This document summarizes evidence from research on various complementary and integrative therapies including massage, aromatherapy, touch therapies like Reiki, and music therapy. It discusses challenges in researching individualized and natural treatments, and presents results from studies showing benefits like reduced pain, anxiety and nausea from therapies like massage, aromatherapy, and music. It also outlines programs that have successfully implemented complementary approaches in hospital settings, improving patient outcomes and reducing costs.

1. Slide 1
Evidence-based Practice Update
Rachel Busse, MD
Diplomate, American Board of Family Medicine
Director of Integrative Medicine at Norton Suburban
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 2
Evidence-based practice update
 Research challenges
 Implementing integrative programs
 Recent research
 Massage
 Aromatherapy
 Reiki
 Relaxation
 Music
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 3
Research challenges
-Herbs and supplements not standardized
-Individualized treatments
-Placebo or “sham” treatments
-Difficult to randomize and double blind
studies
-Funding
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

2. Slide 4
Research & Integrative medicine
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 5 ___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 6
Implementing integrative programs
 Holistic nursing department at 261 bed hospital
 Therapies:
 Relaxation techniques
 Therapeutic touch
 Aromatherapy
 Therapeutic suggestion
 Retrospective chart review and pt survey
 Reduction in pain
 Increase in patient satisfaction
Complement Ther Nurs Midwifery. 2004 Aug;10(3):168-74. Development and evaluation
of an inpatient [correction of impatient] holistic nursing care services department.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

3. Slide 7
Implementing integrative programs
 Inpatient oncology unit at Beth Israel hospital
 Yoga therapy, healing environment, holistic nursing
 2 nonrandomized groups
 Compared: Length of stay, total medication costs, and
cost of as-needed medications
 Demonstrated decrease in meds for pain, nausea &
anxiety, also decrease in overall cost
Am J Manag Care. 2011 Dec;17(12):779-84. Cost savings in inpatient oncology through
an integrative medicine approach.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 8
Implementing integrative programs
 102 studies
 Majority looked at music
 Aromas, decoration, flooring, lighting
 May affect anxiety
http://summaries.cochrane.org/CD005315/sensory-environment-on-health-
related-outcomes-of-hospital-patients
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 9
Massage
 Massage in acute care setting
 Reduction in pain
 Improvement in sleep
 Improvement in relaxation
 Improvement in overall well-being
Int J Ther Massage Bodywork. 2010; 3(1): 4–11. PMCID: PMC3091428 The Effects of
Massage Therapy on Pain Management in the Acute Care Setting
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

4. Slide 10
Massage
 Cochrane review of massage and
aromatherapy massage
 8 RCTs, 357 patients
 Reduction in anxiety
 Reduction in pain
 Some trials showed reduction in nausea
 Mixed data as to whether aromatherapy enhances
effects of massage
Cochrane Database Syst Rev. 2004;(2):CD002287. Aromatherapy and massage for
symptom relief in patients with cancer.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 11
Massage
-RCT with 68 patients
-osteoarthritis of the knee
-significant improvement in stiffness, range of
motion, pain, time to walk 50 feet
Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial
Arch Intern Med. 2006;166(22):2533-2538. doi:10.1001/archinte.166.22.2533
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 12
Aromatherapy
 Anxiety*
 Depression
 Nausea
 Insomnia
 Pain
 Agitation (in dementia)
Br J Gen Pract. Jun 2000; 50(455): 493–496.PMCID: PMC1313734
Aromatherapy: a systematic review.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

5. Slide 13
Aromatherapy
 Literature review, limited studies
 Lavender or orange to treat anxiety
 Peppermint to treat nausea
 Risks of allergic reactions and oral toxicity
J Adv Nurs. 2004 Oct;48(1):93-103. Aromatherapy practice in nursing: literature
review.
Evid Based Complement Alternat Med. 2014;2014:726341. Epub 2014 Feb 24.
Essential Oils for Complementary Treatment of Surgical Patients: State of the
Art.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 14
Aromatherapy
Post-operative nausea and vomiting
 120 patients in 2014 RCT showed
significant improvement
 Cochrane review 2012
 9 studies, 402 participants
 Evidence insufficient
J Perianesth Nurs. 2014 Feb;29(1):5-11. doi: 10.1016/j.jopan.2012.12.004. A
prospective randomized study of the effectiveness of aromatherapy for relief
of postoperative nausea and vomiting.
http://summaries.cochrane.org/CD007598/aromatherapy-for-treating-
postoperative-nausea-and-vomiting
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 15
Touch therapies
 Therapeutic touch
– Energy therapy developed in 1970s
 Jin Shin Jyutsu
 Harmonizing the body's energetic system
 Incorporates acupressure, QiGong, philosophy
 Verbal guidance, light exercise and massage
 Reiki
 Developed 1922 by Mikao Usui
 Universal life energy transferred through palms
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

6. Slide 16
Touch therapies
 Review of 10 studies of biofield therapies
 Little or no changes in physiologic
markers
 Review of biofield therapies for palliative
care
 Relieving pain, improving quality of life,
reducing stress
Explore (NY). 2014 May-Jun;10(3):150-61. doi: 10.1016/j.explore.2014.02.003. Epub 2014
Feb 24. Biofield-based Therapies: A Systematic Review of Physiological Effects on
Practitioners During Healing.
Am J Hosp Palliat Care. 2013 Nov 20. [Epub ahead of print]. Biofield Therapies for
Symptom Management in Palliative and End-of-Life Care.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 17
Reiki
 Literature review of RCTs
 Seven studies met inclusion criteria
 Evidence suggests that Reiki therapy may be effective
for pain and anxiety
 Larger sample sizes, randomized groups, protocols
are needed
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 18
Reiki
 Systematic review of therapeutic effects of Reiki
 12 trials included
 9 showed positive results
 Low quality of reporting, most trials lacking:
 Randomization
 Blinding, or
 Accountability
J Altern Complement Med. 2009 Nov;15(11):1157-69. doi: 10.1089/acm.2009.0036. A
systematic review of the therapeutic effects of Reiki.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

7. Slide 19
Reiki
 118 patients with cancer
 30 minute Reiki session
 Statistically significant reduction in anxiety
 Also helped with pain, relaxation and sleep
Am J Hosp Palliat Care. 2012 Jun;29(4):290-4. doi: 10.1177/1049909111420859. Epub
2011 Oct 13. The effects of Reiki therapy on pain and anxiety in patients attending a
day oncology and infusion services unit.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 20
Music therapy
 Cochrane review
 5 studies, 4 of which demonstrated
significant reduction in symptoms of
depression
 Need additional studies
Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression.
Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.:
CD004517. DOI: 10.1002/14651858.CD004517.pub2
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 21
Music therapy
-Cochrane review
-26 trials
-listening to pre-recorded music
-improved anxiety scores
-reduction in need for medication
Cochrane Database Syst Rev. 2013 Jun 6;6:CD006908. doi:
10.1002/14651858.CD006908.pub2. Music interventions for preoperative
anxiety.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

8. Slide 22
Music therapy
-373 patients at 12 ICUs
-patient directed music (PDM) vs noise
canceling headphones (NCH)
-PDM reduced need for sedation more than
NCH or usual care
-PDM and NCH reduced anxiety more than
usual care
Music Therapy for Reducing Anxiety in Critically Ill Patients. JAMA.
2013;309(22):2386-2387. doi:10.1001/jama.2013.5657.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 23
Future of research
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________