Complementary Health Practices Research Articles

An Integrative Review of Nonpharmacological Interventions to Improve Sleep among Adults with Advanced Serious Illness.

Sleep fragmentation is common among those with advanced serious illness. Nonpharmacological interventions to improve sleep have few, if any, adverse effects and are often underutilized in these settings. We aimed to summarize the literature related to nonpharmacological interventions to improve sleep among adults with advanced serious illness. We systematically searched six electronic databases for literature reporting sleep outcomes associated with nonpharmacological interventions that included participants with advanced serious illness during the period of 1996-2016. From a total of 2731 results, 42 studies met the inclusion criteria. A total of 31 individual interventions were identified, each evaluated individually and some in combination with other interventions. Twelve of these studies employed either multiple interventions within an intervention category (n = 8) or a multicomponent intervention consisting of interventions from two or more categories (n = 5). The following intervention categories emerged: sleep hygiene (1), environmental (6), physical activity (4), complementary health practices (11), and mind-body practices (13). Of the 42 studies, 22 demonstrated a statistically significant, positive impact on sleep and represented each of the categories. The quality of the studies varied considerably, with 17 studies classified as strong, 17 as moderate, and 8 as weak. Several interventions have been demonstrated to improve sleep in these patients. However, the small number of studies and wide variation of individual interventions within each category limit the generalizability of findings. Further studies are needed to assess interventions and determine effectiveness and acceptability.

Complementary and Integrative Health Practices for Depression.

The current article reviews selected complementary health approaches for the treatment of depressive symptoms. Complementary and integrative health (CIH) focuses on the whole person with the goal of optimal health-body, mind, and spirit. Patient use of integrative health practices and products is increasing; therefore, providers must understand these practices and products and be able to recommend or advise for or against their use based on research and guidelines. Difficulty with the current limitations of research on CIH practices is discussed, as these studies often may not have the same rigor or scientific weight as conventional treatment research. Although some individuals may use certain treatment options alone, such as massage therapy, meditation, and supplements to diet, the article discusses ways to combine CIH with allopathic care. Nurse practitioners should be open to considering complementary practices for health care and knowledgeable to guide patients in making safe health decisions. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 22-33.].

A systematic review of mind and body complementary health practices for informal caregivers

This systematic review examined available literature on mind and body complementary health practices for informal caregivers (ICG). The United States Department of Health and Human Services defines mind and body complementary health practices as acupuncture, massage therapy, chiropractic osteopathic manipulation, healing touch, hypnotherapy, guided imagery, breathing exercises, progressive muscle relaxation, yoga, tai chi, qi gong, Rolfing Structural Integration, Feldenkrais method, Alexander technique, and Trager psychophysical integration. Literature related to these mind and body practices were searched using PubMed, Elton B. Stephens Co. (EBSCO), and Google Scholar databases. The screening process resulted in 220 sources that appeared for the search terms “ICG” and each of the mind and body practices. Four yoga manuscripts met the final inclusion criteria. While the level of evidence for ICG is weak generally, examples of improvements after yoga participation included reduced depression levels and state anxiety, and improvement in physical fitness. Implications for recreational therapy practice are discussed.

Yoga therapy for military personnel and veterans: Qualitative perspectives of yoga students and instructors

ObjectiveMillions of military personnel and veterans live with chronic mental and physical health conditions that often do not respond well to pharmacological treatments. Serious side effects and lack of treatment response have led to widespread efforts to study and promote non-pharmacological and behavioral health treatments for many chronic health conditions. Yoga is an increasingly popular mind-body intervention that has growing research support for its efficacy and safety. Our objective was to explore the attitudes, perspectives, and preferences of military personnel and veterans toward yoga as a therapeutic modality, thus providing needed information for designing and promoting yoga interventions for this population. MethodsParticipants included 24 individuals with yoga experience and current or past military service and 12 instructors who have taught yoga for military personnel and/or veterans. A semi-structured set of questions guided interviews with each participant. ResultsFive themes emerged from the interviews: (1) mental health benefits experienced from yoga practice; (2) physical health benefits experienced from yoga practice; (3) important yoga elements and conditions that support effective practice; (4) facilitators for engaging military in yoga practice; and (5) challenges and barriers to yoga practice for military. ConclusionsThe study highlights consistent reports of mental and physical benefits of yoga practice, ongoing stigma resulting in the need for combatting and demystifying yoga and other complementary and integrative health (CIH) practices, the importance of designing interventions to address the unique mental health issues and perspectives of this population, and the importance of efforts by military leadership to bring CIH to military personnel and veterans. Rigorous research addressing these findings, along with further research on the efficacy and effectiveness of yoga interventions for treating various conditions are needed.

