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Brenner LA, Stearns-Yoder KA, Stamper CE, Hoisington AJ, Brostow DP, Hoffmire CA, Forster JE, Donovan ML, Ryan AT, Postolache TT, Lowry CA. Rationale, design, and methods: A randomized placebo-controlled trial of an immunomodulatory probiotic intervention for Veterans with PTSD. Contemp Clin Trials Commun 2022; 28:100960. [PMID: 35812820 PMCID: PMC9260450 DOI: 10.1016/j.conctc.2022.100960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background United States military Veterans from recent conflicts are experiencing symptoms related to posttraumatic stress disorder (PTSD). Many Veterans are resistant to conventional health and mental health interventions (e.g., medication, psychotherapy). Alternative treatment approaches are needed. An underlying feature of PTSD is exaggerated inflammation, both peripherally and in the central nervous system. This inflammation is thought to play an important role in the vulnerability to, aggravation of, and persistence of PTSD symptoms. Therefore, an innovative intervention strategy would be the use of immunoregulatory/anti-inflammatory probiotics to reduce inflammation. Here we describe the rationale, design, and methods of a randomized placebo-controlled trial (RCT) of Lactobacillus rhamnosus GG (LGG; ATCC 53103) for posttraumatic stress disorder (PTSD). Methods This is a Phase IIa trial of LGG for United States military Veterans with PTSD, using a longitudinal, double-blind, randomized placebo-controlled design. The primary outcome measure is plasma concentration of high-sensitivity C-reactive protein. Conclusion Despite the fact that symptoms associated with PTSD can be disabling, individuals living with this trauma-related disorder have limited options in terms of evidence-based interventions. Recent research efforts aimed at highlighting the biological mechanisms of PTSD suggest that increased inflammation and altered autonomic nervous system activity may be treatment targets, and that immunoregulatory probiotics, such as LGG, have the potential to decrease trauma-induced inflammatory responses, as well as associated symptoms. This manuscript describes the best powered human subjects Phase IIa trial, to date, of a probiotic intervention for those living with PTSD.
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Affiliation(s)
- Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Departments of Psychiatry and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States,Corresponding author. VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States.
| | - Kelly A. Stearns-Yoder
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Christopher E. Stamper
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Andrew J. Hoisington
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States,Department of Systems Engineering & Management, Air Force Institute of Technology, Wright-Patterson AFB, OH, United States
| | - Diana P. Brostow
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Claire A. Hoffmire
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Jeri E. Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Meghan L. Donovan
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Arthur T. Ryan
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Teodor T. Postolache
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States,Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States,VISN 5 MIRECC, Department of Veterans Affairs, Baltimore, MD, United States
| | - Christopher A. Lowry
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States,Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States,Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States,Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Brenner LA, Forster JE, Stearns-Yoder KA, Stamper CE, Hoisington AJ, Brostow DP, Mealer M, Wortzel HS, Postolache TT, Lowry CA. Evaluation of an Immunomodulatory Probiotic Intervention for Veterans With Co-occurring Mild Traumatic Brain Injury and Posttraumatic Stress Disorder: A Pilot Study. Front Neurol 2020; 11:1015. [PMID: 33192959 PMCID: PMC7641622 DOI: 10.3389/fneur.2020.01015] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background: US military Veterans returned from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) with symptoms associated with mild traumatic brain injury [mTBI; i.e., persistent post-concussive (PPC) symptoms] and posttraumatic stress disorder (PTSD). Interventions aimed at addressing symptoms associated with both physical and psychological stressors (e.g., PPC and PTSD symptoms) are needed. This study was conducted to assess the feasibility, acceptability, and safety of a probiotic intervention, as well as to begin the process of evaluating potential biological outcomes. Methods: A pilot randomized controlled trial was implemented among US military Veterans from recent conflicts in Iraq and Afghanistan. Those enrolled had clinically significant PPC and PTSD symptoms. Participants were randomized to intervention (Lactobacillus reuteri DSM 17938) or placebo supplementation (daily for 8 weeks +/- 2 weeks) at a 1:1 ratio, stratified by irritable bowel syndrome status. Thirty-one Veterans were enrolled and randomized (15 to the placebo condition and 16 to the probiotic condition). Results: Thresholds for feasibility, acceptability, and safety were met. Probiotic supplementation resulted in a decrease in plasma C-reactive protein (CRP) concentrations relative to the placebo group that approached statistical significance (p = 0.056). Although during the Trier Social Stress Test (TSST; administered post-supplementation) no between-group differences were found on a subjective measure of stress responsivity (Visual Analog Scale), there was a significantly larger increase in mean heart beats per minute between baseline and the math task for the placebo group as compared with the probiotic group (estimated mean change, probiotic 5.3 [95% Confidence Interval: −0.55, 11.0], placebo 16.9 [11.0, 22.7], p = 0.006). Conclusions: Findings from this trial support the feasibility, acceptability, and safety of supplementation with an anti-inflammatory/immunoregulatory probiotic, L. reuteri DSM 17938, among Veterans with PPC and PTSD symptoms. Moreover, results suggest that CRP may be a viable inflammatory marker of interest. A larger randomized controlled trial aimed at measuring both biological and clinical outcomes is indicated. Clinical Trial Registration:ClinicalTrials.gov, Identifier NCT02723344.
