Multimodal pain rehabilitation Incentives for integrative medicine?!!! Tobias Sundberg, PhD!! Senior researcher, Research Group Integrative Care (OMV/NVS),! Karolinska Institutet & IC The Integrative Care Science Center! Visiting fellow, UTS:ARCCIM, Faculty of Health,! University of Technology Sydney, Australia!!
"Is there a place for CAM! in healthcare and academia?"!
Available at:! www.nafkam.no!
Available at:! https://nccia.nih.gov/about!
Available at:! www.imconsortium.org!
"The goals of the strategy are to support Member States in:!! harnessing the potential contribution of TM to health, wellness and peoplecentered health care;!! promoting the safe and effective use of TM by regulating, researching and integrating TM products, practitioners and practice into health systems where appropriate."! Available at:! http://www.who.int/medicines/publications/" traditional/trm_strategy14_23/en/!
"CAM is used by about 100 million EU citizens (that is 20% of the population). CAM is seen by European citizens and patients as the health approach that allows them to experience the attention to and individualized treatment of their specific health needs that they very often miss in conventional medicine."! (http://www.cambrella.eu/press/ policy-09%20hr.pdf)! Available at:! cambrella.eu!
Available at:! nccih.nih.gov!
Scandinavia! Hanssen et al. Scand J Prim Health Care. 2005 Mar; 23(1):57-62!
Denmark!! Current trends? Use?! Integration?!
Multimodal rehabilitation! How can different resources be integrated? "!!! Different models of care?"! Conventional care?"! Complementary care?"! Integrative healthcare?"! Self-care?!!!
Pain = a priority in health care!!! Priority Medicines for Europe and the World 2013 Update! Low back pain!! Guidelines recommend integration of e.g. manual therapies (massage, mobilization, manipulation) in the management of back pain!
"Multimodal rehabilitering förbättrar förutsättningarna för att patienten ska kunna återgå till arbete, jämfört med inga eller mindre omfattande insatser. Förutom faktisk återgång i arbete räknas minskad sjukskrivning och att patienten själv bedömer att arbetsförmågan har ökat som sådan förbättring. Det vetenskapliga underlaget är dock otillräckligt när det gäller vilken typ av multimodal rehabilitering som är bäst i dessa avseenden."! Available at:! www.sbu.se/sv/publikationer/sbu-utvarderar/" rehabilitering-vid-langvarig-smarta!
Kunskapsluckor och framtida forskning (exempel)!!!!! Behov av detaljerade beskrivningar av olika komplexa vårdmodeller och vårdprogram! Hur påverkar vårdorganisation och vårdrutiner utfall av olika behandlingsstrategier?! Orsaker och konsekvenser av praxisvariationer för vård av patienter med långvarig smärta?! Behov av hälsoekonomiska studier avseende kostnader och effekter av icke-farmakologiska behandlingsmetoder!
Available at:! nccih.nih.gov/about/offices/od/director!
Multimodal pain rehabilitation! = integrative medicine?! The current disparity in ways of recommending and integrating CTs and conventional care i.e. lack of conceptual models for delivering IM, may provide many challenges!!!guidelines? Policy? Regulation?!!!Implementation?!!!Evaluation?!
"The Academic Net"! Our story!
Academic CAM/IM courses!!!! Traditional use and current evidence!!! "FoUUU" dialogues and discussons:!!!! Forskning!!! Utbildning!!! Utveckling!!! Utvärdering!!! Clinical "real world" perspectives!!! Research and capacity building of providers, teams and clinics for improved patient care!
EVIDENCE-BASED PRACTICE! Medveten och systematisk användning av bästa tillgängliga vetenskapliga faktaunderlag, tillsammans med klinisk erfarenhet och klienters erfarenheter och önskemål (eng. evidence-based practice).! (Socialstyrelsen, 2016)!
Health Technology Assessment & Evidence-Based Decision Making! Hierarchies of evidence should be replaced! by accepting indeed embracing a diversity of approaches it is a plea to investigators to continue to develop and improve their methods; to decision makers to avoid adopting entrenched positions about the nature of evidence; and for both to accept that the interpretation of evidence requires judgment.! Lancet 2008; 372: 2152-61! Prof Sir Michael Rawlins, NICE, UK.! The Harveian oration. De testimonio: on the evidence! for decisions about the use of therapeutic interventions.!
What type of projects/studies for exploring MMR & IM?! Basic science?! Translational research?! Efficacy studies?! Outcomes & effectiveness research?!!! Towards clinical "real world" projects!
Mixed methods!! Action based! Economic! Triangulation synthesis of evidence! Clinical project! Qualitative! Quanti-! tative!
How can we learn more about! who integrates what, how and why and what are the outcomes?!
PBRNs Practice based research networks!!! Flexible provider/clinic based research possibilities!!! Providers, clinics, patients!!! Examples:" http://www.orion-arccim.com! osteopathy" http://www.acorn-arccim.com! chiropractic! "PBRNs can generate relevant evidence and expedite translation into practice." (Implement Sci. 2014 Dec 2;9:177)!
How can we learn more about CAM/IM and evidence based practice?! Surveys of evidence based practice attitudes, use and skills among CAM and conventional providers!! Implications for professional, " organisational and policy domains?!! Educational and research initiatives?!! Quality assurance?!
The future in Denmark?" Opportunities? Collaborations?!!Academic resources in Denmark?!!Practice based research networks?"!!provider surveys?!!other initiatives or ideas?!
TACK!!