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Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
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 more information about Ann Catlin, LMT, NCTMB, OTR.
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