2024 International Congress on Integrative Medicine & Health Abstracts

Oral Abstracts

Oral Abstract Session 01: Mind-Body Therapies I

OA01.01

Mindfulness-Based Stress Reduction and Inflammatory Dynamics Among Lonely Older Adults: A Randomized Controlled Trial

Emily Lindsay¹, Anna Marsland¹, Steve Cole², Carol Greco¹, Janine Dutcher³, Aidan Wright⁴, Kirk Brown³, and David Creswell³

¹ University of Pittsburgh, Pittsburgh, PA

² UCLA, Los Angeles, CA

³ Carnegie Mellon University, Pittsburgh, PA

⁴ University of Michigan, Ann Arbor, MI

Contact: Emily Lindsay, [e-mail]

Abstract

Purpose: Mindfulness interventions have been shown to improve a range of health outcomes, but underlying pathways remain unclear. Inflammatory processes may play a role. In a sample of lonely older adults, this trial examined whether mindfulness training alters four inflammatory pathways: (1) stimulated IL-6 production, a measure of innate immune responsivity, (2) glucocorticoid resistance (GCR), a measure of immune cell sensitivity to the anti-inflammatory effects of glucocorticoids, (3) pro-inflammatory gene regulation by NF-kB, and (4) circulating IL-6 and CRP, plasma markers of inflammation.

Method(s): Lonely older adults (65-85 years; N=190) were randomly assigned to an 8-week Mindfulness-Based Stress Reduction (MBSR) or matched Health Enhancement Program (HEP). Blood drawn pre-intervention (T1), post-intervention (T2), and at 3-month follow-up (T3) was assayed to test for (1) LPS-stimulated IL-6 production, (2) dexamethasone-induced suppression of LPS-stimulated IL-6 response, (3) transcriptional regulation by NF-kB via RNA profiling, and (4) circulating IL-6 and CRP. Mixed effects linear models tested time (pre, post, follow-up) × condition (MBSR vs. HEP) effects.

Results: First, larger increases in stimulated IL-6 production were observed following MBSR vs. HEP (T1-T2: d=.38; T1-T3: d=.35). Second, MBSR buffered increases in GCR observed in the HEP group from T1-T2 only (d=.29). Third, MBSR reduced NF-kB relative to HEP over time (d=.14). Finally, contrary to predictions, there were no group differences in circulating IL-6 or CRP over time.

Conclusions: Results suggest that MBSR may boost innate immunocompetence, protect against declines in the sensitivity of immune cells to glucocorticoids, and reduce pro-inflammatory gene regulation among at-risk lonely older adults, but may not influence systemic inflammation among older adults. These results provide specificity about how mindfulness interventions impact inflammatory markers among aging adults with implications for extending health span.

OA01.02

A Randomized Trial of Mindfulness for Physical Activity in Older Adults

Roni Evans¹, Alexander Haley¹, Linda Hanson¹, Craig Schulz¹, Douglas Kennedy², Gert Bronfort¹, and Brent Leininger¹

¹ University of Minnesota, Minneapolis, MN

² University of Minnesota--Twin Cities; Integrative Health & Wellbeing Research Team, Minneapolis, MN

Contact: Roni Evans, [e-mail]

Abstract

Purpose: Insufficient physical inactivity is especially problematic for middle to older age adults. Mindfulness based interventions (MBIs) are among the most commonly used complementary and integrative health (CIH) practices. With an emphasis on regulating attention and emotions, establishing body awareness, and shifting self-perceptions, MBIs have the potential for overcoming some of the barriers inactive older individuals face with physical activity. This research reports the results of an NIH funded community based, randomized type II hybrid effectiveness implementation trial in collaboration with YMCA of the North.

Method(s): Interventions consisted of eight weekly, 90-minute group sessions. The MBI was developed using an established behavioral model aimed at meeting participants capability, opportunity/resource and motivational needs. The interventions had similar delivery formats, with each session including YMCA facilitator-led discussions and goal setting, workbook reflections, expert narrated videos, and planning for home practice. The control intervention was structurally identical but focused on general wellbeing with the goal of being ‘mindfulness inert.’ Outcomes were measured using accelerometers for physical activity and self-report questionnaires over 1 year.

Results: A total of 176 individuals were enrolled in the study. While the MBI group experienced nearly twice the gain in physical activity, changes were of questionable clinical importance and did not significantly differ from the active control. However, the MBI group did experience significantly greater improvements in mindfulness and social connection, and had higher satisfaction.

Conclusions: Future trials should consider exploring dose related issues of MBIs and challenges in addressing multiple behaviors (e.g. mindfulness and physical activity) within the context of one program.

OA01.03

Leveraging Mind-Body Skills to Improve Multimodal Physical Function in Adults with Heterogeneous Chronic Pain; a Multisite Feasibility RCT

Jonathan Greenberg¹, Julia Hooker², Julie Brewer¹, Katherine McDermott², Tamara Somers³, John Burns⁴, and Ana-Maria Vranceanu⁵

¹ Massachusetts General Hospital, Boston, MA

² Massachusetts General Hospital / Harvard Medical School, Boston, MA

³ Duke University, Durham, NC

⁴ Rush University, Chicago, IL

⁵ MGH/HMS, Boston, MA

Contact: Jonathan Greenberg, [e-mail]

Abstract

Purpose: Chronic pain is associated with substantial impairment in physical function. GetActive-Fitbit, a mind-body and activity program, is feasible and associated with improvement in physical function among primarily White, sedentary individuals with pain. A need remains to examine feasibility across multiple sites with diverse populations. This presentation will describe and present preliminary results from a multisite, feasibility RCT comparing GetActive-Fitbit with an active control program (Healthy Living for Pain; HLP) at Massachusetts General Hospital, Duke University, and Rush University. We aim to 1) test multisite fidelity of clinician training; 2) evaluate multisite feasibility benchmarks, including ability to recruit sedentary patients with chronic pain and racial and ethnic minorities; and 3) optimize study protocols in preparation for a future multisite efficacy trial.

Method(s): Clinician training fidelity was assessed via roleplays and “mock group” sessions. Feasibility (i.e., recruitment, acceptability, credibility, adherence, satisfaction), multimodal physical function (e.g., self-report, 6-Minute Walk Test, step-count), and other psychosocial outcomes (e.g., mindfulness, pain catastrophizing) are assessed at baseline, posttest, and 6 months. Protocol optimization will be assessed using exit interviews and cross-site meetings. We aim to recruit 90 participants (30 per site).

Results: The trial is ongoing. Clinician training is successfully completed, with all clinicians scoring 95% or above on knowledge checks, protocol adherence, and competency. To date, we enrolled and randomized 54 participants, and 9 completed post-test assessments. Feasibility benchmarks will be presented and discussed.

Conclusions: This study addresses the critical need for feasible, acceptable mind-body interventions for chronic pain that follow evidence-based guidelines and improve all aspects of physical function across diverse populations. It will inform a future fully-powered multisite efficacy trial.

OA01.04

Results from the Learning to Apply Mindfulness to Pain (LAMP) Study: A Pragmatic Clinical Trial

Diana Burgess¹, Roni Evans², Collin Calvert¹, Emily Hagel Campbell¹, Kelli Allen³, Ann Bangerter¹, Mariah Branson¹, Gert Bronfort², Lee Cross¹, John Ferguson², Jessica Friedman¹, Alexander Haley², Mallory Mahaffey¹, Marianne Matthias⁴, Laura Meis¹, Melissa Polusny⁵, Greg Serpa⁶, Stephanie Taylor⁷, and Brent Taylor¹

¹ Minneapolis VA Health Care System, Minneapolis, MN

² University of Minnesota, Minneapolis, MN

³ VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC; Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC., Chapel Hil, NC

⁴ Indiana University, Indianapolis, IN

⁵ Minneapolis Veterans Affairs Health Care System, Minneapolis, MN

⁶ VHA, Los Angeles, CA

⁷ Veterans Health Administration, Los Angeles, CA

Contact: Diana Burgess, [e-mail]

Abstract

Purpose: Mindfulness-Based Interventions (MBIs) are evidence-based nonpharmacological treatments for pain. However, many MBIs have features that pose significant implementation barriers. This study compares two scalable approaches for delivering MBIs that address key patient- and system-level implementation barriers.

Method(s): Randomized pragmatic clinical trial with 12-month follow-up of 811 patients with moderate to severe chronic pain, recruited from three Veterans Affairs facilities. Mobile+Group Learning to Apply Mindfulness to Pain (LAMP) was delivered via videoconferencing and consisted of pre-recorded modules by a mindfulness instructor in a group setting, interspersed with discussions led by a facilitator. Mobile+Calls LAMP consisted of the same modules, was completed asynchronously by patients, and was supplemented by three individual facilitator calls. Both interventions were 8 weeks long and compared to Usual Care.

Results: The primary outcome was change in the Brief Pain Inventory interference score from baseline to 12 months (assessed at baseline, 10 weeks, 6 and 12 months). Secondary outcomes were changes in pain intensity, global improvement in pain, physical function, symptoms of anxiety, depression, and post-traumatic stress disorder, fatigue, sleep disturbance, participation in social roles/activities, and percentage reaching at least 30% improvement in pain interference. Both LAMP interventions resulted in significant reductions in pain interference compared to Usual Care over 12 months; similar results were observed for all secondary outcomes. The two interventions performed similarly, except the Mobile+Calls group showed greater improvement on pain interference.

Conclusions: Two novel, scalable approaches to delivering MBIs significantly reduced pain and biopsychosocial outcomes over the long-term in Veterans.

Oral Abstract Session 02: Health Equity and Disparities

OA02.01

Engagement in Integrative and Nonpharmacologic Pain Management Modalities Among Adults with Chronic Pain

Samuel N. Rodgers-Melnick¹, Robert Trager², Thomas Love³, and Jeffery Dusek⁴

¹ University Hospitals Connor Whole Health, Cleveland, OH

² Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

³ Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH

⁴ University of California - Irvine, Irvine, CA

Contact: Samuel N. Rodgers-Melnick, [e-mail]

Abstract

Purpose: To examine variables associated with engagement in (1) integrative health and medicine (IHM) and (2) nonpharmacologic modalities rather than opioids among United States adults with chronic pain.