Prevalence and patterns of use of mantra, mindfulness and spiritual meditation among adults in the United States

BackgroundDespite a growing body of scientific literature exploring the nature of meditation there is limited information on the characteristics of individuals who use it. This is particularly true of comparative studies examining prevalence and predictors of use of various forms of meditation.MethodsA secondary analysis was conducted using data from the 2012 National Health Interview Survey (n = 34,525). Three popular forms of meditation were compared—mantra, mindfulness, and spiritual—to determine lifetime and 12-month use related to key sociodemographic, health behavior, health status, and healthcare access variables.ResultsThe 12-month prevalence for meditation practice was 3.1% for spiritual meditation, 1.9% for mindfulness meditation, and 1.6% for mantra meditation. This represents approximately 7.0, 4.3, and 3.6 million adults respectively. A comparison across the three meditation practices found many similarities in user characteristics, suggesting interest in meditation may be more related to the type of person meditating than to the type of practice selected. Across meditation styles use was more prevalent among respondents who were female, non-Hispanic White, college educated, physically active; who used other complementary health practices; and who reported depression. Higher utilization of conventional healthcare services was one of the strongest predictors of use of all three styles. In addition to similarities, important distinctions were observed. For example, spiritual meditation practice was more prevalent among former drinkers. This may reflect use of spiritual meditation practices in support of alcohol treatment and sobriety. Reasons for use of meditation were examined using the sample of respondents who practiced mindfulness meditation. Wellness and prevention (74%) was a more common reason than use to treat a specific health condition (30%). Common reasons for use included stress management (92%) and emotional well-being (91%), and to support other health behaviors. Meditation was viewed positively because it was self-care oriented (81%) and focused on the whole person (79%).ConclusionMeditation appears to provide an accessible, self-care resource that has potential value for mental health, behavioral self-regulation, and integrative medical care. Considering consumer preference for distinct types of meditation practices, understanding the underlying mechanisms, benefits, and applications of practice variations is important.

Claim Assessment Profile: A Method for Capturing Healthcare Evidence in the Scientific Evaluation and Review of Claims in Health Care (SEaRCH).

Background: Grounding health claims in an evidence base is essential for determining safety and effectiveness. However, it is not appropriate to evaluate all healthcare claims with the same methods. “Gold standard” randomized controlled trials may skip over important qualitative and observational data about use, benefits, side effects, and preferences, issues especially salient in research on complementary and integrative health (CIH) practices. This gap has prompted a move toward studying treatments in their naturalistic settings. In the 1990s, a program initiated under the National Institutes of Health was designed to provide an outreach to CIH practices for assessing the feasibility of conducting retrospective or prospective evaluations. The Claim Assessment Profile further develops this approach, within the framework of Samueli Institute's Scientific Evaluation and Review of Claims in Health Care (SEaRCH) method.Methods/Design: The goals of a Claim Assessment Profile are to clarify the elements that constitute a practice, define key outcomes, and create an explanatory model of these impacts. The main objective is to determine readiness and capacity of a practice to engage in evaluation of effectiveness. This approach is informed by a variety of rapid assessment and stakeholder-driven methods. Site visits, structured qualitative interviews, surveys, and observational data on implementation provide descriptive data about the practice. Logic modeling defines inputs, processes, and outcome variables; Path modeling defines an analytic map to explore.Discussion: The Claim Assessment Profile is a rapid assessment of the evaluability of a healthcare practice. The method was developed for use on CIH practices but has also been applied in resilience research and may be applied beyond the healthcare sector. Findings are meant to provide sufficient data to improve decision-making for stakeholders. This method provides an important first step for moving existing promising yet untested practices into comprehensive evaluation.

The Use of Complementary and Integrative Health Practices in Disc Herniation Patients

The Use of Complementary and Integrative Health Practices in Disc Herniation Patients

Providers' and Administrators' Perceptions of Complementary and Integrative Health Practices Across the Veterans Health Administration.

