Update on Complementary and Alternative Medicine relevant to Occupational Therapy WOTA October 7, Franklin Stein, PhD, OTR/L, FAOTA

Transcription

1 Update on Complementary and Alternative Medicine relevant to Occupational Therapy WOTA October 7, 2016 Franklin Stein, PhD, OTR/L, FAOTA

2 Purposes of Presentation To identify CAM interventions that can be incorporated into best practice in occupational therapy Identify specific prospective studies and meta-analyses evaluating the effectiveness of CAM

3 Definition of Complementary and Alternative Medicine (CAM) Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine and the Allied Health professions.

4 Example of Complementary Medicine Treatment outcomes of combined cognitive behavioral therapy and pharmacotherapy for a sample of women with and without substance abuse on an acute psychiatric unit Results: Significant improvement Clarke, N, et al. (2013) American Journal of Addiction:

5 Example of Alternative Medicine Surgery versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Random Trial Results showed no significant differences between surgery and PT on measured outcome of physical function. Delitto, A. et al. (2015) Annals of Internal Medicine

6 Emerging Areas of CAM in OT Practice Sensory Integration and autism Constraint therapy and stroke rehabilitation Prescriptive exercises and depression Tai chi and prevention of falling Mirror therapy and stroke rehabilitation Mindfulness and addiction Yoga and autism Animal assisted therapy and PTSD

7 Increasing Prevalence of CAM WHO estimates 80% of world s population uses CAM In the US over 32% of population use CAM annually Herbal vitamin supplements widely used. 83 million adults in the US spent $34 billion on CAM.

8 Reasons for CAM Rising costs of conventional medicine Scientific evidence for CAM Impersonal medical care Recognition of lifestyle factors in disease Patient control of treatment

9 There are 6 principles underlining the practice of CAM that are generally accepted by practitioners are presented in the next 6 slides.

10 Principle 1: Healing Power of Nature The healing power of nature means that the body has the inherent ability to restore health. There is a wisdom of the body.

11 Principle 2: Do no harm This principle is important for both CAM and Conventional Medicine. The clinician must be aware of the interactions between CAM and Conventional Treatments with medications that can potentially cause adverse effects.

12 Principle 3: Treat the Cause of Illness The clinician should attempt to identify and treat the causes of illnesses as well as symptoms, since symptoms are usually expressions of the body s attempt to heal itself.

13 Principle 4: Focus on Prevention Prevention, the ultimate goal of alternative medicine, is accomplished by a change of lifestyle in diet, stress, exercise and taking responsibility for one s health.

14 Principle 5: Role of the OT The therapist who applies CAM is a teacher that encourages the client to incorporate healthy practices into one s lifestyle and everyday schedule.

15 Principle 6: Holism The holistic therapist treats the whole person by consideration of the interaction of the physical, spiritual, mental, emotional, genetic, environmental and social factors in a person s life.

16 Occupational Therapist s Roles Healer: reducing depression in individual with mental illness Teacher: providing the client with information and protocols for improving health Ergonomist: adapting the environment to maximize independence and prevent or minimize disability

17 Occupational Therapist s Expertise in using CAM Utilize existing educational experiences Additional certification or training Special workshops or short courses Individual study with a mentor

18 Levels of Evidence Applied to Research Level I: Systematic review or meta-analysis of randomized controlled trials (RCT's) Level II: Single Randomized Controlled Trial (RCT) Level III: Well-designed studies without randomization, quasi-experimental, or correlational Level IV: Systematic reviews of descriptive and qualitative studies Level V: Observations of occupational therapists, anecdotal case reports.

19 Recent Evidence-Based Practice Recent research on CAM in the Occupational Therapy and Related Literature

20 Tai-Chi Prevention of Falling Del-Pino-Casado R, Obrero-Gaitán E, Lomas-Vega R.(2016)The Effect of Tai Chi on Reducing the Risk of Falling: A Systematic Review and Meta-Analysis. Am J Chin Med.;44(5): Epub 2016 Jul 19.

21 Results of Study This study includes 13 controlled trials published before June 2015 that analyzed the effectiveness of Tai Chi in fall prevention in populations of frail and atrisk adults. We therefore conclude that Tai Chi is more effective than other measures, or no intervention, for fall prevention in atrisk populations.

22 Health benefits: Qigong/Tai Chi Janke, R. et al. (2010) Comprehensive review of health benefits of Qigong and Tai Chi. American Journal of Health Promotion 24(6): e1-e25.

23 Results of Study Tai-chi improved Bone density Cardiopulmonary function Physical function Prevention of falls Improved quality of life Decreased psychological symptoms

24 Constraint Therapy Etoom M et al. (2016) Sep;39(3):Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis. Int J Rehabil Res.

