Therapeutic touch with HIV-infected children: a pilot study

The Role of Salivary Neuropeptides in Pediatrics: Potential Biomarkers for Integrated Therapies

INTRODUCTION

Objective measures of symptom response to integrated complementary approaches in pediatrics are evolving. The purpose of this study was to document the concentration range of salivary neuropeptides in healthy controls and in children with cancer, to explore correlations between serum and salivary measurements for Calcitonin Gene-Related Peptide (CGRP) and Vasoactive Intestinal Polypeptide (VIP), and to determine whether there is a change in these salivary neuropeptide levels in response to integrated mind-body therapies.

METHODS

A non-randomized pragmatic study with three phases: Phase 1- Healthy Control Saliva-10 healthy controls provided saliva samples; Phase 2- Cancer Diagnosis Serum-Saliva- 16 mixed-type cancer patients provided blood and saliva samples; Phase 3- Acute Lymphocytic Leukemia (ALL) Saliva Intervention- 12 patients with ALL provided pre- and post-complementary intervention saliva samples.

INTERVENTIONS

20-minutes of structured touch or scripted relaxation breathing were administered to patients in Phase 3; Phase 1 and 2 patients did not receive this intervention.

OUTCOME MEASURES

cortisol, CGRP, VIP, State/Trait Anxiety Scale, visual analogue scale, vital signs.

RESULTS

Salivary CGRP and VIP were similar for children in Phases 1 and 2. There was a correlation between serum and salivary VIP in the mixed cancer group, though not between serum and salivary CGRP. In Phase 3 children, following a complementary intervention, salivary CGRP, heart rate, and systolic blood pressure decreased.

DISCUSSION/CONCLUSIONS

These data provide evidence of a decrease in sympathetic output after integrative/complementary therapy intervention in children with cancer. The study underscores the potential role of salivary neuropeptides as non-invasive biomarkers for integrated therapies in pediatrics.

Nontouch biofield therapy: a systematic review of human randomized controlled trials reporting use of only nonphysical contact treatment

OBJECTIVE AND CONTEXT: This review was designed to assess the quality and review the outcomes of randomized controlled trials (RCTs) of biofield therapies (external qigong, Healing Touch, Johrei, Reiki, and Therapeutic Touch) that report using only nonphysical touch forms of treatment. RCTs of nonphysical contact biofield therapies have the potential to contribute to an evidence base for health-promoting effects mediated through mechanisms outside the present understanding of biomedicine.

METHODS

Articles meeting inclusion criteria were identified from database and reference list searches and evaluated for a range of reporting and design items. Data were extracted to determine the range of protocol parameters and treatment outcomes. The final set of included RCTs were evaluated via a modified 5-item Jadad scale as well as by a set of 20 criteria that included items relevant to the early-phase nature of the trials and to the examination of nonphysical touch biofield therapy interventions.

RESULTS

Of 90 RCTs that assessed effectiveness of a biofield therapy in humans, 28 trials involving 1775 participants met additional inclusion criteria (most importantly a clearly reported use of only nonphysical contact treatment). The research designs of these 28 trials revealed marked heterogeneity in regard to condition treated, number and duration of treatments, nature of the control/comparison group, and outcome measures. Finally, 10 trials were excluded on the basis of low quality assessment scores. Twelve of the remaining 18 trials (7 Therapeutic Touch, 3 external qigong, 1 Reiki, and 1 Healing Touch) reported at least one primary outcome with statistically significant beneficial treatment outcomes.

CONCLUSIONS

The pilot study nature of essentially all the identified nonphysical contact biofield therapy RCTs, as reflected by low sample sizes alone, precludes drawing robust conclusions. Given this perspective, the finding that two thirds of the higher-scoring trials demonstrated at least partial effectiveness favors a continued research effort, especially in light of the translational value of biofield clinical trials for studies exploring the nature and physiologic basis of biofield healing.

