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Questions?. Establishing an Integrative Care Center Dr. Brent Bauer Dr. Adam Perlman Thursday , October 4th. Title by Presenter Name. From CAM to Integrative Medicine at Mayo Clinic Research Informing Practice and Improving Care.

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Title by presenter name

Questions?

Establishing an Integrative Care Center

Dr. Brent BauerDr. Adam Perlman

Thursday, October 4th

Title by Presenter Name


From cam to integrative medicine at mayo clinic research informing practice and improving care

From CAM to Integrative Medicine at Mayo ClinicResearch Informing Practice and Improving Care

Brent A. Bauer MDDirector, Complementary and Integrative Medicine Program

Mayo Clinic

Department of Medicine


Massage therapy mayo clinic pilot trial

Massage therapy

quiet relaxation

vs

Decreased

Massage Therapy – Mayo ClinicPilot Trial

58 cardiac surgery patients

Pain

Anxiety

Tension

Cutshall, Comp. Therap.Clin. Practice, 2009


Massage therapy after cv surgery

Massage Therapy after CV Surgery

Control group (n=28)

Massage group (n=30)

10

10

8

8

6

6

V

A

S

4

4

2

2

0

0

Before

After

Before

After

Anxiety Level


Massage therapy after cv surgery1

Massage Therapy after CV Surgery

Control group (n=28)

Massage group (n=30)

10

10

8

8

6

6

V

A

S

4

4

2

2

0

0

Before

After

Before

After

Pain level


Massage therapy mayo clinic randomized controlled trial

Massage Therapy – Mayo ClinicRandomized – Controlled Trial

  • 113 cardiac surgery patients

  • MT therapy days 2,4 vs. quiet relaxation

  • Decreased painP<0.001

  • Decreased anxietyP<0.001

  • Decreased tensionP<0.001

  • Increased relaxationP<0.001

Bauer, Comp. Therap. Clin. Practice, 2010


Massage therapy at mayo clinic other studies

Massage Therapy at Mayo ClinicOther Studies

  • MT for colo-rectal surgery patients2009

  • MT prior to cardiac interventions2009

  • MT for thoracic surgery patients2011

  • MT for breast cancer surgery pts2012

  • MT for cardiologists and nurses 2010

  • MT for cardiac ultrasonographers2011

  • MT for in-patient nurses2012


Massage therapy at mayo clinic the impact

Massage Therapy at Mayo ClinicThe Impact

  • Massage therapy now routine at MC

    • Domino effect

    • Small investment > “snowball” returns

  • 48 hospitals in US

  • 7 international hospitals

    • Australia, Austria, China, Ireland, Switzerland, Turkey


Massage therapy at mayo clinic the vision

Massage Therapy at Mayo ClinicThe Vision

Massage therapy routinely available to all

Hospitalized patients at Mayo Clinic

Family members

Staff

Continue to use the Mayo experience to transform

health care in the U.S. and around the world


Questions

Questions

[email protected]


Bibliography

Bibliography

  • Effect of massage therapy for postsurgical mastectomy recipients. Drackley NL, Degnim AC, Jakub JW, Cutshall SM, Thomley BS, Brodt JK, Vanderlei LK, Case JK, Bungum LD, Cha SS, Bauer BA, Boughey JC. Clin J Oncol Nurs. 2012 Apr;16(2):121-4. PMID:22459520

  • Feasibility and effectiveness of massage therapy for symptom relief in cardiac catheter laboratory staff: a pilot study. Keller SR, Engen DJ, Bauer BA, Holmes DR Jr, Rihal CS, Lennon RJ, Loehrer LL, Wahner-Roedler DL. Complement Ther Clin Pract. 2012 Feb;18(1):4-9. Epub 2011 Sep 23. PMID:22196566

  • Effect of massage on pain management for thoracic surgery patients. Dion L, Rodgers N, Cutshall SM, Cordes ME, Bauer B, Cassivi SD, Cha S. Int J Ther Massage Bodywork. 2011;4(2):2-6. Epub 2011 Jun 29. PMID:21847428

  • Massage therapy after cardiac surgery. Wang AT, Sundt TM 3rd, Cutshall SM, Bauer BA. Semin Thorac Cardiovasc Surg. 2010 Autumn;22(3):225-9. Review. PMID:21167456

  • The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study. Engen DJ, Wahner-Roedler DL, Nadolny AM, Persinger CM, Oh JK, Spittell PC, Loehrer LL, Cha SS, Bauer BA. BMC Complement Altern Med. 2010 Sep 16;10:50. PMID:20846441


Bibliography1

Bibliography

  • Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study. Cutshall SM, Wentworth LJ, Engen D, Sundt TM, Kelly RF, Bauer BA. Complement Ther Clin Pract. 2010 May;16(2):92-5. Epub 2009 Nov 14. PMID:20347840

  • Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, Brekke KM, Kelly RF, Sundt TM 3rd. Complement Ther Clin Pract. 2010 May;16(2):70-5. Epub 2009 Jul 14. PMID:20347836

  • Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bartel DC, Cutshall SM, Tilbury RT, Lennon R, Bauer BA. Prog Cardiovasc Nurs. 2009 Dec;24(4):155-61. PMID:20002340

  • Value of massage therapy for patients in a breast clinic. Pruthi S, Degnim AC, Bauer BA, DePompolo RW, Nayar V. Clin J Oncol Nurs. 2009 Aug;13(4):422-5. PMID:19648098


Title by presenter name

Questions?

Title by Presenter Name


Title by presenter name

American Massage Therapy Association

October 4, 2012

Adam Perlman, MD, MPH

Executive Director

Duke Integrative Medicine


At the beginning

At the Beginning


New jersey

New Jersey

Siegler Center for Integrative Medicine

Services Offered

Who do you hire

Research


Pilot study 2006

Pilot Study (2006)

  • Randomized controlled trial; n=68

    • Massage vs. wait list

  • Intervention: Whole body, Swedish massage for 8 weeks

    • Standard techniques of petrissage, effleurage, and tapotement

    • 60 min twice weekly x 4 weeks

    • 60 min once weekly x 4 weeks

  • Outcomes: function (WOMAC), pain (VAS), ROM, 50-ft walk

  • Results: well tolerated, decreased pain, and improved function

  • Effects persisted for weeks after cessation of massage

1. Archives of Internal Med. 2006;166:2533-2538


Umdnj

UMDNJ

Serving the underserved

Institute for Therapeutic Massage

Research


Dose finding study 2009 2011

Dose-finding study (2009-2011)

  • 2-Year study to define the ‘optimal practical’ dose of massage for OA of the knee

  • Designed to inform a future, more definitive trial

  • Randomized, wait list-controlled, clinical trial

  • 5-arm trial

    • 4 different ‘doses’ of standardized, whole body Swedish

    • wait list control

  • Supported by NCCAM grant R01 AT004623

  • Trial Registration: clinicaltrials.gov NCT00970008


Dose finding study design

Dose-finding study - Design

  • Four distinct ‘doses’

    • 1. 30 min/week x 8 weeks (240 min total)

    • 2. 30 min biweekly x 4 weeks, 30 min weekly x 4 weeks (360 min total)

    • 3. 60 min/week x 8 weeks (480 min total)

    • 4. 60 min biweekly x 4 weeks, 60 min weekly x 4 weeks (720 min total)

    • 5. Usual Care (no massage)

  • Included:

    • Adults with radiographically confirmed OA of the knee

    • Self-reported pain between 4-9 on VAS

  • Excluded:

    • RA, fibromyalgia, intraarticular injections, knee replacement

  • Assessed: baseline, 8-, 16-, and 24-weeks

  • Outcomes: WOMAC, VAS, ROM, 50-ft walk


Manualization

Manualization

  • Goal: to produce a study protocol that was tailored to subjects with OA of the knee, while respectful of the individualized nature of massage therapy

  • How to standardize an inherently individualized intervention?

    • CAM/nonphamacological research dilemma

  • 2-month process

    • Massage therapists from pilot study

    • Investigative team

    • Massage scientists

  • Constraints

    • Standard techniques

    • Reproducibility

    • Flexible for individual subject variability


Manualized protocols

Manualized protocols


Results

Results

  • Recruitment completed two months ahead of schedule

    • Free massages…

    • And more free massages!

  • 125 enrolled

    • 119 completed 8-week assessments

    • 115 completed entire trial

    • Intervention delivered: 11/2009 – 10/2010


Conclusions

Conclusions

  • Winner: 60-min once weekly

  • ‘Optimal-practical’= best bang for the buck

    • producing the greatest ratio of desired effect compared to costs

    • costs = time, labor, and convenience

  • Reinforced results of pilot study

  • Dose used for current study -


Title by presenter name

Duke

Shifting the model

Access

Forging relationship

DCI

Research


Current study

Current Study

  • Phase 2b Efficacy Trial

    • Using 60-min once weekly dose

    • Massage vs. light touch vs. wait list

    • 52-week follow-up

    • N=219 at three sites: Duke, UMDNJ, Yale

    • Cost-effectiveness

    • Biomarkers

  • ‘Unanticipated Benefits’

    • Modeled on studies by Cherkin et al. (Seattle)

    • Qualitative study

    • Participants of dose-finding study

    • ‘What else?’


The good the bad and the ugly

The good, the bad, and the ugly.


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