Journal of Integrative and Complementary Medicine最新文献

{"title":"Mechanism of Action of Mindfulness-Based Interventions for Pain Relief-A Systematic Review.","authors":"Markus Ploesser, David Martin","doi":"10.1089/jicm.2023.0328","DOIUrl":"10.1089/jicm.2023.0328","url":null,"abstract":"<p><p><b><i>Background:</i></b> Currently, no systematic evidence synthesis of the mechanism of action of mindfulness-based approaches exists for pain conditions. <b><i>Aim:</i></b> To identify and synthesize experimental and clinical studies examining aspects of the mechanism of action of mindfulness for pain relief. <b><i>Methods:</i></b> The following databases and search interfaces were searched: Embase (via Embase.com) and Medline (via PubMed). Additional references were identified via bibliographies of included studies. The following were the inclusion criteria applied: (1) original studies published in peer-reviewed journals, (2) in adult populations that (3) examined the mechanism of action of mindfulness meditation on pain outcomes or (4) provided conclusions regarding the potential mechanism of action of mindfulness meditation. The studies were selected by two independent reviewers. Discrepancies were resolved by discussion. <b><i>Results:</i></b> A total of 21 studies published in English met the inclusion criteria, of which 5 studies were clinical studies, which included patients with chronic pain, and 16 studies used experimental pain induction. The investigation into brain mechanisms through functional magnetic resonance imaging and diffusion tensor imaging revealed mindfulness meditation's ability to modulate brain activity, particularly in the anterior cingulate cortex, anterior insula, and orbitofrontal cortex, and to enhance structural and functional connectivity in regions associated with pain perception. Regarding the role of opioids, findings across five studies indicated that the analgesic effects of mindfulness are maintained even when opioid receptors are blocked, suggesting a nonopioidergic pathway for pain modulation. Pain perception studies highlighted that mindfulness practices foster pain acceptance and modify pain control beliefs, serving as key mediators in improving pain outcomes. For experienced versus novice mindfulness practitioners, results demonstrated that long-term practice enhances pain threshold and reduces pain unpleasantness through increased activity in salience and attentional control regions. <b><i>Conclusion:</i></b> This systematic review highlights mindfulness meditation as a multifaceted approach to pain management, utilizing mechanisms such as cognitive and emotional reappraisal, nonopioidergic pathways, and enhanced attention in control regions. It emphasizes the role of mindfulness in fostering pain acceptance and altering pain control perceptions, showcasing its broad impact on the neurological and experiential dimensions of pain. However, the predominance of studies on healthy subjects and methodological variations across experiments necessitates careful interpretation of the findings. The review calls for further research to explore the mechanisms of mindfulness in chronic pain populations more deeply, distinguishing the specific effects of mindfulness from nonspecific effects and expanding ","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":"1162-1178"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiropractic Services and Employment Characteristics within U.S. Federally Qualified Health Centers: Cross-Sectional Survey.","authors":"Andrea Albertson, Holli Kells, Charles Sawyer, Michele Maiers","doi":"10.1089/jicm.2024.0681","DOIUrl":"https://doi.org/10.1089/jicm.2024.0681","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Federally Qualified Health Centers (FQHCs) provide comprehensive primary care to underserved populations. While the presence of chiropractic services in these multidisciplinary systems is of growing interest, little is known. The purpose of this study is to identify and map where Doctors of Chiropractic (DCs) are employed or providing care within FQHCs and describe their employment characteristics. <b><i>Methods:</i></b> Websites for FQHC clinics identified by the Health Resources and Services Administration were reviewed to determine whether chiropractic services are offered and/or a DC is employed at that clinic. Identified DCs were invited to participate in