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Affiliation(s)
- Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Psychiatry and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Kelly A Stearns-Yoder
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Christopher E Stamper
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Andrew J Hoisington
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States.,Department of Systems Engineering & Management, Air Force Institute of Technology, Wright-Patterson Air Force Base, OH, United States
| | - Diana P Brostow
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States
| | - Meredith Mealer
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Hal S Wortzel
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Psychiatry and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Teodor T Postolache
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States.,Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States.,Veterans Integrated Service Network (VISN) 5 MIRECC, Department of Veterans Affairs, Baltimore, MD, United States
| | - Christopher A Lowry
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center (RMRVAMC), Aurora, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States.,Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States.,Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States.,Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Bolton RE, Fix GM, VanDeusen Lukas C, Elwy AR, Bokhour BG. Biopsychosocial benefits of movement-based complementary and integrative health therapies for patients with chronic conditions. Chronic Illn 2020; 16:41-54. [PMID: 29914264 DOI: 10.1177/1742395318782377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Complementary and integrative health practices are growing in popularity, including use of movement-based therapies such as yoga, tai-chi, and qigong. Movement-based therapies are beneficial for a range of health conditions and are used more frequently by individuals with chronic illness. Yet little is known about how patients with chronic conditions characterize the health benefits of movement-based therapies. Methods We conducted focus groups with 31 patients enrolled in yoga and qigong programs for chronic conditions at two VA medical centers. Transcripts were analyzed using conventional content analysis with codes developed inductively from the data. Participants’ descriptions of health benefits were then mapped to Engel’s biopsychosocial model. Results Participants described improvements in all biopsychosocial realms, including improved physical and mental health, reduced opiate and psychotropic use, enhanced emotional well-being, and better social relationships. Changes were attributed to physical improvements, development of coping skills, and increased self-awareness. Discussion Patients with chronic illnesses in our sample reported multiple benefits from participation in movement-based therapies, including in physical, mental, and social health realms. Providers treating patients with complex comorbidities may consider referrals to movement-based therapy programs to address multiple concerns simultaneously, particularly among patients seeking alternatives to medication or adjunctive to an opiate reduction strategy.
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Affiliation(s)
- Rendelle E Bolton
- U.S. Department of Veterans Affairs, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, USA
- Heller School for Social Policy and Management, Brandeis University, Waltham, USA
| | - Gemmae M Fix
- U.S. Department of Veterans Affairs, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
| | - Carol VanDeusen Lukas
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
- U.S. Department of Veterans Affairs, VA Boston Healthcare System, Boston, USA
| | - A Rani Elwy
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
- U.S. Department of Veterans Affairs, VA Boston Healthcare System, Boston, USA
| | - Barbara G Bokhour
- U.S. Department of Veterans Affairs, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
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Brenner LA, Stearns-Yoder KA, Hoffberg AS, Penzenik ME, Starosta AJ, Hernández TD, Hadidi DA, Lowry CA. Growing literature but limited evidence: A systematic review regarding prebiotic and probiotic interventions for those with traumatic brain injury and/or posttraumatic stress disorder. Brain Behav Immun 2017; 65:57-67. [PMID: 28606462 DOI: 10.1016/j.bbi.2017.06.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/18/2017] [Accepted: 06/07/2017] [Indexed: 01/10/2023] Open
Abstract
Traumatic brain injury (TBI) is highly prevalent among a wide range of populations, including civilians, military personnel, and Veterans. TBI sequelae may be further exacerbated by symptoms associated with frequently occurring comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD). This is particularly true among the population of military personnel from recent conflicts in Iraq and Afghanistan, with a history of mild TBI (mTBI) and PTSD. The need for efficacious treatments for TBI and comorbid PTSD is significant, and evidence-based interventions for these frequently co-occurring conditions are limited. Based on findings suggesting that inflammation may be an underlying mechanism of both conditions, anti-inflammatory/immunoregulatory agents, including probiotics, may represent a novel strategy to treat TBI and/or PTSD-related symptoms. The focus of this systematic review was to identify and evaluate existing research regarding prebiotic and probiotic interventions for the populations of individuals with a history of TBI and/or PTSD. Only 4 studies were identified (3 severe TBI, 1 PTSD, 0 co-occurring TBI and PTSD). Although findings suggested some promise, work in this area is nascent and results to date do not support some claims within the extensive coverage of probiotics in the popular press.