Method(s): Using the 2019 National Health Interview Survey, we examined sociodemographic, pain, and mental health predictors of (1) the sum of IHM modalities (i.e., chiropractic care, yoga/Tai Chi, massage, or meditation/guided imagery) used to manage pain and (2) exclusive engagement in nonpharmacologic pain management modalities (i.e., IHM, a chronic pain self-management program, support groups, or physical, rehabilitative, occupational, or talk therapy) or opioids in the past 3 months.

Results: Metropolitan residency, higher family income, higher education levels, increased number of pain locations, and increased frequency of pain limiting life/work activities were associated with increased odds of IHM engagement. Older age, male sex, non-Hispanic Black/African American race/ethnicity, and daily opioid use were associated with decreased odds of IHM engagement. Metropolitan residency, higher family income, and higher education levels were associated with increased odds of exclusive nonpharmacologic modality engagement. Older age and increasing frequency of pain limiting life/work activities were associated with decreased odds of exclusive nonpharmacologic modality engagement.

Conclusions: We identified several contrasts between factors prevalent among individuals with chronic pain and factors associated with engagement in nonpharmacologic and IHM modalities. These results support efforts to address barriers to accessing these modalities among subpopulations of adults with chronic pain (e.g., older adults, individuals identifying as Black/African American, rural residents, and those with lower levels of education and income).

OA02.02

Racial and Ethnic Representation Among Complementary and Integrative Health Graduate

Margaret Whitley¹, Nipher Malika¹, Patricia M Herman², Ian Coulter¹, Margaret Chesney³, Michele Maiers⁴, and Emma Bianculli¹

¹ RAND Corporation, Santa Monica, CA

² RAND Corporation, Sonoma, CA

³ UCSF, San Francisco, CA

⁴ Northwestern Health Sciences University, Bloomington, MN

Contact: Margaret Whitley, [e-mail]

Abstract

Purpose: To advance educational equity in complementary and integrative health (CIH), we studied diversity in programs for licensed CIH professions: doctors of chiropractic (DC), acupuncture, traditional Chinese medicine (TCM), naturopathic doctors (ND), direct-entry midwifery (DEM), and massage therapy (MT).

Method(s): Using 2009-21 Integrated Postsecondary Education data, we calculated proportions of Latino, American Indian/Alaska Native (AIAN), Asian, Black, Native Hawaiian/Pacific Islander (NHPI), and White graduates. Averages were calculated and compared across programs, to the US population, and to conventional providers (RN/MD/DO/PT).

Results: There were 6,819 observations from licensed CIH programs; 87% were MT. We examined significant (p<0.05) over- and underrepresentation of CIH graduates versus the US population: Latino: underrepresented in all CIH programs

Black: underrepresented in all but MT

AIAN: overrepresented in MT

Asian: underrepresented in DEM, MT; overrepresented in Acupuncture, TCM

NHPI: underrepresented in DC, overrepresented in acupuncture, MT

White: overrepresented in DC, TCM, DEM, MT

Latino, Black and Asian representation increased over time in CIH and conventional healthcare. Excluding MT, diversity in CIH mirrors conventional care, although Asian students have greater CIH representation.

Conclusions: Racial/ethnic diversity among licensed CIH graduates remains insufficient. CIH training programs should continue strengthening pathway programs and retention.

OA02.03

Examining the Feasibility of Implementing an Adapted Mindfulness-Based Intervention for Youth Experiencing Homelessness

Diane Santa Maria¹, Paula Cuccaro², Erica Sibinga³, Kimberly Bender⁴, and Jennifer Jones⁵

¹ Cizik School of Nursing at UTHealth Houston, Houston, TX

² University of Texas Health Science Center at Houston School of Public Health, Houston, TX, Afghanistan

³ Johns Hopkins University School of Medicine, Baltimore, MD

⁴ University of Denver, Denver, CO

⁵ University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX

Contact: Diane Santa Maria, [e-mail]

Abstract

Purpose: Youth experiencing homelessness (YEH) are an underserved and difficult to reach population that experiences a disproportionate burden of trauma and stress compared to their housed peers. Prolonged trauma and stress can impact the development of negative emotions, reactive stress responses, and impulsive decision making, which can lead to risk-taking behaviors. Growing research shows that Mindfulness-Based interventions (MBIs) can improve coping, impulsivity, emotion regulation, and executive function although no MBIs tailored for YEH have been tested.

Method(s): We adapted an MBI for YEH and conducted a one-site pilot attention control randomized trial to test the feasibility and acceptability of .b4me for YEH staying in a homeless shelter. We randomized youth to .b4me or the control condition, Healthy Habits. Each curriculum was five lessons, approximately an hour long and delivered by trained facilitators. Pre- and post- lesson assessments were collected as well as a baseline, immediate-, 3- and 6- month post follow-ups. With feedback from a youth working group and expert advisors, measures were chosen to assess loneliness, stress, depression, anxiety, emotional distress, anger, sleep disturbance/impairment, risk propensity, coping, emotion regulation, mindfulness, self-compassion, psychosocial vulnerability, social connectedness, resilience, social isolation, self-efficacy, executive function, and risk behaviors.

Results: Mean age of participants (N=90) is 21.5 years old, with majority identifying as male (62.2%), Black (50.0%), and Hispanic (29%). The majority (83.3%), attended over half of the sessions and over half (56.7%) attended the entire curriculum. Follow-ups are ongoing. The study experienced several challenges due to COVID restrictions and the demolition and relocation of the shelter which increased resident turn-over.

Conclusions: This study demonstrates that a tailored MBI is acceptable and it is feasible to conduct a pilot randomized trial with YEH living in a shelter.

OA02.04

Feasibility and Acceptability of a Therapeutic Garden at an Inner-City Substance Use Disorder Center using “Mindful PhotoVoice”

Teresa Horton¹, Susan Redden², Charles Dykstal², Leah McClellan³, Bruriah Horowitz⁴, Abby Kisicki¹, Anna Weiss², Dan Hostetler², and David Victorson¹

¹ Northwestern University, Evanston, IL

² Above and Beyond Family Recovery Center, Chicago, IL

³ Loyola University of Chicago, Chicago, IL

⁴ Northwestern University Feinberg School of Medicine, Chicago, IL

Contact: Teresa Horton, [e-mail]

Abstract

Purpose: A community-academic partnership evaluated the feasibility and acceptability of implementing a therapeutic garden at an inner-city substance use disorder center to gain a deeper understanding of perceptions among clientele and staff.

Method(s): Following IRB approval (NU IRB: STU00218393) and protocol development by addiction counselors, academic researchers, nurses, and clients in recovery, staff implemented the pilot program. Based in photovoice, a method that empowers people to express their experiences through photography and reflection, clientele was taught to use digital instant cameras to photograph meaningful elements of the therapeutic garden in response to different mindfulness-inspired prompts that were written by the study team. Next, clients reflected out loud on their photographs in a group therapy setting. Clients retained hard copies of their photographs; digital copies were saved to client records. Check-in and -out surveys were administered. Survey data, clinical notes, and comments about clients’ photographs were recorded in the clinical record. A mixed-methods analysis of deidentified patient records was conducted.

Results: Overall, 34 clients participated in either one garden session (n=19) or between 2 to 7 sessions (n=15). The majority were male (54%) and White (43%) or Black (36%). Initial analyses suggest positive findings. Client comments included, “I took a picture of dirt because if I went back out there, I would be dirt. But I also took some pictures of the amaranth standing tall because I want to stand firm like that.” A therapist noted, “The photographs provide an ‘arm’s length’ distance that lets people talk more easily about their emotions. This is especially important for the men in the groups.

Conclusions: The therapeutic garden complements the workflow and recovery center culture through engaging clients and staff in open discourse about their recovery. The mindful garden photography program should be examined further to evaluate its benefits.

Oral Abstract Session 03: Acupuncture

OA03.01

Acupuncture in the Emergency Department for Pain Management: Results from a Multi-site Feasibility Study in BraveNet Practice-Based Research Network

Jeffery Dusek¹, Gene Kalllenberg², Alan Storrow³, Robert Hughes⁴, Christopher J. Coyne⁵, David Vago⁶, Arya Nielsen, PhD⁷, Alison Karasz⁸, Ryung Kim⁹, Jessica Surdam¹⁰, Tracy Segall¹¹, Kiran A. Faryar¹², Natalie L Dyer¹³, Bruce Barton¹⁴, and M. Diane McKee¹⁵

¹ University of California - Irvine, Irvine, CA

² Department of Family Medicine, University of California San Diego, La Jolla, CA

³ Vanderbilt University Medical Center, Nashville, TN

⁴ University Hospitals, Cleveland, OH

⁵ Department of Emergency Medicine, University of California San Diego, La Jolla, CA

⁶ Department of Psychology, Vanderbilt University, Nashville, TN

⁷ Icahn School of Medicine at Mount Sinai, New York, NY

⁸ Department of Family Medicine, University of Massachusetts Chan Medical School, Worcester, MA

⁹ Department of Epidemiology and Population Health and Institute of Clinical and Translational Research, Albert Einstein College of Medicine/Montefiore, New York, NY

¹⁰ University Hospitals Connor Whole Health, Cleveland, OH

¹¹ University Hospitals of Cleveland, Cleveland, OH

¹² Department of Emergency Medicine, University Hospitals, Cleveland, OH

¹³ Connor Whole Health, University Hospitals, Cleveland, OH

¹⁴ Department of Population and Quantitative Health Sciences, University of Massachusetts Chan School of Medicine, Worcester, MA

¹⁵ Department of Family Medicine and Community Health, University of Massachusetts Chan School of Medicine, Worcester, MA

Contact: Jeffery Dusek, [e-mail]

Abstract

Purpose: Pain plays a major role in emergency department (ED) visits. Since reliance on pain medications comes with risk of adverse effects, non-pharmacologic options are needed to reduce patients’ pain. Prior studies of acupuncture in the ED reported pain reduction with minimal side effects. However, these studies were predominantly conducted at single centers and had small sample sizes. To prepare for a future study, we conducted a multi-center, feasibility randomized control trial of acupuncture for acute pain in the ED and examine recruitment rate, retention rate, data collection procedures and adherence to the manualized responsive acupuncture protocol.

