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Questions?. Establishing an Integrative Care Center Dr. Brent Bauer Dr. Adam Perlman Thursday , October 4th. Title by Presenter Name. From CAM to Integrative Medicine at Mayo Clinic Research Informing Practice and Improving Care.

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  1. Questions? Establishing an Integrative Care Center Dr. Brent BauerDr. Adam Perlman Thursday, October 4th Title by Presenter Name

  2. From CAM to Integrative Medicine at Mayo ClinicResearch Informing Practice and Improving Care Brent A. Bauer MDDirector, Complementary and Integrative Medicine Program Mayo Clinic Department of Medicine

  3. Massage therapy quiet relaxation vs Decreased Massage Therapy – Mayo ClinicPilot Trial 58 cardiac surgery patients Pain Anxiety Tension Cutshall, Comp. Therap.Clin. Practice, 2009

  4. Massage Therapy after CV Surgery Control group (n=28) Massage group (n=30) 10 10 8 8 6 6 V A S 4 4 2 2 0 0 Before After Before After Anxiety Level

  5. Massage Therapy after CV Surgery Control group (n=28) Massage group (n=30) 10 10 8 8 6 6 V A S 4 4 2 2 0 0 Before After Before After Pain level

  6. Massage Therapy – Mayo ClinicRandomized – Controlled Trial • 113 cardiac surgery patients • MT therapy days 2,4 vs. quiet relaxation • Decreased pain P<0.001 • Decreased anxiety P<0.001 • Decreased tension P<0.001 • Increased relaxation P<0.001 Bauer, Comp. Therap. Clin. Practice, 2010

  7. Massage Therapy at Mayo ClinicOther Studies • MT for colo-rectal surgery patients 2009 • MT prior to cardiac interventions 2009 • MT for thoracic surgery patients 2011 • MT for breast cancer surgery pts 2012 • MT for cardiologists and nurses 2010 • MT for cardiac ultrasonographers 2011 • MT for in-patient nurses 2012

  8. Massage Therapy at Mayo ClinicThe Impact • Massage therapy now routine at MC • Domino effect • Small investment > “snowball” returns • 48 hospitals in US • 7 international hospitals • Australia, Austria, China, Ireland, Switzerland, Turkey

  9. Massage Therapy at Mayo ClinicThe Vision Massage therapy routinely available to all Hospitalized patients at Mayo Clinic Family members Staff Continue to use the Mayo experience to transform health care in the U.S. and around the world

  10. Questions bauer.brent@mayo.edu

  11. Bibliography • Effect of massage therapy for postsurgical mastectomy recipients. Drackley NL, Degnim AC, Jakub JW, Cutshall SM, Thomley BS, Brodt JK, Vanderlei LK, Case JK, Bungum LD, Cha SS, Bauer BA, Boughey JC. Clin J Oncol Nurs. 2012 Apr;16(2):121-4. PMID:22459520 • Feasibility and effectiveness of massage therapy for symptom relief in cardiac catheter laboratory staff: a pilot study. Keller SR, Engen DJ, Bauer BA, Holmes DR Jr, Rihal CS, Lennon RJ, Loehrer LL, Wahner-Roedler DL. Complement Ther Clin Pract. 2012 Feb;18(1):4-9. Epub 2011 Sep 23. PMID:22196566 • Effect of massage on pain management for thoracic surgery patients. Dion L, Rodgers N, Cutshall SM, Cordes ME, Bauer B, Cassivi SD, Cha S. Int J Ther Massage Bodywork. 2011;4(2):2-6. Epub 2011 Jun 29. PMID:21847428 • Massage therapy after cardiac surgery. Wang AT, Sundt TM 3rd, Cutshall SM, Bauer BA. Semin Thorac Cardiovasc Surg. 2010 Autumn;22(3):225-9. Review. PMID:21167456 • The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study. Engen DJ, Wahner-Roedler DL, Nadolny AM, Persinger CM, Oh JK, Spittell PC, Loehrer LL, Cha SS, Bauer BA. BMC Complement Altern Med. 2010 Sep 16;10:50. PMID:20846441

