Germany
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Eaves ER, Hsu CW, DeBar LL, Livingston CJ, Ocker LE, McDonald SJ, Dillon-Sumner L, Ritenbaugh C. Whole Systems Within Whole Systems: The Oregon Health Plan's Expansion of Services for Back and Neck Pain. J Altern Complement Med 2019; 25:S61-S68. [PMID: 30870022 DOI: 10.1089/acm.2018.0431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. DESIGN Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. METHODS Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. RESULTS Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. CONCLUSIONS In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.
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Affiliation(s)
- Emery R Eaves
- 1 Department of Anthropology, Northern Arizona University, Flagstaff, AZ
| | - Clarissa W Hsu
- 2 Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Lynn L DeBar
- 2 Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | - Sarah J McDonald
- 2 Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Cheryl Ritenbaugh
- 5 Department of Family and Community Medicine, University of Arizona, Tucson, AZ
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Shannon ZK, Salsbury SA, Gosselin D, Vining RD. Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study. Altern Ther Health Med 2018; 18:316. [PMID: 30514271 PMCID: PMC6278071 DOI: 10.1186/s12906-018-2386-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022]
Abstract
Background Few studies have investigated patient and provider expectations of chiropractic care, particularly in multidisciplinary settings. This qualitative study explored stakeholder expectations of adding a chiropractor to the healthcare team at a rehabilitation specialty hospital. Methods The research methodology was an organizational case study with an inpatient facility for persons recovering from complex neurological conditions serving as the setting. Sixty stakeholders, including patients, families, hospital staff, and administrators, were interviewed or participated in focus groups in June 2015. Semi-structured questions guided the interview sessions which were digitally audiorecorded and transcribed. Data were entered into a qualitative software program to conduct content analysis using an iterative approach to identify key themes. Results Expectations for the chiropractic program were mostly positive with themes consistently reported across stakeholder groups. The central domain, making progress, encompassed the organizational mission to empower patients to reach hospital discharge and return to life in the community. Higher order goals, characterized as achieving whole person healing, encompassed patients’ quality of life, self-efficacy, and activities of daily living. Stakeholders expected the addition of chiropractic to help patients progress toward these goals by improving pain management and physical functioning. Pain management themes included pain intensity, medication use, and pain-related behaviors, while functional improvement themes included muscle tone, extremity function, and balance and mobility. In addition to these direct effects on clinical outcomes, stakeholders also expected indirect effects of chiropractic care on healthcare integration. This indirect effect was expected to increase patient participation in other providers’ treatments leading to improved care for the patient across the team and facility-level outcomes such as decreased length of stay. Conclusions Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge. Understanding stakeholder expectations may allow providers to align current expectations with what may be reasonable, in an effort to achieve appropriate clinical outcomes and patient and staff satisfaction.
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Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Briggs AM, Wluka AE. Patients' perceived needs for allied health, and complementary and alternative medicines for low back pain: A systematic scoping review. Health Expect 2018; 21:824-847. [PMID: 29983004 PMCID: PMC6186543 DOI: 10.1111/hex.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Allied health and complementary and alternative medicines (CAM) are therapeutic therapies commonly accessed by consumers to manage low back pain (LBP). We aimed to identify the literature regarding patients' perceived needs for physiotherapy, chiropractic therapy and CAM for the management of LBP. METHODS A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016) was conducted to identify studies examining patients' perceived needs for allied health and CAM for LBP. Data regarding study design and methodology were extracted. Areas of patients' perceived need for allied health and CAM were aggregated. RESULTS Forty-four studies from 2202 were included: 25 qualitative, 18 quantitative and 1 mixed-methods study. Three areas of need emerged: (i) physiotherapy was viewed as important, particularly when individually tailored. However, patients had concerns about adherence, adverse outcomes and correct exercise technique. (ii) Chiropractic therapy was perceived to be effective and needed by some patients, but others were concerned about adverse outcomes. (iii) An inconsistent need for CAM was identified with some patients perceiving a need, while others questioning the legitimacy and short-term duration of these therapies. CONCLUSIONS Our findings regarding patients' perceived needs for allied health and CAM for LBP may assist in informing development of more patient-centred guidelines and service models for LBP. Understanding patients' concerns regarding active-based physiotherapy, which is recommended in most guidelines, and issues surrounding chiropractic and CAM, which are generally not, may help inform management that better aligns patient's perceived needs with effective treatments, to improve outcomes for both patients and the health-care system.
