Eisenberg DM, Post DE, Hrbek AL, Connelly MT, Levy D,
O'Connor B, Cunningham M, Davis RB, Cohen MH, Cherkin DC, Buring JE.
Testing a model of integrative care in an academic health
center: results of a pilot study.
Harvard Medical School, Division for Research
and Education in Complementary and Integrative Medical Therapies, Osher
Institute, 401 Park Drive, Suite 22 A Boston, MA 02215. David_eisenberg@hms.harvard.edu
CONTEXT: While there are many emerging models
of integrative care, there are no studies comparing the relative effectiveness
of a multi-disciplinary care approach which combines both conventional
and complementary/alternative medicine (CAM) practice (i.e., "integrative
care") to care provided by conventional practitioners alone (i.e.,
"usual care") for common medical problems.
OBJECTIVE: To implement a model of integrative
care in an academic teaching hospital and evaluate this approach as
applied to individuals with sub-acute low back pain (LBP) as a target
condition.
DESIGN/SETTING/PATIENTS: Adults with sub-acute
LBP (3-12 weeks duration) recruited from an occupational health clinic
and community health centers were randomized in a 1:2 ratio to usual
care or usual care plus treatment by the integrative care team at the
Brigham and Women's Hospital, a teaching hospital affiliated with Harvard
Medical School.
INTERVENTION: Integrative care was provided
by a multidisciplinary team trained to work efficiently across disciplines.
The licensed, clinical professions represented included: acupuncture,
chiropractic, internal medicine, massage therapy, neurology, nursing,
nutritional counseling, occupational therapy, orthopedics, psychiatry/mind-body,
physical therapy and rheumatology. Initial evaluations were done by
two members of the team (1 MD, 1 CAM clinician) and an individualized
treatment plan was developed. Treatment was provided for up to 12 weeks
and was modified based on progress and input by the team.
MAIN OUTCOME: Differences in pain scores (0-10
scale) and functional status (Roland score, 0-23 scale) measured at
baseline, 2, 5 and 12 weeks post randomization
ANALYSIS: We fit longitudinal regression models
using generalized estimating equations to compare the rates of change
in outcomes between the randomized groups.
RESULTS: To date, 19 patients have been randomized,
13 to Integrative Care (IC), 6 to Usual Care (UC). Characteristics at
baseline: mean age 47 years; 9 male and 10 female; 5 were recruited
from occupational health, 14 from community health centers; mean baseline
pain 5.05; mean baseline function (Roland) 15.58. Over 12-weeks, participants
in the IC group had an average of 12.2 visits (range of 5 to17) and
experienced significantly greater reduction in pain scores (0.37 per
week for IC compared to 0.14 per week for UC, p=0.04) and functional
status as measured by Roland score (1.11 per week for IC compared to
0.49 per week for UC, p=0.03).
CONCLUSION: It was feasible for a multidisciplinary
integrative care team to deliver a coordinated, integrative care intervention
to patients with sub-acute low back pain. Initial results show a promising
trend for benefit of treating patients with persistent low back pain
and should be further evaluated.
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