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Marotta N, de Sire A, Lippi L, Moggio L, Tasselli A, Invernizzi M, Ammendolia A, Iona T. Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study. J Orthop Res 2024. [PMID: 38379407 DOI: 10.1002/jor.25790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion-relaxation phenomenon (FRP) evaluation is a valid clinical tool for low back pain (LBP) assessment. Yoga, a holistic mind-body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight-session yoga asanas program, with the first session conducted in-clinic and the rest delivered with tele-approach. Outcome measures included pain intensity, flexion-relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow-up (visual analog scale [VAS]: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele-yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long-term effects of yoga for managing LBP.
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Affiliation(s)
- Nicola Marotta
- Physical and Rehabilitative Medicine Division, Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro de Sire
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical and Rehabilitative Medicine Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine Division, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine Division, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Lucrezia Moggio
- Physical and Rehabilitative Medicine Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Rehabilitation Unit, Ospedale degli Infermi, Biella, Italy
| | - Anna Tasselli
- Physical and Rehabilitative Medicine Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine Division, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine Division, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical and Rehabilitative Medicine Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Teresa Iona
- Motor Sciences Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Whitehead AM, Mullur R, Sullivan MB, Nicosia FM. Remote Delivery of Mindful Movement Within Healthcare Systems: Lessons Learned From the Veterans Health Administration. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241235908. [PMID: 38501126 PMCID: PMC10946065 DOI: 10.1177/27536130241235908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/20/2024]
Abstract
Mindful Movement approaches have been a growing part of the Veterans Health Administration (VA). Innovations in tele-health technology had been an important initiative before the public health emergency to meet the needs of rural veterans as well as challenges in getting to a physical location for care. The onset of the COVID-19 pandemic accelerated this transition to tele-delivery of many practices including mindful movement. This paper aims to share lessons learned from virtual delivery of mindful movement as part of clinical and well-being programs in VA. Benefits of virtual care discussed include the convenience and decreased travel burden; accessibility for adaptive movement options; translation to home practice; and shifting the emphasis to interoceptive skills-building supportive of self-efficacy for exploring and identifying safe movement. Important challenges are also identified such as technology related barriers; teachers trained to meet the need of offering adaptations for a heterogenous population and supporting interoceptive skill-building; and supporting both physical and psychological safety. Examples are provided of medical groups incorporating virtual mindful movement within programs for diabetes and pain care to further explore the potential benefit of these practices being integrated within the care itself, rather than as a separate practice. It is hoped that the lessons learned will provide support for Veterans and staff, and the wider health care community, in what they need to participate in virtual care that is high quality, accessible, and meets the needs for greater health and well-being.
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Affiliation(s)
- Alison M. Whitehead
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Rashmi Mullur
- Greater Los Angles Veterans Affairs Health Care System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Marlysa B. Sullivan
- Empower Veterans Program, Atlanta VA Health Care System (AVAHCS), Atlanta, GA, USA
| | - Francesca M. Nicosia
- Institute for Health and Aging, University of California, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- VHA Office of Rural Health, Veterans Rural Health Resource Center, Lowa, IA, USA
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Wu J, Bolton RE, Anwar C, Bokhour BG, Khanna A, Mullur RS, Taylor SL, Hyde J. Modifying Whole Health Services for Successful Telehealth Delivery: Lessons from Veterans Health Administration's Rapid Transition During the COVID-19 Pandemic. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:792-804. [PMID: 37668607 DOI: 10.1089/jicm.2023.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Introduction: The Veterans Health Administration (VHA) is shifting care from a disease-oriented to health-creating approach that aims to provide whole person care. This Whole Health (WH) system combines person-centered care with delivery of WH services (e.g., health coaching, well-being education and skill-building classes, and evidence-based complementary and integrative health therapies), alongside conventional medical services. During the COVID-19 pandemic, WH services were modified for delivery through telehealth (teleWH). This article characterizes modifications to WH services made to maintain continuity during the transition to telehealth formats. Materials and methods: We conducted semistructured qualitative interviews with a purposive sample of 51 providers delivering teleWH services at 10 VHA medical centers. We examined WH service modifications as well as facilitators and barriers to those modifications using rapid coding and directed content analysis. Results: Modifications were driven by (1) preparing for teleWH service delivery and (2) improving teleWH service delivery. To prepare for teleWH services, modifications were prompted by access, readiness, and setting and resources. Modifications to improve the delivery of teleWH services were motivated by engagement, community-building, safety, and content for a teleWH environment. One-on-one teleWH services required the fewest modifications, while more significant modifications were needed for well-being, skill-building, and movement-based groups, and reconfiguration of manual therapies. Discussion: Findings highlighted the need for modifications to ensure that teleWH services are accessible and safe and support interpersonal relationships between patients and providers, as well as in group-based classes. Successfully delivering teleWH services requires proactive preparation that considers access, readiness, and the availability of resources to engage in teleWH services. Tailoring strategies and considering the unique needs of different teleWH services are critical. Conclusions: The COVID-19 pandemic catalyzed teleWH service implementation, utilization, and sustainment. The challenges faced and modifications made during this transition provide lessons learned for other health care systems as they attempt to implement teleWH services.
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Affiliation(s)
- Juliet Wu
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Rendelle E Bolton
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Chitra Anwar
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Barbara G Bokhour
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Aishwarya Khanna
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rashmi S Mullur
- U.S. Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy (CSHIIP), Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Integrative Medicine Collaborative, University of California Los Angeles Health, Los Angeles, CA, USA
| | - Stephanie L Taylor
- U.S. Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy (CSHIIP), Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Justeen Hyde
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Huang A, Anthonypillai J, Hapidou EG. Experiences of Veteran and Civilian Patients in Exploratory Yoga Sessions for Chronic Pain: A Qualitative Study. Can J Pain 2023; 7:2244025. [PMID: 37719472 PMCID: PMC10503449 DOI: 10.1080/24740527.2023.2244025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 07/15/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023]
Abstract
Background Yoga integrates all aspects of self, with biological, mental, intellectual, and spiritual elements. The practice of yoga aligns with the biopsychosocial model of health and, as such, it can be instrumental in pain treatment. Aims The purpose of this qualitative study was to explore perceptions regarding the yoga sessions for chronic pain through thematic content analysis with comparison of gender, veteran or civilian status, and delivery methods. Methods Patients with chronic pain attended a 5-week intensive interdisciplinary chronic pain management program at the Michael G. DeGroote Pain Clinic. Participants were asked to complete six open-ended questions following four weekly 1-h yoga classes, through in-person or virtual delivery. Survey responses were thematically and separately analyzed by reviewers. Results Forty-one (N = 41) participants (56% males, 71% veterans) with an average age of 50.87 (SD 10.10) years provided comments. Nine themes emerged: (1) mind and body are one through yoga practices; (2) meaningful practice of yoga basics is productive for range of motion/movement, tension in joints, and chronic pain; (3) yoga classes provide an enjoyable process of learning; (4) yoga reminds patients of their physical capabilities; (5) routine practices lead to improvements; (6) yoga improved on strategies for chronic pain; (7) yoga can be adapted for each patient; (8) mindset improves to include positive thinking, better focus, and willingness to try new things; and (9) improvements exist for the current yoga programming. Conclusion Findings of the current study were nine qualitative themes that present the experience of patients with chronic pain in the yoga sessions.
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Affiliation(s)
- Amy Huang
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Eleni G. Hapidou
- Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Ganesh N, Sun S, Feder A, Galfalvy H, Yehuda R, Byma L, Haghighi F. Delivery of Telehealth Complementary and Integrated Health Interventions Improves Mental Health and Overall Wellness to Broaden Veterans' Access to Care. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:127-130. [PMID: 36516132 PMCID: PMC10133970 DOI: 10.1089/jicm.2022.0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Complementary and integrative health (CIH) interventions show promise in improving overall wellness and engaging Veterans at risk of suicide. Methods: An intensive 4-week telehealth CIH intervention programming was delivered motivated by the COVID-19 pandemic, and outcomes were measured pre-post program completion. Results: With 93% program completion (121 Veterans), significant reduction in depression and post-traumatic stress disorder symptoms were observed pre-post telehealth CIH programing, but not in sleep quality. Improvements in pain symptoms, and stress management skills were observed in Veterans at risk of suicide. Discussion: Telehealth CIH interventions show promise in improving mental health symptoms among at-risk Veterans, with great potential to broaden access to care toward suicide prevention.
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Affiliation(s)
| | - Shengnan Sun
- James J. Peters VA Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann Feder
- James J. Peters VA Medical Center, Bronx, NY, USA
| | | | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Byma
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Gilchrist H, Haynes A, Oliveira JS, Sherrington C, Clementson L, Glenn J, Jones J, Sesto R, Tiedemann A. 'My words become my hands': Yoga instructors' experiences of adapting teleyoga in the SAGE fall prevention trial-A qualitative analysis. Digit Health 2023; 9:20552076231185273. [PMID: 37434722 PMCID: PMC10331186 DOI: 10.1177/20552076231185273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
Objective This research identifies practical lessons regarding the delivery of teleyoga. Our objectives are to (1) describe challenges and opportunities experienced by yoga instructors when moving the Successful AGEing (SAGE) yoga programme online, and (2) describe how yoga instructors adapted to manage the challenges and leverage opportunities presented by teleyoga. Methods This study is a secondary analysis of the data from a previous realist process evaluation of the SAGE yoga trial. The SAGE yoga trial is testing the effect of a yoga-based exercise programme on falls among 700 community-dwelling people aged 60+ years. We draw on focus groups and interviews with four SAGE yoga instructors which we analysed using previously developed programme theories combined with inductive coding and an analytical workshop. Results The concerns of the yoga instructors about teleyoga can be characterised into four broad issues: threats to safety, altered interpersonal dynamics, facilitating mind-body connection and difficulties with technology. The SAGE instructors identified eight modifications they used to manage these challenges: a 1:1 participant interview prior to programme commencement, more descriptive verbal instructions, increased focus on interoception, increased attention and support, slower more structured class flow, simplifying poses, adapting the studio environment and IT support. Conclusions We have created a typology of strategies for addressing challenges in the delivery of teleyoga for older people. As well as maximising engagement with teleyoga, these manageable strategies could be applied by other instructors to a wide range of telehealth classes, improving the uptake and adherence of beneficial online programmes and services.
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Affiliation(s)
- Heidi Gilchrist
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, Gadigal Country, NSW, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW, Australia
| | - Abby Haynes
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, Gadigal Country, NSW, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW, Australia
| | - Juliana S Oliveira
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, Gadigal Country, NSW, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW, Australia
| | - Catherine Sherrington
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, Gadigal Country, NSW, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW, Australia
| | | | | | - June Jones
- Omnibody Yoga and Pilates, Sydney, Australia
| | | | - Anne Tiedemann
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, Gadigal Country, NSW, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW, Australia
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Khanna A, Dryden EM, Bolton RE, Wu J, Taylor SL, Clayman ML, Anwar C, Kasom D, McGowan M, Mullur RS, Bokhour BG, Hyde J. Promoting Whole Health and Well-Being at Home: Veteran and Provider Perspectives on the Impact of Tele-Whole Health Services. Glob Adv Health Med 2022; 11:2164957X221142608. [PMID: 36452292 PMCID: PMC9703484 DOI: 10.1177/2164957x221142608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background The Veterans Health Administration (VA) is undergoing a transformation in how healthcare is organized and provided. This transformation to a Whole Health System of Care encompasses the integration of complementary and integrative health services, education, and Whole Health coaching to develop Veterans' self-care skills. During the COVID-19 pandemic, these services were provided via telehealth (tele-WH). Objective We sought to understand Veteran and provider perspectives on how tele-WH impacts Veteran engagement in Whole Health-aligned services and the impact on their well-being. Methods Semi-structured interviews were conducted with 51 providers who delivered tele-WH at 10 VA Medical Centers (VAMCs) and 19 Veterans receiving tele-WH at 6 VAMCs. Participants were asked about their experiences with tele-WH, what they perceived to be the impact of tele-WH on Veterans, and their preferences moving forward. Interviews were transcribed, and a content analysis was performed using a rapid approach. Results We identified 3 major themes that describe the perceived impact of tele-WH on Veterans. These include: (1) increased use of Whole Health-aligned services; (2) deeper engagement with Whole-Health aligned services; and (3) improvements in social, psychological, and physical well-being. Conclusion Tele-WH is perceived to be a strong complement to in-person services and is a promising mechanism for improving engagement with Whole Health-aligned services and promoting Veteran well-being. Future research is needed to measure outcomes identified in this study and to support more equitable access to telehealth for all.
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Affiliation(s)
- Aishwarya Khanna
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Eileen M. Dryden
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Rendelle E. Bolton
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Brandeis University, The Heller School for Social Policy and Management, MA, USA
| | - Juliet Wu
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Stephanie L. Taylor
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
- University of California Los Angeles, David Geffen School of Medicine, Department of Medicine School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA
| | - Marla L. Clayman
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, 368 Plantation Street Worcester, MA 01605
| | - Chitra Anwar
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Danna Kasom
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Michael McGowan
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Rashmi S. Mullur
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
- Division of Diabetes, Endocrinology & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Integrative Medicine Collaborative, University of California Los Angeles Health, Los Angeles, CA, USA
| | - Barbara G. Bokhour
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, 368 Plantation Street Worcester, MA 01605
| | - Justeen Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of Medicine, Section of General Internal Medicine, Department of Medicine, Boston, MA, USA
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Haynes A, Gilchrist H, Oliveira JS, Sherrington C, Tiedemann A. "I wouldn't have joined if it wasn't online": understanding older people's engagement with teleyoga classes for fall prevention. BMC Complement Med Ther 2022; 22:283. [PMID: 36324148 PMCID: PMC9628174 DOI: 10.1186/s12906-022-03756-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Yoga-based exercise is a promising strategy for promoting healthy ageing, with the potential to reduce falls and increase physical, cognitive and psychological wellbeing. Teleyoga (real-time yoga provided via interactive videoconferencing) can deliver yoga programs at scale, potentially reducing costs, increasing convenience, and reaching people who cannot attend studio-based classes. But better understanding of how older people perceive and engage with teleyoga is needed to optimise its design, implementation and promotion. METHODS This study built on a previous realist process evaluation of the SAGE yoga trial which is testing the effect of a yoga-based exercise program on falls among 700 community-dwelling people aged 60 + years. In this second phase of evaluation we conducted focus groups with participants who had completed the SAGE program online and with the yoga instructors who were delivering it. We also conducted interviews with participants who had withdrawn from the trial. Six program theories developed in the earlier evaluation provided a framework for data analysis, supplemented by inductive coding and an analytical workshop. RESULTS Participants described physical and psychological benefits from the SAGE teleyoga program. While noting that teleyoga cannot facilitate hands-on correction or the same quality of observation or interaction as studio classes, participants were highly appreciative of their yoga instructors' strategies for optimising visibility, instruction, social connection and therapeutic alliance, and for adapting to constrained home environments. Some participants argued that teleyoga was superior to studio classes due to its accessibility and convenience, its lower exposure to potential embarrassment about physical appearance or capabilities, and a reduced sense of peer competition and distraction. Our program theories applied across studio and online modes of delivery. CONCLUSION Teleyoga increases accessibility for people in diverse locations and circumstances; it provides a psychologically safer space which combats self-consciousness and unwanted competitiveness; it may enhance embodiment and mindfulness for some; and it has the potential to be offered relatively cheaply at scale which could support free or reduced price classes for people on low incomes and pensions, thereby encouraging a wider population to engage in yoga for healthy ageing and fall prevention.
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Affiliation(s)
- Abby Haynes
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
| | - Heidi Gilchrist
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
| | - Juliana S Oliveira
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
| | - Catherine Sherrington
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
| | - Anne Tiedemann
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
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What helps older people persevere with yoga classes? A realist process evaluation of a COVID-19-affected yoga program for fall prevention. BMC Public Health 2022; 22:463. [PMID: 35255864 PMCID: PMC8901433 DOI: 10.1186/s12889-022-12818-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/21/2022] [Indexed: 12/29/2022] Open
Abstract
Background Falls among older people are a major global health concern. This process evaluation investigates the experience of participants aged 60+ in a yoga program aimed at preventing falls which transitioned from studio-based classes to online classes in response to COVID-19 restrictions. We sought to understand how the Successful AGEing (SAGE) yoga program functioned in both settings and as a hybrid program, and to explain why it worked well for most participants. Methods Realist process evaluation was used to explore the factors that facilitated a successful transition for most participants, and to consider why it did not work for a minority. This approach develops program theories that describe which mechanisms an intervention is (or is not) activating, and how this is mediated by context to generate process outcomes. Data included interviews with participants (n = 21) and yoga instructors (n = 3), self-report feedback forms (n = 46), observation of classes and routine process measures. Results Factors that facilitated a successful transition for most participants included the quality of yoga instruction, the program format and inherent characteristics of yoga. Gains in transitioning online included continuity and greater convenience. Losses included perceived reduction in the effectiveness of yoga instruction. There were greater challenges for people struggling with pain and in disadvantageous home environments. We identified six program theories configured around 16 mechanisms: 1. It’s worth the effort and 2. In expert hands (these had the same mechanisms: value expectancy, therapeutic alliance and achievement/mastery), 3. A communal experience (these mechanisms were shared experience, social connection, social comparison and peer checking), 4. Putting yoga within reach (accessibility, convenience, gratitude), 5. Building yoga habits (purposeful structure, momentum, accountability and continuity), and 6. Yoga’s special properties (embodiment and mindfulness). Conclusions This study showed that online delivery of a yoga program for people aged 60+ retained much of the value of a face-to-face program for the majority of participants, and increased the value for some. The structured, communal nature of an organised group program delivered by a skilled instructor, together with yoga’s intrinsic focus on mindfulness, facilitated continued engagement and perceived health benefits, despite the change in delivery mode. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12818-5.
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10
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Kwok JYY, Lee JJ, Choi EPH, Chau PH, Auyeung M. Stay mindfully active during the coronavirus pandemic: a feasibility study of mHealth-delivered mindfulness yoga program for people with Parkinson's disease. BMC Complement Med Ther 2022; 22:37. [PMID: 35130894 PMCID: PMC8818838 DOI: 10.1186/s12906-022-03519-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Importance Patients with long-term neurological conditions, such as Parkinson’s disease (PD), are particularly vulnerable to the public health measures taken to combat the COVID-19 pandemic. The inaccessibility of center-based rehabilitation further aggravated their motor dysfunctions as well as mental distress, leading to exacerbation of motor and non-motor symptoms, high healthcare utilization and worsened health-related quality of life (HRQOL). Objective This study aimed to evaluate the feasibility, safety, and preliminary effects of the mHealth-delivered home-based mindfulness yoga program on functional balance, motor symptoms, mental health and HRQOL in patients with PD. Design, setting and participants This prospective, single-arm, non-randomized feasibility study adopted a sequential explanatory mixed-method design. Adults (aged ≥ 18) with a clinical diagnosis of idiopathic Parkinson’s disease (Hoehn and Yahr stage I to III) who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling. Intervention Home-based mindfulness yoga training were delivered via video-conferencing software (Zoom) in eight bi-weekly 90-min sessions. Main outcomes and measures This current study measured functional balance, motor symptoms, perceived balance confidence, perceived freezing of gait symptoms, anxiety and depression, mindfulness and HRQOL using a tele-assessment approach at baseline and 1-week post-intervention. All participants were invited to attend qualitative individual interviews to explore their experience of using online mindfulness yoga program as a lifestyle intervention for PD rehabilitation. Results Among the ten patients, 80% completed the program with an adherence rate of 98.4%. All participants were able to learn and practice mindfulness yoga following the eight bi-weekly online mindfulness yoga training sessions, without any significant adverse events. Tele-assessment of outcomes were feasible and uneventful. Qualitative feedback revealed participants had a high preference of using the tele-rehabilitation approach to stay mindful and being active, both physically and socially, while confronting the changes brought by COVID-19 pandemic. Conclusions and relevance The mHealth-delivered home-based mindfulness yoga intervention was feasible, safe, and well-accepted among people with PD to relieve the burden brought by COVID-19 pandemic. Future studies should adopt a design with enhanced rigor, a comparison group, and enlarged sample size to evaluate the efficacy of the program in patients with long-term neurological conditions and/or physical impairments. We recommend a longer intervention duration of at least 8 weeks to enhance the psychophysiological effects.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
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11
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Huang AJ, Chesney MA, Schembri M, Pawlowsky S, Nicosia F, Subak LL. Rapid Conversion of a Group-Based Yoga Trial for Diverse Older Women to Home-Based Telehealth: Lessons Learned Using Zoom to Deliver Movement-Based Interventions. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:188-192. [PMID: 35167358 PMCID: PMC8867109 DOI: 10.1089/jicm.2021.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This brief report describes the rapid conversion of a randomized trial of a Hatha-based yoga program for older women with urinary incontinence to a telehealth videoconference platform during the coronavirus disease 2019 (COVID-19) pandemic. Interim results demonstrate the feasibility of recruiting and retaining participants across a wide range of ages and ethnic backgrounds, but also point to potential obstacles and safety concerns arising from telehealth-based instruction. The investigators present lessons learned about the benefits and challenges of using telehealth platforms to deliver movement-based interventions and consider strategies to promote accessible and well-tolerated telehealth-based yoga programs for older and diverse populations. Clinical Trial Registration number: NCT03672461.
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Affiliation(s)
- Alison J. Huang
- Department of Medicine, University of California, San Francisco, California, USA
| | - Margaret A. Chesney
- Department of Medicine, University of California, San Francisco, California, USA
| | - Michael Schembri
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Sarah Pawlowsky
- Department of Physical Therapy, San Francisco State University, San Francisco, California, USA
| | - Francesca Nicosia
- Integrative Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, California, USA
| | - Leslee L. Subak
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
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12
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Betthauser LM, Forster JE, Bortz A, Penzenik M, Hernández TD, Bahraini N, Brenner LA. Strength and awareness in action: Feasibility of a yoga-based intervention for post-acute mild TBI headaches among veterans. Contemp Clin Trials Commun 2021; 22:100762. [PMID: 34013090 PMCID: PMC8113729 DOI: 10.1016/j.conctc.2021.100762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/12/2021] [Accepted: 03/16/2021] [Indexed: 01/03/2023] Open
Abstract
Background Mild traumatic brain injury (mTBI) is a signature injury sustained by Veterans during recent conflicts. For some, mTBI/concussion is associated with disabling symptoms, including post-concussive headaches (PCH). However, there are limited evidence-based treatments for persistent PCH. Objective Investigators assessed the feasibility of design elements of a yoga-based interventional trial for PCH among Veterans, as well as the acceptability of the intervention. Methods This randomized controlled acceptability and feasibility trial was implemented using a waitlist-control design. Design elements of interest included: an exercise run-in class; recruitment and retention strategies; and, ecological momentary assessment (EMA) modalities to track headaches and yoga practice. Veteran satisfaction regarding the intervention was also evaluated. A descriptive analysis was conducted on candidate outcomes including PCH, post-concussive symptoms, pain, and daily functioning. Results Twenty-seven participants (out of 70 consented and eligible after Study Visit 1) completed each evaluation timepoint and regularly attended yoga sessions, with 89% of these Veterans reporting moderate to high levels of satisfaction with the intervention at study completion. Qualitatively, participants endorsed improvements in headaches, chronic pain, and mood. Feasibility results were mixed. Initial feasibility criterion regarding yoga attendance was not met; however, modifications, such as expansion to an additional clinic site and reduction of in-person yoga sessions with increased encouragement to use study-created online yoga videos improved feasibility of the study design. Participants most frequently used mobile and web-based EMA modalities to track yoga practice. Conclusions Although challenges with feasibility of the study design elements were noted, results suggested acceptability of the yoga-based intervention for Veterans with persistent PCH. Additional exploration regarding the frequency and modality of yoga delivery (e.g., in-person, telehealth) is warranted. Impact Veterans found the yoga-based intervention acceptable, however exploration of novel modalities of intervention delivery will likely be necessary to enhance the feasibility of intervention implementation during future trials.
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Affiliation(s)
- Lisa M Betthauser
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, 12631 E 17th Ave, Rm1201G, Aurora, CO, 80045, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, 12631 E 17th Ave, Rm1201G, Aurora, CO, 80045, USA
| | - Ann Bortz
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, 12631 E 17th Ave, Rm1201G, Aurora, CO, 80045, USA
| | - Molly Penzenik
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Theresa D Hernández
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, 12631 E 17th Ave, Rm1201G, Aurora, CO, 80045, USA.,Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, Muenzinger D244, 345 UCD, Boulder, CO, 80309, USA
| | - Nazanin Bahraini
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, 12631 E 17th Ave, Rm1201G, Aurora, CO, 80045, USA.,Department of Psychiatry University of Colorado, Anschutz Medical Campus, Aurora, 13001 E 17th Pl, Q20-C2000, Aurora, CO, 80045, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, 12631 E 17th Ave, Rm1201G, Aurora, CO, 80045, USA.,Department of Psychiatry University of Colorado, Anschutz Medical Campus, Aurora, 13001 E 17th Pl, Q20-C2000, Aurora, CO, 80045, USA.,Department of Neurology University of Colorado, Anschutz Medical Campus, Aurora, 13001 E 17th Pl, Q20-C2000, Aurora, CO, 80045, USA
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13
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Finn MTM, Brown HR, Friedman ER, Kelly AG, Hansen K. Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine. Glob Adv Health Med 2021; 10:2164956121997361. [PMID: 33680574 PMCID: PMC7900841 DOI: 10.1177/2164956121997361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/17/2021] [Accepted: 01/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Integrative medicine is a key framework for the treatment of chronic medical
conditions, particularly chronic pain conditions. The COVID-19 pandemic
prompted rapid implementation of telehealth services. Objective We present outcomes of a complete and rapid transition to telehealth visits
at an outpatient integrative medicine center in the Southeastern United
States. Method Patients and administrative staff took surveys comparing telehealth to
in-person visits within four weeks of our clinic's transition to telehealth
and three months later. Beginning four weeks after the clinic’s telehealth
conversion in March 2020, patients who had a telehealth visit at the center
completed a survey about their telehealth experience and another survey
three months later. Results Patient quality judgements significantly favored telehealth at baseline,
B = .77 [0.29 – 1.25], SE = .25, t(712) = 3.15, p = .002,
and increased at three months, B = .27 [–0.03 – 0.57], SE = .15,
t(712) = 1.76, p = .079. Telehealth technology
usability and distance from the center predicted patient ratings of
telehealth favorability. Providers favored in-person visits more than
patients, B = –1.00 [–1.56 – –0.44], SE = .29,
t(799) = –3.48, p < .001, though did not favor either
in-person or telehealth more than the other. Patient discrete choice between
telehealth and in-person visits was split at baseline (in-person: n = 86
[54%]; telehealth: n = 73 [46%]), but favored telehealth at three months
(in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete
choice favored telehealth at follow-up across providers and patients,
OR = 2.69 [.1.18 – 6.14], z = 2.36, p = .018. Major qualitative themes
highlight telehealth as acceptable and convenient, with some challenges
including technological issues. Some felt a loss of interpersonal connection
during telehealth visits, while others felt the opposite. Conclusion We report converging mixed-method data on the successful and sustained
implementation of telehealth with associated policy and clinical
implications during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Michael T M Finn
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Adult Congenital Heart Disease Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Hannah R Brown
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Emily R Friedman
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University School of Nursing, Nashville, Tennessee
| | - A Grace Kelly
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn Hansen
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Nanda U, Luo J, Wonders Q, Pangarkar S. Telerehabilitation for Pain Management. Phys Med Rehabil Clin N Am 2021; 32:355-372. [PMID: 33814062 PMCID: PMC9585226 DOI: 10.1016/j.pmr.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Telerehabilitation for pain management uses communication technology to minimize geographic barriers. Access to such technology has proven critically important during the coronavirus disease-2019 pandemic and has been useful for patients with chronic pain disorders unable to travel. The evaluation and treatment of such disorders requires a whole health approach that individualizes treatment options and delivers care through a biopsychosocial approach. The goals of care are unchanged from an in-person patient-provider experience. Telerehabilitation can be successfully implemented in pain management with appropriate consideration for staging an evaluation, a structured approach to the visit, and application of standard clinical metrics.
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Affiliation(s)
- Udai Nanda
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (W117), Los Angeles, CA 90073, USA; Division of Physical Medicine and Rehabilitation, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Jerry Luo
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (W117), Los Angeles, CA 90073, USA; Division of Physical Medicine and Rehabilitation, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Quinn Wonders
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (W117), Los Angeles, CA 90073, USA; Department of Pharmacy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Sanjog Pangarkar
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (W117), Los Angeles, CA 90073, USA; Division of Physical Medicine and Rehabilitation, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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15
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Mullur RS, Kaur Cheema SP, Alano RE, Chang LE. Tele-Integrative Medicine to Support Rehabilitative Care. Phys Med Rehabil Clin N Am 2021; 32:393-403. [PMID: 33814064 DOI: 10.1016/j.pmr.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Complementary and integrative health (CIH) modalities have therapeutic value in the multidisciplinary rehabilitation of chronic pain patients. Evidence of such has been seen with the Whole Health Model at the (Veterans Affairs) VA Healthcare system. CIH therapies, including yoga, tai chi, mindfulness meditation, hypnosis, self-massage, and acupressure, are significantly effective for managing chronic pain with little to no negative effects, and can be easily incorporated into telemedicine care with great potential benefit. The future of wellness in telemedicine is evolving with great potential, and needs further attention to addressing barriers of care.
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Affiliation(s)
- Rashmi S Mullur
- Department of Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, 11301 Wilshire Boulevard, Mail Code 111-D, Los Angeles, CA 90073, USA.
| | - Seetal Preet Kaur Cheema
- Department of Anesthesia (212), VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Ryan Edward Alano
- Department of Physical Medicine and Rehabilitation (1415), VA Greater Los Angeles Healthcare System, 1301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Lynn Elizabeth Chang
- Department of Physical Medicine and Rehabilitation (1415), VA Greater Los Angeles Healthcare System, 1301 Wilshire Boulevard, Los Angeles, CA 90073, USA
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16
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Abstract
Headache is one of the most disabling conditions in the world. Despite plentiful evidence supporting rehabilitation strategies, headache is significantly underassessed and undertreated. Obstacles to headache care include lack of available expertise in headache management, few available resources for effective assessment and treatment, and cost and disability that preclude treatment seeking in patients with headache. Telerehabilitation can allow providers to access expert consultation and gives patients easier access to assessment and treatment. This article covers existing telerehabilitation options for headache management and explores the strength of evidence supporting these approaches. Risks of telerehabilitation and recommendations for future development are discussed.
