Journal of alternative and complementary medicine最新文献

Objective: This systematic review evaluated equine-assisted activities and therapies (EAATs), formerly referred to as equine-assisted services (EAS), in children and youth (ages 6-18 years) with attention-deficit/hyperactivity disorder (ADHD), according to the International Classification of Functioning, Disability, and Health. Methods: Electronic database searches were conducted of studies from inception through December 2020. Results: A total of 12 articles were included: 8 noncontrolled prospective studies and 4 randomized-controlled trials (RCTs). Furthermore, seven of moderate methodological quality studies and five of moderate high methodological quality studies were included. Evidence was found for the effectiveness of various forms of EAS, including equine-assisted physical therapy (EAPT) and therapeutic riding (TR). Improvements in body functions and structures (n = 10) were found in the domains of mental and neuromusculoskeletal functions, as well as functions of the cardiovascular system using EAPT (n = 6). Limited evidence was found regarding the positive effect on activity and participation (n = 4) following TR interventions. Quality of life (QoL) was improved in both TR and EAPT (n = 4). Conclusion: There seems to be preliminary evidence that EAS may be beneficial in promoting the physiological functions of body systems for children with ADHD. The influence on participation and QoL still requires further evidence. More generally, further controlled studies, including bigger sample sizes, are needed to understand the specific effects of different EAS on the core symptoms and consequence of ADHD.

Objectives: As part of a pragmatic effectiveness trial of integrative pain management among inpatients with cancer, the authors sought to understand the clinical context and adaptations to implementation of two study interventions, acupuncture and pain counseling (i.e., pain education and coping skills). Design: The larger study uses a 2 × 2 factorial design with inpatients randomized to: (1) usual care (UC), (2) UC with acupuncture, (3) UC with pain counseling, and (4) UC with acupuncture and pain counseling. The study is being conducted in two hospitals (one academic and one public) and three languages (Cantonese, English, and Spanish). The authors conducted a process evaluation by interviewing study interventionists. Analysis included deductive coding to describe context, intervention, implementation, and inductive thematic coding related to intervention delivery. Results: Interviewees included seven acupuncturists and four pain counselors. Qualitative themes covered adaptations and recognizing site-specific differences that affected implementation. Interventionists adhered closely to protocols and made patient-centered adaptations that were then standardized in broader implementation (e.g., including caregivers in pain counseling sessions; working in culturally nuanced ways with non-English-speaking patients). The public hospital included more patients with recent diagnoses and advanced disease, more ethnically and linguistically diverse patients, less continuity of staffing, and shared patient rooms. At the academic medical center, more patients were familiar with integrative therapies and all were located in single rooms. Providing acupuncture to hospital staff was a key strategy to establish trust, experientially explain the intervention, and create camaraderie and staff buy-in. Conclusions: Providing nonpharmacologic interventions for a pragmatic trial requires adapting to a range of clinical factors. Site-specific factors included greater coordination and resources needed for successful implementation in the public hospital. The authors conclude that adaptation to context and individual patient needs can be done without compromising intervention fidelity and that intervention design should apply principles such as centering at the margins to reduce participation barriers for diverse patient populations.

Objectives: To investigate the viability of integrating acupuncture services into a Patient-Centered Primary Care Home (PCPCH) and Federally Qualified Healthcare Center (FQHC) located in a frontier community. The study had two primary aims: (1) to assess demographics, clinical characteristics, and utilization patterns of patients who accessed acupuncture services at Winding Waters Community Health Center (WWCHC), (2) to perform cost-benefit analysis using a basic revenue versus expense calculation. Design: This observational study consisted of two primary components: (1) a retrospective chart review and (2) a basic cost versus revenue assessment. Setting/Location: WWCHC, an FQHC located in frontier Northeastern Oregon. Subjects: Data from 551 charts of patients aging ≥18 years who accessed acupuncture services at WWCHC between January 2017 and December 2018. Results: Patients attended 3210 acupuncture visits. The demographics of patients utilizing acupuncture services reflected community demographics. Mean age was 54 years (±16.9) and 99 patients (18%) reported income below the federal poverty level. The prevalent chief complaint was back and neck pain (46.6% of visits). WWCHC medical providers placed 538 internal referrals for patients to receive acupuncture. Although patients are actively utilizing insurance benefits for acupuncture, reimbursement remains a challenge. Reimbursement rates ranged between 34% and 69% of billed rate. In 2018, 779 visits were paid by patients at an average rate of $48.71 per visit. Despite challenges, clinic revenue for acupuncture services exceeded costs by 4%. Conclusions: The acupuncture program at WWCHC is economically feasible and well utilized by patients. Adequate reimbursement remains a challenge, but it is not cost-prohibitive and provides a nonpharmacologic treatment option in this frontier setting. Revenue for acupuncture services exceeded costs by 4%.

This commentary addresses individual barriers to implementation of a Whole Health approach to pain management that included a group pain education session and individual therapy. The authors identify individual barriers to veteran participation in the Whole Health program and also make recommendations for future programs. One of the most intriguing identified barriers to participation was the concern about the veteran's readiness for change that would facilitate active engagement in the program.