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Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
April, 2014, Vol. 14, Issue 04
What Does an Evidence-Based Practice Look Like?
By Ann Catlin, LMT, NCTMB, OTR
We hear a lot these days about evidence-based practice (EBP). As massage therapy becomes more accepted as an allied health profession, I think it's important that we continue to build an evidence-based case for why massage works.So, what makes a practice evidenced-based? I hope to give you a basic understanding of EBP and offer examples from my own work elders in long-term care facilities.
Definitions of EBP vary somewhat but they all seem to agree that EBP is a combination of:
The desired outcome of EBP is optimal service to each client/patient on a case-by-case basis. I've paraphrased the steps presented by Duke University Medical School to determine if an approach, modality or method is indeed evidence-based. What we are really trying to find out is whether the methods or techniques we use really are effective to meet the client's need and why or why not? Then we can be confident in the actions we take in caring for our client and also when we articulate the benefits of our services.
Start with the client's clinical problem or a question which arises from the care of the client. Identify the need or problem of the individual client. What's the reason you are seeing this client? Generally, the reason for referral or the client's stated goal is a good place to start.
For example, I have a client who has Alzheimer's disease who is cared for in a memory support unit of an assisted living facility. She becomes increasingly physically agitated (rummaging through other elder's things and grabbing people's arms as they walk by her) and disoriented (going into other people's rooms) in the afternoons, disturbing those who also live there. She has been referred in hopes of calming her and easing the agitated, restless behavior.
Construct a well-built clinical question derived from this client's problem. The question must be phrased in such a way as to facilitate finding an answer when you look for relevant research. The question should include: 1. The key problem of the patient; 2. What treatment, method or modalities are you are considering using; and 3. The desired outcome.
In the case of my client, I might ask this question: "In people with Alzheimer's disease, is hand massage and/or back massage effective in reducing physical agitation or restlessness?"
Select the appropriate resource(s) and conduct a search. The type of question we ask can help lead us to the best type of study or research to look for. Massage therapy questions often center on how to select treatments that do more good than harm and that are worth the efforts and costs of using them. We're told by the Duke team that randomized controlled trials are best to look for when asking a therapy or treatment question. They offer this explanation of this kind of study: "Randomized controlled clinical trials are carefully planned experiments that introduce a treatment or exposure to study its effect on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between intervention groups and control (no intervention) groups. A randomized controlled trial is a planned experiment and can provide sound evidence of cause and effect."
It's important to understand that just searching the internet for articles isn't enough. We must be careful about the source. The quip, "if it's written on the Web, it must be so," does not apply here! So, where should we look? One recommended source is PubMed/MEDLINE, a respected database of literature. It's beyond the scope of this article to explain how to go about a search in PubMed, however there are tutorials on that website. Since my question is a therapy question, I set out to find studies that used randomized controlled trials about hand and/or back massage to decrease agitation in people with dementia. I found a number of studies exploring massage in dementia care. Several abstracts of the articles report that hand or slow-stroke back massage reduced anxiety, restlessness and other forms of agitation. My next task is to review the articles to see if the methods used for the study meet criteria for valid research.
Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice). Fortunately, there are guides to help with this process. We are looking to answer three basic questions:
In the end, we want to have confidence in the research we cite. One example from my search is a 2008 study, Favorite Music and Hand Massage: Two Interventions to Decrease Agitation in Residents with Dementia. In my best judgment, this study holds up to the criteria for validity. It compares the effectiveness of favorite music (FM) and hand massage (HM) in reducing agitated behaviors. Researchers found that following ten minute sessions of FM and HM individually and combined significantly decreased agitation for up to an hour following the session.
Apply the results to your client. Integrate that evidence with clinical expertise, patient preferences and apply it to practice. So, back to my client. Because the afternoon is the time when she becomes more restless, I schedule sessions for mid-afternoon twice a week. Sessions consists of hand massage, slow-stroke back massage and focused one-to-one attention. I also do staff education, teaching them how to do a simple five minute hand massage and focused touch.
Evaluate client's response to treatment. What result do you see in the individual client? Were they similar or different from results you found in the research? Do you need to make adjustments to your approach? In the case of my client, she was receptive to receiving hand and back massage and she tolerated a thirty minute session without distraction when the session was carried out in a quiet room. She was talkative during the hand massage and often fell asleep during the back massage. At the end of the session, she remained in a calm, quiet state from thirty minutes to an hour. The care staff reported that they noticed a decrease in the restless behaviors, especially her tendency to grab people's arms. The staff used the simple hand massage protocol in the late afternoon and reported it seemed to also help relax her and that she enjoyed the interaction and smiled.
Where does my clinical experience fit in to all this? I've had hundreds of sessions with elders living with Alzheimer's disease and related dementia, many of whom have some degree of agitated behavior, anxiety and restlessness. It's been my experience that human touch, massage and compassionate presence ease these issues and have a profound effect on enhancing quality of life. I've also witnessed the effect of shared human touch on the ability of a person with advanced dementia to engage in relationship.
And last, but certainly not least, what about my client's needs, preferences, expectations? It's a little tricky sometimes to determine what my client might want or need when she can't state them clearly because of dementia. It falls to me to tune in to the non-verbal cues. People with dementia tell us a lot about their inner world and needs through behavior. My client's restless behaviors that annoyed others are her way of communicating a need in the moment. Perhaps she's lonely or is disoriented and thinks she needs to get home to take care of her kids. I also always know that one universal expectation of each client is to have basic human needs met and to be treated with respect.
Taking all this into account, can I state with confidence that my approach is evidence-based? I believe that, yes, I can. I hope this has helped you understand what evidence-based practice is all about so you can perhaps apply it to your own work.
Click here for previous articles by Ann Catlin, LMT, NCTMB, OTR.
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