Tobias Sundberg

Towards a model for integrative medicine in Swedish primary care.

BackgroundCollaboration between providers of conventional care and complementary therapies (CTs) has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM). The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care.MethodsInvestigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes.ResultsThe outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong.ConclusionDespite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.

Differences between Male and Female Consumers of Complementary and Alternative Medicine in a National US Population: A Secondary Analysis of 2012 NIHS Data

We examined the National Health Interview Survey (NHIS) 2012 to explore how US adult consumers of CAM differ by gender in terms of their sociodemographic characteristics, current health conditions, and perceived benefits of CAM. All individuals who completed the adults core interviews (N = 34,525) were included. CAM use, major sociodemographic variables, perceived benefits of using CAM, and top ten reported health conditions for which CAM was used were selected and analyzed by Stata. Findings revealed that 29.6% (n = 10,181) reported having used at least one form of CAM in the previous 12 months. Compared to male CAM users, female CAM users were more likely to have a bachelor degree, to be divorced/separated or widowed, and less likely to earn

Effects of Chiropractic Care on Pain and Function in Patients With Hip Osteoarthritis Waiting for Arthroplasty: A Clinical Pilot Trial

75,000 or more. Back pain/problem was the most common problem reported by both male and female CAM users (32.2% and 22.6%, resp.). A higher proportion of female CAM users reported using CAM for perceived benefits such as general wellness or general disease prevention. This paper provides foundation information regarding gender differences in CAM use and is a platform for further in-depth examination into how and why males and females differ in their reasons for CAM use.

Opposite Drug Prescription and Cost Trajectories following Integrative and Conventional Care for Pain – A Case-Control Study

OBJECTIVE The purpose of this study was to explore the short-term effects of chiropractic care on pain and function in patients with hip osteoarthritis. METHODS A convenience sample of 14 patients waiting to undergo unilateral hip arthroplasty at a large university hospital received either chiropractic care (n = 7) or no additional treatment (n = 7) during a 3-week period. The main outcome was the change in self-rated hip pain on a 100 mm Visual Analogue Scale (VAS, 0-100). Secondary outcomes were the change in the five Hip disability and Osteoarthritis Outcome Subscales (HOOS, 0-100), which include pain, other symptoms, function in daily living, function in sport and recreation and hip related quality of life. Nonparametric statistics were used to explore outcome changes from baseline to follow-up after three weeks within and between the groups. RESULTS Patients receiving chiropractic care, on average 4.4 (SD +/-1.0) treatments over 3 weeks, showed a clinically and statistically significant improvement in self-rated hip pain, VAS - 26.0 (SD +/-28.4), P = .043. The chiropractic patients also had clinically important, but not statistically significant, improvement scores in HOOS function in daily living 18.6 (SD +/-18.5), pain 15.4 (SD +/-17.2), and hip-related quality of life 12.4 (SD +/-19.6). The waiting list controls had no statistically significant improvements in any outcome measured, but a clinically relevant improvement in HOOS Pain 12.2 (SD +/-18.2), P = .051 was observed. There were no statistically significant differences between the groups due to the small sample size. Approximately 25 patients per arm would be required to adequately power a full scale randomized controlled trial with VAS for hip pain as the main outcome measure. CONCLUSIONS Chiropractic care may provide a short-term benefit in decreasing hip pain for patients with hip osteoarthritis waiting for hip arthroplasty. The pilot findings warrant larger scale randomized controlled trials with longer-term follow-ups.

Tactile massage and hypnosis as a health promotion for nurses in emergency care-a qualitative study

Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC.

The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: A systematic review with meta-analysis.

BackgroundThis study explores nursing personnels experiences and perceptions of receiving tactile massage and hypnosis during a personnel health promotion project. Nursing in a short term emergency ward environment can be emotionally and physically exhausting due to the stressful work environment and the high dependency patient care. A health promotion project integrating tactile massage and hypnosis with conventional physical activities was therefore introduced for nursing personnel working in this setting at a large university hospital in Sweden.MethodsFour semi-structured focus group discussions were conducted with volunteer nursing personnel participants after the health promotion project had been completed. There were 16 participants in the focus groups and there were 57 in the health promotion intervention. The discussions were transcribed verbatim and analysed with qualitative content analysis.ResultsThe findings indicated that tactile massage and hypnosis may contribute to reduced levels of stress and pain and increase work ability for some nursing personnel. The sense of well-being obtained in relation to health promotion intervention with tactile massage and hypnosis seemed to have positive implications for both work and leisure. Self-awareness, contentment and self-control may be contributing factors related to engaging in tactile massage and hypnosis that might help nursing personnel understand their patients and colleagues and helped them deal with difficult situations that occurred during their working hours.ConclusionThe findings indicate that the integration of tactile massage and hypnosis in personnel health promotion may be valuable stress management options in addition to conventional physical activities.