a cross-sectional survey, which included questions about their employment. Analysis of survey data utilized descriptive statistics and content analysis of open-ended questions. <b><i>Results:</i></b> We identified 233 DCs working full- or part-time in 146 of 1537 (9.5%) FQHC systems, with two thirds of those employing more than one DC. Chiropractic services are delivered at FQHCs in 28/50 U.S. states, 75.0% of which offer a chiropractic benefit in their state Medicaid program. California had the largest concentration of FQHCs offering chiropractic services (65/146, 44.5%). Of surveys sent to 206 viable DC e-mail addresses, 101 were completed (49.0% response rate). Most DCs responded to personal (39.0%) or advertised (26.0%) solicitation for employment by the FQHC, while some DCs (14.0%) initiated the opportunity. Average employment at the FQHC was 5.1 years. Credentialing levels and compensation structures were inconsistent. DCs predominantly spend their time on clinical care (mean 88.0%) compared with administrative tasks (mean 10.4%). <b><i>Conclusion:</i></b> This study provides important baseline information about the presence of chiropractic within FQHCs and DCs employment characteristics. Future research should include exploring the roles DCs fulfill within FQHCs, skills necessary for successful collaboration, and barriers to incorporating chiropractic services within these systems.</p>","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Acupuncture an Effective Treatment for Radiation-Induced Xerostomia of Patients with Head and Neck Cancer? A Systematic Review and Meta-Analysis.","authors":"Wenzhe Gu, Hongjun Dong, Yuan Yuan, Zijiang Yuan, Xiaoting Jiang, Yuhan Qian, Zhengjie Shen","doi":"10.1089/jicm.2023.0781","DOIUrl":"https://doi.org/10.1089/jicm.2023.0781","url":null,"abstract":"<p><p><b><i>Background:</i></b> Radiation-induced xerostomia (RIX) stands out as one of the most severe side effects among patients with head and neck cancer (HNC). Given the varied conclusions in previous studies concerning the association between acupuncture, sham acupuncture, or acupuncture combined with standard oral care and therapeutic effects, our aim is to conduct a systematic review to assess the effectiveness and safety of acupuncture in managing RIX in patients with HNC. <b><i>Methods:</i></b> Six databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Chongqing VIP, and WanFang Database) were electronically searched, following the Cochrane manual and adhering to reported Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines, from their inception dates to July 1, 2024. Primary randomized clinical trials included in systematic reviews or meta-analyses were identified, with the Xerostomia Questionnaire and Xerostomia Inventory designated as the primary outcomes. Salivary flow rates (unstimulated or stimulated) were defined as secondary outcomes. <b><i>Results:</i></b> Eight clinical trials involving 1273 participants were analyzed, with six studies included in the meta-analysis. The results indicate that acupuncture demonstrated a significant improvement in patient-reported xerostomia scores (standardized mean difference [SMD] = -0.20, 95% confidence interval [95% CI] [-0.38, -0.02], <i>I</i>² = 0%) in comparison to standard care, but did not significantly improve oral dryness symptoms compared with sham acupuncture (SMD = -0.06, 95% CI [-0.29, 0.16], <i>I</i>² = 25.8%). The merged total showed negative result (SMD = -0.13, 95% CI [-0.27, 0.01], <i>I</i>² = 8.2%). Additionally, there was no significant difference in stimulated salivary flow rate (SMD = -0.22, 95% CI [-0.58, 0.13], <i>I</i>² = 0%) and unstimulated salivary flow rate (SMD = -0.19, 95% CI [-0.11, 0.72], <i>I</i>² = 67.2%). In general, the acupuncture did not cause serious adverse effects. <b><i>Conclusion:</i></b> As far as current research is concerned, acupuncture treatment for RIX symptoms in patients with HNC still lacks strong and convincing evidence support. The more scientific research methods and more clinical trials are still needed.