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Affiliation(s)
- Don McGeary
- Department of Rehabilitation Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Cindy McGeary
- Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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17
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Cohen SP, Baber ZB, Buvanendran A, McLean BC, Chen Y, Hooten WM, Laker SR, Wasan AD, Kennedy DJ, Sandbrink F, King SA, Fowler IM, Stojanovic MP, Hayek SM, Phillips CR. Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises. PAIN MEDICINE 2020; 21:1331-1346. [PMID: 32259247 PMCID: PMC7184417 DOI: 10.1093/pm/pnaa127] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for. METHODS To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period. RESULTS In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization. CONCLUSIONS The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.
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Affiliation(s)
- Steven P Cohen
- Anesthesiology, Neurology and Physical Medicine and Rehabilitation, Pain Medicine, Johns Hopkins School of Medicine, Maryland.,Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zafeer B Baber
- Division of Anesthesiology and Interventional Pain Management, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Asokumar Buvanendran
- Anesthesiology and Orthopedic Surgery, Rush University College of Medicine, Chicago, Illinois
| | - Brian C McLean
- US Army Pain Management Consultant, Pain Management, Department of Anesthesiology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Yian Chen
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - W Michael Hooten
- Anesthesiology and Psychiatry, Mayo School of Medicine, Rochester, Minnesota
| | - Scott R Laker
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado
| | - Ajay D Wasan
- Anesthesiology and Psychiatry, Pain Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David J Kennedy
- Department of Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Friedhelm Sandbrink
- Pain Management Specialty Services Director, Veterans Health Administration, Washington DC VA Medical Center, Washington, DC
| | - Scott A King
- US Air Force Pain Management Consultant, Eglin Air Force Base, Florida
| | - Ian M Fowler
- US Navy Pain Management Consultant, Director of Surgical Services, Naval Medical Center-San Diego, San Diego, California
| | - Milan P Stojanovic
- Anesthesiology, Critical Care and Pain Medicine Service, Interventional Pain Medicine, Edith Nourse Rogers Memorial Veterans Hospital, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
| | - Salim M Hayek
- Department of Anesthesiology, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Christopher R Phillips
- Department of Surgery, Anesthesiology Service, Naval Medical Center- San Diego, California, USA
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18
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Ghai B, Malhotra N, Bajwa SJS. Telemedicine for chronic pain management during COVID-19 pandemic. Indian J Anaesth 2020; 64:456-462. [PMID: 32792708 PMCID: PMC7398026 DOI: 10.4103/ija.ija_652_20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/23/2022] Open
Abstract
Treatment of chronic pain is an essential service. Due to lockdown, travel restrictions, social and physical distancing requirements or fear that health care facilities may be infected; patients may avoid visiting health care facilities in person. It is also imperative to decrease the risk of exposure of the health care workers (HCWs) to severe acute respiratory syndrome corona virus 2 (SARS CoV2) and to ease the overtly burdened health care system. But any disruption in pain practice will have alarming consequences for individuals, society, and whole of health care system and providers. In the current scenario of COVID-19 pandemic, telemedicine is emerging as a key technology for efficient communication and sustainable solution to provide essential health care services and should be considered for chronic pain patients (CPPs). Recently, Board of Governors in supersession of Medical Council of India along with National Institution for Transforming India (NITI Aayog) released “Telemedicine Practice Guidelines” enabling registered medical practitioners to provide healthcare using telemedicine. This article describes the challenges in CPPs during COVID-19 pandemic and the use of telemedicine as the rescue management vehicle for CPPs in current scenario.
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Affiliation(s)
- Babita Ghai
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Malhotra
- Professor Anaesthesiology and In Charge Pain Management Centre, Pt BDS PGIMS, Rohtak, Haryana, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
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19
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Krusche M, Mucke J, Burmester GR. What will be the job of the rheumatologist in 2030? Joint Bone Spine 2020; 87:525-527. [PMID: 32278812 DOI: 10.1016/j.jbspin.2020.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, 1, Charitéplatz, D-10117 Berlin, Germany.
| | - Johanna Mucke
- Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, 1, Charitéplatz, D-10117 Berlin, Germany
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