1. Slide 1
Evidence-based Practice Update
Rachel Busse, MD
Diplomate, American Board of Family Medicine
Director of Integrative Medicine at Norton Suburban
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Slide 2
Evidence-based practice update
Research challenges
Implementing integrative programs
Recent research
Massage
Aromatherapy
Reiki
Relaxation
Music
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Slide 3
Research challenges
-Herbs and supplements not standardized
-Individualized treatments
-Placebo or “sham” treatments
-Difficult to randomize and double blind
studies
-Funding
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2. Slide 4
Research & Integrative medicine
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Slide 5 ___________________________________
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Slide 6
Implementing integrative programs
Holistic nursing department at 261 bed hospital
Therapies:
Relaxation techniques
Therapeutic touch
Aromatherapy
Therapeutic suggestion
Retrospective chart review and pt survey
Reduction in pain
Increase in patient satisfaction
Complement Ther Nurs Midwifery. 2004 Aug;10(3):168-74. Development and evaluation
of an inpatient [correction of impatient] holistic nursing care services department.
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3. Slide 7
Implementing integrative programs
Inpatient oncology unit at Beth Israel hospital
Yoga therapy, healing environment, holistic nursing
2 nonrandomized groups
Compared: Length of stay, total medication costs, and
cost of as-needed medications
Demonstrated decrease in meds for pain, nausea &
anxiety, also decrease in overall cost
Am J Manag Care. 2011 Dec;17(12):779-84. Cost savings in inpatient oncology through
an integrative medicine approach.
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Slide 8
Implementing integrative programs
102 studies
Majority looked at music
Aromas, decoration, flooring, lighting
May affect anxiety
http://summaries.cochrane.org/CD005315/sensory-environment-on-health-
related-outcomes-of-hospital-patients
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Slide 9
Massage
Massage in acute care setting
Reduction in pain
Improvement in sleep
Improvement in relaxation
Improvement in overall well-being
Int J Ther Massage Bodywork. 2010; 3(1): 4–11. PMCID: PMC3091428 The Effects of
Massage Therapy on Pain Management in the Acute Care Setting
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4. Slide 10
Massage
Cochrane review of massage and
aromatherapy massage
8 RCTs, 357 patients
Reduction in anxiety
Reduction in pain
Some trials showed reduction in nausea
Mixed data as to whether aromatherapy enhances
effects of massage
Cochrane Database Syst Rev. 2004;(2):CD002287. Aromatherapy and massage for
symptom relief in patients with cancer.
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Slide 11
Massage
-RCT with 68 patients
-osteoarthritis of the knee
-significant improvement in stiffness, range of
motion, pain, time to walk 50 feet
Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial
Arch Intern Med. 2006;166(22):2533-2538. doi:10.1001/archinte.166.22.2533
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Slide 12
Aromatherapy
Anxiety*
Depression
Nausea
Insomnia
Pain
Agitation (in dementia)
Br J Gen Pract. Jun 2000; 50(455): 493–496.PMCID: PMC1313734
Aromatherapy: a systematic review.
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5. Slide 13
Aromatherapy
Literature review, limited studies
Lavender or orange to treat anxiety
Peppermint to treat nausea
Risks of allergic reactions and oral toxicity
J Adv Nurs. 2004 Oct;48(1):93-103. Aromatherapy practice in nursing: literature
review.
Evid Based Complement Alternat Med. 2014;2014:726341. Epub 2014 Feb 24.
Essential Oils for Complementary Treatment of Surgical Patients: State of the
Art.
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Slide 14
Aromatherapy
Post-operative nausea and vomiting
120 patients in 2014 RCT showed
significant improvement
Cochrane review 2012
9 studies, 402 participants
Evidence insufficient
J Perianesth Nurs. 2014 Feb;29(1):5-11. doi: 10.1016/j.jopan.2012.12.004. A
prospective randomized study of the effectiveness of aromatherapy for relief
of postoperative nausea and vomiting.
http://summaries.cochrane.org/CD007598/aromatherapy-for-treating-
postoperative-nausea-and-vomiting
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Slide 15
Touch therapies
Therapeutic touch
– Energy therapy developed in 1970s
Jin Shin Jyutsu
Harmonizing the body's energetic system
Incorporates acupressure, QiGong, philosophy
Verbal guidance, light exercise and massage
Reiki
Developed 1922 by Mikao Usui
Universal life energy transferred through palms
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6. Slide 16
Touch therapies
Review of 10 studies of biofield therapies
Little or no changes in physiologic
markers
Review of biofield therapies for palliative
care
Relieving pain, improving quality of life,
reducing stress
Explore (NY). 2014 May-Jun;10(3):150-61. doi: 10.1016/j.explore.2014.02.003. Epub 2014
Feb 24. Biofield-based Therapies: A Systematic Review of Physiological Effects on
Practitioners During Healing.
Am J Hosp Palliat Care. 2013 Nov 20. [Epub ahead of print]. Biofield Therapies for
Symptom Management in Palliative and End-of-Life Care.
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Slide 17
Reiki
Literature review of RCTs
Seven studies met inclusion criteria
Evidence suggests that Reiki therapy may be effective
for pain and anxiety
Larger sample sizes, randomized groups, protocols
are needed
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Slide 18
Reiki
Systematic review of therapeutic effects of Reiki
12 trials included
9 showed positive results
Low quality of reporting, most trials lacking:
Randomization
Blinding, or
Accountability
J Altern Complement Med. 2009 Nov;15(11):1157-69. doi: 10.1089/acm.2009.0036. A
systematic review of the therapeutic effects of Reiki.
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7. Slide 19
Reiki
118 patients with cancer
30 minute Reiki session
Statistically significant reduction in anxiety
Also helped with pain, relaxation and sleep
Am J Hosp Palliat Care. 2012 Jun;29(4):290-4. doi: 10.1177/1049909111420859. Epub
2011 Oct 13. The effects of Reiki therapy on pain and anxiety in patients attending a
day oncology and infusion services unit.
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Slide 20
Music therapy
Cochrane review
5 studies, 4 of which demonstrated
significant reduction in symptoms of
depression
Need additional studies
Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression.
Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.:
CD004517. DOI: 10.1002/14651858.CD004517.pub2
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Slide 21
Music therapy
-Cochrane review
-26 trials
-listening to pre-recorded music
-improved anxiety scores
-reduction in need for medication
Cochrane Database Syst Rev. 2013 Jun 6;6:CD006908. doi:
10.1002/14651858.CD006908.pub2. Music interventions for preoperative
anxiety.
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8. Slide 22
Music therapy
-373 patients at 12 ICUs
-patient directed music (PDM) vs noise
canceling headphones (NCH)
-PDM reduced need for sedation more than
NCH or usual care
-PDM and NCH reduced anxiety more than
usual care
Music Therapy for Reducing Anxiety in Critically Ill Patients. JAMA.
2013;309(22):2386-2387. doi:10.1001/jama.2013.5657.
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Slide 23
Future of research
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