Effects of Therapeutic Touch on Anxiety, Vital Signs, and Cardiac Dysrhythmia in a Sample of Iranian Women Undergoing Cardiac Catheterization

Purpose of the study: To investigate the effects of Therapeutic Touch (TT) on anxiety, vital signs, and cardiac dysrhythmia in women undergoing cardiac catheterization. Design: It was a quasi-experimental study. The participants had no history of hallucination, anxiety, or other psychological problems. Participants had to be conscious and have attained at least sixth-grade literacy level. Participants were randomly assigned into an intervention group ( n = 23; received 10-15 minutes TT), a placebo group ( n = 23; received 10-15 minutes simulated touch), and a control group ( n = 23; did not receive any therapy). Data were collected using Spielberger’s anxiety test, cardiac dysrhythmia checklist, and vital signs recording sheet. Statistical analyses were considered to be significant at α = .05 levels. Findings: Sixty-nine women ranging in age from 35 to 65 years participated. TT significantly decreased state anxiety p < 0.0001 but not trait anxiety ( p = .88), decreased the incidence of all cardiac dysrhythmias p < 0.0001 except premature ventricular contraction ( p = .01), and regulated vital signs p < 0.0001 in the intervention group versus placebo and control group. Conclusions: TT is an effective approach for managing state anxiety, regulating vital signs, and decreasing the incidence of cardiac dysrhythmia during stressful situations, such as cardiac catheterization, in Iranian cardiac patients.

New insights on therapeutic touch: a discussion of experimental methodology and design that resulted in significant effects on normal human cells and osteosarcoma

Our purpose is to discuss the study design and innovative approaches that led to finding significant effects of one energy medicine therapy, Therapeutic Touch (TT), on cells. In the original published studies, TT was shown to significantly increase human osteoblast DNA synthesis, differentiation, and mineralization; increase in a dose-dependent manner the growth of other human cell types; and decrease the differentiation and mineralization of a human osteosarcoma-derived cell line. A unique feature of the study's methodology and design that contributed to the success of the findings was that a basic level of skill and maturity of the TT practitioner was quantified for producing observable and replicable outcomes in a test administered to all TT practitioners. Only those practitioners that passed the test were selected for the study. (2) The practitioners were required to keep a journal, which appeared to promote their ability to stay centered and replicate their treatments over months of cell experimentation. (3) The origin of the cells that the practitioners were treating was explained to them, although they were blinded to cell type during the experiments. (4) Only early passage cells were used to maintain a stable cell phenotype. (5) Standard protocols for performing TT in the room were followed to ensure reproducible conditions. (6) Placebo controls and untreated controls were used for each experiment. (7) The principal investigator and technicians performing the assays were blinded as to the experimental groups, and all assays and procedures were well established in the laboratory prior to the start of the TT experiments. The absence of studies on the human biofield from mainstream scientific literature is also discussed by describing the difficulties encountered in publishing. These roadblocks contribute to our lack of understanding of the human biofield and energy medicine modalities in science. In conclusion, this report seeks to encourage well-designed, evidence-based studies on the human biofield and the therapeutic potential of the human biofield.

Biofield therapies: helpful or full of hype? A best evidence synthesis

BACKGROUND

Biofield therapies (such as Reiki, therapeutic touch, and healing touch) are complementary medicine modalities that remain controversial and are utilized by a significant number of patients, with little information regarding their efficacy.

PURPOSE

This systematic review examines 66 clinical studies with a variety of biofield therapies in different patient populations.

METHOD

We conducted a quality assessment as well as a best evidence synthesis approach to examine evidence for biofield therapies in relevant outcomes for different clinical populations.

RESULTS

Studies overall are of medium quality, and generally meet minimum standards for validity of inferences. Biofield therapies show strong evidence for reducing pain intensity in pain populations, and moderate evidence for reducing pain intensity hospitalized and cancer populations. There is moderate evidence for decreasing negative behavioral symptoms in dementia and moderate evidence for decreasing anxiety for hospitalized populations. There is equivocal evidence for biofield therapies' effects on fatigue and quality of life for cancer patients, as well as for comprehensive pain outcomes and affect in pain patients, and for decreasing anxiety in cardiovascular patients.

CONCLUSION

There is a need for further high-quality studies in this area. Implications and future research directions are discussed.

A double-blind randomized controlled pilot trial examining the safety and efficacy of therapeutic touch in premature infants

PURPOSE

To explore the hypothesis that nontouch therapy such as therapeutic touch (TT) reduces stress to a clinically important degree and is safe to use in preterm infants.

DESIGN

A pilot randomized, double-blind, controlled trial.

SUBJECTS

Two groups of 10 infants were enrolled and randomly assigned to treatment or nontreatment groups. Gestational age was less than 29 weeks. Demographic descriptions of the 2 groups were statistically similar.

METHODS

The observer and staff were blinded to assignment; the TT practitioner was blinded to observed measurements. Each infant received either TT or no therapeutic touch (NTT) for 5 minutes on 3 consecutive days at the same time of day, behind a curtain. Heart period variability (HPV) was measured 5 minutes before, during, and after the treatment phase.

