Enheten för studier av integrativ vård

Transkript

1 Om forskning inom manuella och komplementära terapier Tobias Sundberg Leg sjukgymnast, med kand, doktorand Unit for studies of integrative health care Dept Neurobiology, care sciences and society Karolinska Institutet Enheten för studier av integrativ vård FORSKNING (exempel): Policyutveckling & guidelines (WHO) Integrativ medicin i svensk sjukvård Komplementärmedicin & cancer Komplementärmedicin & depression Rosenmetoden UTBILDNING: Valbar kurs på läkarprogrammet Kurser för hälso- & sjukvårdspersonal mfl Uppdragsutbildningar/föredrag, SLL, ÖLL mfl Konferenser Enheten för studier av integrativ vård 1

2 Om forskning inom manuella och komplementära terapier 1. Definitioner av begrepp 2. Forskning i världen och Sverige 3. Forska på egen klinik? Kvalitetssäkring! Vad är?? Traditionell medicin Konventionell medicin/skolmedicin Alternativ medicin Komplementär medicin Integrativ medicin Manuell medicin Traditionell medicin Traditional medicine includes diverse health practices, approaches, knowledge and beliefs incorporating plant-, animal- and/or mineral-based medicines, spiritual therapies, manual techniques and exercises applied singularly or in combination to maintain well-being, as well as to treat, diagnose or prevent illness. Ref: WHO Guidelines on Developing Consumer Information on Proper Use of Traditional, Complementary and Alternative Medicine. Geneva, WHO,

3 Traditionell medicin Medicinska system som utvecklats parallellt med mänskligheten inom olika kulturer Exempel på traditionella medicinska system: - Traditionell Kinesisk Medicin, Ayurveda, Siddha Vaidya, Unani, Tibetansk & Mongolisk medicin, Samisk medicin (Sverige & Norden) Traditionell medicin Manuella behandlingsmetoder återfinns inom de flesta traditionella medicinska system runt om i världen. Världshälsoorganisationen förespråkar: - Utövandet av TM - Integrering av TM i vården där nationer så önskar Skolmedicin/konventionell medicin Conventional medicine is medicine as practiced by medical physicians (MDs), physical therapists (RPTs), psychologists (DPs), nurses (RNs)or osteopaths (DOs) and allied health professionals including medical assistants and laboratory staff. Other terms for conventional medicine include: - Biomedicine - Allopathy/allopathic medicine - Western medicine - Mainstream medicine - Orthodox medicine - Regular medicine Ref: Adapted from National Institutes of Health, USA,

4 Alternativ & komplementär medicin Terapiformer som ej är del av landets egen tradition och/eller framför allt existerar utanför det dominerande hälso- och sjukvårdssystemet (vård och utbildning). ALTERNATIV = Används som alternativ (i stället för) skolmedicin. KOMPLEMENTÄR = Används som komplement (i tillägg) till skolmedicin. Integrativ medicin What is integrative medicine? Integrative medicine, as defined by NCCAM, combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. Ref: National Institutes of Health, USA, 2007 Manuell medicin MANUELL = för hand MEDICIN = förebygga, lindra och läka Medicinska metoder som helt eller delvis baseras på manuella tekniker för diagnos och behandling. Återfinns inom alla världsdelar och kulturer. Omfattar olika inriktningar och traditioner inom olika kulturer. 4

5 Manuell medicin De idag största västerländska manuella terapierna har framför allt utvecklats och etablerats under de senaste 200 åren Founding fathers Per Henrik Ling ( ) Andrew Taylor Still ( ) Daniel David Palmer ( ) Bartlett Joshua Palmer ( ) Oakley Smith ( ) Manuell medicin Kategoriseras ofta som "manipulative and body based therapies/practicies" Fokuserar huvudsakligen på sambandet mellan kroppens strukturer och dess funktioner (vs patologi): Skelett Leder Ligament Ledband Fascia/bindväv Muskler Viscera Ledrörlighet Flexibilitet Proprioception Neurodynamik Arteriellt, venöst och lymfatiskt flöde 5

6 FORSKNING?? För vilka besvär används KAM? Common conditions: back pain, head cold, neck pain, joint pain, arthritis, anxiety/depression, stomach upset, headache, recurring pain, insomnia Common treatments: massage therapy, herbal medicines, chiropractic, relaxation techniques, yoga, mega vitamin therapy Adapted from: Eisenberg et al, Trends in Alternative Medicine Use in the United States, Varför ska man forska? PATIENTS MAY: See unqualified practitioners Risk missed or delayed diagnosis Stop or refuse effective conventional treatment Waste money on ineffective treatments Experience dangerous adverse effects from treatments including unwanted interactions DAGENS METRO!!! Adapted from: Zolleman and Vickers, ABC of Complementary Medicine, British Medical Journal Books, 2000 But with research we might also find new clinically and cost effective solutions to common conditions not managed well within conventional care! 6

7 Who pays for research? No industry backing Who will sponsor R&D in the area of massage, manual therapy, yoga, acupuncture, etc? Despite popularity only 0.08% of NHS budget in the UK goes to CAM research To support evidence-based CAM it is crucial to find adequate funds for research Olika typer av forskning & evidens "ATT FORSKNING" att det fungerar hypotesgenererande kvalitativa och kvantitativa studier, kliniska metodstudier, hälsosystemforskning "HUR FORSKNING" hur det fungerar bakomliggande mekanismer, grundforskning, lab.studier (Field et al ) Cochrane collaboration Massage for low-back pain Furlan AD, Brosseau L, Imamura M, Irvin E. The Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD DOI: / CD Conclusions: Massage might be beneficial for patients with subacute and chronic non-specific low-back pain, especially when combined with exercises and education. The evidence suggest that acupuncture massage is more effective than classic massage, but this need confirmation. More studies are needed to confirm these conclusions and to assess the impact of massage on return-to-work, and to measure longer term effects to determine cost-effectiveness of massage as an intervention for low-back pain. 7

8 Cochrane collaboration Exercises for mechanical neck disorders. Kay TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G, Cervical Overview Group. The Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD DOI: / CD pub3. Main results: There is strong evidence of benefit favouring a multimodal care approach of exercise combined with mobilisations or manipulations for subacute and chronic MND with or without headache in the short and long term. MANUELL MEDICIN Kliniska studier (att ) Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC, Koes BW, Vondeling H, Bouter LM. BMJ Apr 26;326(7395):911. MAIN RESULTS: The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks, but differences were negligible by follow up at 52 weeks. The total costs of manual therapy were around one third of the costs of physiotherapy and general practitioner care (1379 euro). Manual therapy was less costly and more effective than physiotherapy or general practitioner care. CONCLUSIONS: Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner. FORSKNING I SVERIGE Towards a model for integrative medicine in Swedish primary care (pågående) Multiprofessionellt samverkansprojekt Husläkare och team med komplementära terapeuter Svensk klassisk massage, manuell terapi/naprapati, shiatsu, akupunktur och qigong 8

9 FORSKNING I SVERIGE Towards a model for integrative medicine in Swedish primary care Läs rapporten om en integrativ vårdmodell i svensk primärvård gratis på internet här: MANUELL MEDICIN Forska på egen klinik. Vad kan man själv göra? Utvärdera dina behandlingsresultat = KVALITETSSÄKRING! (t.ex. via "S.O.A.P. notes") MANUELL MEDICIN Case reports (fallbeskrivningar) - Individual -Series - Förbundsrapporter 9

10 MANUELL MEDICIN TACK & LYCKA TILL! 10