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Affiliation(s)
- Louisa Chou
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Tom A. Ranger
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Waruna Peiris
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Flavia M. Cicuttini
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Donna M. Urquhart
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Andrew M. Briggs
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWAAustralia
- Move: Muscle, Bone & Joint HealthMelbourneVicAustralia
| | - Anita E. Wluka
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
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Lynch AD, Bove AM, Ammendolia C, Schneider M. Individuals with lumbar spinal stenosis seek education and care focused on self-management-results of focus groups among participants enrolled in a randomized controlled trial. Spine J 2018; 18:1303-1312. [PMID: 29246847 DOI: 10.1016/j.spinee.2017.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/10/2017] [Accepted: 11/22/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effectiveness of treatments for chronic, degenerative conditions of the lumbar spine can be influenced by patient perceptions and expectations regarding treatment. PURPOSE The primary purpose of this study was to understand the factors that are important to individuals with lumbar spinal stenosis (LSS) regarding different nonsurgical treatments. These factors were considered within the context of each treatment received as a part of the parent randomized controlled trial (RCT). STUDY DESIGN Focus group study of RCT participants. PATIENT SAMPLE Convenience sample of 50 individuals with LSS (28 female, average age 73±7.7 years) from an RCT participated in one of six focus groups. Focus groups consisted of patients previously randomized to one of three nonsurgical treatments: (1) medical care; (2) community-based group exercise; and (3) clinic-based manual therapy and individualized exercise. OUTCOME MEASURES Experiences, opinions, and preferences of individuals with LSS who participated in an RCT. Inter-coder agreement for qualitative analysis was conducted with kappa statistics. METHODS Participants discussed their experiences and perceptions regarding study treatment and their general experience with LSS using open-ended questions provided by a facilitator. Transcripts were coded according to modified grounded theory in an open approach, using codes that addressed the primary focus group discussion topics (primary coding) and codes for emerging topics (secondary coding). Secondary coding sought to identify themes concerning living with LSS and seeking treatment that were emergent from the focus groups. This study was funded by the Patient-Centered Research Outcomes Institute. The authors report no conflicts of interest. RESULTS Three themes related to medical treatment and symptom management arose from analyses: (1) an emotional response to LSS; (2) a desire for education about LSS and motivation to pursue education from any available source; and (3) a desire for individualized care based on self-management techniques and lifestyle changes. Emotional responses were more evident in individuals receiving medical care, whereas the other two themes were consistent across all three treatment groups. CONCLUSIONS The chronic pain associated with LSS may result in negative emotional responses. Individuals with LSS may believe misinformation and information from nonmedical sources, especially when medical providers do not spend sufficient time explaining the disease process and the reasoning behind treatment strategies. Receiving individualized care focused on self-management led to fewer negative emotions toward care and the disease process. Clinicians should be prepared to address all three of these aspects when providing care to individuals with LSS.
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Affiliation(s)
- Andrew D Lynch
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA.
| | - Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College St, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA
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Abstract
Integrative health modalities can provide useful tools in the management of persistent pain in the primary care setting. These modalities, such as acupuncture, mind-body medicine, diet and herbs, and movement strategies can be safely used and may provide patients with hope and empowerment. It is highly recommended that the patient work alongside trained professionals for a given modality and/or an interprofessional team.
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Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, French SD. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap 2017; 25:35. [PMID: 29201346 PMCID: PMC5698931 DOI: 10.1186/s12998-017-0165-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided. Methods Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition. Results The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%). Conclusions This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.
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Affiliation(s)
| | - Jessica J. Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Deborah A. Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
| | - Nir Ben Simon
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - André E. Bussières
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, Canada
| | - Silvano A. Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Simon D. French
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Highland KB, Schoomaker A, Rojas W, Suen J, Ahmed A, Zhang Z, Carlin SF, Calilung CE, Kent M, McDonough C, Buckenmaier CC. Benefits of the Restorative Exercise and Strength Training for Operational Resilience and Excellence Yoga Program for Chronic Low Back Pain in Service Members: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 99:91-98. [PMID: 28919191 DOI: 10.1016/j.apmr.2017.08.473] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/20/2017] [Accepted: 08/14/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine the feasibility and preliminary effectiveness of an individualized yoga program. DESIGN Pilot randomized controlled trial. SETTING Military medical center. PARTICIPANTS Patients (N=68) with chronic low back pain. INTERVENTIONS Restorative Exercise and Strength Training for Operational Resilience and Excellence (RESTORE) program (9-12 individual yoga sessions) or treatment as usual (control) for an 8-week period. MAIN OUTCOME MEASURES The primary outcome was past 24-hour pain (Defense & Veterans Pain Rating Scale 2.0). Secondary outcomes included disability (Roland-Morris Disability Questionnaire) and physical functioning and symptom burden (Patient-Reported Outcomes Measurement Information System-29 subscales). Assessment occurred at baseline, week 4, week 8, 3-month follow-up, and 6-month follow-up. Exploratory outcomes included the proportion of participants in each group reporting clinically meaningful changes at 3- and 6-month follow-ups. RESULTS Generalized linear mixed models with sequential Bonferroni-adjusted pairwise significance tests and chi-square analyses examined longitudinal outcomes. Secondary outcome significance tests were Bonferroni adjusted for multiple outcomes. The RESTORE group reported improved pain compared with the control group. Secondary outcomes did not retain significance after Bonferroni adjustments for multiple outcomes, although a higher proportion of RESTORE participants reported clinically meaningfully changes in all outcomes at 3-month follow-up and in symptom burden at 6-month follow-up. CONCLUSIONS RESTORE may be a viable nonpharmacological treatment for low back pain with minimal side effects, and research efforts are needed to compare the effectiveness of RESTORE delivery formats (eg, group vs individual) with that of other treatment modalities.