  12. Bibliography • Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study. Cutshall SM, Wentworth LJ, Engen D, Sundt TM, Kelly RF, Bauer BA. Complement Ther Clin Pract. 2010 May;16(2):92-5. Epub 2009 Nov 14. PMID:20347840 • Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, Brekke KM, Kelly RF, Sundt TM 3rd. Complement Ther Clin Pract. 2010 May;16(2):70-5. Epub 2009 Jul 14. PMID:20347836 • Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bartel DC, Cutshall SM, Tilbury RT, Lennon R, Bauer BA. Prog Cardiovasc Nurs. 2009 Dec;24(4):155-61. PMID:20002340 • Value of massage therapy for patients in a breast clinic. Pruthi S, Degnim AC, Bauer BA, DePompolo RW, Nayar V. Clin J Oncol Nurs. 2009 Aug;13(4):422-5. PMID:19648098

  13. Questions? Title by Presenter Name

  14. American Massage Therapy Association October 4, 2012 Adam Perlman, MD, MPH Executive Director Duke Integrative Medicine

  15. At the Beginning

  16. New Jersey Siegler Center for Integrative Medicine Services Offered Who do you hire Research

  17. Pilot Study (2006) • Randomized controlled trial; n=68 • Massage vs. wait list • Intervention: Whole body, Swedish massage for 8 weeks • Standard techniques of petrissage, effleurage, and tapotement • 60 min twice weekly x 4 weeks • 60 min once weekly x 4 weeks • Outcomes: function (WOMAC), pain (VAS), ROM, 50-ft walk • Results: well tolerated, decreased pain, and improved function • Effects persisted for weeks after cessation of massage 1. Archives of Internal Med. 2006;166:2533-2538

  18. UMDNJ Serving the underserved Institute for Therapeutic Massage Research

  19. Dose-finding study (2009-2011) • 2-Year study to define the ‘optimal practical’ dose of massage for OA of the knee • Designed to inform a future, more definitive trial • Randomized, wait list-controlled, clinical trial • 5-arm trial • 4 different ‘doses’ of standardized, whole body Swedish • wait list control • Supported by NCCAM grant R01 AT004623 • Trial Registration: clinicaltrials.gov NCT00970008

  20. Dose-finding study - Design • Four distinct ‘doses’ • 1. 30 min/week x 8 weeks (240 min total) • 2. 30 min biweekly x 4 weeks, 30 min weekly x 4 weeks (360 min total) • 3. 60 min/week x 8 weeks (480 min total) • 4. 60 min biweekly x 4 weeks, 60 min weekly x 4 weeks (720 min total) • 5. Usual Care (no massage) • Included: • Adults with radiographically confirmed OA of the knee • Self-reported pain between 4-9 on VAS • Excluded: • RA, fibromyalgia, intraarticular injections, knee replacement • Assessed: baseline, 8-, 16-, and 24-weeks • Outcomes: WOMAC, VAS, ROM, 50-ft walk

  21. Manualization • Goal: to produce a study protocol that was tailored to subjects with OA of the knee, while respectful of the individualized nature of massage therapy • How to standardize an inherently individualized intervention? • CAM/nonphamacological research dilemma • 2-month process • Massage therapists from pilot study • Investigative team • Massage scientists • Constraints • Standard techniques • Reproducibility • Flexible for individual subject variability

  22. Manualized protocols

  23. Results • Recruitment completed two months ahead of schedule • Free massages… • And more free massages! • 125 enrolled • 119 completed 8-week assessments • 115 completed entire trial • Intervention delivered: 11/2009 – 10/2010

  24. Conclusions • Winner: 60-min once weekly • ‘Optimal-practical’= best bang for the buck • producing the greatest ratio of desired effect compared to costs • costs = time, labor, and convenience • Reinforced results of pilot study • Dose used for current study -

  25. Duke Shifting the model Access Forging relationship DCI Research

  26. Current Study • Phase 2b Efficacy Trial • Using 60-min once weekly dose • Massage vs. light touch vs. wait list • 52-week follow-up • N=219 at three sites: Duke, UMDNJ, Yale • Cost-effectiveness • Biomarkers • ‘Unanticipated Benefits’ • Modeled on studies by Cherkin et al. (Seattle) • Qualitative study • Participants of dose-finding study • ‘What else?’

  27. The good, the bad, and the ugly.

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