1. Slide 1
Evidence-based Practice Update
Rachel Busse, MD
Diplomate, American Board of Family Medicine
Director of Integrative Medicine at Norton Suburban
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Slide 2
Evidence-based practice update
 Research challenges
 Implementing integrative programs
 Recent research
 Massage
 Aromatherapy
 Reiki
 Relaxation
 Music
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Slide 3
Research challenges
-Herbs and supplements not standardized
-Individualized treatments
-Placebo or “sham” treatments
-Difficult to randomize and double blind
studies
-Funding
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2. Slide 4
Research & Integrative medicine
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Slide 5 ___________________________________
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Slide 6
Implementing integrative programs
 Holistic nursing department at 261 bed hospital
 Therapies:
 Relaxation techniques
 Therapeutic touch
 Aromatherapy
 Therapeutic suggestion
 Retrospective chart review and pt survey
 Reduction in pain
 Increase in patient satisfaction
Complement Ther Nurs Midwifery. 2004 Aug;10(3):168-74. Development and evaluation
of an inpatient [correction of impatient] holistic nursing care services department.
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3. Slide 7
Implementing integrative programs
 Inpatient oncology unit at Beth Israel hospital
 Yoga therapy, healing environment, holistic nursing
 2 nonrandomized groups
 Compared: Length of stay, total medication costs, and
cost of as-needed medications
 Demonstrated decrease in meds for pain, nausea &
anxiety, also decrease in overall cost
Am J Manag Care. 2011 Dec;17(12):779-84. Cost savings in inpatient oncology through
an integrative medicine approach.
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Slide 8
Implementing integrative programs
 102 studies
 Majority looked at music
 Aromas, decoration, flooring, lighting
 May affect anxiety
http://summaries.cochrane.org/CD005315/sensory-environment-on-health-
related-outcomes-of-hospital-patients
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Slide 9
Massage
 Massage in acute care setting
 Reduction in pain
 Improvement in sleep
 Improvement in relaxation
 Improvement in overall well-being
Int J Ther Massage Bodywork. 2010; 3(1): 4–11. PMCID: PMC3091428 The Effects of
Massage Therapy on Pain Management in the Acute Care Setting
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4. Slide 10
Massage
 Cochrane review of massage and
aromatherapy massage
 8 RCTs, 357 patients
 Reduction in anxiety
 Reduction in pain
 Some trials showed reduction in nausea
 Mixed data as to whether aromatherapy enhances
effects of massage
Cochrane Database Syst Rev. 2004;(2):CD002287. Aromatherapy and massage for
symptom relief in patients with cancer.
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Slide 11
Massage
-RCT with 68 patients
-osteoarthritis of the knee
-significant improvement in stiffness, range of
motion, pain, time to walk 50 feet
Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial
Arch Intern Med. 2006;166(22):2533-2538. doi:10.1001/archinte.166.22.2533
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Slide 12
Aromatherapy
 Anxiety*
 Depression
 Nausea
 Insomnia
 Pain
 Agitation (in dementia)
Br J Gen Pract. Jun 2000; 50(455): 493–496.PMCID: PMC1313734
Aromatherapy: a systematic review.
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5. Slide 13
Aromatherapy
 Literature review, limited studies
 Lavender or orange to treat anxiety
 Peppermint to treat nausea
 Risks of allergic reactions and oral toxicity
J Adv Nurs. 2004 Oct;48(1):93-103. Aromatherapy practice in nursing: literature
review.
Evid Based Complement Alternat Med. 2014;2014:726341. Epub 2014 Feb 24.
Essential Oils for Complementary Treatment of Surgical Patients: State of the
Art.
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Slide 14
Aromatherapy
Post-operative nausea and vomiting
 120 patients in 2014 RCT showed
significant improvement
 Cochrane review 2012
 9 studies, 402 participants
 Evidence insufficient
J Perianesth Nurs. 2014 Feb;29(1):5-11. doi: 10.1016/j.jopan.2012.12.004. A
prospective randomized study of the effectiveness of aromatherapy for relief
of postoperative nausea and vomiting.
http://summaries.cochrane.org/CD007598/aromatherapy-for-treating-
postoperative-nausea-and-vomiting
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Slide 15
Touch therapies
 Therapeutic touch
– Energy therapy developed in 1970s
 Jin Shin Jyutsu
 Harmonizing the body's energetic system
 Incorporates acupressure, QiGong, philosophy
 Verbal guidance, light exercise and massage
 Reiki
 Developed 1922 by Mikao Usui
 Universal life energy transferred through palms
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6. Slide 16
Touch therapies
 Review of 10 studies of biofield therapies
 Little or no changes in physiologic
markers
 Review of biofield therapies for palliative
care
 Relieving pain, improving quality of life,
reducing stress
Explore (NY). 2014 May-Jun;10(3):150-61. doi: 10.1016/j.explore.2014.02.003. Epub 2014
Feb 24. Biofield-based Therapies: A Systematic Review of Physiological Effects on
Practitioners During Healing.
Am J Hosp Palliat Care. 2013 Nov 20. [Epub ahead of print]. Biofield Therapies for
Symptom Management in Palliative and End-of-Life Care.
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Slide 17
Reiki
 Literature review of RCTs
 Seven studies met inclusion criteria
 Evidence suggests that Reiki therapy may be effective
for pain and anxiety
 Larger sample sizes, randomized groups, protocols
are needed
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Slide 18
Reiki
 Systematic review of therapeutic effects of Reiki
 12 trials included
 9 showed positive results
 Low quality of reporting, most trials lacking:
 Randomization
 Blinding, or
 Accountability
J Altern Complement Med. 2009 Nov;15(11):1157-69. doi: 10.1089/acm.2009.0036. A
systematic review of the therapeutic effects of Reiki.
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7. Slide 19
Reiki
 118 patients with cancer
 30 minute Reiki session
 Statistically significant reduction in anxiety
 Also helped with pain, relaxation and sleep
Am J Hosp Palliat Care. 2012 Jun;29(4):290-4. doi: 10.1177/1049909111420859. Epub
2011 Oct 13. The effects of Reiki therapy on pain and anxiety in patients attending a
day oncology and infusion services unit.
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Slide 20
Music therapy
 Cochrane review
 5 studies, 4 of which demonstrated
significant reduction in symptoms of
depression
 Need additional studies
Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression.
Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.:
CD004517. DOI: 10.1002/14651858.CD004517.pub2
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Slide 21
Music therapy
-Cochrane review
-26 trials
-listening to pre-recorded music
-improved anxiety scores
-reduction in need for medication
Cochrane Database Syst Rev. 2013 Jun 6;6:CD006908. doi:
10.1002/14651858.CD006908.pub2. Music interventions for preoperative
anxiety.
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8. Slide 22
Music therapy
-373 patients at 12 ICUs
-patient directed music (PDM) vs noise
canceling headphones (NCH)
-PDM reduced need for sedation more than
NCH or usual care
-PDM and NCH reduced anxiety more than
usual care
Music Therapy for Reducing Anxiety in Critically Ill Patients. JAMA.
2013;309(22):2386-2387. doi:10.1001/jama.2013.5657.
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Slide 23
Future of research
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