Exploring perceptions of the educational environment among undergraduate physiotherapy students

Background:Low back pain and pelvic girth pain are common in pregnancy and women commonly utilize complementary manual therapies such as massage, spinal manipulation, chiropractic, and osteopathy to manage their symptoms. Objective:The aim of this systematically review was to critically appraise and synthesize the best available evidence regarding the effectiveness of manual therapies for managing pregnancy-related low back and pelvic pain. Methods:Seven databases were searched from their inception until April 2015 for randomized controlled trials. Studies investigating the effectiveness of massage and chiropractic and osteopathic therapies were included. The study population was pregnant women of any age and at any time during the antenatal period. Study selection, data extraction, and assessment of risk of bias were conducted by 2 reviewers independently, using the Cochrane tool. Separate meta-analyses were conducted to compare manual therapies to different control interventions. Results:Out of 348 nonduplicate records, 11 articles reporting on 10 studies on a total of 1198 pregnant women were included in this meta-analysis. The therapeutic interventions predominantly involved massage and osteopathic manipulative therapy. Meta-analyses found positive effects for manual therapy on pain intensity when compared to usual care and relaxation but not when compared to sham interventions. Acceptability did not differ between manual therapy and usual care or sham interventions. Conclusions:There is currently limited evidence to support the use of complementary manual therapies as an option for managing low back and pelvic pain during pregnancy. Considering the lack of effect compared to sham interventions, further high-quality research is needed to determine causal effects, the influence of the therapist on the perceived effectiveness of treatments, and adequate dose–response of complementary manual therapies on low back and pelvic pain outcomes during pregnancy.

Characteristics of Americans Choosing Vegetarian and Vegan Diets for Health Reasons

Objectives The aim of this study was to explore areas of strength and weakness in the educational environment as perceived by undergraduate physiotherapy students and to investigate these areas in relation to the respondents’ demographic characteristics. Methods This study utilized a cross-sectional study design and employed the Dundee Ready Education Environment Measure, a 50-item, self-administered inventory relating to a variety of topics directly pertinent to educational environments. Convenience sampling was used, and the scores were compared across demographic variables. All undergraduate physiotherapy students in their first five terms of the programme in a major Swedish university were invited to participate in the study. Results A total of 222 students (80%) completed the inventory. With an overall score of 150/200 (75%), the students rated the educational environment in this institution as “more positive than negative”. Two items consistently received deprived scores - authoritarian teachers and teaching with an overemphasis on factual learning. Students in term 4 differed significantly from others, and students with earlier university education experience perceived the atmosphere more negatively than their counterparts. There were no significant differences with regards to other demographic variables. Conclusions This study provides valuable insight into how undergraduate physiotherapy students perceive their educational environment. In general, students perceived that their educational programme fostered a sound educational environment. However, some areas require remedial measures in order to enhance the educational experience.

Prevalence and characteristics of women who consult with osteopathic practitioners during pregnancy; a report from the Australian Longitudinal Study on Women's Health (ALSWH).

Objective: Examine the prevalence, patterns, and associated factors of using a vegetarian or vegan diet for health reasons in the US general population. Design: Cross‐sectional data from the 2012 National Health Interview Survey. Participants: Nationally representative sample (N = 34,525). Variables Measured: Prevalence of ever use and 12‐month use of vegetarian or vegan diet for health reasons, patterns of use, and sociodemographic and health‐related factor associated with use. Analysis: Multiple logistic regression analysis. Results: Prevalence of ever use and 12‐month use was 4.0% (n = 1,367) and 1.9% (n = 648), respectively. Health vegetarians and vegans were more likely aged 30–65 years, female, not Hispanic, from the Western US region, at least high school educated, chronically ill, and physically active. They were less likely to be in a relationship, overweight or obese, or smoking, or to have public or private health insurance. Among health vegetarians and vegans, 6.3% consulted with a practitioner for special diets; 26.1% followed the diet because of a specific health problem, mainly high cholesterol, overweight, hypertension, and diabetes; and 59.4% disclosed the diet to their health care provider. Conclusions and Implications: Less than 2% of participants reported using a vegetarian or vegan diet for health reasons within the past 12 months. Despite potential benefits of plant‐based nutrition, more research is warranted on the actual use and its effects and safety.

The Prevalence, Patterns, and Predictors of Chiropractic Use Among Us Adults: Results From the 2012 National Health Interview Survey

BACKGROUND/AIM The use of complementary medicine (CM) is common during pregnancy with visits to osteopathic practitioners growing in recent years. This study was conducted to investigate the prevalence and characteristics of women who consult osteopathic practitioners during pregnancy. METHOD The study sample was obtained via the Australian Longitudinal Study on Womens Health (ALSWH). The women answered questions about consultations with osteopathic practitioners, pregnancy-related health concerns and attitudes to CM use. RESULTS A total response rate of 79.2% (1835) was obtained. Of these, 104 women (6.1%) consulted with an osteopath during pregnancy for a pregnancy-related health condition. Women were more likely to consult an osteopath if they suffered from back pain, sadness, weight management issues, or had a history of retained placenta. CONCLUSION Women are visiting osteopaths for help with common pregnancy health complaints, highlighting the need for research to evaluate the safety, clinical and cost effectiveness of osteopathy in pregnancy.