RESULTS

Examination of the parameters of oxygen saturation and episodes of apnea demonstrated no increase in adverse events in TT group compared with NTT group. Repeated-measures multivariate analysis of variance on HPV revealed differences in the interaction of group assignment with low-frequency, high-frequency, and low-to-high- frequency ratio interaction (F2,143 = 8.076, P = .000) and for group, day, and low-frequency, high-frequency, and low-to-high-frequency ratio (F2,288 = 3.146, P = .015), and in the posttreatment time period (F1,16 = 6.259, P = .024), reflective of greater parasympathetic activity in TT group.

CONCLUSION

In this pilot trial, HPV showed an increase for the TT group compared with the NTT group. The study reveals no adverse effects of TT in preterm infants.

American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics

The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to these goals, the American Academy of Pediatrics recognizes the increasing use of complementary and alternative medicine in children and, as a result, the need to provide information and support for pediatricians. From 2000 to 2002, the American Academy of Pediatrics convened and charged the Task Force on Complementary and Alternative Medicine to address issues related to the use of complementary and alternative medicine in children and to develop resources to educate physicians, patients, and families. One of these resources is this report describing complementary and alternative medicine services, current levels of utilization and financial expenditures, and associated legal and ethical considerations. The subject of complementary and alternative medicine is large and diverse, and consequently, an in-depth discussion of each method of complementary and alternative medicine is beyond the scope of this report. Instead, this report will define terms; describe epidemiology; outline common types of complementary and alternative medicine therapies; review medicolegal, ethical, and research implications; review education and training for complementary and alternative medicine providers; provide resources for learning more about complementary and alternative medicine; and suggest communication strategies to use when discussing complementary and alternative medicine with patients and families.

The Internal Process of Therapeutic Touch

Therapeutic Touch (TT) is a complementary healing modality used by health care providers to reduce anxiety, accelerate relaxation, decrease pain, and enhance immunity. Research studies report outcomes of TT treatments, but few describe the specific process. This qualitative research study was conducted to describe the nature of the core process of TT in adults and full term infants as practiced by five professional nurses, each treating one adult and one infant. Analysis of data obtained from interviews and focused participant observations was conducted. Findings provide empirical data to depict an overall process divided into three phases: (a) preparation, (b) treatment, and (c) termination, that adheres to the standard process as described by Krieger. It expands on the description of each phase, including two new subcomponents, orienting and disengagement, not previously seen in the literature. Lastly, the study describes the modification of the TT process with infants compared to adults.

Evaluating the effectiveness of preoperative interventions: the appropriateness of using the children's emotional manifestation scale

AIMS

This study aimed to compare the effectiveness of two preoperative nursing interventions and examining the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative interventions.

BACKGROUND

There is some evidence that the Children's Emotional Manifestation Scale can be used as an objective assessment tool in documenting children's emotional responses. However, it is uncertain from previous study that whether the scale can be used in evaluating the effectiveness of preoperative interventions.

DESIGN

A randomized controlled trial, between subjects design was carried out in a well-established day surgery unit.

METHOD

Children (7-12 years of age; n = 203) admitted for elective day surgery during a 13-month period, were recruited. By using a simple randomization method, 97 of children were assigned to the experimental group receiving therapeutic play intervention and 106 children were assigned to the control group receiving routine information preparation.

RESULTS

Children receiving therapeutic play preparation reported statistically significant lower anxiety levels, fewer negative emotions and lower heart rates and mean arterial blood pressures than children receiving information preparation. Children with high preoperative anxiety levels manifested more negative emotional behaviour during anaesthesia induction and were associated with faster heart rates and higher mean blood pressures.

CONCLUSION

The study demonstrates the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative nursing interventions and presents clear evidence to support the effectiveness of therapeutic play intervention in preparing children for surgery when compared with the information preparation approach.

RELEVANCE TO CLINICAL PRACTICE

This study contributes towards enriching the experience of using child-sensitive research tools in evaluating the effectiveness of preoperative nursing interventions. The findings heighten the awareness of the importance of integrating therapeutic play as an essential component of holistic and quality nursing care to prepare children for surgery.

Treating children with therapeutic and healing touch

HT and TT are unique touch techniques with origins in the nursing profession. They are widely available in pediatric hospitals and often are used as adjunct therapies to decrease stress, anxiety, and pain. Practitioners, as well as patients, may notice improved sense of well-being during and after treatments. Additional research is needed to determine the mechanisms by which these effects occur, the optimal duration and frequency of treatments, factors predictive of treatment response, and the overall costs and benefits of including TT and HT in treatment in addition to traditional therapies. These therapies are safe and readily available.