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Affiliation(s)
- Lisa A Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, United States; Departments of Physical Medicine and Rehabilitation, Psychiatry and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, United States.
| | - Kelly A Stearns-Yoder
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, United States; Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, United States
| | - Adam S Hoffberg
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, United States
| | - Molly E Penzenik
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, United States
| | - Amy J Starosta
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, United States
| | - Theresa D Hernández
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, United States; Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel A Hadidi
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, United States; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher A Lowry
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, United States; Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, United States; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States
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5
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Sedlander E, Barboza KC, Jensen A, Skursky N, Bennett K, Sherman S, Schwartz M. Veterans' Preferences for Remote Management of Chronic Conditions. Telemed J E Health 2017; 24:229-235. [PMID: 28745941 DOI: 10.1089/tmj.2017.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VA) is investing considerable resources into providing remote management care to patients for disease prevention and management. Remote management includes online patient portals, e-mails between patients and providers, follow-up phone calls, and home health devices to monitor health status. However, little is known about patients' attitudes and preferences for this type of care. This qualitative study was conducted to better understand patient preferences for receiving remote care. METHODS Ten focus groups were held comprising 77 patients with hypertension or tobacco use history at two VA medical centers. Discussion questions focused on experience with current VA remote management efforts and preferences for receiving additional care between outpatient visits. RESULTS Most participants were receptive to remote management for referrals, appointment reminders, resource information, and motivational and emotional support between visits, but described challenges with some technological tools. Participants reported that remote management should be personalized and tailored to individual needs. They expressed preferences for frequency, scope, continuity of provider, and mode of communication between visits. Most participants were open to nonclinicians contacting them as long as they had direct connection to their medical team. Some participants expressed a preference for a licensed medical professional. All groups raised concerns around confidentiality and privacy of healthcare information. Female Veterans expressed a desire for gender-sensitive care and an interest in complementary and alternative medicine. CONCLUSIONS The findings and specific recommendations from this study can improve existing remote management programs and inform the design of future efforts.
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Affiliation(s)
- Erica Sedlander
- 1 Milken Institute School of Public Health, George Washington University , Washington, District of Columbia.,2 VA New York Harbor Healthcare System , New York, New York
| | - Katherine C Barboza
- 3 Department of Population Health, NYU School of Medicine , New York, New York
| | - Ashley Jensen
- 4 Cumming School of Medicine, University of Calgary , Calgary, Canada
| | - Nicole Skursky
- 3 Department of Population Health, NYU School of Medicine , New York, New York
| | | | - Scott Sherman
- 2 VA New York Harbor Healthcare System , New York, New York.,5 Lifeworks , Austin, Texas
| | - Mark Schwartz
- 2 VA New York Harbor Healthcare System , New York, New York.,3 Department of Population Health, NYU School of Medicine , New York, New York
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Hernández TD, Brenner LA, Walter KH, Bormann JE, Johansson B. Complementary and alternative medicine (CAM) following traumatic brain injury (TBI): Opportunities and challenges. Brain Res 2016; 1640:139-151. [PMID: 26806403 DOI: 10.1016/j.brainres.2016.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 11/15/2022]
Abstract
Traumatic brain injury (TBI) is highly prevalent and occurs in a variety of populations. Because of the complexity of its sequelae, treatment strategies pose a challenge. Given this complexity, TBI provides a unique target of opportunity for complementary and alternative medicine (CAM) treatments. The present review describes and discusses current opportunitites and challenges associated with CAM research and clinical applications in civilian, veteran and military service populations. In addition to a brief overview of CAM, the translational capacity from basic to clinical research to clinical practice will be described. Finally, a systematic approach to developing an adoptable evidence base, with proof of effectiveness based on the literature will be discussed. Inherent in this discussion will be the methodological and ethical challenges associated with CAM research in those with TBI and associated comorbidities, specifically in terms of how these challenges relate to practice and policy issues, implementation and dissemination. This article is part of a Special Issue entitled SI:Brain injury and recovery.
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Affiliation(s)
- Theresa D Hernández
- Department of Psychology and Neuroscience, University of Colorado at Boulder, United States; Center for Neuroscience, University of Colorado at Boulder, United States; Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), United States.
| | - Lisa A Brenner
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States; Department of Neurology, University of Colorado Anschutz Medical Campus, United States
| | | | - Jill E Bormann
- Department of Veteran Affairs, San Diego Healthcare System, Center of Excellence for Stress and Mental Health (CESAMH) and University of San Diego Hahn School of Nursing and Health Sciences/Beyster Institute of Nursing Research, United States
| | - Birgitta Johansson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
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