Use of complementary and integrative health (CIH) therapies is being promoted by the Veterans Health Administration (VA), but promotion may not equate to adoption. The purpose of this study was to explore whether perceptions regarding CIH at one VA medical center (VAMC) were similar to perceptions from a sample of other VAMCs. This article reports a subset of qualitative findings from a mixed-methods study. Sites were recruited through a VA-wide CIH listserver. On the basis of site description (e.g., therapies offered, interest in CIH), sustained site interest, and geographic location, recorded interviews of 22 persons were conducted at 6 sites across the country. Interviewees were asked the same questions as the single-site VAMC study respondents. Variable access to CIH services across the VA created the need for workarounds. Multiple barriers (e.g., limited space and challenging credentialing) and facilitators (e.g., strong champion and high veteran demand) were cited. Respondents described nonpharmacologic pain control, the usefulness in treating mental health and/or post-traumatic stress disorder issues, and improvement of staff morale as additional reasons to promote CIH. Findings confirmed those from the earlier single-site VAMC phase of the study. Even the highest-performing sites reported struggling to meet veterans' demands for delivery of CIH. Almost half of active-duty military personnel report the use of at least one type of CIH therapy. As active-duty personnel transition to veteran status, both their physical and mental healthcare needs can potentially benefit from CIH therapies. The VA must actively support local enthusiastic CIH proponents and receive congressional support if it is to actually meet its stated goal of providing personalized, proactive, patient-driven healthcare through the promotion of comprehensive CIH services to veterans.

Complementary and Integrative Health Practices Among Hispanics Diagnosed with Colorectal Cancer: Utilization and Communication with Physicians.

Objective: Complementary and integrative health (CIH) use among Hispanic adults with colorectal cancer (CRC) diagnosis is not well documented. Understanding the prevalence and patterns of CIH use among Hispanics offers insights to uncover potential needs for clinical services.Design: Participants were age 21 years or older with a first-time diagnosis of CRC from population-based cancer registries in California. In-person and/or telephone-based interviews were administered to collect data on CIH use. Demographic and clinical diagnosis data were abstracted from medical records. Descriptive statistical and logistic regression was used to analyze the frequencies and associations between selected patient characteristics and CIH use.Results: Among 631 Hispanic patients, 40.1% reported ever using CIH. Herbal products/dietary supplements were used most often (35.3%), followed by bodywork (16.5%), mind–body practices (7.8%), and homeopathy (6.7%). About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). Women reported higher CIH use than did men (45.1% versus 35.9%; odds ratio, 1.49 [95% confidence interval, 1.07–2.08]; p = 0.02). CIH use did not differ by clinical stage, time since diagnosis, or preferred language.Conclusions: CIH use is prevalent among Hispanic patients with CRC, especially women. Little communication about CIH use occurs between participants and their healthcare providers. Efforts aimed at improving integrative oncology services provide an opportunity to address such gaps in healthcare service.

Complementary and Alternative Health Practices in the Rehabilitation Nursing

This article discusses the connection between the Theory of Integral Nursing and the use of complementary and alternative medicine to rehabilitation nursing. Complementary and alternative health practices refers to methods, practices, and modalities that are outside of the realm of biomedicine. Some of the types of treatments and practices that are considered to be alternative include folk medicine, herbal medicine, homeopathy, faith healing, massage, energy healing, acupuncture and acupressure, supplements, aromatherapy, and music therapy. The Theory of Integral Nursing is explained in some detail. Components of self-care, nursing-based complementary and alternative medicine practices, and supplement alternatives for pain and antidepressant medications used in the rehabilitation setting are also reviewed.

Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes

ObjectivePatient–provider communication about complementary health approaches can support diabetes self-management by minimizing risk and optimizing care. We sought to identify sociodemographic and communication factors associated with disclosure of complementary health approaches to providers by low-income patients with diabetes. MethodsWe used data from San Francisco Health Plan's SMARTSteps Program, a trial of diabetes self-management support for low-income patients (n=278) through multilingual automated telephone support. Interviews collected use and disclosure of complementary health approaches in the prior month, patient–physician language concordance, and quality of communication. ResultsAmong racially, linguistically diverse participants, half (47.8%) reported using complementary health practices (n=133), of whom 55.3% disclosed use to providers. Age, sex, race/ethnicity, nativity, education, income, and health literacy were not associated with disclosure. In adjusted analyses, disclosure was associated with language concordance (AOR=2.21, 95% CI: 1.05, 4.67), physicians’ interpersonal communication scores (AOR=1.50, 95% CI: 1.03, 2.19), shared decision making (AOR=1.74, 95% CI: 1.33, 2.29), and explanatory-type communication (AOR=1.46, 95% CI: 1.03, 2.09). ConclusionSafety net patients with diabetes commonly use complementary health approaches and disclose to providers with higher patient-rated quality of communication. Practice implicationsPatient–provider language concordance and patient-centered communication can facilitate disclosure of complementary health approaches.

