Synthesizing the Strength of the Evidence of Complementary and Integrative Health Therapies for Pain

Abstract Objective Pain and opioid use are highly prevalent, leading for calls to include nonpharmacological options in pain management, including complementary and integrative health (CIH) therapies. More than 2,000 randomized controlled trials (RCTs) and many systematic reviews have been conducted on CIH therapies, making it difficult to easily understand what type of CIH therapy might be effective for what type of pain. Here we synthesize the strength of the evidence for four types of CIH therapies on pain: acupuncture, therapeutic massage, mindfulness techniques, and tai chi. Design We conducted searches of English-language systematic reviews and RCTs in 11 electronic databases and previously published reviews for each type of CIH. To synthesize that large body of literature, we then created an “evidence map,” or a visual display, of the literature size and broad estimates of effectiveness for pain. Results Many systematic reviews met our inclusion criteria: acupuncture (86), massage (38), mindfulness techniques (11), and tai chi (21). The evidence for acupuncture was strongest, and largest for headache and chronic pain. Mindfulness, massage, and tai chi have statistically significant positive effects on some types of pain. However, firm conclusions cannot be drawn for many types of pain due to methodological limitations or lack of RCTs. Conclusions There is sufficient strength of evidence for acupuncture for various types of pain. Individual studies indicate that tai chi, mindfulness, and massage may be promising for multiple types of chronic pain. Additional sufficiently powered RCTs are warranted to indicate tai chi, mindfulness, and massage for other types of pain.

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Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map

Frontiers in Public Health ◽

10.3389/fpubh.2021.659075 ◽

2021 ◽

Vol 9 ◽

Author(s):

Lissandra Zanovelo Fogaça ◽

Caio Fabio Schlechta Portella ◽

Ricardo Ghelman ◽

Carmen Verônica Mendes Abdala ◽

Mariana Cabral Schveitzer

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Quality Assessment ◽

Systematic Reviews ◽

Tai Chi ◽

Well Being ◽

Evidence Map ◽

Qi Gong ◽

Positive Effects ◽

The Mind

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes.Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects.Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia.Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

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Meditation: Evidence Map of Systematic Reviews

Frontiers in Public Health ◽

10.3389/fpubh.2021.742715 ◽

2021 ◽

Vol 9 ◽

Author(s):

Caio Fábio Schlechta Portella ◽

Ricardo Ghelman ◽

Veronica Abdala ◽

Mariana Cabral Schveitzer ◽

Rui Ferreira Afonso

Keyword(s):

Health Outcomes ◽

Systematic Reviews ◽

Well Being ◽

Complementary Therapy ◽

Evidence Map ◽

Confidence Levels ◽

Positive Effects ◽

Key Word ◽

Meta Analyses

Study Basis: This evidence map presents a summary of studies that addressed the effects of meditation on various clinical and health conditions. Meditation is a contemplative practice that has been used for the promotion of health, and the treatment of different conditions.Method: The study is based on the search of four electronic databases for the period 1994-November 2019 and includes systematic reviews, meta-analyses, meta-syntheses, and integrative reviews. 3iE evidence gap map was the methodology of choice, and AMSTAR 2 was used for the analyses. Tableau was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects.Results: This map encompasses 191 studies, with Mindfulness being the key word that retrieved the highest number of results. Several meditation techniques were evaluated in different contexts, and the confidence levels of 22 studies were high, 84 were moderate, and 82 were low. Two 2 meta-syntheses and 1 integrative review were also included. Most of the studies reported positive effects and a beneficial potential of the practice of meditation. Health outcomes were divided into five groups out of which mental health and vitality, and well-being and quality of life stood out with the largest number of studies.Conclusions: Meditation has been applied in different areas. This Evidence Map intends to be an easy visual tool to access valuable evidence-based information on this complementary therapy for patients, health professionals, and managers.

