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The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
January, 2014, Vol. 14, Issue 01
Economic Evaluation of CAM/CIM Practices
By Massage Therapy Foundation Contributor
Contributed by MK Brennan MS, RN, LMBT; Jolie Haun, PhD EdS, LMT, April Neufeld, BS, LMT
In this month's review, the Massage Therapy Foundation's writing group selected a study done in 2012 that evaluates the economy of Complementary and Alternative Medicine (CAM), also referred to as Complementary and Integrative Medicine (CIM).This review is timely given the non-discrimination section of the Affordable Care Act is set to go into effect on January 1, 2014. Section 2706 provides a possibility for insurance reimbursement for massage therapy: "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law."
The objective of the review done by Herman et al., was to establish the value of complementary and integrative therapies within the health reform context. Numerous sources including PubMed, CINAHL, AMED, Psych Info, Web of Science and EMBASE, were searched for information published between 2001 and 2010. The Cochrane complementary and alternative medical group was used for determining the criteria for studies and all of the sources reporting economic outcomes were reviewed with the terms "integrative," "integrated" and "collaborative" medicine added to the search. Three hundred, thirty-eight (338) economic evaluations were identified and 204 of those were published between 2001 and 2010. One hundred, fourteen (114) of the 204 were full economic evaluations with 90% of those being studies of single therapies. Only one study compared usual care to usual care with access to CIM practitioners.
Surveys done in 1990, 1997 and 2007 show estimated out of pocket expenditures of $14 billion, $27 billion and $34 billion for CAM to treat principal medical conditions. This indicates an increase in the use of CAM for healthcare and the willingness of individuals to pay for it. The cost-effectiveness of CAM use, however, has not been well defined. As the authors explain, "Economic evaluations allow costs to be included, alongside data on safety and effectiveness, in healthcare policy decisions. As healthcare costs rise, the availability of these economic evaluations becomes increasingly important to the formulation of disease management strategies which are both clinically effective and financially responsible." This type of evaluation provides massage therapists and other CAM practitioners information that is valuable when meeting with conventional healthcare providers, insurance providers, policy makers, consumers and other stakeholders.
Articles were categorized as full or partial economic reviews. A full evaluation compared the costs, as well as the outcomes, of two or more therapeutic treatments for the same population. A partial evaluation was one that focused on cost-identification or cost-comparison. The authors used the 35-item British Medical Journal checklist to capture components of internal validity and transferability of information. They "also chose five quality criteria by which to identify a subset of full economic evaluations to highlight as being of most interest to policy makers." These include a comparison of CAM to usual and customary care; use of at least one recognized perspective such as hospital or third-party payer; randomized control studies or non-randomized ones that are adjusted to address baseline differences; a measured outcome unless the study was a modeling one that used the data from previously published studies; a sensitivity analysis since assumptions made can factor into uncertainties in economic evaluations.
Items reviewed from the studies that met the above criteria included: "treatment and study duration, primary clinical and economic outcome measures, the setting in which treatment took place, study design and sample size, the type and perspective (i.e., the point of view used to define costs) of the economic analysis, and incremental cost effectiveness of the CIM alternative compared to usual care."
Results of the analysis are mixed. Thirty-one of the full economic studies were considered a higher-quality than the others because they met all five of the study criteria. These indicate potential cost effectiveness and even cost savings across a number of CIM therapies and populations. "Of the 56 comparisons made in the higher-quality studies, 16 (29%) show a health improvement with cost savings for the CIM therapy versus usual care. Study quality of the cost-utility analyses (CUAs) of CIM was generally comparable to that seen in CUAs across all medicine according to several measures, and the quality of the cost-saving studies was slightly, but not significantly, lower than those showing cost increases (85% vs 88%, p=0.460)."
Other studies reviewed provide information for specific practices and/or settings. For example, cost savings were seen with acupuncture for breech presentations in pregnant women and also for low back pain. Other cost savings were found with some supplements, naturopathic care, Tai Chi and manual therapy.
The methods used in this article are comprehensive and applied multiple measures of study quality in the review of the articles. However, the authors recognize some study limitations, including: 1. The reviewers not blinded to journals and article authors; and 2. Publication bias was not assessed. However, the authors suggest for the purposes of this review, it is not clear if either of these limitations is relevant.
This report and those like it are valuable to those interested in making a case for the inclusion of CAM in healthcare settings or insurance reimbursement as well as consumer awareness. As the use of CAM increases and policies change to increase reimbursement of CAM care, economical evaluations of this type are needed to determine the use and cost effectiveness of CAM in the healthcare setting.
To learn more about the economic impact of CAM, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, or search Pub Med for CAM/CIM cost analysis studies.
Click here for more information about Massage Therapy Foundation Contributor.
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