Limited Health Knowledge as a Reason for Non-Use of Four Common Complementary Health Practices.

BackgroundComplementary health practices are an important element of health/healthcare seeking behavior among adults in the United States. Reasons for use include medical need, prevention and wellness promotion, and cultural relevance. Survey studies published over the past several decades have provided important information on the use of complementary health practices, such as acupuncture and yoga. A review of the literature, however, reveals an absence of studies looking specifically at who does not use these approaches, and why not.MethodsTo explore this issue two samples were created using data from the 2007 National Health Interview Survey Complementary and Alternative Medicine supplement. Of particular interest was the relationship between lack of health knowledge, as a reason for non-use, and key independent variables. The first sample was comprised of individuals who had never used any of four common complementary health practices -- acupuncture, chiropractic, natural products, and yoga. The second was a subset of those same non-users who had also reported low back pain, the most frequently cited health concern related to use of complementary therapies.ResultsA hypothesized association between lack of health knowledge, lower educational attainment, and other key socioeconomic indicators was supported in the findings. Although it was hypothesized that low back pain would be associated with greater information seeking, regardless of level of education, that hypothesis was not supported.ConclusionLack of knowledge was found to affect utilization of common complementary health practices, regardless of the potentially motivating presence of back pain. Disparities in the utilization of complementary medicine, related to educational attainment and other socioeconomic factors, may negatively affect quality of care for many Americans. Creative approaches are needed to help reduce inequities in understanding and improve access to care for underserved populations.

Considerations for Complementary and Alternative Interventions for Pain

Nurses play an important role in pain management. When considering strategies for effective pain management, nurses must consider and be able to provide information about complementary and alternative therapies. Awareness of alternative interventions for pain extends across herbal therapies, energy medicine, and mind-body exercises. Treatment regimens that integrate conventional therapies with alternative therapies based on the medical systems of non-Western cultures may affect outcomes positively through medical interactions. Nurses should question patients and families about complementary health practices to determine whether they may affect postsurgical recovery and also to determine the level of openness to alternative practices that have evidence of success or equivalency in managing pain.

Building the evidence base for integrative approaches to care of cancer survivors.

Like hospice and palliative care, the integrative medicine movement began as edgy outsiders. But in the last 10–15 years, integrative oncology practices, often tied with integrative medicine programs, are being established in major medical institutions across the country. Many are embedded in medical centers that are leaders in the development and provision of the most advanced modern technologies for cancer care. This issue of JNCI Monographs focuses on the role of integrative oncology in care of cancer survivors; the editors have brought together commentaries on the “state of the science.” We at the National Center for Complementary and Alternative Medicine together with our partners in the Office of Cancer Complementary and Alternative Medicine at the National Cancer Institute are the main National Institutes of Health supporters of that science. Our shared goal is a rigorous evidence base to guide patient decisions and to help providers make sensible recommendations: a solid scientific basis, assessing both risks and benefits. Not surprisingly, since integrative oncology is a relatively new movement, the science is just beginning. It is already very clear that approaches that fall under the general rubric “integrative oncology” are meeting important and often neglected needs. Two things are driving change. In part, the integrative oncology movement is a response to patient demand. Patients are asking for change—for access to an approach to care that is seen as more “holistic,” perhaps gentler, perhaps more optimistic. Change is also being driven by providers. Some physicians, including a number of oncologists, see in the integrative medicine movement an opportunity to develop a style of practice that will facilitate changed relationships with patients: less emphasis on technical advice, more emphasis on healing, defined broadly, on provision of emotional and spiritual supports, on creation of positive expectations, on encouragement to healthy living. By and large, when integrative practitioners offer “alternative” practices, it is as a complement to modern “mainstream medicine.” And by and large, patients interested in integrated approaches, do not want (and are not well-served by) care that does not integrate effective mainstream techniques for cure, prolongation of life, or substantive palliation. National Center for Complementary and Alternative Medicine has decided, through a year-long strategic planning process (1), to focus our resources on research on benefits and risk of complementary health practices for symptom management, particularly pain management, but also fatigue, loss of sleep, loss of appetite. A variety of complementary approaches and a number of practitioners from disciplines outside mainstream medicine are increasingly part of the integrative approach to symptom management. This monograph will, we hope, stimulate continued interest in testing these approaches and in their continued improvement. Our patients deserve nothing less.

