Journal of Integrative and Complementary Medicine最新文献

Objectives: To detect differences between individualized homeopathic medicinal products (IHMPs) and placebo after 4 months of intervention in patients with chronic low-back pain (LBP). Design: Four-month, double-blind, randomized (1:1), placebo-controlled, two parallel arms trial. Setting: PG3 and research outpatient department of D. N. De Homoeopathic Medical College & Hospital. Subjects: Sixty participants with chronic LBP. Interventions: Verum (n = 30; IHMPs plus concomitant care) versus control (n = 30; placebos plus concomitant care). Outcome Measures: Primary-Oswestry LBP Disability Questionnaire (ODQ); Secondary-Roland Morris Pain and Disability Questionnaire (RMPDQ); McGill Pain Questionnaire-Short Form (SF-MPQ); measured at baseline, and every month, up to 4 months. Results: Group differences achieved significance or near significance in all the specified outcomes-ODQ score (F_{1, 58} = 4.331, p = 0.042), RMPDQ score (F_{1, 58} = 2.939, p = 0.092), and SF-MPQ total score (F_{1, 58} = 6.666, p = 0.012). Rhus toxicodendron (n = 13), Bryonia alba (n = 8), Hypericum perforatum, and Nux vomica (n = 5 each) were the most frequently prescribed medicines. Different repertories were used as per the need of the cases-Kent, Synthesis, Murphy, Pulford, Boericke, Boger Boenninghausen's Characteristics and Repertory, and Complete. Minor adverse events were reported from either group. Conclusions: Thus, homeopathic medicines worked significantly better than placebos in reducing chronic LBP. Independent replications are warranted to substantiate the findings. Clinical Trial Registration Number: CTRI/2022/04/041878.

Objective: To examine the extent to which the Veterans Health Administration Whole Health System of Care (VA Whole Health) has reached Veterans with multiple mental health diagnoses. Methods: As part of a large-scale evaluation of VA Whole Health, Veterans were recruited from the 18 VA Whole Health pilot sites. In this cross-sectional evaluation, electronic health record data were used to examine the reach of core Whole Health educational and coaching activities and complementary and integrative health (CIH) use among Veterans across four mental health diagnostic groups: zero, one, two, or three diagnoses (i.e., anxiety, depression, post-traumatic stress disorder) in the past year. Logistic regression was used to determine the likelihood of core Whole Health and CIH use in each group, compared with each of the other diagnostic groups, adjusting for covariates. Results: Veterans (n = 9689; age = 64.1 years) were mostly men (86.8%) and White (75.3%). Veterans with more mental health diagnoses had higher odds of core Whole Health use, with adjusted odds ratios ranging from 1.19 (95% confidence interval [CI]: 1.02-1.38; two vs. one mental health diagnoses) to 2.36 (95% CI: 1.90-2.92; three vs. zero mental health diagnoses). Veterans with more mental health diagnoses also had higher odds of CIH use, with significant adjusted odds ratios ranging from 1.30 (95% CI: 1.05-1.62; three vs. two mental health diagnoses) to 2.29 (95% CI: 1.85-2.82; three vs. zero mental health diagnoses). Conclusions: VA Whole Health is designed to reach all Veterans, including those with complex health care needs, and this evaluation indicates promise that it is reaching this goal among Veterans with mental health concerns.

Objective: To analyze the prevalence of nurses trained in traditional, complementary, and integrative medicine (TCIM), the different practices, and associated sociodemographic factors. Methods: This quantitative, cross-sectional study was implemented online in Brazil from June 2021 to January 2022 among 1,154 nurses using a questionnaire comprising open- and closed-ended questions. The Stata IC software, version 16.0, was used in the statistical analysis. The dependent variable was training in TCIM, and the prevalence of different TCIM practices was also investigated. The independent variables included sociodemographic information. Descriptive and inferential statistical tests were performed. This study was approved by the Institutional Review Board at the Federal University of Rio Grande do Sul and was developed according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) initiative. Results: The prevalence of TCIM training was 43.50%. Most participants were women (89.49%), Brazilian (99.65%), aged 39.71 on average (SD = 10.37), and had an income of up to four times the minimum wage (52.43%). The prevalence of professionals implementing TCIM in their practice among those with training was 64.60%. They reported working up to 2 h a week (36.96%) in primary health care settings (33.40%) and providing individual consultations (78.0%). After the adjusted analysis, TCIM training appeared significantly associated with age (p < 0.001), the region where the workplace is located (p < 0.001), and income (p < 0.001). Auriculotherapy (59.96%) stood out among the TCIM practices in which nurses were trained. Conclusions: Almost half of the nurses working in Brazil have training in TCIM and sociodemographic factors such as age, region of work, and income are significantly associated with this training.