Method(s): Our goal was to recruit 165 adults with acute non-emergent pain of ≥4 on a 0-10-point scale presenting at three EDs (University Hospitals Cleveland Medical Center, Vanderbilt University Medical Center and University of California- San Diego) affiliated with the BraveNet Practice Based Research Network. At baseline and roughly 45 minutes later, all patients self-assessed pain and anxiety using a 0-10 rating scale. Opioid use and adverse events were assessed at 1 and 4 weeks.

Results: From May 3, 2021 to September 24, 2022, 632 eligible patients were approached with 165 enrolled (165/632: 26.1% recruitment). Notably, 42.4% of enrollees were Black/African American, 42.4% were Caucasian and 55.1% had public insurance. Of enrollees, 151 (91.5 %) and 128 (77.6%) provided pain and anxiety scores at post-treatment and 1-week respectively. Participants were randomized to Acupuncture (n=83) or Usual care (n=82) and we found the randomization and data collection procedures were successful. Study acupuncturists were ∼99% adherent to the acupuncture protocol.

Conclusions: With the successful completion of the feasibility trial (even during COVID-19 pandemic), the team has the collective expertise and preliminary data necessary to conduct a future, definitive, multi-center, definitive randomized controlled trial.

Clinical Trials.gov: NCT04880733.

OA03.02

Acupuncture for Chronic Low Back Pain in Older Adults: Main Outcomes from the BackInAction Pragmatic Clinical Trial

Lynn DeBar¹, Andy L. Avins², Andrea Cook³, Carolyn Eng³, Morgan Justice³, Arya Nielsen, PhD⁴, Alice R. Pressman⁵, Katie Stone⁶, Raymond Teets⁷, and Robert Wellman³

¹ Kaiser Permanente Center for Health Research, Portland, OR

² KP Department of Research, Oakland, CA

³ Kaiser Permanente Washington Health Research Institute, Seattle, WA

⁴ Icahn School of Medicine at Mount Sinai, New York, NY

⁵ Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA

⁶ Sutter Health / University of California, San Francisco, San Francisco, CA

⁷ Icahn School of Medicine at Mount Sinai / Institute for Family Health, New York, NY

Contact: Lynn DeBar, [e-mail]

Abstract

Purpose: Approximately one-third of US older adults experience chronic low back pain (cLBP), however, many treatments for younger adults may be inappropriate for older adults given their greater prevalence of comorbidities and polypharmacy. Acupuncture is safe and effective for treating cLBP in adults, but few studies focus on older adults. The BackInAction study addresses a critical gap in evidence on the effectiveness and safety of acupuncture treatment for Medicare-eligible older adults with cLBP. It will inform revisions to the narrow criteria for CMS coverage which preclude reimbursement for most licensed and practicing acupuncturists in the US.

Method(s): This study is a pragmatic, multi-site, three-arm, parallel group randomized controlled trial testing the effectiveness of community-based acupuncture needling for improving back pain-related disability among 800 adults ≥ 65 years old with cLBP. Study treatments compared usual care plus standard acupuncture (SA; ≤ 15 sessions in 12 weeks), usual care plus enhanced acupuncture (EA; SA followed by ≤6 additional sessions in the next 12 weeks), and usual medical care alone. Participants were followed for 12 months with main study outcomes assessed at 3, 6, and 12 months and the primary outcome timepoint at 6 months.

Results: Enrolled participants have a mean age of 74 (6.0 SD), are 62% female, represent a broad geographic and racially/ethnically diverse sample, and most have multiple or widespread pain. Analyses are underway and main study outcomes will be included in the presentation.

Conclusions: The BackInAction study offers an opportunity to further understand the effectiveness, dose-dependence, and safety of acupuncture in a Medicare-aged population. Additionally, study results may encourage broader adoption of effective, safer, and more satisfactory options than the continuing over-reliance on opioids and invasive medical treatments for cLBP among older adults.

OA03.03

Characteristics of Insurance Plans that Cover Acupuncture Therapy, 2010-2019

Molly Candon¹, Jeffery Dusek², and Arya Nielsen, PhD³

¹ University of Pennsylvania, Philadelphia, PA

² University of California - Irvine, Irvine, CA

³ Icahn School of Medicine at Mount Sinai, New York, NY

Contact: Molly Candon [e-mail]

Abstract

Purpose: Insurance coverage for acupuncture is inconsistent. When acupuncture is reimbursed, insurance coverage is often restricted to approved indications (e.g., low back pain) and has higher out-of-pocket costs than other types of pain care (e.g., physical therapy). To date, few studies of acupuncture have used claims data.

Method(s): At the 2022 ICIMH, we presented data from the Medical Expenditure Panel Survey, a nationally representative survey of U.S. households. We reported an increasing rate of insurance coverage for acupuncture (40% of visits were covered 2010; 50% were covered in 2019) and found that joint-related conditions were the most frequent indication. We were limited by a small sample (n<1,000) and unable to measure characteristics of insurance plans that cover acupuncture. We now examine this question using Optum insurance claims, which include >10 million individuals annually. In addition to measuring the socioeconomics of individuals whose insurance covered acupuncture, we document characteristics including approved indications (e.g., low back pain), cost sharing (e.g., copays), and insurance plan type (e.g., health maintenance organizations).

Results: In 2010, there were 20,720 individuals with >1 reimbursed acupuncture visit. By 2019, the number increased to 49,431, who were mainly female (66.8%) and more likely to be Asian (22.7%) or White (62.2%) than Black (4.4%) or Hispanic (10.3%). Acupuncture users were highly educated (91.0% had some college/college degree) and had higher incomes (51.7% had a household income of >$100,000). In 2019, back pain was the most common indication (46.3% of acupuncture claims cited back pain), followed by other joint disorders (13.6%), headaches/migraines (4.2%), and other soft tissue disorders, including fibromyalgia (4.1%).

Conclusions: Insurance coverage for acupuncture therapy is increasing, especially for back pain and among high-income, highly-educated households. At the 2024 ICIMH, cost sharing and insurance plan type will also be presented.

OA03.04

Alternatives to Opioids: Using Settlement Funds To Increase Access to Nonpharmacological Therapies

Michele Maiers¹, Patricia M Herman², Ryan Burdick³, and Bradley Stein⁴

¹ Northwestern Health Sciences University, Bloomington, MN

² RAND Corporation, Sonoma, CA

³ Northwestern Health Sciences University, Cincinnati, OH

⁴ RAND Corporation, Pittsburgh, PA

Contact: Michele Maiers, [e-mail]

Abstract

Purpose: Most recommendations for distributing over $50 billion in opioid settlement funds focus on reducing opioid-related harms and death, and addressing substance use disorders. However, primary prevention strategies to reduce initiation of opioids in individuals with non-cancer pain are an important component of a multi-faceted strategy to further stem the opioid crisis. Unfortunately, reducing unnecessary opioid initiation has been under-emphasized or absent from most recommendations, presenting a dangerous gap in strategy given the widespread prevalence of pain. Guidelines recommend the use of nonpharmacologic therapy (NPT) for pain. This study presents strategies for the use of settlement funds to facilitate the use of NPT as an alternative to opioids.

Method(s): Our team developed and published recommendations to guide states and localities to use opioid settlement funds to increase access to evidence-based, nonpharmacologic therapy (NPT) for pain management, as a means of preventing unnecessary opioid use.

Results: Recommendations include: increase awareness of NPT use for pain; expand coverage of NPT, especially under Medicaid; enhance equity, including through community-informed access; support non-clinical NPT interventions for pain management; reduce barriers specific to accessing provider-led NPT; illuminate gaps in guideline adherent care pathways for pain; fund pilot projects that integrate NPT into opioid use disorder treatment programs; and build infrastructure to facilitate NPT use. Each recommendation includes several practical, actionable steps decision makers can take, engaging communities and the complementary and integrative healthcare profession in the process.

Conclusions: Increased access to NPT for pain management is an upstream prevention strategy that complements other opioid mitigation strategies. Settlement funds should be used to support the use of NPT as alternatives to opioids and invest in long-term population health.

Oral Abstract Session 04: Remote Intervention and Quality Improvement

OA04.01

Women Veterans and VA TeleYoga: Engagement, Satisfaction, and Perceived Health Outcomes

Francesca Nicosia¹, Molly Delzio², Mary K³, Tony Pomales³, and Rashmi Mullur⁴

¹ University of California San Francisco / San Francisco VA Healthcare System, Oakland, CA

² SFVA, San Francisco, CA

³ Veterans Rural Health Resource Center-Iowa City, Center for Access & Delivery Research and Evaluation, Iowa City VAHCS, Iowa City, IA

⁴ Greater Los Angeles VAHCS, University of California, Los Angeles, Los Angeles, CA

Contact: Molly Delzio, [e-mail]

Abstract

Purpose: Yoga is a mind-body movement modality with evidence for chronic pain and PTSD, which disproportionately affect women Veterans. As part of a VA Office of Rural Health program to expand access to telehealth yoga (tele-yoga) within 7 VA healthcare systems, this study evaluated reach, satisfaction, and effectiveness among women Veterans.

Method(s): We used VA administrative data to measure reach and participant characteristics. To assess effectiveness and implementation factors, we distributed an electronic survey to participants with ≥2 encounters between October 2021- March 2023. Key characteristics were summarized with descriptive statistics; group comparisons were examined with Wilcoxon tests; open-ended responses were analyzed using qualitative content analysis.