25 Results of Study These meta-analysis findings indicate that evidence for the superiority of CIMT in comparison with other rehabilitative interventions is weak. Information on the optimal dose of CIMT and optimal time to start CIMT is still limited.

26 Physical Exercise ADHD Cerrillo-Urbina et. Al, (2015) The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev :41(6):

27 Results Eight randomized controlled trials (n = 249) satisfied the inclusion criteria. The studies were grouped according to the intervention program, aerobic and yoga exercise. Yoga exercise suggests an improvement in the core symptoms of ADHD. The main cumulative evidence indicates that short-term aerobic exercise seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function and social disorders in children with ADHD.

28 Yoga and Occupational Therapy Chugh-Gupta N1, Baldassarre FG, Vrkljan BH. Can J Occup Ther Jun 80(3): A systematic review of yoga for state anxiety: considerations for occupational therapy

29 Results A total of 25 unique studies represented by 26 publications made up the sample: two systematic reviews; 16 randomized controlled trials, and seven prospective, controlled, non-randomized studies. Evidence suggests yoga can be a viable therapeutic option for reducing state anxiety in certain situations.

30 Sensory Integration Case-Smith Weaver LLFristad MA (2015).A systematic review of sensory processing interventions for children with autism spectrum Autism;19:133-48

31 Results A total of 19 studies were reviewed: 5 examined the effects of sensory integration therapy and 14 sensory-based intervention...sensory integration therapies clinicbased interventions that use sensory-rich, child-directed activities to improve a child's adaptive responses to sensory experiences. Two randomized controlled trials found positive effects for SI therapy on child performance..

32 Sensory Integration and Autism Watling R, Hauer S (2015) Sep-Oct;69(5) Am J Occup Ther. Effectiveness of Ayres Sensory Integration and Sensory- Based Interventions for People With Autism Spectrum Disorder: A Systematic Review.

33 Results This systematic review examines the literature published from January 2006 through April 2013 related to the effectiveness of Ayres Sensory Integration (ASI) and sensory-based interventions (SBIs) within the scope of occupational therapy for people with autism spectrum disorder to improve performance in daily life activities and occupations. Of the 368 abstracts screened, 23 met the inclusion criteria and were reviewed. Moderate evidence was found to support the use of ASI. The results for sensory-based methods were mixed. Recommendations include performing higher level studies with larger samples, using the Fidelity Measure in studies of ASI, and using carefully operationalized definitions and systematic methods in examination of SBIs.

34 Animal-Assisted Therapy Ajzenman HF1, Standeven JW, Shurtleff TL.Am J Occup Ther Nov- Dec;67(6): Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder: a pilot study

35 Results Significant increases were observed in overall adaptive behaviors (receptive communication and coping) and in participation in self-care, low-demand leisure, and social interactions. These results suggest that hippotherapy has a positive influence on children with ASD and can be a useful treatment tool.

36 Pollock et al (2014) Cochrane Rev Interventions for Improving Upper Limb Function After Stroke

37 Results Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice. Results suggested that these may be effective interventions.

38 Mindfulness and PTSD King AP et al. (2013) A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depress Anxiety Jul;30(7):

39 Results "Mindfulness-based" interventions show promise for stress reduction in general medical conditions, and initial evidence suggests that they are accepted in traumaexposed individuals. Mindfulness-based cognitive therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat posttraumatic stress disorder (PTSD).

40 Results Continued PTSD Intent to treat analyses showed significant improvement in PTSD in the MBCT condition but not the TAU conditions. MBCT completers showed good compliance with assigned homework exercises, and significant and clinically meaningful improvement in PTSD symptom severity on post treatment assessment in CAPS and PDS (particularly in avoidance/numbing symptoms), and reduced PTSDrelevant cognitions in PTCI (self blame). These data suggest group MBCT as an acceptable brief intervention/adjunctive therapy for combat PTSD, with potential for reducing avoidance symptom cluster and PTSD cognitions

41 Stress management in the treatment of essential arterial hypertension [Article in German] MMW Fortschr Med Nov 23;148(47):40-2;

42 Review of Research Between 60 and 90% of clients consult their family doctor for stress-associated complaints. Not infrequently, a considerable number of these patients already have elevated blood pressure. The positive effect on high blood pressure of relaxation techniques has been confirmed in many studies.

43 Stress Management Stress management should now have a permanent place in effective anti-hypertensive treatment. Appropriate relaxation techniques include autogenic training, progressive muscle relaxation, visualization and breathing exercises, Qigong and yoga.

44 Conclusions There is growing evidence that many CAMs are effective interventions in treatment and rehabilitation. Occupational therapists are increasingly using CAMs in their everyday practice. The use of CAMs by occupational therapists will increase as research evidence continues to validate practice.