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Implementation of health-focused interventions in vulnerable populations: protocol for a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-036937 ◽

2020 ◽

Vol 10 (7) ◽

pp. e036937

Author(s):

Amanda M Midboe ◽

Caroline Gray ◽

Hannah Cheng ◽

Leonore Okwara ◽

Randall C Gale

Keyword(s):

Social Services ◽

Vulnerable Populations ◽

Systematic Reviews ◽

Scoping Review ◽

English Language ◽

Grey Literature ◽

Large Body ◽

Care Continuum ◽

Scoping Reviews ◽

Meta Analyses

IntroductionVulnerable populations face significant challenges in navigating the care continuum, ranging from diagnosis of illness to linkage and retention in healthcare. Understanding how best to move individuals within these vulnerable populations across the care continuum is critical to improving their health. A large body of literature has focused on evaluation of implementation of various health-focused interventions in this population. However, we do not fully understand the unique challenges to implementing healthcare interventions for vulnerable populations. This study aims to examine the literature describing implementation of health service interventions among vulnerable populations to identify how implementations using the Consolidated Framework for Implementation Research are adapted. Findings from this review will be useful to implementation scientists to identify gaps in evidence and for adapting similar interventions in unique settings.Methods and analysisThis study protocol outlines a scoping review of the peer-reviewed and grey literature, using established approaches delineated in Arksey and O'Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. Search strategies will be developed and refined by a medical librarian in collaboration with the research team. Searches will be conducted in electronic databases (CINAHL, Cochrane, PsychINFO, PubMed, Social Services Abstracts, Web of Science, Google and Google Scholar) and limited to studies published between 1 August 2009 and 1 June 2020. Additionally, hand searches will be conducted in three relevant journals—Implementation Science, Systematic Reviews and BMJ Open. English-language studies and reports meeting inclusion criteria will be screened independently by two reviewers and the final list will be abstracted and charted in duplicate.Ethics and disseminationThis is a review of the literature; ethics approval is not indicated. We will disseminate findings from this study in peer-reviewed journals as well as presentations to relevant stakeholders and conferences.

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Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews

Medicina ◽

10.3390/medicina56010006 ◽

2019 ◽

Vol 56 (1) ◽

pp. 6

Author(s):

Carole A. Paley ◽

Mark I. Johnson

Keyword(s):

Chronic Pain ◽

Systematic Reviews ◽

Statistical Power ◽

English Language ◽

Meta Analysis ◽

Risk Of Bias ◽

Supporting Evidence ◽

Pharmacological Interventions ◽

Eligibility Criteria ◽

Meta Analyses

Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.

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Tai Chi and workplace wellness for health care workers

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.492 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R A Cocchiara ◽

B Dorelli ◽

A Mannocci ◽

G La Torre

Keyword(s):

Systematic Review ◽

Health Care ◽

Case Report ◽

Health Care Workers ◽

English Language ◽

Tai Chi ◽

Workplace Wellness ◽

Beneficial Effects ◽

Positive Effects ◽

Care Workers

Abstract Background Several studies show the positive effects of new non-medical therapies known as complementary and alternative medicines (CAMs). In this context, the discipline of tai chi is obtaining a wider consensus because of its many beneficial effects both on the human body and mind. Objective The aim of this study was to perform a systematic review of the scientific literature concerning the relationship between tai chi practice and wellness of health care workers (HCW) in their professional setting. Methods The research was performed in September 2019, investigating the databases Cinahl, Scopus, Web of Science, and PubMed. Full-text articles, written in English language and published after 1995, were taken into account. No restrictions regarding the study design were applied. A quality assessment was developed using AMSTAR, Jadad, Newcastle-Ottawa Scale, INSA, and CASE REPORT scale. Six papers were finally included: Three clinical trials, one observational study, one systematic review, and one case report. The methodological quality of the included studies was judged as medium level. Conclusions This systematic review suggests the potential impact of interventions such as tai chi as tools for reducing work-related stress among healthcare professionals. Keywords: Tai chi, Workplace Wellness, Nursing Key messages Tai chi, Workplace Wellness, Nursing. Health Professional, Stress, Workplace Wellbeing.

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Taping for conditions of the musculoskeletal system: an evidence map review

Chiropractic & Manual Therapies ◽

10.1186/s12998-020-00337-2 ◽

2020 ◽

Vol 28 (1) ◽

Author(s):

Zachary A. Cupler ◽

Muhammad Alrwaily ◽

Emily Polakowski ◽

Kevin S. Mathers ◽

Michael J. Schneider

Keyword(s):

Systematic Reviews ◽

Musculoskeletal System ◽

English Language ◽

Data Extraction ◽

Meta Analysis ◽

Body Region ◽

Controlled Trials ◽

Cochrane Central Register ◽

Evidence Map ◽

Body Regions

Abstract Background Taping is a common treatment modality used by many rehabilitation providers. Several types of tapes and taping methods are used in the treatment of musculoskeletal dysfunction and pain. Purpose To summarize and map the evidence related to taping methods used for various joints and conditions of the musculoskeletal system, and to provide clinicians and researchers with a user-friendly reference with organized evidence tables. Data sources The PEDro, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register for Controlled Trials, PubMed, and PROSPERO databases were searched from inception through October 31, 2019. Study selection Eligible studies were selected by two independent reviewers and included either systematic reviews (SRs) or randomized controlled trials (RCTs) and included a musculoskeletal complaint using a clinical outcome measure. Data extraction Data was extracted by two investigators independently. Risk of bias and quality were assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) for SRs or the Physiotherapy Evidence Database (PEDro) scale for RCTs. The protocol was registered with PROSPERO (CRD42019122857). Data synthesis Twenty-five musculoskeletal conditions were summarized from forty-one SRs and 127 RCTs. There were 6 SRs and 49 RCTs for spinal conditions. Kinesio tape was the most common type of tape considered. Four evidence tables representing the synthesized SRs and RCTs were produced and organized by body region per condition. Limitations Inclusion of only English language studies. Also, the heterogeneous nature of the included studies prevented a meta-analysis. Conclusions There is mixed quality evidence of effectiveness for the different types of taping methods for different body regions and conditions. All of the SRs and RCTs found during our search of the taping literature have been organized into a series of appendices. A synthesis of the results have been placed in evidence tables that may serve as a useful guide to clinicians and researchers.

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Tai Chi and Workplace Wellness for Health Care Workers: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010343 ◽

2020 ◽

Vol 17 (1) ◽

pp. 343

Author(s):

Rosario Andrea Cocchiara ◽

Barbara Dorelli ◽

Shima Gholamalishahi ◽

William Longo ◽

Emiliano Musumeci ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Case Report ◽

Health Care Workers ◽

English Language ◽

Tai Chi ◽

Beneficial Effects ◽

Work Related ◽

Positive Effects ◽

Care Workers

Several studies show the positive effects of new non-medical therapies known as complementary and alternative medicines (CAMs). In this context, the discipline of tai chi is obtaining a wider consensus because of its many beneficial effects both on the human body and mind. The aim of this study was to perform a systematic review of the scientific literature concerning the relationship between tai chi practice and wellness of health care workers (HCW) in their professional setting. The research was performed in September 2019, investigating the databases Cinahl, Scopus, Web of Science, and PubMed. Full-text articles, written in English language and published after 1995, were taken into account. No restrictions regarding the study design were applied. A quality assessment was developed using AMSTAR, Jadad, Newcastle–Ottawa Scale, INSA, and CASE REPORT scale. Six papers were finally included: Three clinical trials, one observational study, one systematic review, and one case report. The methodological quality of the included studies was judged as medium level. In conclusion, this systematic review suggests the potential impact of interventions such as tai chi as tools for reducing work-related stress among healthcare professionals. Further research will be needed in order to gain robust evidence of its efficacy.

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