Results: The TeleYoga program reached 373 women Veterans (mean age: 55.5 ± 12.3, 53% white, 17% rural). Higher engagement was associated with rural location (mean 10.2 vs. 9.3 encounters, p=0.04) and older age (≥65, mean 21.1 vs. 6.6 encounters, p<0.001). Survey participants (n=75) were 58.3 ± 12.5 years and 63% white. Primary goals (improve health and well-being, pain management) were met, as most agreed that tele-yoga helped them engage in their personal healthcare (78%), reduce stress (73%) and pain (66%), and improve mental health (63%). Most (70%) reported that the online format of tele-yoga made it a great deal easier to attend than an in-person class and 68% wrote about convenience as the most valuable aspect of the program. Almost all women Veterans rated their experience with tele-yoga as “good to excellent” (93%) and would recommend tele-yoga to other Veterans (96%). The most common suggestions for program improvement were providing more class options (e.g., afternoon and evening) and increased communication.

Conclusions: Remotely delivered video-based tele-yoga shows promise as an effective and accessible component of whole health care, especially among older and rural women Veterans.

OA04.02

Remote and In-Person Delivery of Tai Chi and Wellness Interventions to Address Veterans Gulf War Illness: A Two-Part Randomized Controlled Trial

Barbara Niles¹, DeAnna Mori², and Chenchen Wang³

¹ VA Boston Healthcare System, National Center for PTSD, and Boston University School of Medicine, Boston, MA

² VA Boston Healthcare System and Boston University School of Medicine, Boston, MA

³ Center for Integrative Medicine at Tufts Medical Center, Tufts University School of Medicine, Boston, MA

Contact: Barbara Niles, [e-mail]

Abstract

Purpose: To comply with pandemic restrictions initiated in March 2020, clinical trial researchers were required to either halt or make drastic modifications to studies. This presentation will report results from a two-part randomized controlled trial examining integrative interventions for Veterans Gulf War Illness that began prior to the pandemic and was adapted to continue as a fully remote trial during Covid lockdown.

Method(s): In both the in-person trial (Study 1; n = 48) and remote trial (Study 2; n = 63), veteran participants were randomly assigned to either Tai Chi or Wellness intervention arms. Group sessions were held twice weekly for 12 weeks. Assessments were conducted at baseline, post-intervention, and 3 and 9 months following the interventions. Qualitative interviews were conducted at post-treatment assessments. Gulf War Illness (GWI) symptoms of pain interference, fatigue, and mood were assessed in both studies.

Results: Attendance, satisfaction, and outcome results will be presented and compared across both studies. Remote session attendance was substantially higher (75%) than for the pre-pandemic in-person sessions (59%). The presenter will convey quantitative outcomes on GWI and related variables as well as qualitative findings from feedback interviews on the advantages and drawbacks of remote groups. Participants noted that remote delivery of the interventions to their homes or places of work was very convenient and allowed increased participation for Covid-restricted, working, traveling, and rural veterans.

Conclusions: A randomized trial of integrative interventions for veterans was successfully adapted to be fully remote. Findings indicate increased attendance and greater convenience for veteran participants.

OA04.03

Iterative Development of a Natural Language Processing Model to Identify Patient Reported Outcome Measure Documentation in VA Chiropractic Care

Brian Coleman¹, Kelsey Corcoran², Anthony Lisi³, Dezon Finch⁴, Stephen Luther⁴, and Cynthia Brandt⁵

¹ Yale School of Medicine & VA Connecticut, New Haven, CT

² Yale School of Medicine & VA Connecticut HCS, New Haven, CT

³ Yale University, New Haven, CT

⁴ James A. Haley Veterans Hospital, Tampa, FL

⁵ Yale School of Medicine/VA Connecticut, New Haven, CT

Contact: Brian Coleman, [e-mail]

Abstract

Purpose: The use of patient reported outcome measures (PROMs) to assess pain intensity and function is an expected standard of high-quality chiropractic care. Yet PROMs are not routinely captured as structured data. In this study, we describe the iterative development of a rule-based natural language processing (NLP) model for identifying PROM use in Veterans Affairs (VA) chiropractic care notes.

Method(s): A stratified random sample of 300 notes was obtained from a corpus from VA chiropractic care visits from 10/1/2017 to 9/30/2020. Notes were annotated by two reviewers using a validated method with adjudication. A rule-based NLP model was built using medspaCy and SpaCy 3.6 to automate PROM identification in the clinical text. NLP model evaluation statistics were calculated comparing the NLP model to the annotated gold standard in soft-boundary matching and binary note classification. False positive and negatives were reviewed, with iterative refinement of NLP rules to optimize model performance to limit false negatives.

Results: There were 76 outcome measure spans identified in 53 notes in the gold standard. The initial NLP model identified 111 spans in 58 notes and the refined model found 158 spans from 73 notes. Initial soft-boundary matching model performance was fair (precision, P=48%; recall, R=68%; F-measure, F=56%) and improved with refinement (P=47%; R=95%; F=63%). Binary note classification was fair-to-good initially (P=71%; R=77%; F =74%; accuracy, A=90%) with improvement post-refinement (P=70%, R=96%, F=81%, A=92%). Remaining false positives described treatment goals or were in abbreviation lists.

Conclusions: Rule-based NLP can automate chiropractic care quality monitoring and identified PROM documentation with improving performance after refinement. Performance was likely limited by a low prevalence of PROM use in the corpus and a small annotation set sample size. Additional training data can be strategically sampled for programmatic labeling to improve performance while balancing overfitting.

OA04.04

Developing Preliminary Quality Indicators for Chiropractic Care: A Scoping Review

Robert Vining¹, Jennifer Smith², Brian Anderson, Zachary Almquist¹, and Danveshka Wong²

¹ Palmer Center for Chiropractic Research, Davenport, IA

² Palmer College of Chiropractic, Davenport, IA

Contact: Robert Vining, [e-mail]

Abstract

Purpose: Quality indicators are objective measures needed to assess health care quality in integrative settings. This project focused on developing a preliminary set of indicators for chiropractic care.

Method(s): We systematically searched PubMed/MEDLINE, CINAHL, and Index to Chiropractic Literature databases for best practice articles and clinical guidelines applicable to chiropractic and published in English after 2011. Non-peer-reviewed sources such as the Royal College of Chiropractors quality standards were also eligible. Data abstraction included transforming recommendations and standards, potentially measurable with administrative data, into draft indicators by generating a title, description, and metric. Draft indicators were then assessed by with 5 criteria: 1) Describes a narrowly defined structure, process, or outcome; 2) Quantitative data can plausibly be available; 3) Performance is achievable by a health organization; 4) Metric is relevant; 5) Data can be obtainable within practical time limits. Unique indicators meeting all criteria were included in the final set.

Results: Of 2562 articles identified, 18 were eligible after a staged eligibility determination process. Clinical guidelines (n=10) and best practice recommendation (n=6) articles were most common, with 1 consensus and 1 clinical standards development study. Two non-peer-reviewed clinical standards, a guideline, and quality measures from U.S. Centers for Medicare and Medicaid were also included. Of 204 draft quality indicators, 57 were removed for failing to meet assessment criteria. Removing duplicates (n=77) reduced the final set to 70. Indicators matching the Donabedian category of process (n=35) were most common, with 31 matching structure, and 4 matching outcome categories.

Conclusions: A preliminary set of quality indicators facilitates further research focused on validation, leading toward objectively assessing outcomes related to the quality of chiropractic care in integrative settings.

Oral Abstract Session 05: Population Health

OA05.01

Patient Reported Health Outcomes in Patients Receiving Complementary and Integrative Health Therapies in VA

Melissa Medich¹, Marlena Shin², Michael McGowan³, Danna Kasom³, Briana Lott³, Steven Zeliadt⁴, and Stephanie Taylor⁵

¹ Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, Los Angeles, CA

² Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA

³ Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA

⁴ VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

⁵ Veterans Health Administration, Los Angeles, CA

Contact: Melissa Medich, [e-mail]

Abstract

Purpose: Healthcare systems (HCS), including the Veterans Health Administration (VA), have expanded provision of non-pharmacological pain management therapies such as complementary & integrative health (CIH) therapies to help patients with chronic pain avoid risks associated with opioids. The VA APPROACH study not only examines the effectiveness of individual CIH therapies but compares patient-reported health benefits of self-care CIH therapies (e.g., yoga, meditation, Tai Chi, Qigong), practitioner-delivered CIH therapies (e.g., chiropractic care, acupuncture, massage therapy), versus patients’ combined use. This presentation reports on the qualitative component.

Method(s): Between 3/2022 & 2/2023, we interviewed 125 Veterans from 6 VA hospitals using CIH therapies in the previous 6 months. We examined 5 outcomes (e.g., overall quality of life/wellbeing, managing health, pain, anxiety, sleep & fatigue) among patients using 3 groups of CIH therapies: 1) only practitioner-delivered, 2) only self-care, & 3) a combination. We used an inductive approach to code content and a reflexive one for thematic analyses refined through consensus.

Results: Patients using only practitioner-delivered therapies reported pain relief but emphasized a need for frequent treatments to sustain pain symptom relief; they reported less anxiety & fatigue relief. Patients using only self-care therapies reported decreased anxiety, but modest pain relief & fatigue relief. Patients using a combination reported overall physical & mental health symptom relief & decreased medication use, emphasizing diffused treatments over time as key to sustained relief. This group & those using only self-care therapies reported an increased control over their health & overall quality of life/wellbeing.

Conclusions: Using a combination of practitioner-delivered & self-care therapies may help patients achieve longer-lasting pain relief & better health management. HCS should consider increasing provision of self-care therapies with practitioner-delivered ones.

OA05.02

Investigating Complementary and Integrative Health Representation Within the All of Us Research Program

Brian Anderson¹ and Ryan Bradley²

¹ Palmer College Of Chiropractic, Davenport, IA

² National University of Natural Medicine, Portland, OR

Contact: Brian Anderson, [e-mail]

Abstract

Purpose: The All of Us (AoU) research program aims to create a comprehensive health information database by recruiting 1 million Americans. One AoU core goal is to engage a diverse group of researchers. However, no publications and few ongoing AoU research projects have investigated Complementary and Integrative Health (CIH) approaches. Thus, our objective was to identify CIH-related data within AoU to build a foundation for future research.