Background: The use of acupuncture for common pediatric conditions continues to grow in the United States. Six previous reviews have summarized the research; however, approximately 8 years have accumulated adding to this growing body of literature. Objectives: The aim of this article is to provide a scoping review of acupuncture research in pediatric conditions and a summary of the effectiveness of acupuncture in the pediatric population. Methods: A systematic search was performed to identify clinical trials and reviews published between August 2015 and October 2023. Trials and reviews were excluded if they were not: (1) acupuncture specific, (2) data limited to pediatric patients, and (3) published in English. The literature was assessed and synthesized into a scoping review and commentary. Results: Seventy-one publications were identified (42 clinical trials and 29 reviews) that represented 17 conditions and 10 countries; the top 2 were China and the United States. The top five areas of new research (based on numbers of clinical trials) are pain, cerebral palsy (CP), attention-deficit hyperactivity disorder, autism spectrum disorder, and nausea and vomiting. Conclusions: Clinical trials in pediatric acupuncture represent a small but important subset of acupuncture literature. Data are positive for postoperative nausea and vomiting and promising for CP, nocturnal enuresis, perioperative pain, procedural pain, and tic disorders. Several factors preclude additional firm conclusions from being drawn, including a limited number of trials, small sample size (n < 100) of the majority of randomized controlled trials (78.6%), and heterogeneity of treatment approaches. Continued research on the use of acupuncture for pediatric conditions is warranted, particularly in conditions demonstrating recent promising evidence.

Introduction: Children with upper extremity neuromotor impairments often have decreased participation in life activities. Hippotherapy and rehabilitation in the equine environment might be effective in targeting participation, given the community context and natural activity involvement. This randomized controlled feasibility trial assessed recruitment, retention, treatment fidelity, and acceptability of rehabilitation using hippotherapy and the equine environment, targeting upper extremity function and participation for children with neuromotor impairments to inform a larger trial. Methods: This 6-month trial occurred in Ohio, June-December 2021. Participants were 6-17 years old with upper extremity neuromotor impairment (and primary diagnosis of cerebral palsy and/or autism). Participants were randomized into treatment or waitlist control using REDCap. Treatment was 16 h (4 h/week/4 weeks) of rehabilitation using hippotherapy and the equine environment. Control participants completed a 4-week waiting period, then received the treatment. Recruitment, screening, enrollment, attendance, and retention were tracked. Nonblinded assessments of body structures and functions, activity, and participation were administered pre- and postcontrol and treatment. Assessment measure completion, treatment fidelity, and acceptability were recorded. Results: Twenty-six participants were screened between July and October 2021; 77% (20/26) met inclusion criteria; 70% (14/20) enrolled and randomized: 6 control and 8 treatment. Two withdrew after randomization and one was excluded for fear of horses. In total, n = 5 control and n = 6 treatment completed initial assessment. Retention was 80% (4/5) control and 83% (5/6) treatment, just below the a priori criteria (85%). Assessment measure completion was variable (77%-100%) and replacement of some should be considered before advancing to a clinical trial. Treatment fidelity and acceptability were moderate to high. There were no adverse events from study participation. Conclusions: Results demonstrated preliminary evidence of fidelity and acceptability of rehabilitation using hippotherapy and the equine environment for children with upper extremity neuromotor impairments. Some changes should be made to improve enrollment, retention, and outcome measure completion before advancing to a definitive trial. Trial registration: ClinicalTrials.gov identifier: NCT0653068. Trial funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Foundation for Physical Therapy Research, American Academy of Cerebral Palsy and Developmental Medicine, and Pedal With Pete Foundation.

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.

Objective: This 12-week open-label study evaluated a multi-herbal tablet containing Reynoutria japonica, Vitis vinifera, Silybum marianum, Ginkgo biloba, and Panax ginseng, for potential improvement of cognitive function in 25 healthy older adults (50-75 years). Methods: The primary outcome, cognition, was assessed using the Cambridge Neuropsychological Test Automated Battery. Results: Significant improvement in working memory was observed. Errors in the Paired Associate Learning (PAL) task and spatial working memory reduced by -7.9 (95%CI: -12.3, -3.5) and -3.3 (95%CI: -6.3, -0.3) respectively, while PAL memory score increased by 2.0 (95%CI: 0.9, 3.1). Conclusion: These preliminary results suggest memory improvement, but further rigorous testing is needed.

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: Mindfulness-based interventions (MBIs) are effective in improving mental health outcomes, including depression, anxiety, and post-traumatic stress disorder (PTSD). However, research on how MBIs have been tailored for racial and ethnic minoritized communities is limited. To address this gap, this scoping review utilizes the Ecological Validity Framework to systematically explore cultural adaptations in MBIs for communities of color. Concurrently, this review examines the effectiveness of culturally adapted MBIs. Methods: Following PRISMA guidelines, the authors conducted a search on MEDLINE, PsycINFO, and Embase databases from 2010 to 2023. Inclusion criteria required studies to be published in English, accessible in full-text, and peer-reviewed, focusing primarily on communities of color or diverse non-White populations (comprising 75% or more of the sample). Exclusion criteria were studies primarily centered on behavioral interventions other than MBIs, studies lacking primary outcomes, and studies not explicitly addressing cultural adaptations. Results: Search results identified 371 publications, 13 of which met the inclusion criteria. The most frequently reported cultural adaptations were surface-level adaptations, which can enhance the relevance of MBIs by modifying the language, content, format, or intervention delivery. MBIs with surface-level adaptations reported significant improvements in mental health outcomes, including depression, anxiety, and stress levels. Conclusion: Findings from this review indicate that culturally adapted MBIs for communities of color could potentially make them more relevant and acceptable. Surface-level and deep structure adaptations are both necessary to ensure MBIs are responsive, relevant, and sustainable across diverse contexts and populations.