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Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
March, 2016, Vol. 16, Issue 03
Hand Massage in the ICU for Post-Op Cardiac Patients
By Massage Therapy Foundation Contributor
Contributed by MK Brennan MS, RN, LMBT, BCTMB; Derek R. Austin PT, DPT, MS, BCTMB, CSCS; S. Pualani Gillespie BCMT, MSN, RN
Massage therapy may be an effective non-pharmaceutical approach to pain management. This month, the Massage Therapy Foundation research review presents a study that considers massage for post-operative pain relief. As non-pharmaceutical approaches for pain relief are increasingly considered, massage could potentially decrease pain perception based on the Gate Control Theory. This theory is the idea that the stimulation of large diameter nerve fibers by massage contributes to inhibiting nociceptive stimuli transmitted by smaller nerve fibers in the spinal cord. The study, "Feasibility and acceptability of hand massage therapy for pain management of postoperative cardiac surgery patients in the intensive care unit," by Géraldine Martorella, RN, PhD, Madalina Boitor, RN, BSN, Cécile Michaud, RN, PhD, Céline Gélinas, RN, PhD, was published in Heart & Lung in 2014.
The main purpose of this study was to examine the acceptability and feasibility of providing hand massage for surgical intensive care unit (ICU) patients. Acceptability is described based on appropriateness, convenience, effectiveness, risks/adverse reactions, and adherence. This was determined through interviews with both the treatment group and the control group participants. Feasibility relates to the ability to provide the treatment and considers challenges to do so.
Field notes entered by the one trained research nurse who provided both treatments as well as video recordings of the treatments were used when looking at the feasibility of the massage treatments. The nurse documented environmental items such as lighting, noise, and alarms as well as any interruptions or concomitant interventions (medications, lab blood draws, and physical examinations, for example) in her field notes. The patients' responses were also noted. The video analysis focused on the patient's awake/asleep status and activity around the patient. Experimental Hand Massage (EHM) and Control Hand Holding (CHH) were established as the treatment groups. The authors reviewed previous studies done in ICU settings but found a wide range of massage treatments, dosing, areas of the body massaged, and timing of the massage as well as patient conditions. They based this study on a previously conducted pilot study of postoperative pain in cardiac surgery patients that indicated a decrease in pain intensity for the massage treatment group.
Inclusion criteria for this qualitative study were patients 18 years of age and older, able to speak English or French, elective surgery that required a sternal incision, an ejection fraction of 35% or more, and able to answer questions and report pain levels. Exclusion criteria included those with cognitive or psychological disorders, pulmonary artery pressure >50mm Hg, right ventricular failure, body mass index >30 or abnormalities to one or both hands. A total of 40 patients participated in the study from a pool of 70 who were approached. Sixteen of the 70 did not meet the inclusion criteria and another 14 chose not to participate in the study.
In the EHM, the research nurse held the patient's right hand for five seconds and applied five to 10 ml of lavender massage cream to the hand and wrist. Massage was then performed for 5 minutes on the palm and back of the hand and procedure was repeated on the other hand. The total duration of the massage was 15 minutes and was followed by a 30-minute rest period. In the control group (CHH), the treatment consisted of holding the hand for five seconds and applying the lavender cream. The research nurse then held each of the patient's hand in her hands for 5 minutes per hand without performing massage therapy. The goal was to deliver two to three treatments per participant in both groups in the 24 hours following their admission to the ICU. All of the 40 individuals in the study received the first two treatments, but 28 did not receive the third one. The lack of a third treatment was most commonly due to discharge of the patient from the ICU.
The results on acceptability indicate that the criteria used were met based on comments by the participants. The comments included themes of feeling calmness or relaxation, wanting the session to last longer, wanting the treatment to occur at the moment the patient went to the ICU, and appreciation for the human touch. The majority of patient quotes used in the table indicate a relief from pain, even if only temporarily, and were more prevalent in the EHM group. There were eight participants who did not feel that it was beneficial. Six of those were from the control group. Feasibility was more challenging due to the ICU environment with open rooms that contributed to ambient noise, especially during the rest period. Support of the medical team was beneficial in being able to provide the treatment without interference but did not completely eliminate it. Some interruptions, however, were related to needs of the patient due to shortness of breath, thirst, and nausea for example. Staff acceptance and the length of the treatment need to be considered when developing a massage plan for patients in the ICU to help minimize interruptions.
Limitations of the study included acceptability being determined based on only the patients' perspectives. Three sessions were rarely done which impacted feasibility. Scheduling was challenging since there was only one research nurse providing the EHM and CHH and the participants may have also have commented in appreciation of the therapist and not necessarily the treatment. Finally, using lavender cream may have confounded the perceived benefit of the treatments due to its relaxing properties.
Future studies are warranted to examine the support and opportunities for implementation of massage therapy in the ICU. These can include the use of more than one person providing the massage sessions and possibly comparing having a family member or friend providing the hand holding. Identifying the times for the treatment in order to achieve the greatest therapeutic effect is another consideration for future research.
To read other studies regarding massage, please view the Massage Therapy Foundation review article archives, browse accepted MTF Research Grant abstracts, or search PubMed for massage therapy research.
Registration is now open for the International Massage Therapy Research Conference in Seattle May 12-15, 2016. Visit www.massagetherapyfoundation.org for more updates and registration information.
Click here for more information about Massage Therapy Foundation Contributor.
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