The experience of Therapeutic Touch in the lives of five postpartum women

PURPOSE

To examine the experience of therapeutic touch in the lives of postpartum women.

METHODS

Qualitative study of five postpartum women who participated in therapeutic touch for 2 months during home visits that focused on postpartum issues and concerns. The visits were audiotaped and transcribed. Data were coded and classified; linkages between categories were sought.

RESULTS

Five themes or essences of the experience emerged: Feeling Relaxed, Feeling Open, Feeling Cared For, Feeling Connected, and Feeling Skeptical.

CLINICAL IMPLICATIONS

The women and the researcher experienced many positive emotions during the home visits. Although it is unknown whether it was the visit, the interaction, or the therapeutic touch that helped the women feel cared for, the experience of participating in therapeutic touch seemed to add a dimension of mutual caring that added a special and unique quality to the home visit.

Complementary and alternative medicine use among children in the Washington, DC area

OBJECTIVE

To determine the prevalence and reasons for complementary and alternative medicine (CAM) use among children in primary pediatric care practice in the Washington, DC area.

DESIGN

Cross-sectional survey of parents at 4 Children's National Medical Center Pediatric Research Network (PRN) practices from July 1998 through November 1998. Survey information included demographics, child health problems, satisfaction with health care, and CAM use over the past year.

RESULTS

Parents completed 348 surveys. Forty percent (138) of parents were CAM users themselves, whereas 21% (72) had treated their child with CAM over the past year. Factors positively associated with child CAM use included parents' use of CAM (P <.0001); greater parent age (P =.0005); greater child age (P =.001); and complaints of frequent respiratory illnesses, asthma, headaches, and nosebleeds. Ethnicity and parental education were not associated with child CAM use. Over 50% of pediatric CAM users reported specific vitamin supplementation, whereas 25% used other nutritional supplements or elimination diets, and over 40% used herbal therapies. Thirty-two percent of CAM users had visited a CAM practitioner; 81% of pediatric CAM users would have liked to discuss it with their pediatrician, but only 36% did so.

CONCLUSION

Treatment of children with CAM is common and is frequently undertaken by parents without the knowledge or advice of their pediatrician.

Healing as a therapy for human disease: a systematic review

OBJECTIVE

To assess, from published clinical trials, the evidence for the use of healing as a complementary medical intervention in human disease.

DESIGN

Limited to studies involving random assignment to a treatment group consisting of "healing," broadly defined, or to a concurrent control group. All randomized trials published up to the year 2000, were identified from MEDLINE, CINAHL, BIDS-EMBASE, the CISCOM complementary medicine databases and from bibliographic references of published articles. Copies of all published studies were obtained, data were extracted, and methodological quality (Jadad) scores were derived where possible.

RESULTS

Fifty-nine randomized clinical trials (RCTs) were found comparing healing with a control intervention on human participants. In 37 of these, healing was used for existing diseases or symptoms (22 existed as fully accessible published reports, 10 as dissertation abstracts only, and 5 as "preliminary" investigations with limited evidential value). The 22 full trials (10 reporting a "significant" effect of healing compared with control) constitute an extremely heterogeneous group, varying greatly in the method and duration of healing; the medical condition treated; the outcome measure employed; and the control intervention used. Many trials had a number of methodological shortcomings, including small sample sizes, and were inadequately reported. Only 8 studies (5 with a significant outcome for healing) had a maximum methodological quality score of 5, and in 10 studies this score was 3 or less. Two trials-both large scale and methodologically sound-were replicates, and each found a significant beneficial effect of intercessory prayer on the clinical progress of cardiac patients. Eleven of the 15 dissertation abstracts and pilot studies reported nonsignificant results for healing compared with control, a finding that probably reflects the relatively small sample sizes and the likelihood of type II errors. The significant heterogeneity found in this group of trials makes categorization problematic and inhibits the pooling of results by meta-analysis or similar techniques to obtain a global estimate of the "treatment effect" of healing.

CONCLUSIONS

No firm conclusions about the efficacy or inefficacy of healing can be drawn from this diverse group of RCTs. Given the current emphasis on evidence-based medicine, future investigations should be adequately powered, appropriately controlled, and properly described. These future investigations would most usefully consist of: (1) pragmatic trials of healing for undifferentiated conditions on patients based in general practice and (2) larger RCTs of distant healing on large numbers of patients with well-defined measurable illness.