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Affiliation(s)
- Krista Beth Highland
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD.
| | - Audrey Schoomaker
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Winifred Rojas
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Josh Suen
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Ambareen Ahmed
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Zhiwei Zhang
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | | | - Christian E Calilung
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Michael Kent
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; Walter Reed National Military Medical Center, Bethesda, MD
| | - Christin McDonough
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Chester C Buckenmaier
- Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD; Walter Reed National Military Medical Center, Bethesda, MD
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Baldwin JA, Williamson HJ, Eaves ER, Levin BL, Burton DL, Massey OT. Broadening measures of success: results of a behavioral health translational research training program. Implement Sci 2017; 12:92. [PMID: 28738825 PMCID: PMC5525239 DOI: 10.1186/s13012-017-0621-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap.
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Affiliation(s)
- Julie A Baldwin
- Northern Arizona University College of Health and Human Services, Center for Health Equity Research, 1395 S. Knoles Dr., #4065, ARD Building, Suite 140, Flagstaff, AZ, 86011, USA.
| | - Heather J Williamson
- Northern Arizona University College of Health and Human Services, Center for Health Equity Research, 1395 S. Knoles Dr., #4065, ARD Building, Suite 140, Flagstaff, AZ, 86011, USA.,Department of Occupational Therapy, Northern Arizona University College of Health and Human Services, 435 N 5th Street, Health Sciences Education Building, Phoenix, AZ, 85004, USA
| | - Emery R Eaves
- Northern Arizona University College of Health and Human Services, Center for Health Equity Research, 1395 S. Knoles Dr., #4065, ARD Building, Suite 140, Flagstaff, AZ, 86011, USA
| | - Bruce L Levin
- Department of Child and Family Studies, University of South Florida College of Behavioral and Community Sciences, 13301 Bruce B. Downs Blvd., MHC 2321, Tampa, FL, 33612, USA.,Department of Community & Family Health, University of South Florida College of Public Health, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA
| | - Donna L Burton
- Department of Child and Family Studies, University of South Florida College of Behavioral and Community Sciences, 13301 Bruce B. Downs Blvd., MHC 2321, Tampa, FL, 33612, USA
| | - Oliver T Massey
- Department of Child and Family Studies, University of South Florida College of Behavioral and Community Sciences, 13301 Bruce B. Downs Blvd., MHC 2321, Tampa, FL, 33612, USA
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Schüßler B, Abel A, Holzer M, Meise R, Voigt-Radloff S, Schäfer A. Potential analysis of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain / Potentialanalyse der multidisziplinären biopsychosozialen Rehabilitation für Patienten/-innen mit chronischen Rückenschmerzen. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2017. [DOI: 10.1515/ijhp-2017-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Health problem
The prevalence of low back pain ranges from 74 to 85%, almost everybody in Germany suffers from low back pain once in his or her life. The recurrence rate within twelve months is 62%, which often leads to inability to work and reduction in earning capacity. The rate of chronic manifestation of low back pain is 5%. Subsequent loss of mobility and functional disability lowers quality of life and participation in private life and at work.
Evidence
A recent Cochrane review (Kamper et al., 2014) analysed six (outcome disability) and seven (outcome pain) studies with 722 and 821 participants respectively and showed that multidisciplinary rehabilitation compared to usual care has a small, but clinically relevant effect (pain: SMD -0,21 [CI 95% -0,37; -0,04]; disability: SMD -0,23 [CI 95% -0,4; -0,06]). There is a lack of evidence about the intervention conception, patient-centred outcomes and the cost effectiveness.
Implication for research
Prior to a randomised controlled trial a feasibility study about individualised multidisciplinary biopsychosocial rehabilitation compared to usual care considering people with chronic low back pain at employable age in Germany is needed. The applicability of available manuals, patient-centred outcomes and cost effectiveness should be explored.
