Marc Brodsky

Evaluating the Statistical Significance of Health-Related Quality-Of-Life Change in Individual Patients:

Assessing individual change is feasible and potentially useful in clinical practice. This article provides an overview of the evaluation of statistically significant change in health-related quality of life (HRQOL) for individual patients. We review the standard error of measurement, standard error of prediction, and reliable change indices using a sample of 54 patients receiving care at the UCLA Center for East-West Medicine. The largest amount of change necessary for statistical significance was found for the reliable change index and the smallest change was needed for the standard error of measurement. The amount of change required for statistical significance was intermediate for the standard error of prediction. The median kappa for classifying change (declined, stayed the same, improved) by different indices was .82, indicating a high level of agreement. Future research is needed to determine if one index is most appropriate for evaluating the significance of individual change.

Developing and implementing core competencies for integrative medicine fellowships

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing.” Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force’s process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.

Efficacy of a 0.1% Capsaicin Hydrogel Patch for Myofascial Neck Pain: A Double-Blinded Randomized Trial

OBJECTIVE The objective of this study was to evaluate the efficacy of a hydrogel patch containing capsaicin 0.1% compared with a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain. DESIGN The study was designed as a double-blinded randomized controlled trial. Setting.  The study was set at Kyung-hee University Hospital at Gangdong, Korea. SUBJECTS Sixty-one participants between 18 and 65 years with at least 3 months duration of neck pain and a clinical presentation of myofascial pain syndrome were enrolled in the study from September 1 to November 20, 2010. Interventions.  Participants received capsaicin 0.1% hydrogel patches or control hydrogel patches without capsaicin according to the randomization scheme. All participants were instructed to apply one patch to each side of the neck and shoulder girdle overlying the point of maximal pain for 12 hours daily during the duration of the 4-week study. OUTCOME MEASURES Each participant completed five surveys at baseline, at 2 weeks after the start of treatments, and at the conclusion of the 4-week study. The primary outcome measure was visual analog scale (VAS). Other outcome measures included the Neck Disability Index (NDI), Becks Depression inventory (BDI), Short Form 36 Korean version, and Euroqol 5-D. RESULTS Fifty-seven patients completed the study. The mean VAS, NDI, and BDI scores were significantly decreased at 2 and 4 weeks after the start of the intervention in both groups. There was no significant difference between the two groups in any of the outcome measures. CONCLUSIONS   Future research may help to discern specific effects of capsaicin, trigger point stimulation by application of the patch, and the placebo effect.

Scleroderma, stress and CAM utilization.

Scleroderma is an autoimmune disease influenced by interplay among genetic and environmental factors, of which one is stress. Complementary and alternative medicine (CAM) is frequently used to treat stress and those diseases in which stress has been implicated. Results are presented from a survey of patients with scleroderma. Respondents were a convenient sample of those attending a national conference in Las Vegas in 2002. Findings implicate stress in the onset, continuation and exacerbation of scleroderma. The implication is that CAM providers may be filling an important patient need in their provision of services that identify and treat stress and its related disorders.

Playing-Related Problems among Musicians of the Orquesta Buena Vista Social Club® and Supporting Bands.

BACKGROUND The Orquesta Buena Vista Social Club® is a world-renowned group of Cuban musicians accomplished in a variety of musical styles. The musicians of the Orquesta Buena Vista Social Club and supporting musicians of their orchestras represent a cohort of musicians throughout Cuba who continue to play traditional genres and perform into their older ages. PURPOSE The purpose of the study was to (1) identify musculoskeletal conditions that occurred over the previous 12 months among the members of the Orquesta and supporting musicians and (2) to discover if these conditions, in part, were caused by or in some way affected musical performance. METHODS The study was a convenience sample of musicians within the Orquesta Buena Vista Social Club and supporting musical groups. Thirty-six musicians completed a self-administered survey. RESULTS Sixty-seven percent (24/36) of the total sample of musicians and 89% (16/18) of those over age 60 years had at least one musculoskeletal condition over the previous 12 months. Forty-four percent (16/36) of the total sample of musicians and 61% (11/18) of those older than 60 years of age reported that a musculoskeletal complaint was either, in part, caused by or affected their performance. CONCLUSION Musculoskeletal conditions were prevalent among the Cuban musicians, especially in those over 60 years of age. Collaboration of medical professionals, managers, and musicians may help to generate ideas on how to prevent injuries as well as to evaluate what treatments for playing-related conditions, including both conventional and complementary and alternative therapies, are most effective.

Teaching Self-Care at UCLA Medical School

However, underlying the process and ractices as defined above, an essential omponent to this medicine of the future and increasingly the present) is the selfare practices of its adherents and practiioners. Walking the walk involves taking ime for healthful personal practices, reection and relaxation, proper diet, reguar exercise, spirituality, relationships, and ommunity. If the practitioner does not ake such measures, he or she risks both ack of integrity and even hypocrisy in onsulting with patients. Another risk is urnout and suboptimal professional perormance unless the sustained stressors of rofessional life are counterbalanced by elf-care practices such as those we would ecommend to patients. However, health professional students nd lifestyle changes as part of their curiculum. Thus, introducing such experienial learning as a “required” part of curriclum is a challenging dance of teaching vidence-based, clinically relevant, scienifically valid practices that are both transormative and realizable with a curricuum. Elective opportunities, as described beow, are a first step in such a process, alhough hopefully such activities and learnng can be organically embedded in required urriculum as described in our last column bout Monash University and the previous ne on the University of Minnesota’s elecive immersion course in Hawaii. In the eantime, Dr Brodsky and his colleagues re to be commended for their frontline eforts in bringing self-care curriculum to anther medical school. His data are impresive and the process an excellent model for thers to adopt.

Change in Health-Related Quality-of-Life at Group and Individual Levels Over Time in Patients Treated for Chronic Myofascial Neck Pain

Background. This study evaluated change in health-related quality of life at the group and individual levels in a consecutive series of patients with chronic myofascial neck pain. Methods. Fifty patients with chronic neck pain self-administered the Short Form-36 Version 2 (SF-36 v2) before treatment and 6 weeks later. Internal consistency reliability was estimated for the 8 scale scores and Mosier’s formula was used to estimate reliability of the physical and mental health composite scores. Significance of group-level change was estimated using within-group t statistics. Significance of individual change was evaluated by reliable change index. Results. Statistically significant (P < .05) group mean improvement over time was found for all SF-36 scores. At the individual level, 20% of the possible changes were statistically significant (17% improvement, 3% decline). Conclusions. Estimating the significance of individual change in health-related quality of life adds important information in comparing different treatment modalities for chronic myofascial neck pain.

P02.02. Efficacy of a topical 0.1% Capsaicin hydrogel patch to treat chronic neck pain: a double-blind randomized clinical trial

Purpose Myofascial trigger points are a common component of musculoskeletal neck pain. Capsaicin, a vanilloid 1 (TRPV1) receptor agonist, has been shown to induce pain in human tendon tissues and to increase trigger point sensitivity in humans. TRPV1 receptor agonists, with repeated use, inhibit the initiation of transmission of pain-related neurotransmitters and may alleviate pain. This study evaluated the efficacy of a hydrogel patch containing capsaicin 0.1% compared to a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain.