Journal of Integrative and Complementary Medicine最新文献

Introduction: Complementary and integrative health (CIH) therapies are widely used and make up billions of dollars in out-of-pocket expenditures. This quality improvement project aimed to identify stakeholders' perceptions of implementing CIH therapies in health care systems to examine the barriers and facilitators to CIH implementation in Rhode Island (RI). Methods: A qualitative approach guided by the Consolidated Framework for Implementation Research (CFIR) was used to conduct interviews with key stakeholder groups: health care administrators, health insurance administrators, physicians, and CIH practitioners. Interviews were analyzed by directed content analysis of transcripts with CFIR as the a priori coding framework. Results: Eleven subconstructs within four major domains were most prominent in interviews across all stakeholder groups. Key barriers in the "innovation" domain include a perceived lack of evidence and credibility of CIH therapies, logistical and administrative complexity of implementation, high costs to patients, and little financial incentive for hospitals and insurance companies. The "outer setting" domain highlights the utility of market pressure in decision making to implement CIH and the role of health policy. The "inner setting" domain demonstrates the varied personal beliefs about CIH, credentialing challenges, and the dissonance between medical system priorities and patient needs. Positive facilitation of implementation is marked by personal exposure to CIH and provider satisfaction in the "implementation process" domain. Conclusion: CIH therapies offer the medical system low risk and effective interventions that meet patient needs not currently met by Western medicine. However, implementation is difficult due to poor perception of evidence and lack of financial gain for the medical system. Acupuncture and massage may be modalities better situated for implementation in the RI medical system. Further education, awareness, and advocacy for CIH therapies would help meet patients' needs for CIH availability.

Background: Spiritual well-being is an essential component of whole-person care and is increasingly recognized in various clinical disciplines as positively affecting mental health. Mantram repetition (MR) is an intervention rooted in Eastern spiritual traditions that has been shown to have clinical benefits, including reduction of psychological distress, among individuals with chronic psychological conditions. The central aim of this meta-analysis was to examine the effects of MR on spiritual well-being. Methods: Fifteen databases were searched from their inception year to July 19, 2023. Two independent reviewers extracted and coded data from randomized or quasi-experimental studies with comparison groups, conducted to test MR, measured spiritual well-being, and reported their study in English. Coded data included study quality indicators which were used in moderator analyses. Results: After the initial and updated searches and removal of duplicates, we reviewed 2,072 articles; seven studies met inclusion criteria with a total sample size of 556 (MR = 272, comparison = 284). Overall, MR had a positive effect on spiritual well-being with a pooled effect size of 0.535 with Hartung-Knapp-Sidik-Jonkman adjusted 95% confidence intervals of 0.18 and 0.89 (p = 011). Using moderator analyses, we examined the effect of the quality indicators and intervention characteristics on effect size; only session length was significant. Longer MR intervention sessions (i.e., 90 min) had greater effects than shorter sessions (i.e., 50-60 min). Conclusions: Across these seven studies, MR showed moderate to strong effects on spiritual well-being. Additional studies are needed to determine the reliability of these findings.

Background: Long COVID is a serious, complex condition that has affected the lives of millions of people globally. Complementary and integrative health (CIH) approaches offer a wide range of potential therapies for the management of long COVID symptoms. However, there is limited information available about the utilization of CIH among long COVID patients. Methods: Nationally representative cross-sectional data from the United States 2022 National Health Interview Survey (NHIS, response rate 47.7%, n = 27,651) were used to investigate prevalence and predictors of CIH use in the past 12 months among individuals who experienced long COVID. The 12-month prevalence of CIH use was descriptively analyzed for those with long COVID versus those without using chi-squared tests or unpaired t-tests. Independent predictors of CIH use among individuals with long COVID were analyzed using a stepwise multiple logistic regression analysis. Results: A weighted total of 17,610,801 US adults (19.7%) who had a confirmed case of coronavirus disease 2019 (COVID-19) developed long COVID symptoms. A slightly greater proportion of individuals with long COVID (44.4%) than those without (40.9%) used CIH approaches in the past 12 months. The most used approaches were meditation, yoga, and massage therapy. CIH use by those with long COVID was significantly associated with younger age, female sex, higher education level, having health insurance coverage, higher household income level, receiving three or more COVID-19 vaccination doses, ever having asthma, and ever having an anxiety or depression diagnosis. Conclusions: Long COVID represents a major challenge for patients, health care providers, health care systems, economies, and global public health. CIH approaches may play an important role in symptom management for some patients, and additional research is needed to identify which modalities are most effective. Patients and health care providers may benefit from better information about the available options for treatment.

Background: Current treatments for osteoarthritis (OA) pain and stiffness have limitations, including adverse effects. Therefore, effective and safe complementary or alternative therapies are needed. Dietary supplement GJ 191, comprising Epimedium, Dioscorea, and Salvia miltiorrhiza extracts, may address this need. Methods: This randomized, double-blind, placebo-controlled study investigated GJ 191 supplementation on knee OA symptoms. Seventy-two adults (40-75 years) with mild to moderate knee OA and mild to moderate knee pain were enrolled. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Pain Visual Analog Scale (VAS), Quality of Life questionnaire, knee joint range of motion, serum C-reactive protein, and rescue medication use were assessed. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores were computed using KOOS scores. Results: Decreases in WOMAC pain scores were reported by both GJ 191 and placebo groups after 6 (-1.78 ± 2.71 and -1.34 ± 1.93, respectively; p < 0.01) and 12 (-2.31 ± 2.83 and -1.59 ± 2.69, respectively; p < 0.01) weeks, with no significant difference between groups. There were decreases in WOMAC stiffness scores for participants supplemented with GJ 191 by 0.53 ± 1.22 and 0.72 ± 1.46 (p ≤0.02) after 6 and 12 weeks, respectively, with respective decreases of 0.81 ± 1.51 and 0.75 ± 1.85 (p ≤0.03) for those on placebo. Significant improvements in current pain, as assessed by the Pain VAS, and bodily pain were reported by the GJ 191 group after 6 and 12 weeks, while the placebo group only reported significant improvements in these measures after 12 weeks. GJ 191 supplementation was safe and well tolerated. Conclusion: There was no significant difference in pain and stiffness scores between GJ 191 and placebo over the 12 weeks. While both groups reported improvements in WOMAC pain from baseline, improvements in current and bodily pain were experienced sooner with GJ 191 than placebo and were sustained over the study period. GJ 191 supplementation was safe and well tolerated. (CTR#: NCT04395547).

Introduction: Acupuncture's role in surgical and postoperative contexts is gaining traction. However, the evidence remains patchy and is often of low-grade quality, particularly in the context of postintestinal surgery. Purpose: To assess acupuncture's efficacy in pain relief and functional recovery after abdominal surgery. Methods: We searched PubMed, Cochrane, Web of Science, and Google Scholar for randomized trials using manual acupuncture as the main intervention. Outcomes included postoperative pain, analgesic use, nausea, gastrointestinal (GI) regeneration, and length of hospital stay. For risk of bias assessment Cochrane risk of bias tool 2 was employed. Registered with PROSPERO: CRD42022311718. Results: Of 700 records till May 2023, 8 trials (551 patients; 16-200/trial) were included. Due to factors such as varying experimental settings and unpublished protocols, there was high risk of bias and heterogeneity, making meta-analysis unfeasible. Safety data were documented sufficiently by two trials. However, acupuncture showed marked benefits in pain relief, less analgesic use, fewer nausea cases, and improved GI recovery. One study reported reduced hospitalization time. Conclusion: Due to the varied methodologies and potential biases in existing studies, the definitive effectiveness of acupuncture remains unclear. To confirm the potential benefits of acupuncture as suggested by the reviewed studies, it's imperative to have more standardized study protocols, well-defined interventions and controls, and objective measures of efficacy.

Background: Preoperative state anxiety is a known predisposing factor for enhanced postoperative pain and hindered recovery following total knee or hip replacement. Acupuncture administered preoperatively has been associated with reduced anxiety in surgical studies, yet evidence of its efficacy in the orthopedic surgical setting is limited. Objective: This study investigated the effects of preoperative acupuncture on preoperative anxiety and pain and compared acute postoperative pain between acupuncture and control patient groups. Design: Parallel-arm, open-label, randomized controlled trial. Setting: Bone and Joint Institute, Hartford Hospital, Hartford, CT. Participants: Sixty middle-aged and elderly men and women with clinically validated preoperative anxiety undergoing elective total hip or knee replacement. Intervention: One-to-one randomization to preoperative acupuncture (n = 30) or no acupuncture treatment (n = 30) on the day of surgery. Coprimary outcomes: Anxiety before and after preoperative acupuncture using the visual analog scale and postsurgical pain using the numeric pain scale. Secondary outcomes: Incidence of acupuncture-related complications, pain before and after acupuncture, nausea and vomiting incidence, opioid consumption, anxiolytics and antiemetics use, and patient satisfaction. Results: Patients reported lower anxiety and pain preoperatively following acupuncture compared with before treatment (both p < 0.001). Postoperatively, the acupuncture group reported lower pain in the first 3 h than the control group, although this difference was not statistically significant. No significant differences in postoperative complications or patient satisfaction were observed between the study groups. Most patients were satisfied with the acupuncture treatment and reported a likelihood of considering preoperative acupuncture for future surgeries. Conclusions: These preliminary findings support that preoperative acupuncture is a safe and effective means to reduce perioperative anxiety and pain in patients undergoing total hip or knee replacement surgery. Additional studies should be conducted to best determine the value of preoperative acupuncture in total hip or knee patients presenting with surgically related anxiety. Clinical Trial Registration: ClinicalTrials.gov (10/31/2023, NCT06099223).

Introduction: Incarceration represents an opportune moment to improve self-management of anger and aggression. A hatha yoga-based intervention (YBI) could serve as a useful adjunctive intervention for anger within prisons. Methods: We enrolled 40 people with elevated levels of anger who were incarcerated (20 in a women's facility, and 20 in a men's facility) in a 10-week pilot randomized controlled trial of a YBI versus. a health education (HE) control group. Participants attended their respective groups once per week. We examined indices of feasibility and acceptability, including intervention credibility, expectancy the intervention would be helpful, intervention satisfaction, class attendance, engagement in personal practice, instructor fidelity, intervention safety, and study recruitment and retention rates. We also examined changes in clinical outcomes including anger, depression, anxiety, and behavioral infractions over time. Results: We met targets for several outcomes: credibility of the YBI and HE interventions, expectancy that they would be helpful, and satisfaction with the programs. Instructors demonstrated fidelity to both manuals. There were no serious adverse events related to study participation. Class attendance did not meet our target outcome in either facility and rates of personal practice met our target outcome in the men's but not the women's facility. For people enrolled in the YBI, anger, depression, and anxiety tended to decrease over time. Qualitative interviews with participants pointed to overall high satisfaction with the YBI and provided information on facility-related barriers to class attendance. Conclusion: Although we did not meet all our feasibility targets in this study, we note high participant enthusiasm. Thus, we believe this line of research is worth pursuing, with further attention to ways to decrease facility-related barriers to class attendance and personal practice. Clinical trials registration: NCT05336123.

Objectives: To conduct a systematic review on the use of hypnosis in the treatment of orofacial pain. Methods: The search was performed on February 2021 and updated in July 2024 in the following databases: MEDLINE via PUBMED, Virtual Health Library (VHL), Web of Science, Cochrane Library, Embase, Clinical Trials, ISRCTN Registry, Psycinfo, Open Grey, Google Scholar, and Brazilian Digital Library of Theses and Dissertations (BDTD). The descriptors referring to Orofacial Pain and hypnosis were used to select clinical trials on the use of hypnosis in the treatment of Orofacial Pain, in English, Spanish, Portuguese, French, and Italian, without restriction on date and place of publication. In a first stage, two independent, trained, and calibrated reviewers classified the abstracts and then the full texts. The data were extracted, and the risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Of the 642 references identified, 6 studies-published between 1986 and 2010-were included in the review, with 232 patients reported. Hypnosis was mainly used in cases of chronic pain associated with temporomandibular disorders (TMDs), compared with relaxation sessions, acupuncture, occlusal splint, minimal treatment, or no interference. Hypnotherapy was applied in different ways, either exclusively by professionals or by means of self-hypnosis in a complementary or exclusive manner. All studies showed statistical significance for the effect of the intervention (hypnotherapy). The overall RoB2 consisted of three studies with high risk of bias and three studies with some concern. Conclusions: Although there were clinical studies on the subject and they had methodological flaws, hypnotherapy (induction and/or self-hypnosis) appears to be a promising strategy for the treatment of orofacial pain, especially TMDs. There is, therefore, a need for new randomized clinical studies with adequate methodological standards to confirm the findings.