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Affiliation(s)
- Beate Schüßler
- Fakultät Soziale Arbeit und Gesundheit , HAWK Hildesheim, Hildesheim , Germany
| | - Angsar Abel
- Fakultät Soziale Arbeit und Gesundheit , HAWK Hildesheim, Hildesheim , Germany
| | - Milena Holzer
- Fakultät Soziale Arbeit und Gesundheit , HAWK Hildesheim, Hildesheim , Germany
| | - Ruth Meise
- Fakultät Soziale Arbeit und Gesundheit , HAWK Hildesheim, Hildesheim , Germany
| | | | - Axel Schäfer
- Hochschule Bremen, Fakultät Gesellschaftswissenschaften , Studiengang Angewandte Therapiewissenschaften Logopädie und Physiotherapie, Bremen , Germany
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Ali A, Rosenberger L, Weiss TR, Milak C, Perlman AI. Massage Therapy and Quality of Life in Osteoarthritis of the Knee: A Qualitative Study. PAIN MEDICINE 2017; 18:1168-1175. [PMID: 27590465 DOI: 10.1093/pm/pnw217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective We hypothesized that participants receiving Swedish massage would experience benefits such as stress reduction and enhanced quality of life, in addition to the osteoarthritis-specific effects assessed in a randomized controlled clinical trial. Design Qualitative methods were used to explore a deeper contextual understanding of participants' experiences with massage and osteoarthritis, in addition to the quantitative data collected from primary and secondary outcome measures of the dose-finding study. Setting Two community hospitals affiliated with academic health centers in Connecticut and New Jersey. Subjects Eighteen adults who previously participated in a dose-finding clinical trial of massage therapy for osteoarthritis of the knee. Methods Face-to-face and telephone interviews using a standardized interview guide. Triangulation of qualitative and quantitative data allowed for a more thorough understanding of the effects of massage therapy. Results Three salient themes emerged from our analysis. Participants discussed 1) relaxation effects, 2) improved quality of life associated with receiving massage therapy, and 3) the accessibility of massage therapy in treating osteoarthritis. Conclusions Participant responses noted empowerment with an improved ability to perform activities of daily living after experiencing massage therapy. The majority of statements were consistent with their quantitative changes on standard osteoarthritis measures. Future research in pain conditions should include health-related quality of life assessments as well as outcomes related to perceived well-being, along with greater exploration of the concept of salutogenic side effects of an intervention in the context of complementary and integrative therapies.
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Affiliation(s)
- Ather Ali
- Yale School of Medicine, New Haven, Connecticut
| | - Lisa Rosenberger
- Yale-Griffin Prevention Research Center, Yale School of Public Health, Derby, Connecticut
| | | | - Carl Milak
- Institute for Complementary and Alternative Medicine, School of Health Related Professions, Rutgers University, Newark, New Jersey
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Kavadar G, Demircioğlu DT, Can H, Emre TY, Civelek E, Senyigit A. The clinical factors associated with benefit finding of complementary medicine use in patients with back pain: A cross-sectional study with cluster analysis. J Back Musculoskelet Rehabil 2017; 30:271-277. [PMID: 27689602 DOI: 10.3233/bmr-150470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) use has been increasing. OBJECTIVE To identify the factors associated with perceived benefit from CAM methods in back problems. METHODS The study was conducted on patients who practiced any CAM methods due to complaints of back pain. Social-demographic properties, details of CAM methods employed were questioned. Severity of pain was measured by visual analog scale (VAS); benefits were evaluated by the Likert scale. Hierarchical cluster analysis was used to discover relationships among variables. RESULTS In total, 500 patients (265 female, 235 male) were included in the study. Mostly used methods were herbal therapy (32%), balneotherapy (31%), cupping (19.4%) and massage-manipulation (19.2%). Of patients, 355 (71%) were satisfied. The variables associated with benefit finding were female gender, age, chronicity and severity of pain, high educational level, upper middle income status, use as a result of recommendation, dissatisfaction with conventional methods, residence in an urban area, non-herbal method use, being married, and social insurance (p < 0.005). CONCLUSION The majority of patients using CAM perceived benefits; in particular, women living in urban areas, highly educated, aged more than 40, who suffer from severe chronic back pain, may be more inclined to go to CAM therapists.
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Affiliation(s)
- Gulis Kavadar
- Physical Medicine and Rehabilitation Department, Gunesli Medicine Hospital, Istanbul, Turkey
| | | | - Halil Can
- Neurosurgery Department, Gunesli Medicine Hospital, Istanbul, Turkey
| | - Tuluhan Yunus Emre
- Orthopedics and Traumatology Department, Memorial Hizmet Hospital, Istanbul, Turkey
| | - Erdinç Civelek
- Neurosurgery Department, Gunesli Medicine Hospital, Istanbul, Turkey
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Penney LS, Ritenbaugh C, DeBar LL, Elder C, Deyo RA. Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study. BMC FAMILY PRACTICE 2017; 17:164. [PMID: 28403822 PMCID: PMC5390355 DOI: 10.1186/s12875-016-0566-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues. METHODS Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1. RESULTS We identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants' perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment. CONCLUSIONS These results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more satisfaction for patients and providers, and provide important input to policy makers. TRIAL REGISTRATION ClinicalTrials.gov NCT01345409 , date of registration 28/4/2011.