Method(s): We searched survey and electronic health records (EHR) data for CIH-related keywords, including complementary, integrative, chiropractic, spinal manipulation, acupuncture, mindfulness/meditation, yoga, tai chi, massage, vitamins/minerals/herbal products and naturopathy. Concept sets were developed by combining categories of CIH data.

Results: 500,000+ subjects were enrolled, with 50% sharing EHR data and 90% completing demographic, lifestyle, and overall health surveys. Twenty-five percent completed surveys on healthcare use, social determinants, and medical history. CIH concept sets developed include: Chiropractic; Acupuncture; Dietary intervention; Manual therapies; Natural products; and Nutritional deficiencies. PROMIS Global-10 scores were available for 410k subjects. A survey question inquired if subjects used alternative therapies to save money (14k).

Conclusions: AoU contains data useful for CIH-related studies, presenting an opportunity to advance research in this field. Potential studies may use survey data to characterize CIH user’s vs non-users with specific conditions, or EHR data to evaluate long-term healthcare use in subjects choosing non-pharmacologic vs medical care for back pain. The authors plan to develop further resources for studying CIH approaches within AoU.

OA05.03

The Impact of Chiropractic Care on Opioid Prescription Fills in Veterans Health Administration Patients Receiving Care for Neck Pain Conditions

Anthony Lisi¹, Lori Bastian², Cynthia Brandt³, Brian Coleman⁴, and Joseph Goulet⁵

¹ Yale University, New Haven, CT

² VA Connecticut Healthcare System, West Haven, CT

³ Yale School of Medicine/VA Connecticut, New Haven, CT

⁴ Yale School of Medicine & VA Connecticut, New Haven, CT

⁵ VA Connecticut, West Haven, CT

Contact: Anthony Lisi, [e-mail]

Abstract

Purpose: To evaluate the impact of chiropractic care on the receipt of opioid prescriptions among Veterans Health Administration (VA) patients after incident visits for neck pain conditions (NP).

Method(s): We identified national VA patients from 10/1/2015-9/30/2021 with incident (index) visits for NP occurring in primary care clinics without any NP visits or opioid prescription fills in the prior 12 months, followed by ≥2 subsequent visits for NP within 12 months after index. Chiropractic users received ≥2 NP visits in chiropractic care; non-users received ≥2 NP visits in any other clinics. We used logistic regression including demographics, medical and mental health comorbidities, and Functional Comorbidity Index (FCI) scores to estimate a propensity score for receipt of chiropractic care. We matched chiropractic recipients to non-recipients 1:3 on the propensity score, then calculated the time to first opioid fill from the date of the index NP visit, or until the end of the 12-month observation period (censored) for all patients. We then used Cox proportional hazards regression to estimate the hazard ratio for receipt of opioids, including the propensity score as a covariate.

Results: 24,590 Veterans with NP (1,652 chiropractic users, 22,938 non-users) met study criteria. Both groups were similar with respect to co-morbid mental health diagnoses and FCI scores. Chiropractic users were more likely to be younger (mean 44.1 v. 49.7 years, p<0.0001) and also have LBP (57.5% v. 32.9%, p<0.0001). In the propensity score matched sample (N=6,180), the hazard ratio for opioid prescription for those receiving compared to those not receiving chiropractic care was 0.733 (95% confidence interval 0.623-0.864), indicating a significantly lower risk for opioid prescription fills among chiropractic users.

Conclusions: Use of VA chiropractic care decreases the likelihood of opioid prescription fills after incident visits for NP, emphasizing the need for research and operations efforts to optimize clinical care pathways.

OA05.04

Impact of Integrative Health and Medicine on Costs Among Adult Health System Beneficiaries with Musculoskeletal Conditions: Retrospective Cohort Study

Robert Trager¹, Matthew Nichols², Tyler Barnett³, Samuel N. Rodgers-Melnick⁴, Sunah Song⁵, Thomas Love³, Francoise Adan⁶, and Jeffery Dusek⁷

¹ Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

² Population Health Data Science and Analytics, University Hospitals Accountable Care Organization, Cleveland, OH

³ Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH

⁴ University Hospitals Connor Whole Health, Cleveland, OH

⁵ Cleveland Institute for Computational Biology, Cleveland, OH

⁶ University Hospitals Health System, Cleveland, OH

⁷ University of California - Irvine, Irvine, CA

Contact: Robert Trager, [e-mail]

Abstract

Purpose: Integrative health and medicine (IHM) modalities are associated with improved patient-reported outcomes (PROs). However, due to perceived additional costs, patients may avoid, and insurers may not cover IHM treatments. We hypothesized that adult employees of a health system’s insurance plan and their dependents with musculoskeletal (MSK) conditions receiving covered IHM in an outpatient setting would have reduced total, medical, and pharmaceutical costs over 1-year follow-up compared to matched controls.

Method(s): We queried medical records and Accountable Care Organization administrative claims spanning 2018-2023 for beneficiaries aged 18-89 with a new MSK episode using a 90-day washout. Data were de-identified per Institutional Review Board not human subjects’ determination. Patients were divided into 2 cohorts: 1) IHM within ≤ 3 months following MSK diagnosis, and 2) No IHM after initiating primary care. Propensity-score matching was used to balance cohorts on socio-demographics, comorbidities, healthcare utilization, and prior 12-month medical and pharmaceutical spend. Least-squared (LS) mean total, medical, and pharmaceutical allowed costs over 1-year follow-up were analyzed using a linear mixed model.

Results: After matching, there were 253 patients per cohort, with adequate covariate balance. There were no meaningful between-cohort differences (IHM vs. No IHM) in LS mean cost for total ($3724 vs. $3620), medical ($2815 vs. $2439), or pharmaceutical ($169 vs. $224) costs.

Conclusions: IHM use among adult health system beneficiaries with MSK conditions was not associated with differences in 1-year follow-up healthcare costs compared to matched controls. Importantly, offering IHM services did not increase costs to the insurer. Future research should include a larger sample of patients and examine longitudinal changes in PROs which may help explain subgroup changes in health costs.

Oral Abstract Session 06: Education Research

OA06.01

Integrating DEIB Principles in Nutrition and Culinary Education: A Step Towards Culturally Competent Healthcare

Melinda Ring¹, David Ai², and Geeta Maker-Clark³

¹ Osher Center for Integrative Health at Northwestern University, CHICAGO, IL

² Baylor College of Medicine, Houston, TX

³ North Shore University Health System, University of Chicago, Evanston, IL

Contact: Melinda Ring, [e-mail]

Abstract

Purpose: This study aims to create a robust checklist to facilitate the incorporation of Diversity, Equity, Inclusion, and Belonging (DEIB) principles into nutrition and culinary education, fostering a generation of healthcare professionals adept at implementing DEIB principles in their practice, thus promoting inclusive and equitable healthcare.

Method(s): A literature review was undertaken to analyze existing resources focusing on DEIB principles in nutrition and health education. This review, guided by specific keywords, helped in identifying pertinent articles and extracting common themes and insights, forming the basis for a three-tiered checklist that outlines actionable steps for assimilating DEIB principles into healthcare education.

Results: The study led to the creation of a detailed checklist delineating three tiers:

• Avoiding Bias and Discrimination: Concentrates on eradicating biases and discriminatory practices in the curriculum.

• Enhancing DEIB and Cultural Awareness: Focuses on integrating DEIB principles into the educational experience, nurturing empathy and respect among learners.

• Building Skills for DEIB Implementation: Aims at fostering the necessary skills for effective DEIB implementation in professional healthcare environments.

This checklist further categorizes specific focal areas into three segments: DEIB in Nutrition Curriculum Content, DEIB in Recipes and Cooking, and DEIB in Curriculum Delivery, offering a structured pathway to develop culturally competent healthcare professionals.

Conclusions: Incorporating DEIB principles into nutrition and culinary education is vital in advancing a more inclusive and equitable healthcare system. The formulated checklist stands as a practical tool, signifying a commitment to grooming healthcare professionals proficient in applying DEIB principles practically, marking a notable progression towards a culturally sensitive healthcare system that actively addresses health disparities.

OA06.02

Why Doesn’t My Doctor Seem to Know Much About Medical Cannabis? Determining Medical Cannabis Education Competencies: A Delphi Process

Mikhail Kogan¹, Leslie Mendoza Temple², Jade Isaac³, Yuval Zolotov⁴, and Richard Isralowitz⁵

¹ George Washington University, Takoma Park, MD

² Endeavor Health (formerly NorthShore University HealthSystem) and University of Chicago Pritzker School of Medicine, Highland Park, IL

³ University of Chicago, Downers Grove, IL

⁴ Albert Einstein School of Medicine, Tel Aviv, Tel-Aviv, Israel

⁵ Ben Gurion University, Beersheba, Tel-Aviv, Israel

Contact: Mikhail Kogan, [e-mail]

Abstract

Purpose: The rapid growth of medical cannabis use in over half of the United States has created an unprecedented gap between what medical students and allied healthcare students learn versus the amount of information patients require for safe and effective outcomes. We previously demonstrated that students who demand this knowledge are compelled to look beyond their training programs. (Zolotov et al., 2021). Creating competency-based medical school curriculum on the therapeutic uses of medical cannabis and its attendant risks is an urgently needed task.

Method(s): The Delphi method is one of the most common research tools for obtaining consensus about complex topics and is widely used in educational research. We have assembled a diverse panel of leaders in medicine, nursing, pharmacy, and social work fields to identify the most useful competency-based medical education curriculum on medical cannabis to date. The Delphi method has guided the panel’s decision-making process with the goal of creating the first of an evolving set of curriculum for students in the health professions, starting with medical students.

Results: The Delphi Method led to formation of the world's first standardized Medical Cannabis Curriculum that we will share during the meeting ahead of planned publication. A total of 6 competencies were generated to cover basic pharmacology, clinical aspects, regulations, policies, and racial and socioeconomic disparities. An example of proposed curriculum determined by the Delphi process is: "Medical students should learn how structural racism has impacted cannabis policy and healthcare."