</p>","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Pause: Mind-Body Pathways to Menopausal Health.","authors":"Darshan H Mehta","doi":"10.1089/jicm.2024.0942","DOIUrl":"https://doi.org/10.1089/jicm.2024.0942","url":null,"abstract":"","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators to the Inclusion of Naturopaths in Interprofessional Health Care Teams: A Scoping Review.","authors":"Isabelle Taye, Sandra Grace, Joanne Bradbury","doi":"10.1089/jicm.2024.0569","DOIUrl":"https://doi.org/10.1089/jicm.2024.0569","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The growing population of individuals with chronic pain presents a challenge to a globally overburdened health care workforce. Naturopaths are trained as primary health care providers who manage patients with chronic pain and, yet, are often overlooked in health care teams. This scoping review aims to identify barriers and facilitators affecting naturopathic inclusion into interprofessional health care teams managing patients with chronic pain. <b><i>Methods:</i></b> This study protocol was registered <i>a priori</i> through Open Science (https://doi.org/10.17605/OSF.IO/2G3JT). A search was conducted using databases AMED, CINAHL, MEDLINE, SCOPUS, Web of Science, APA PsycInfo, and Health Business Elite. Search limits included English language from 2012 to 2023. Included publications were from academic and gray literature. Search terms used included the following: \"Naturopath*\" OR \"Integrative medicine\" AND \"Health care system*\" OR \"Health system*\" OR \"Models of health care\" OR \"Professional autonomy\" OR \"Professional regulation\" OR \"Professional govern*\" OR \"Interprofessional practice (IPP)\" OR \"Multidisciplinary communication.\" The scoping review utilized Covidence software and was analyzed using thematic analysis. Themes were identified following Arksey and O'Malley's (2005) framework to inform a narrative approach. <b><i>Results:</i></b> Five themes emerged that relate to the inclusion of naturopaths in health care teams as follows: (1) perceptions of naturopathy, (2) practice standards, (3) legitimacy, (4) resources, and (5) shifting power dynamics and cooperation. <b><i>Conclusions:</i></b> Barriers for naturopathic inclusion into health care teams are influenced by perceptions of naturopathy, naturopathic education standards, regulations, research, and patient equity and access. Facilitators for inclusion include the growing shift toward person-centered care, greater interprofessional education, and shared assets, including colocation.</p>","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piloting an Educational Approach to Assess eHealth Literacy and Evidence-Based Medicine in Integrative Health: A Feasibility and Validation Study.","authors":"Daryl Nault, Atiera Abatemarco, Marybeth Missenda, Christine Cherpak-Castagna, Steffany Moonaz","doi":"10.1089/jicm.2024.0594","DOIUrl":"https://doi.org/10.1089/jicm.2024.0594","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Low rates of online health literacy put consumers at risk of misinformation, but this could be mitigated through practitioner engagement. Integrative health (IH) crosses health care disciplines, so it is well-positioned to improve health information sharing. IH practitioners require evidence-based medicine (EBM) and electronic health literacy (eHL) competencies to make such impact. Several EBM assessments exist, but none are IH-specific. The Fresno Test of EBM FEBM is a validated, performance-based assessment used in medical education. We sought to assess feasibility of incorporating eHL and EBM assessments into graduate coursework while adapting and validating the FEBM for an IH audience (FEBM-IH). <b><i>Methods:</i></b> A pilot observational design was used to adapt, evaluate, administer, and validate the FEBM-IH. Revalidation of the FEBM-IH began with a discipline-focused adaptation, which was reviewed by an expert panel. The FEBM-IH was then administered to IH students and faculty. Independently scored assessments determined inter-rater reliability, internal consistency, item discrimination, and item difficulty. eHL assessments (eHEALS and General Health Numeracy Test-6) were also embedded in the online course. <b><i>Results:</i></b> Outcome completion rates suggest the FEBM-IH and eHL assessment tools are feasible to include in online courses, with 68.9% (102/148) eligible participants joining and 76.5% (78/102) completing all questions in all measures. The FEBM-IH demonstrated excellent assessor agreement (kappa = 0.97, <i>p</i> < 0.001), high internal consistency (α = 0.799), and acceptable item discrimination (0.26-0.68). Median self-perceived eHL scores increased from 30/40 to 33/40 points by course's end, suggesting some increase in eHL. <b><i>Conclusions:</i></b> Tools were feasible to integrate; FEBM-IH maintains acceptable validity; and further exploration of the relationship between EBM and eHL is warranted.