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Affiliation(s)
- Lauren S. Penney
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229 USA
| | - Cheryl Ritenbaugh
- The University of Arizona, Department of Family and Community Medicine, 1450N. Cherry Ave, Tucson, AZ 85719 USA
| | - Lynn L. DeBar
- Kaiser Permanente Center for Health Research Northwest Region, 3800N. Interstate Ave, Portland, OR 97227 USA
| | - Charles Elder
- Kaiser Permanente Center for Health Research Northwest Region, 3800N. Interstate Ave, Portland, OR 97227 USA
| | - Richard A. Deyo
- Oregon Health & Science University, 3181S.W. Sam Jackson Park Rd, Portland, OR 97239 USA
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Ness KK, Hudson MM, Jones KE, Leisenring W, Yasui Y, Chen Y, Stovall M, Gibson TM, Green DM, Neglia JP, Henderson TO, Casillas J, Ford JS, Effinger KE, Krull KR, Armstrong GT, Robison LL, Oeffinger KC, Nathan PC. Effect of Temporal Changes in Therapeutic Exposure on Self-reported Health Status in Childhood Cancer Survivors. Ann Intern Med 2017; 166:89-98. [PMID: 27820947 PMCID: PMC5239750 DOI: 10.7326/m16-0742] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The effect of temporal changes in cancer therapy on health status among childhood cancer survivors has not been evaluated. OBJECTIVE To compare proportions of self-reported adverse health status outcomes among childhood cancer survivors across 3 decades. DESIGN Cross-sectional. (ClinicalTrials.gov: NCT01120353). SETTING 27 North American institutions. PARTICIPANTS 14 566 adults, who survived for 5 or more years after initial diagnosis (median age, 27 years; range, 18 to 48 years), treated from 1970 to 1999. MEASUREMENTS Patient report of poor general or mental health, functional impairment, activity limitation, or cancer-related anxiety or pain was evaluated as a function of treatment decade, cancer treatment exposure, chronic health conditions, demographic characteristics, and health habits. RESULTS Despite reductions in late mortality and the proportions of survivors with severe, disabling, or life-threatening chronic health conditions (33.4% among those treated from 1970 to 1979 and 21.0% among those treated from 1990 to 1999), those reporting adverse health status did not decrease by treatment decade. Compared with survivors diagnosed in 1970 to 1979, those diagnosed in 1990 to 1999 were more likely to report poor general health (11.2% vs. 13.7%; P < 0.001) and cancer-related anxiety (13.3% vs. 15.0%; P < 0.001). From 1970 to 1979 and 1990 to 1999, the proportions of survivors reporting adverse outcomes were higher (P < 0.001) among those with leukemia (poor general health, 9.5% and 13.9%) and osteosarcoma (pain, 23.9% and 36.6%). Temporal changes in treatment exposures were not associated with changes in the proportions of survivors reporting adverse health status. Smoking, not meeting physical activity guidelines, and being either underweight or obese were associated with poor health status. LIMITATION Considerable improvement in survival among children diagnosed with cancer in the 1990s compared with those diagnosed in the 1970s makes it difficult to definitively determine the effect of risk factors on later self-reported health status without considering their effect on mortality. CONCLUSION Because survival rates after a diagnosis of childhood cancer have improved substantially over the past 30 years, the population of survivors now includes those who would have died in earlier decades. Self-reported health status among survivors has not improved despite evolution of treatment designed to reduce toxicities. PRIMARY FUNDING SOURCE The National Cancer Institute.
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Affiliation(s)
- Kirsten K Ness
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa M Hudson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kendra E Jones
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy Leisenring
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yutaka Yasui
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yan Chen
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marilyn Stovall
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Todd M Gibson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel M Green
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph P Neglia
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tara O Henderson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacqueline Casillas
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer S Ford
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen E Effinger
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin R Krull
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory T Armstrong
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leslie L Robison
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin C Oeffinger
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
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Change Narratives That Elude Quantification: A Mixed-Methods Analysis of How People with Chronic Pain Perceive Pain Rehabilitation. Pain Res Manag 2017; 2016:9570581. [PMID: 28070161 PMCID: PMC5192338 DOI: 10.1155/2016/9570581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
Chronic pain negatively impacts health, well-being, and social participation. Effective rehabilitation often hinges on long-term changes in pain-related perceptions and behaviors. However, there are important gaps in understanding how patients perceive these changes. The present pilot study addresses this gap by using qualitative and quantitative methodologies to explore how patients perceive and experience changes in function, participation, and pain-related factors following a chronic pain rehabilitation program. A mixed-method design was used in which the core method was qualitative. Descriptive quantitative data was used to further characterize the sample. Semistructured interviews were conducted 1-6 months following treatment completion. Questionnaires were administered before and after treatment and at follow-up. Interview data was analyzed thematically. Participants' individual descriptive data was compared to established cut-scores and criteria for change. A major theme of personal growth emerged in the qualitative analysis. Participants also discussed the factors that facilitated personal growth and the ongoing challenges to this growth. The quantitative data revealed limited improvement on measures of pain, disability, catastrophizing, and depression. These findings suggest that, despite limited improvement on treatment-related questionnaires, patients can experience an important and enduring sense of personal growth. Clinical and theoretical implications are discussed.