Conclusions: Our work can pave the way for universal incorporation of medical cannabis curriculum into undergraduate medical education. This curriculum may be adapted to meet the needs of nursing, pharmacy, social work, and other allied health profession students.

OA06.03

How to Foster Resident Physician Wellness in an Unwell System: Challenges & Rewards of a Family Medicine Residency Pilot Program

London Breedlove¹, Debra Bell¹, and Christine Wineberg²

¹ University of Washington, Seattle, WA

² Columbia Valley Community Health RTT/University of Washington Family Medicine Residency, Chelan, WA

Contact: London Breedlove, [e-mail]

Abstract

Purpose: Between 50-75% of resident physicians experience burnout at some point in their training. The purpose of this proposal is to examine our process of developing a longitudinal family medicine resident wellness program that could meet diverse needs of residents within burned out and under-resourced clinical and educational systems. Our approach includes ongoing qualitative and objective evaluation of the program to make and create an effective program well received by residents and faculty.

Method(s): Resident and faculty feedback and literature review informed the development a program called Wellness ² that aims to 1) Create a safe, welcoming community space for residents to process their residency experience with peers and faculty facilitators; 2) Teach evidence-based skills to better cope with the stress that can often accompany residency and to better navigate common challenges that arise during training; and 3) Cultivate positive aspects of being life-long learners, physicians, and healers.

Results: We discovered several challenges while developing our program, including establishing protected time for residents to attend the program. There is a belief that taking time away from patient contact jeopardizes the ability to graduate an excellent physician. Faculty expressed that high level of stress and long hours are a symbol of the profession, which has communicated to residents that they must choose between their own wellbeing and their profession. Preliminary data gathered indicated a high level of perceived stress for residents coupled with a high level of satisfaction with the program. There is a preference for having an open discussion time with peers over didactic learning.

Conclusions: Although residents expect programs to prioritize their wellbeing, there is much cultural and systemic resistance and other barriers to developing and implementing a longitudinal resident wellbeing program. Adaptations must be made at the local level in order for the program to be feasible and successful.

OA06.04

Cross Institutional Curriculum for Integrative Medicine Training - Challenges & Opportunities

Anna Shannahan¹, Elizabeth Walsh², Melinda Ring³, Iman Majd⁴, Darshan Mehta⁵, Vincent Minichiello⁶, Karen Koffler⁷, and Anand Dhruva⁸

¹ Osher Center for Integrative Medicine at Northwestern, Chicago, IL

² Vanderbilt University Medical Center, Nashville, TN

³ Osher Center for Integrative Health at Northwestern University, CHICAGO, IL

⁴ Osher Center for Integrative Medicine, University of Washington, National Certification Commission for AOM (NCCAOM), Medical Acupuncture Research Foundation, Seattle, WA

⁵ Harvard Medical School, Boston, MA

⁶ University of Wisconsin, Madison, WI

⁷ Osher Center for Integrative Medicine at Miami, Miami, FL

⁸ University of California San Francisco, San Francisco, CA

Contact: Anna Shannahan, [e-mail]

Abstract

Purpose: The COVID-19 pandemic catalyzed a reevaluation and reinvention of integrative medicine curriculum. Faculty across the 10 U.S.-based Osher Centers converged to address common barriers to implementation of elective rotation curricula for medical learners. This initiative aims to foster a unified approach, leveraging a shared repository of resources.

Method(s): A group of educational leaders from the participating Osher Centers collaborated to curate a well-rounded curriculum encompassing foundational integrative medicine topics. These topics, each covered by one or more centers, include: Introduction, nutrition, Manual Therapies, Mind-Body medicine, Herbs & Supplements, Lifestyle Medicine, Planetary Health, Whole systems, and others.

Results: To alleviate barriers in implementing integrative medicine training, the Osher Collaborative is at the forefront in developing a reservoir of materials. This repository, inclusive of video lectures, PowerPoint presentations, and peer-reviewed scientific articles, serves as a versatile educational toolkit. Furthermore, a proposed schedule format has been crafted, embedding processes for experiential activities, community resource engagement, and robust learning objectives and assessment tools, primed for integration by curriculum committees.

Conclusions: Embarking on a mission to expand the reach of integrative medicine education, the Osher Collaborative is spearheading the creation of a modular, adaptable curriculum with potential for widespread adoption across the U.S.-based Osher Centers and beyond. The proposed two-week elective format is intended to seamlessly integrate into existing medical and residency curricula. This initiative is not only a collaborative milestone but also heralds a future where integrative medicine education transcends institutional walls, fostering a community of medical professional’s adept in offering holistic, evidence-based health solutions.

Oral Abstract Session 07: Implementation Science

OA07.01

VA’s National Implementation of Whole Health and Impact on Patient Experiences

Steven Zeliadt¹, Claire Chen², David Reed³, Bella Etingen⁴, Rendelle Bolton⁵, Alex Kloehn⁶, Scott Coggeshall⁷, and Barbara Bokhour⁷

¹ VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

² Veterans Health Administration, Denver, CO

³ University of Washington, Seattle, WA

⁴ Veterans Health Administration, Dallas, TX

⁵ VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, MA

⁶ [e-mail], Seattle, WA

⁷ Veterans Health Administration, Seattle, WA

Contact: Steven Zeliadt, [e-mail]

Abstract

Purpose: The Veterans Health Administration (VHA) is moving toward personalized, proactive, patient-driven care through national implementation of Whole Health (WH) including training over 33,000 clinicians to more actively engage Veterans in broad conversations about their well-being. We used VHA’s annual quality of care survey, Survey of Healthcare Experiences of Patients, to assess how VHA’s WH rollout is impacting Veterans’ experiences with their providers and perspectives of VA care.

Method(s): Responders with use of WH-aligned services in the 12-month period before survey completion were compared to responders without recent WH use, adjusting for demographics and clinical characteristics with multivariate logistic regression. We focused on 2 patient-centered goal items included in the national survey.

Results: A total of 629,134 outpatient survey respondents (FY19-21) were identified of whom 25,800 had recent WH use. Veterans with WH had higher levels of disability (52% vs 39%), were less likely to be over age 65 (63% vs 77%), and had more chronic conditions (3.2 vs 2.4). Participation in WH services was associated with increased discussions with providers about specific health goals: adjusted OR 1.33 (1.29, 1.37), and discussions about challenges in taking care of health: adjusted OR 1.20 (1.16, 1.23). While there were slight trends associated with COVID and decreased satisfaction with healthcare at VHA facilities, in adjusted analyses accounting for COVID, participation in WH-aligned services was not associated with overall satisfaction: adjusted OR 0.98 (0.94, 1.02).

Conclusions: These findings suggest that VHA’s national implementation of WH is leading to more personalized and patient-centered care across the organization by increasing care team member discussions with patients about setting goals related to, and taking care of, their health and well-being. However, there is still room for improvement and continued efforts and innovations such as WH to improve patient-centered care are needed.

OA07.02

Doctors of Chiropractics Working With or Within Integrated Health Care Delivery Systems: A Scoping Review

Eric Roseen¹, Kelsey Corcoran², Maya Williams³, Isabelle Hanna³, Lance Laird⁴, Robert Saper⁵, Anthony Lisi⁶, Dan Alford³, Ezra Cohen³, Steven Atlas⁷, Jonathan Bean⁸, Roni Evans⁹, and André Bussières¹⁰

¹ Boston University School of Medicine and Boston Medical Center, Boston, MA

² Yale School of Medicine & VA Connecticut HCS, New Haven, CT

³ Boston Medical Center, Boston, MA

⁴ Boston University, Boston, MA

⁵ Cleveland Clinic, Cleveland, OH

⁶ Yale University, New Haven, CT

⁷ Massachusetts General Hospital, Boston, MA

⁸ VA Boston Healthcare System, Boston, MA

⁹ University of Minnesota, Minneapolis, MN

¹⁰ McGill University, Montreal, QC

Contact: Eric Roseen, [e-mail]

Abstract

Purpose: While current clinical practice guidelines support chiropractic care for back pain, integration of doctors of chiropractic (DCs) in healthcare delivery systems is rare. A better understanding of chiropractic care delivery in healthcare systems, implementation strategies, and outcomes is needed to increase adoption of chiropractic care in this setting.

Method(s): We performed a scoping review to identify published literature documenting DCs working in healthcare systems (protocol PMID: 33495261). PubMed, Embase and Web of Science were searched from January 1998 to January 2023. Two reviewers screened titles, abstracts, and relevant full-text articles, and then abstracted information from selected articles on characteristics of integrated chiropractic services, implementation strategies, and outcomes. We conducted descriptive analysis and categorized implementation strategies using ERIC (Expert Recommendations for Implementing Change) Taxonomy.

Results: From 3,157 unique abstracts, we reviewed 443 full text articles, of which 66 studies met inclusion criteria. Studies observed DCs working within health systems in the US (n=41), Canada (n=13), Europe (n=8), Australia (n=2), Asia (n=1), and South America (n=1). Chiropractic care, described in 42 studies, commonly included manual therapies (n=37) and advice on self-care (n=30). Most studies (n=42) described at least 1 implementation strategy, commonly from the following broad categories: train/educate stakeholders (n=31); evaluative/iterative (n=23); provide clinician support (n=22); and build stakeholder relationships (n=20). Strategies that involved infrastructure change (n=8) or modifying payment schemes (n=14) were less common.

Conclusions: We identified a wide range of implementation strategies from mostly observational studies of DCs working within healthcare systems, but few assessed comparative outcomes. Prospective RCTs are needed to test whether different implementation support adoption of chiropractic care in this setting or related outcomes.

