Kristine Westrom

Integrative care for the management of low back pain: use of a clinical care pathway

BackgroundFor the treatment of chronic back pain, it has been theorized that integrative care plans can lead to better outcomes than those achieved by monodisciplinary care alone, especially when using a collaborative, interdisciplinary, and non-hierarchical team approach. This paper describes the use of a care pathway designed to guide treatment by an integrative group of providers within a randomized controlled trial.MethodsA clinical care pathway was used by a multidisciplinary group of providers, which included acupuncturists, chiropractors, cognitive behavioral therapists, exercise therapists, massage therapists and primary care physicians. Treatment recommendations were based on an evidence-informed practice model, and reached by group consensus. Research study participants were empowered to select one of the treatment recommendations proposed by the integrative group. Common principles and benchmarks were established to guide treatment management throughout the study.ResultsThirteen providers representing 5 healthcare professions collaborated to provide integrative care to study participants. On average, 3 to 4 treatment plans, each consisting of 2 to 3 modalities, were recommended to study participants. Exercise, massage, and acupuncture were both most commonly recommended by the team and selected by study participants. Changes to care commonly incorporated cognitive behavioral therapy into treatment plans.ConclusionThis clinical care pathway was a useful tool for the consistent application of evidence-based care for low back pain in the context of an integrative setting.Trial registrationClinicalTrials.gov NCT00567333

Complementary and Integrative Healthcare in a Long-term Care Facility: A Pilot Project.

Introduction: The worlds population is aging quickly, leading to increased challenges of how to care for individuals who can no longer independently care for themselves. With global social and economic pressures leading to declines in family support, increased reliance is being placed on community- and government-based facilities to provide long-term care (LTC) for many of societys older citizens. Complementary and integrative healthcare (CIH) is commonly used by older adults and may offer an opportunity to enhance LTC residents’ wellbeing. Little work has been done, however, rigorously examining the safety and effectiveness of CIH for LTC residents. Objective: The goal of this work is to describe a pilot project to develop and evaluate one model of CIH in an LTC facility in the Midwestern United States. Methods: A prospective, mixed-methods pilot project was conducted in two main phases: (1) preparation and (2) implementation and evaluation. The preparation phase entailed assessment, CIH model design and development, and training. A CIH model including acupuncture, chiropractic, and massage therapy, guided by principles of collaborative integration, evidence informed practice, and sustainability, was applied in the implementation and evaluation phase. CIH services were provided for 16 months in the LTC facility. Quantitative data collection included pain, quality of life, and adverse events. Qualitative interviews of LTC residents, their family members, and LTC staff members queried perceptions of CIH services. Results: A total of 46 LTC residents received CIH care, most commonly for musculoskeletal pain (61%). Participants were predominantly female (85%) and over the age of 80 years (67%). The median number of CIH treatments was 13, with a range of 1 to 92. Residents who were able to provide self-report data demonstrated, on average, a 15% decline in pain and a 4% improvement in quality of life. No serious adverse events related to treatment were documented; the most common mild and expected side effect was increased pain (63 reports over 859 treatments). Qualitative interviews revealed most residents, family members and LTC staff members felt CIH services were worthwhile due to perceived benefits including pain relief and enhanced psychological and social wellbeing. Conclusion: This project demonstrated that with extensive attention to preparation, one patient-centered model of CIH in LTC was feasible on several levels. Quantitative and qualitative data suggest that CIH can be safely implemented and might provide relief and enhanced wellbeing for residents. However, some aspects of model delivery and data collection were challenging, resulting in limitations, and should be addressed in future efforts.

P02.129. Individualized chiropractic and integrative care for low back pain: a randomized clinical trial.

Purpose To determine the relative effectiveness of multidisciplinary integrative care compared to chiropractic care for chronic LBP in patients over 18 years of age using pain as the primary outcome measure. Secondary outcomes were patient self-reported disability, global perceived effect, general health status, satisfaction, self-efficacy, fear avoidance behavior, lumbar dynamic motion, and trunk muscle strength and endurance.

P02.65. Chiropractic, acupuncture and oriental medicine, and massagec services in two geriatric facilities: outcomes of 1033 patient visits

Purpose There is insufficient information published on the topic of complementary and alternative medicine (CAM) clinical services within geriatric settings. The purpose of this presentation is to describe results of a CAM demonstration project carried out within two geriatric facilities. Acupuncture and Oriental medicine (AOM), chiropractic, and massage clinical services were integrated into the facilities and data systematically collected. We prospectively gathered information on all patient visits provided by the CAM clinicians.

OA11.01. Integrative care for the management of low back pain: design of a clinical care pathway

Purpose For the treatment of chronic back pain, it has been theorized that integrative care plans can lead to better outcomes than those achieved by monodisciplinary care alone, especially when using a collaborative, interdisciplinary, and non-hierarchical team approach. This paper describes the development and implementation of a care pathway designed to guide treatment by an integrative group of providers within a randomized controlled trial.

OA11.04. Psychosocial outcomes from the chiropractic and integrative care low back pain randomized clinical trial

Purpose Evidence to date suggests there is no one treatment approach which is clearly superior for low back pain (LBP). It is plausible that combining treatments with small to moderate effect sizes will improve patient outcomes. Additional benefit might also be achieved by individualizing treatment plans according to patient presentation, for example, by addressing psychosocial factors. Our objective was to assess the relative clinical effectiveness of: 1) mono-disciplinary chiropractic care versus 2) multi-disciplinary integrative care for LBP, within the context of defined clinical care pathways.

Short or long-term treatment of spinal disability in older adults with manipulation and exercise

Back and neck pain are associated with disability and loss of independence in older adults. Whether long‐term management using commonly recommended treatments is superior to shorter‐term treatment is unknown. This randomized clinical trial compared short‐term treatment (12 weeks) versus long‐term management (36 weeks) of back‐ and neck‐related disability in older adults using spinal manipulative therapy (SMT) combined with supervised rehabilitative exercises (SRE).

P03.17. A fellowship program for CAM providers in evidence informed geriatrics

Purpose Elderly residents in long term care (LTC) settings experience a myriad of health complaints that may be amenable to complementary and alternative medicine (CAM) therapies. However, specialized training addressing the unique features of geriatric health care, particularly in LTC settings, will be required if CAM professionals are to play a meaningful role. The purpose of this presentation is to describe an evidence informed geriatric fellowship program at a CAM institution which educates acupuncture, chiropractic and massage therapy practitioners.