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Geurts JW, Willems PC, Lockwood C, van Kleef M, Kleijnen J, Dirksen C. Patient expectations for management of chronic non-cancer pain: A systematic review. Health Expect 2016; 20:1201-1217. [PMID: 28009082 PMCID: PMC5689237 DOI: 10.1111/hex.12527] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/29/2022] Open
Abstract
Background Chronic pain is a major economic and social health problem. Up to 79% of chronic pain patients are unsatisfied with their pain management. Meeting patients’ expectations is likely to produce greater satisfaction with care. The challenge is to explore patients’ genuine expectations and needs. However, the term expectation encompasses several concepts and may concern different aspects of health‐care provision. Objective This review aimed to systematically collect information on types and subject of patients’ expectations for chronic pain management. Search strategy We searched for quantitative and qualitative studies. Because of the multidimensional character of the term “expectations,” the search included subject headings and free text words related to the concept of expectations. Data extraction and synthesis A framework for understanding patients’ expectations was used to map types of expectations within structure, process or outcome of health care. Main results Twenty‐three research papers met the inclusion criteria: 18 quantitative and five qualitative. This review found that assessment of patients’ expectations for treatment is mostly limited to outcome expectations (all 18 quantitative papers and four qualitative papers). Patients generally have high expectations regarding pain reduction after treatment, but expectations were higher when expressed as an ideal expectation (81‐93% relief) than as a predicted expectation (44‐64%). Discussion and conclusions For health‐care providers, for pain management and for pain research purposes, the awareness that patients express different types of expectations is important. For shared decision making in clinical practice, it is important that predicted expectations of the patient are known to the treating physician and discussed. Structure and process expectations are under‐represented in our findings. However, exploring and meeting patients’ expectations regarding structure, process and outcome aspects of pain management may increase patient satisfaction.
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Affiliation(s)
- Jose W Geurts
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paul C Willems
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Craig Lockwood
- The Joanna Briggs Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Maarten van Kleef
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos Kleijnen
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Kleijnen Systematic Reviews Ltd, York, UK
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Gonçalves AV, Makuch MY, Setubal MS, Barros NF, Bahamondes L. A Qualitative Study on the Practice of Yoga for Women with Pain-Associated Endometriosis. J Altern Complement Med 2016; 22:977-982. [PMID: 27552065 DOI: 10.1089/acm.2016.0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To understand the meaning women with pain-associated endometriosis attribute to yoga practice regarding their physical and emotional state at the beginning of the practice; pain management by integrating body and mind; secondary benefits of the practice of yoga, such as self-knowledge, self-care, and autonomy; and the role of the yoga group as psychosocial support. DESIGN Qualitative study conducted simultaneously with a randomized clinical trial. SETTING Public university hospital in southeastern Brazil between August 2013 and December 2014. PARTICIPANTS Fifteen women with pain-associated endometriosis who practiced yoga for 8 weeks. INTERVENTION After completing the twice-a-week program, all women participated in a single, semi-structured interview. Interviews were recorded and transcribed verbatim, and thematic analyses were performed. OUTCOME MEASURES The main themes of analysis were women's expectations regarding the practice of yoga, physical and emotional state of women at the beginning of yoga practice, control and pain management through the integration of body and mind, secondary benefits, acquisition of self-knowledge and autonomy, and the role of yoga group as psychosocial support. RESULTS All participants reported that yoga was beneficial to control pelvic pain. They related that they were aware of the integration of body and psyche during yoga practice and that this helped in the management of pain. Women said they had identified a relationship between pain management and breathing techniques (pranayama) learned in yoga and that breathing increased their ability to be introspective, which relieved pain. The participants have developed greater self-knowledge, autonomy, and self-care and have reduced the use of pain and psychiatric medications. They created ties among themselves, suggesting that the yoga group allowed psychosocial support. CONCLUSIONS Bodily and psychosocial mechanisms to control pain were identified in women with endometriosis. To reach such control, it is crucial that mind and body integrative techniques are learned.