</p>","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review on Clinical Research of Acupuncture Treatment for Pressure Injury.","authors":"Hengjing Zhu, Yingqi Xu, Rongrong Hu, Jinlan Jiang, Ruxuan Zhang, Xiaoqing Jin","doi":"10.1089/jicm.2024.0695","DOIUrl":"https://doi.org/10.1089/jicm.2024.0695","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Acupuncture is a traditional Chinese medical therapy that has shown effective results in the treatment of pressure injuries (PI). However, current clinical research methodologies have certain flaws that impact the evaluation of efficacy. This review aims to summarize the characteristics of existing clinical studies on acupuncture treatment for PI and analyze the current research status. <b><i>Methods:</i></b> Following the research methodology for scoping reviews, databases, including CNKI, Wanfang Data, China Biology Medicine, Web of Science, PubMed, EMBASE, and Cochrane Library, were searched. The search period covered from the inception of the databases up to February 22, 2024. The studies included were screened, summarized, and analyzed, extracting data from three aspects as follows: bibliometric data, patient information, and research design. <b><i>Results:</i></b> A total of 46 clinical studies were included. These comprised 30 randomized controlled trials (RCTs), 11 case series, 2 case reports, and 3 controlled clinical trials. Filiform needle therapy was the most commonly used acupuncture technique. Acupuncture is basically performed locally on the wound surface. The clinical efficacy rate was the most frequently used outcome measure. <b><i>Conclusions:</i></b> Clinical studies on acupuncture for PI have issues such as nonstandard selection and reporting of outcomes, inconsistent indicator evaluation tools, and unclear concept of \"randomization\" in RCTs. These factors lead to significant heterogeneity among studies, affecting the assessment of treatment efficacy. Future research should strictly standardize the design and reporting of RCTs and promote the establishment of core outcome sets for acupuncture treatment of PI, to enhance the evidence quality of acupuncture clinical research.</p>","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provider Identified Access Barriers to Delivering Acupuncture to Persons with Traumatic Brain Injury and Chronic Pain: A Cross-Sectional Self-Report Survey.","authors":"Jolie N Haun, Risa Nakase-Richardson, Jeanne M Hoffman, Mitch Sevigny, Mark D Sodders, Flora M Hammond, Bridget A Cotner, Amanda Tweed, Robin Hanks, Aaron M Martin","doi":"10.1089/jicm.2024.0486","DOIUrl":"10.1089/jicm.2024.0486","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Traumatic brain injury (TBI) clinical practice guidelines for pain management and rehabilitation support the use of nonpharmacologic complementary and integrative health (CIH) modalities, such as acupuncture for remediating pain. Barriers to delivering CIH modalities, such as acupuncture warrant examination. The objective of this study is to explore provider perspectives on challenges to accessing acupuncture treatment for chronic pain in persons with TBI and describe differences across health care settings. <b><i>Setting:</i></b> Civilian, Veterans Affairs (VA), and Department of Defense health care systems. <b><i>Participants:</i></b> Health care providers (<i>n</i> = 145) were recruited from November 2022 to March 2023 via email through professional organizations and health care systems. <b><i>Design:</i></b> Descriptive cross-sectional self-report online survey. <b><i>Main Measures:</i></b> A survey assessed barriers using a 5-point Likert scale (<i>always a barrier</i> to <i>never a barrier</i>) using the Levesque Access to Care framework. <b><i>Results:</i></b> Of the 137 participants who provided information on setting, 86 (63%) worked in civilian health care; 47 (34%) worked in the Department of VA; and 4 (2.6%) in the Department of Defense (8 were missing data). Overall, providers endorsed all ten items as being barriers to accessing acupuncture treatment. However, these barriers were more statistically more frequently reported for