OA07.03

Mindful Awareness in Body-Oriented Therapy (MABT) for Chronic Pain: A Hybrid Mixed-Methods Implementation Science Pilot Study

Cynthia Price¹, Kathryn Hansen², Dana Dharmakaya Colgan³, and Erin Blakeney⁴

¹ University of WA, Seattle, WA

² Vanderbilt, Nashville, TN

³ OHSU, Portland, OR

⁴ University of Washington, Department of Biobehavioral Nursing and Health Informatics, Seattle, WA

Contact: Cynthia Price, [e-mail]

Abstract

Purpose: Complementary and integrative health (CIH) therapies are now considered best practice for chronic pain treatment. Yet CIH is prescribed less than 30% of the time. There has been little research of CIH implementation for chronic pain. This hybrid pilot assessed a) implementation outcomes and b) longitudinal health outcomes for patients who received Mindful Awareness in Body-oriented Therapy (MABT) at an integrative chronic pain clinic. MABT, designed to reduce symptomatic distress by teaching interoceptive awareness skills for emotion regulation, was delivered individually by staff massage therapists using an 8-week manualized protocol.

Method(s): Key implementation outcomes of acceptability, appropriateness, adoption, feasibility and sustainability were examined using data collected from: a) surveys of clinic staff at 7 time points over 20 months, b) focus groups with clinic staff, and c) electronic health records. A one-group repeated measures design was implemented with patients referred by clinic providers. Health outcomes were collected at baseline, post-intervention, and 3-month follow-up. Repeated measures ANOVA.was used for analysis.

Results: MABT was considered acceptable and appropriate on stakeholder surveys (n=190); and focus groups highlighted that MABT addressed a gap in individualized patient services to enhance mindfulness and regulation. Adoption was high: 70 patients were referred, 41 scheduled, and 73% completed the MABT program. PROMIS-29 scales showed significant improvements on physical function (p=.02), fatigue (p=.01), sleep disturbance (p=.02), social roles (p=.001), and pain interference (p=01) from baseline to post-test. Interoceptive awareness and emotion regulation both significantly improved at p<0.0001. Health outcomes were maintained or improved through 3-month follow-up.

Conclusions: MABT was successfully implemented as a clinical service. Significant improvement on chronic pain outcomes indicate the promise of this approach and need for future study.

OA07.04

Group-based Integrative Pain Management in Primary Care Safety Net Clinics: A Multilevel Intervention to Advance Health Equity

Maria Chao¹, Ariana Thompson-Lastad², Melissa Craven³, Annika Hansen⁴, Wendy Hartogensis⁵, Jhia Jackson⁵, Sudha Prathikanti⁵, Vadan Ritter⁶, Nakari Ron⁷, Denise Ruvalcaba⁴, Naomi Schoenfeld⁷, Antonella Soldaini⁸, Candice Turchin⁸, Folashade Wolfe-Modupe⁵, Julia Wu⁴, Jesse Wennik⁷, and Pam Swedlow⁷

¹ Osher Center for Integrative Health, UCSF, San Francisco, CA

² UCSF, Berkeley, CA

³ n/a, San Francisco, CA

⁴ UCSF Osher Center for Integrative Health, San Francisco, CA

⁵ UCSF, San Francisco, CA

⁶ SFDPH, San Francisco, CA

⁷ Department of Public Health, San Francisco, San Francisco, CA

⁸ SFDPH, SF, CA

Contact: Maria Chao, [e-mail]

Abstract

Purpose: We tested group-based models as a multilevel approach to increase access to integrative pain care in primary care safety net clinics and improve pain-related outcomes in low-income patients.

Method(s): We piloted a 2x2 factorial randomized clinical trial of two 12-week group-based models: group acupuncture and integrative group medical visits (IGMV, with psychoeducation, mind-body approaches, and social support). English or Spanish-speaking adults with chronic pain for ≥3 months referred from San Francisco Department of Public Health primary care clinics were eligible for the trial. Participants received usual care and were randomized to group acupuncture, IGMV, neither, or both. Our preliminary analysis used linear mixed models of pre/post changes in pain-related outcomes; and flexible coding for qualitative data.

Results: Of randomized participants (n=44, 25 English, 19 Spanish), 59% were female (mean age=57); 21% identified as African American/Black, 52% Latine, 21% non-Latine White, and 5% ≥1 race; 80% had household income <$35,000. Participants’ average duration of chronic pain was 13.0 years with baseline pain intensity of 7.6 out of 10. Based on global impression of change, 86% of patients randomized to a study intervention reported clinically-relevant pain improvements vs. 20% of patients randomized to usual care (p=0.0003). Changes varied by intervention. Those in group acupuncture had decreased pain intensity, compared with no acupuncture (between-group difference=1.4, 95% CI=-2.6, -0.3). IGMV participants had improved social support for chronic pain, compared with no IGMV (group difference of 4.5, 95% CI=0.7, 8.3). Qualitative data revealed substantial barriers to accessing multimodal care prior to study participation, as well as benefits of group-based models.

Conclusions: Multilevel approaches are needed to advance health equity in pain management. Our study contributes to knowledge of group-based integrative pain management co-located in primary care to address disparities in pain care.

Oral Abstract Session 08: Culinary Medicine and Group Medical Visits

OA08.01

Nudging Strategies for Plant-Based Dietary Choices in Hospital Patients: A Field Experiment

Heidemarie Haller¹, Rebeca Montejano Vallej¹, Maik Plonka¹, Gustav Dobos¹, and Kristin Hünninghaus¹

¹ Center for Integrative Medicine and Planetary Health, University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany

Contact: Heidemarie Haller, [e-mail]

Abstract

Purpose: The prevalence of diet-related, chronic diseases is increasing worldwide. At the same time, the global food system is responsible for climate change, biodiversity loss, and land-use changes such as deforestation. A dietary shift to a plant-based diet could protect both individual and planetary health. Studies have shown that in community samples, nudging can positively influence dietary choices. In hospital patients, no study investigating nudging strategies has been conducted to date. We therefore investigated how different kind of nudges would influence patients’ choice of vegetarian menus.

Method(s): Three cohorts of inpatients of the University Hospital Essen, Germany were studied, each in a 4-week period: a baseline control cohort without nudges, a second exposed to an order nudge and a third cohort exposed to a combination of order and label (recommendation of the vegetarian menu) nudges. Analyses were conducted using chi-square tests and logistic regression modelling.

Results: In total, 7.462 patients (age: 57.6 ± 18.4, 51.6% female, hospital stay: 5.1 ± 6.0 days) provided 41.782 datasets. Analyses showed that in comparison to baseline, the order nudge (29.3% versus 34.8%, p<.001) as well as the combination nudge (29.3% versus 35.9%, p<.001) led to significant increased choices of the vegetarian dishes. In contrast, no significant differences were found between the two cohorts with nudges (p=.974). Independent of the nudging strategies applied, female gender and younger age were both significant predictors of choosing vegetarian menus (p<.001, respectively).

Conclusions: This study showed that simple and centrally implemented nudging strategies could increase patients’ choice of plant-based foods, which in turn will promote the health of patients and has positive environmental impact.

OA08.02

Dietary Counselling Plus Omega-3 Supplementation in the Treatment of Generalized Anxiety Disorder: The “EASe-GAD Trial”

Monique Aucoin¹, Laura LaChance², and Kieran Cooley²

¹ CCNM, Toronto, ON

² Canadian College of Naturopathic Medicine, Toronto, ON

Contact: Monique Aucoin, [e-mail]

Abstract

Purpose: Anxiety disorders are prevalent and disabling conditions. Many individuals report that treatment options are not accessible, effective, or tolerable. Clinical evidence suggests that the Mediterranean diet and omega-3 fatty acids can significantly improve symptoms of depression; however, the effects on anxiety symptoms have not been studied in a clinical population. The primary objective of the present study was to assess the feasibility and acceptability of a nutrition intervention delivered to women with GAD. The secondary objectives included assessing changes in anxiety symptom severity, quality of life, and biomarkers.

Method(s): This study was a randomized, wait-list controlled pilot trial delivering a 12-week, dietary counseling intervention and omega-3 supplementation to 50 adult women with GAD. Participants completed seven individual counselling sessions which included education, personalized recommendations, mindful eating techniques, motivational interviewing, and goal setting. They were provided with recipes and food items. Questionnaires and blood work were completed at baseline, after the wait period (for those in the waitlist group) and after the intervention.

Results: A total of 443 individuals contacted the study within a period of seven months. Ninety-five percent of the 50 participants reported that they strongly agreed with the statement “My experience during this study was positive”. In the intervention group, the average anxiety symptom severity decreased from 26.2 (SD 8.1) to 10.9 (SD 7.3). In the waitlist group, the score decreased from 29.3 (SD 11.7) to 26.8 (SD 11.9). Additional outcome analyses are in progress and will be complete at the time of the conference.

Conclusions: Early results suggest that this study was feasible and acceptable. Additionally, participants in the intervention group experienced a substantial decrease in anxiety symptoms. These results lay the foundation for future large-scale studies.

OA08.03

Easing Pain Holistically: A Mixed-Methods Pilot Study on Integrative Group Medical Visits for People with Chronic Pain

Arti Prasad¹, Katherine Shafto, Catherine Justice, Susan (Sue) Haddow², Tegan Reeves³, and Jeffery Dusek⁴

¹ Hennepin HealthCare, Minneapolis, MN

² Hennepin Healthcare, Minneapolis, Minneapolis, MN

³ Sensei Inc, Palm Springs, CA

⁴ University of California - Irvine, Irvine, CA

Contact: Katherine Shafto, [e-mail]

Abstract

Purpose: In chronic pain care, integrative Group Medical Visits (GMV) show promise, while social drivers of health create barriers to wellbeing. The purpose of this study was to evaluate quantitative and qualitative outcomes from Easing Pain Holistically (EPH), an 8-week integrative GMV series at Hennepin Healthcare Systems (a safety-net hospital system in Minneapolis).

Method(s): EPH GMV’s utilized mindfulness, discussion, movement, healing touch, healthy foods/recipes, self-care tools, and education on the science of pain, stress, lifestyle, and low/no cost community resources. Two-hour long visits were co-facilitated by a Board-Certified Integrative physician, an integrative Physical Therapist, and a psychologist. Guest speakers included chiropractic, acupuncture, spiritual care, healing touch, and sleep psychology. Quantitative measures included attendance, 0-10 pain scores, and PROMIS-29 (weeks 1 & 8). Qualitative data was collected via weekly pre/post journal responses and analyzed through grounded thematic analysis.