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Affiliation(s)
| | - Maria Y Makuch
- 1 Department of Obstetrics and Gynecology, University of Campinas Medical School , Campinas, São Paulo, Brazil
| | - Maria Silvia Setubal
- 1 Department of Obstetrics and Gynecology, University of Campinas Medical School , Campinas, São Paulo, Brazil
| | - Nelson Filice Barros
- 2 Department of Collective Health, University of Campinas Medical School , Campinas, São Paulo, Brazil
| | - Luis Bahamondes
- 1 Department of Obstetrics and Gynecology, University of Campinas Medical School , Campinas, São Paulo, Brazil
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Muramoto ML, Gordon JS, Bell ML, Nichter M, Floden L, Howerter A, Ritenbaugh CK. Tobacco Cessation Training for Complementary and Alternative Medicine Practitioners: Results of a Practice-Based Trial. Am J Prev Med 2016; 51:e35-e44. [PMID: 27061892 DOI: 10.1016/j.amepre.2016.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/19/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Brief behavioral intervention (BI) is a tobacco-cessation best practice well established among conventional healthcare practitioners. Complementary and alternative medicine (CAM) practitioners treat significant numbers of tobacco users, but do not systematically receive BI training. The CAM Reach study developed and evaluated a tobacco cessation BI training program/practice system intervention adapted specifically for CAM practitioners, and evaluated in real-world CAM practices. STUDY DESIGN Single-arm intervention. Data were collected in 2010-2014 and analyzed in 2015. SETTING/PARTICIPANTS Private practices of 30 chiropractors, 27 acupuncturists, 42 massage therapists (N=99), in metropolitan Tucson, Arizona. INTERVENTION Eight-hour tobacco cessation BI continuing education workshop, in-office BI skills practice/assessment, and system intervention. Training tailored to the CAM practice setting addressed tobacco cessation best practices from the U.S. Public Health Service Guidelines. MAIN OUTCOME MEASURES Seventeen items (assessing practitioner behavior, motivation, and self-efficacy with tobacco cessation) comprising three factors, Tobacco Cessation Activity, Tobacco Cessation Motivation, and Non-CAM Tobacco Cessation Comfort, were assessed at baseline and 3, 6, 9, and 12 months post-training by practitioner self-report. Research staff visited practices at approximately the same intervals to directly observe changes in clinical practice systems. RESULTS At 3 months, there were significant increases in practitioners' tobacco cessation activities, motivation and confidence in helping patients quit tobacco, and comfort with providing information and referrals for guideline-based tobacco cessation aids (p<0.0001). Practitioners significantly increased rates of discussing cessation medications with patients (AOR=3.76, 95% CI=1.84, 7.68), and routinely asking about tobacco use in clinical practice (AOR=2.62, 95% CI=1.11, 6.20). Increases occurred across all three practitioner types and were sustained at 12 months-despite heterogeneity in professional training, practice patterns/organization, and practice business models. CONCLUSIONS Results suggest CAM practitioners are willing and able to offer BIs, and are an important, yet overlooked channel for promoting tobacco cessation and use of evidence-based cessation aids.
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Affiliation(s)
- Myra L Muramoto
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona.
| | - Judith S Gordon
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Mark Nichter
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona; School of Anthropology, College of Social and Behavioral Sciences, University of Arizona, Tucson, Arizona
| | - Lysbeth Floden
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Amy Howerter
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Cheryl K Ritenbaugh
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
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Rodrigues-de-Souza DP, Palacios-Ceña D, Moro-Gutiérrez L, Camargo PR, Salvini TF, Alburquerque-Sendín F. Socio-Cultural Factors and Experience of Chronic Low Back Pain: a Spanish and Brazilian Patients' Perspective. A Qualitative Study. PLoS One 2016; 11:e0159554. [PMID: 27434594 PMCID: PMC4951039 DOI: 10.1371/journal.pone.0159554] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/04/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low back pain (LBP) could be influenced by socio-cultural factors. Pain narratives are important to understand the influence of environment on patients with chronic LBP. There are few studies that have explored the experience of patients with chronic LBP in different socio-cultural environments. The aim of this study was to describe the experience of patients with chronic LBP in Spain and Brazil. METHODS A qualitative phenomenology approach was implemented. Chronic LBP patients from the University Hospital of Salamanca (Spain), and/or Federal University of São Carlos (Brazil) were included, using purposeful sampling. Data were collected from 22 Spanish and 26 Brazilian patients during in-depth interviews and using researchers' field notes and patients' personal diaries and letters. A thematic analysis was performed and the guidelines for reporting qualitative research were applied. RESULTS Forty-eight patients with a mean age of 50.7 years (SD: ± 13.1 years) were included in the study. The themes identified included: a) ways of perceiving and expressing pain-the participants focused constantly on their pain and anything outside it was considered secondary; b) the socio-familial environment as a modulator of pain-most participants stated that no one was able to understand the pain they were experiencing; c) religion as a modulator of pain-all Brazilian patients stated that religious belief affected the experience of pain; and d) socio-economic and educational status as a modulator of pain-the study reported that economic factors influenced the experience of pain. CONCLUSIONS The influences of LBP can be determined based on the how a patient defines pain. Religion can be considered as a possible mechanism for patients to manage pain and as a form of solace.