Is It Hot in Here? Menopause Symptom Management

Is It Hot in Here? Menopause Symptom Management

Conhecimentos, atitudes e práticas de Cirurgiões-Dentistas de Anápolis-GO sobre a fitoterapia em odontologia

INTRODUÇÃO: Em um cenário de expansão das práticas integrativas e complementares em saúde no Brasil, são escassos os estudos relacionados ao uso da fitoterapia em Odontologia.OBJETIVO: Investigar os conhecimentos, atitudes e práticas do Cirurgião-Dentista sobre a fitoterapia na prática clínica.MATERIAL E MÉTODO: Foi realizado um estudo transversal com um grupo de 105 Cirurgiões-Dentistas, no exercício clínico da Odontologia dos serviços público e privado, do município de Anápolis-GO (taxa de resposta de 52,5% dos 200 profissionais convidados), que responderam um questionário.RESULTADO: Cerca de 16% dos respondentes afirmaram que tiveram embasamento teórico acerca da fitoterapia e, destes, metade relatou ter tido este embasamento na Graduação. Embora mais da metade dos Cirurgiões-Dentistas (61,9%) tenha considerado viável a inserção dos fitoterápicos na prática clínica, poucos relataram prescrevê-los (12,4%) ou questionarem, durante a consulta, se os pacientes faziam uso de fitoterápicos (36,2%). Quanto à opinião sobre os fatores que dificultam a inserção dos fitoterápicos no âmbito da Odontologia, os mais citados foram o desconhecimento, a ausência de pesquisas e a falta de divulgação. Embora a maioria desconhecesse a legislação a respeito do tema, este conhecimento foi associado ao uso de fitoterapia na prática clínica (p<0,05).CONCLUSÃO: Os Cirurgiões-Dentistas do município pesquisado apresentaram deficiências no conhecimento, pouca utilização e atitudes favoráveis acerca do uso da fitoterapia na prática clínica, sendo necessária uma reorientação na formação acadêmica e profissional, para que haja suporte apropriado para a sua utilização.

Associations between perceived stress, quality of life and complementary health practices in Japanese outpatients: a multicenter observational study

In Japan and other countries, complementary health practices based on lifestyle modification such as exercise, diet, art and culture, gardening, and biofield therapy, have received increasing attention. This study was conducted to demonstrate associations between perceived stress, quality of life (QOL), and these complementary health practices. Computer-assisted data collection was conducted with Japanese outpatients in 10 clinics. Participants completed questionnaires that measured socioeconomic status (SES) and frequencies of complementary health practices. Psychological stress was measured using the 10-Item Japanese version of the Perceived Stress Scale. QOL was measured using the 10-Item Mokichi Okada Association Quality of Life Questionnaire. Data were analyzed using linear regression modeling. Baseline data of 1480 participants were available for cross-sectional analysis and data of 318 participants were available at follow-up for longitudinal analysis. Gender differences were not observed in stress and QOL, but age was positively correlated with QOL, and negatively with stress. A multiple regression model adjusted for age, gender, and SES indicated weak associations between each health practice and QOL in the cross-sectional (β=0.14-0.28) and the longitudinal analysis (β=0.17-0.27). Moreover, negative associations between each health practice and stress varied from -0.08 to -0.18, with the exception of biofield therapy in the cross-sectional analysis. In the longitudinal analysis, associations varied from -0.13 to -0.27, but diet and biofield therapy were not significantly associated with stress. These results suggest that complementary health practices had a significant effect on maintaining, or improving QOL, as well as in reducing stress of Japanese outpatients.

Complementary Health Practices

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Complementary Health Practices

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