civilian providers compared with VA providers for six of the 10 items, including lack of caregiver support (<i>p</i> < 0.0001); own knowledge and understanding of the treatment (<i>p</i> = 0.0025); health care setting culture discourages the treatment (<i>p</i> = 0.0181); lack of qualified providers (<i>p</i> = 0.0467); insurance does not cover (<i>p</i> < 0.0001), and patient cannot afford (<i>p</i> < 0.0001). VA provider respondents were more likely to answer all six items, as \"Rarely/Never a Barrier,\" while providers in a civilian setting were more likely to respond \"Always/Frequently\" or \"Sometimes\" a barrier. <b><i>Conclusion:</i></b> Results reflect the cultural, organizational, and structural differences that make acupuncture more accessible within the VA. understanding barriers to delivering care is critical to inform implementation strategy mapping efforts, to tailor strategies that are aimed to increase access and engagement with acupuncture treatment in civilian health care settings.</p>","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Feasibility Study of Rehabilitation Targeting Upper Extremity Function and Participation Using Hippotherapy and the Equine Environment for Children with Cerebral Palsy and Autism Spectrum Disorder.","authors":"Julia Mazzarella, Jill C Heathcock","doi":"10.1089/jicm.2024.0292","DOIUrl":"https://doi.org/10.1089/jicm.2024.0292","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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, <i>n</i> = 5 control and <i>n</i> = 6 treatment completed initial assessment. Retention was 80% (4/5) control and 83% (5/6) treatment, just below the <i>a priori</i> 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. <b><i>Conclusions:</i></b> 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. <b><i>Trial registration:</i></b> ClinicalTrials.gov identifier: NCT0653068. <b><i>Trial funding:</i></b> 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.</p>","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"It Has Improved My Practice to Be Able to Offer Alternative Treatments\": A Longitudinal Qualitative Study of Oregon Medicaid Back Pain Providers.","authors":"Mary Gray, Alexis Cooke, Catherine J Livingston, Kate LaForge, Diana P Flores, Esther K Choo","doi":"10.1089/jicm.2023.0743","DOIUrl":"10.1089/jicm.2023.0743","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> This study aimed to understand health care providers' experiences implementing the Oregon Back Pain Policy (OBPP) over time. The Medicaid OBPP expanded coverage of evidence-based nonpharmacological therapy (NPT) for back pain and restricted access to opioid therapy and interventional approaches. <b><i>Methods:</i></b> The study included six online, asynchronous focus groups with providers in February 2020 (Time 1) and August 2022 (Time 2). Analysis was conducted with a longitudinal, recurrent cross-sectional approach. Analysis occurred in three stages: (1) An immersion/crystallization approach was used to analyze Time 1 focus group data, (2) reflexive thematic analysis was used to analyze Time 2 data, and (3) longitudinal analysis was used to integrate the findings across time points. <b><i>Results:</i></b> At Time 1, 48 clinicians and 44 NPT providers participated in the study. Time 2 included 63 clinicians and 59 NPT providers. The longitudinal analysis of the focus group data resulted in four themes: (1) general awareness of the policy, (2) providers support the policy and perceive a benefit to their patients, (3) barriers to NPT accessibility, and (4) barriers to referring patients to NPT. <b><i>Conclusion:</i></b> The goal of the OBPP was to improve back pain care for Oregon Medicaid members by increasing access to evidence-based NPT and decreasing reliance on opioid medications. This study revealed that, although clinicians and NPT providers supported the policy, they faced persistent implementation challenges related to referrals, prior authorizations, coverage limitations, low reimbursement rates, and a reduced workforce for NPT providers. In some cases, implementation barriers were removed during the COVID-19 pandemic, but other challenges were more prominent during the pandemic.</p>","PeriodicalId":29734,"journal":{"name":"Journal of Integrative and Complementary Medicine","volume":" ","pages":"1092-1101"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}