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Affiliation(s)
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Lourdes Moro-Gutiérrez
- Department of Social Psychology and Anthropology, University of Salamanca, Salamanca, Spain
| | | | - Tania Fátima Salvini
- Department of Physical Therapy, Federal University of Sao Carlos, São Paulo, Brazil
| | - Francisco Alburquerque-Sendín
- Biomedical Research Institute of Salamanca (IBSAL), Department of Nursing and Physical Therapy, University of Salamanca, Salamanca, Spain
- * E-mail:
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Mehl-Madrona L, Mainguy B, Plummer J. Integration of Complementary and Alternative Medicine Therapies into Primary-Care Pain Management for Opiate Reduction in a Rural Setting. J Altern Complement Med 2016; 22:621-6. [PMID: 27419856 DOI: 10.1089/acm.2015.0212] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Opiates are no longer considered the best strategy for the long-term management of chronic pain. Yet, physicians have made many patients dependent on them, and these patients still request treatment. Complementary and alternative medicine (CAM) therapies have been shown to be effective, but are not widely available and are not often covered by insurance or available to the medically underserved. METHODS Group medical visits (GMVs) provided education about non-pharmacological methods for pain management and taught mindfulness techniques, movement, guided imagery, relaxation training, yoga, qigong, and t'ai chi. Forty-two patients attending GMVs for at least six months were matched prospectively with patients receiving conventional care. RESULTS No one increased their dose of opiates. Seventeen people reduced their dose, and seven people stopped opiates. On a 10-point scale of pain intensity, reductions in pain ratings achieved statistical significance (p = 0.001). The average reduction was 0.19 (95% confidence interval [CI] 0.12-0.60; p = 0.01). The primary symptom improved on average by -0.42 (95% CI -0.31 to -0.93; p = 0.02) on the My Medical Outcome Profile, 2nd version. Improvement in the quality-of-life rating was statistically significant (p = 0.007) with a change of -1.42 (95% CI = -0.59 to -1.62). In conventional care, no patients reduced their opiate use, and 48.5% increased their dose over the two years of the project. CONCLUSIONS GMVs that incorporated CAM therapies helped patients reduce opiate use. While some patients found other physicians to give them the opiates they desired, those who persisted in an environment of respect and acceptance significantly reduced opiate consumption compared with patients in conventional care. While resistant to CAM therapies initially, the majority of patients came to accept and to appreciate their usefulness. GMVs were useful for incorporating non-reimbursed CAM therapies into primary medical care.
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Affiliation(s)
- Lewis Mehl-Madrona
- 1 Department of Research, Coyote Institute , Orono, ME.,2 Family Medicine Residency, Eastern Maine Medical Center , Bangor, ME.,3 Department of Family Medicine, University of New England College of Osteopathic Medicine , Bangor Clinical Campus, ME.,4 Department of Psychiatry, Acadia Hospital , Bangor, ME
| | - Barbara Mainguy
- 5 Department of Creative Arts Therapy, Coyote Institute , Orono, ME
| | - Julie Plummer
- 6 Department of Psychiatry, Dartmouth University School of Medicine , Hanover, NH
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Abstract
The definition of functional pain syndromes is varied across literature. No effort has been made to see all functional pain disorder groups under broad nomenclature which would exclude conditions for which pathophysiology is strongly known. Since these disorders are commonly treated with alternative treatment modalities and impose significant burden on health utilization, an effort to look into studies on yoga-based interventions on 'functional pain syndromes' (FPS) was made. This study defined FPS as 'Chronic relapsing remitting pain conditions, the origin of which is difficult to trace with no definite physical pathology on clinical suspicion or available laboratory measures and are valid based on subjective pain reporting, associated distress and socio-occupational dysfunction'. Chronic headache, neck pain, back pain, fibromyalgia, pelvic pain, Irritable Bowel Syndrome, Chronic Fatigue Syndrome, and somatoform pain disorders were included for this review. The review found four meta-analyses on the selected topic both indicating modest efficacy and benefit of yoga in these disorders. Future efforts should be directed to do a large meta-analysis of functional pain syndromes.
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Affiliation(s)
- Roshan Sutar
- a Department of Psychiatry , National Institute of Mental Health and Neurosciences , Bangalore , India
| | - Suresh Yadav
- a Department of Psychiatry , National Institute of Mental Health and Neurosciences , Bangalore , India
| | - Geetha Desai
- a Department of Psychiatry , National Institute of Mental Health and Neurosciences , Bangalore , India
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