Results: The EPH series enrolled 28 patients (86% White, 14% Black; 75% female, 14% male, 11% non-binary) with 75% average attendance. Average pain scores decreased within sessions by –2.2. Analysis of the PROMIS-29 (n=18) indicated reductions in anxiety (95% CI -8.04, -1.67) and fatigue (-6.03, -0.88) and increases in social participation (0.48, 5.22). Thematic analysis indicated patients’ state before the group as: Stress (14); Fatigue (11); Pain (11); Rushed (5); Emotional Language (4); Ache (4); and Overwhelmed (3) and after the group as: Relaxed (15); Better (10); Calm (8); Peaceful (7); and Hopeful (4). “Sharing” was the most common response to the question “What portion(s) of the group visit did you like the most?”, followed by nervous system information, nutrition, and meditation.

Conclusions: The EPH GMV is an example of how integrative approaches to chronic pain applied in a group/cohort setting have potential to improve function and pain in historically underserved populations.

OA08.04

Adapting Integrative Group Medical Visits for Spanish-Speaking Patients with Chronic Pain in Underserved Communities

Annika Hansen¹, Ariana Thompson-Lastad², Denise Ruvalcaba¹, Nakari Ron³, Naomi Schoenfeld³, Victoria Garcia Drago¹, Jesse Wennik³, Pam Swedlow³, Julia Wu¹, and Maria Chao⁴

¹ UCSF Osher Center for Integrative Health, San Francisco, CA

² UCSF, Berkeley, CA

³ Department of Public Health, San Francisco, San Francisco, CA

⁴ Osher Center for Integrative Health, UCSF, San Francisco, CA

Contact: Annika Hansen, [e-mail]

Abstract

Purpose: Chronic pain is one of the most burdensome conditions in the United States. Nonpharmacologic, integrative approaches are recommended for optimal pain management but are not widely accessible due in part to a lack of linguistic and culturally appropriate care. Group medical visits are a promising model to increase access to integrative care and reduce pain-related disparities. We describe our process of adapting an Integrative Group Medical Visit (IGMV) program for Spanish-speaking, primary care safety-net patients.

Method(s): We adapted our study interventions into Spanish using the Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities. We convened 2 expert panels on IGMVs, including 7 bilingual/bicultural IGMV facilitators. Topics included core and modifiable components of pain programs, strategies for addressing stigma, and supporting belonging. We evaluated study procedures (e.g., recruitment, consent, intervention delivery) to reduce participation barriers.

Results: Both the English and Spanish versions of IGMV include movement, psychoeducation, mind-body skills, and co-facilitation by an interdisciplinary team. Consultants recommended several adaptations to improve IGMVs for Spanish-speaking patients. Recommended study procedures included: culturally tailored recruitment strategies including hosting study orientations; improving accessibility across literacy levels (e.g., eliminating use of PowerPoint); providing space and food for caregivers. Content recommendations included having facilitators acknowledge diverse spiritual or religious backgrounds, indigenous healing traditions, and experiences with immigration. Gender inclusive language translations, transportation, and options for remote participation were also discussed.

Conclusions: Cultural and linguistic adaptations are critical for improving access to integrative health interventions. Providing IGMVs in multiple languages is an important part of providing equitable integrative care.

Oral Abstract Session 09: Mind-Body Therapies II

OA09.01

“It’s a Shift in How I Manage Stress and Experience My Body and Feelings”: A Controlled Trial of a Mind-Body Program for Eating Disorders and PTSD

Esther Estey¹, Wendy Guyker², Chelsea Roff³, and Catherine Cook-Cottone²

¹ Harvard Medical School/Center for Mindfulness and Compassion, Menlo Park, CA

² University at Buffalo, The State University of New York, Buffalo, NY

³ Eat Breathe Thrive, London, London, United Kingdom

Contact: Esther Estey, [e-mail]

Abstract

Purpose: Posttraumatic stress disorder (PTSD) and eating disorders (EDs) are pervasive mental health conditions with high rates of comorbidity. The cognitive and emotional aspects of both disorders fuel an experience of the body as unsafe, unworthy, and disconnected. Yoga and mindfulness practices, emphasizing present moment awareness, self-compassion, and relating to the body as a resource for safety, support, and connection, can be beneficial for those at risk for, and struggling with these disorders. This study examined the impact of a yoga and mindfulness group ED intervention, Eat Breath Thrive (EBT), on PTSD symptoms.

Method(s): Adults (N = 168, 93.5% women), ages 18-65, in the US and UK were randomized to EBT or waitlist-control group. The 2-hour, 7-week program consisted of yoga, meditation, education, experiential activities, and peer support. Repeated measures ANOVAs analyses assessed scores on the Brief Coping Orientations to Problems Experienced Inventory, Eating Disorder Examination Questionnaire, Embodied Intimacy Scale, Functional Appreciation Scale, Self-Compassion Scale-Short, State-Trait Anxiety Inventory for Adults, and PTSD Checklist. Acceptability and usability were also assessed.

Results: Compared to controls, EBT participants reported significant decreases in ED behaviors, PTSD symptoms, state anxiety, and use of self-blame for coping. They endorsed greater functional appreciation for the body, self-compassion, and embodied intimacy with self and others. Most effects were maintained at 6-months. Acceptability and useability were established.

Conclusions: Findings suggest that although designed to address ED symptoms, EBT’s targeted focus on mindful awareness, acceptance, self-compassion and the felt-experience of the body as a friend and resource may also help reduce symptoms of PTSD. Ameliorating both EDs and comorbid PTSD, this study is a novel contribution to whole health, mind-body literature. Recommendations for future studies and trauma-informed, responsive methods are provided.

OA09.02

Interoceptive Awareness Training as an Adjunct to MOUD: Immediate Findings from a Mixed-Methods Study

Cynthia Price¹, Joseph Merrill¹, Anna Treadway¹, Julia Palmer¹, and Kenneth Pike¹

¹ University of WA, Seattle, WA

Contact: Cynthia Price, [e-mail]

Abstract

Purpose: This NCCIH-funded study examined Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to medication for OUD (MOUD). MABT teaches interoceptive awareness to promote regulation and self-care. This study compared between-group pre-post change on health outcomes, and triangulated with qualitative findings.

Method(s): People in MOUD from 5 clinics (N=303), were randomly assigned to either MABT + MOUD or to MOUD only. MABT was delivered individually, involving eight 75-minute sessions. Participants completed a substance use interview, and survey to assess distress, pain, and interoceptive awareness; analyses included descriptive statistics, and linear mixed models. A qualitative survey collected responses to questions about MABT experience among those who received the intervention (n=142), and analyzed using Atlas TI software and content analysis approach.

Results: Participants were low SES; 50% had chronic pain; 40% were above cut-off for moderate-severe anxiety (40%), 49% for depression, and 41% for PTSD. MABT was highly acceptable and 77% completed the intervention. Results show no change in opioid use or other substances, but a significant decrease in anxiety (p=.05), an increase in interoceptive awareness (p =.001), and a trend toward reduced pain interference (p = .07) for MABT vs. Control. MABT was perceived to be highly relevant to treatment. Primary themes specific to the MABT experience were: increased somato-emotional awareness; learned new skills to promote emotional regulation and/or sensation management, as well as mindfulness; and improved mental and/or physical health symptoms and self-care/agency.

Conclusions: These findings demonstrate that MABT teaches interoceptive awareness and reduces anxiety. The combined results point to the positive impact of improved somato-emotional awareness for self-regulation/ symptom management/ self-care agency, that together are critical for empowering behavior change, supporting overall recovery and positive treatment outcomes.

OA09.03

Recalibrating One's Self-Perceptions of Dispositional Mindfulness Following Meditation Training: The Partially Mediating Role of Mindful Humility

David Victorson¹, Carol Greco², Natalia Morone³, Kathryn Jackson⁴, Bruriah Horowitz⁵, Christina Sauer⁵, Nathan Dodds⁶, and Paul Pilkonis⁶

¹ Northwestern University, Evanston, IL

² University of Pittsburgh, Pittsburgh, PA

³ Boston University/Boston Medical Center, Boston, MA

⁴ Northwestern University, Chicago, IL

⁵ Northwestern University Feinberg School of Medicine, Chicago, IL

⁶ University of Pittsburg, Pittsburg, PA

Contact: David Victorson, [e-mail]

Abstract

Purpose: To examine the potential mediating role of meditation training-induced mindful humility on the temporal relationship between pre and post dispositional mindfulness.

Method(s): Participants were recruited nationally from teacher-led, group-based, multi-week mindfulness courses. They completed PROs at pre and post timepoints, including items about perceived dispositional mindfulness (e.g., I consider myself to be a mindful person, I am naturally mindful of things without needing to practice meditation, being fully present without judgment comes easy to me). At follow-up, they completed “humility” items about not realizing until they started practicing meditation how unmindful they were, how challenging being mindful can be, or overestimating how mindful they had been. A series of multiple mediation models were tested using a bootstrapping approach with pre/post dispositional mindfulness items as IV's/DV's respectively, and humility items as mediating variables.

Results: PROs at baseline (n=300) and follow-up (n=276) were completed by a mostly female (81%), white (84%), educated (88% college+), middle age sample (average age: 45), with 46% reporting currently meditating on a regular basis. Results showed that realizing being mindful is more challenging than previously appreciated partially mediated the pre-post temporal relationships of: 1) considering oneself to be a mindful person (b=-.25, p<.01) and 2) being present without judgment coming fairly easy (b=-.22, p<.01). Realizing how unmindful they had been until they started practicing meditation partially mediated the pre-post temporal relationship of: 3) being naturally mindful without needing to practice meditation (b=-.24, p<.01).

Conclusions: Following meditation training, a humility-informed recalibration may occur for some individuals about their previous self-perceptions of being mindful. This may be useful to better understand varying levels or types of dispositional mindfulness and possible response shift patterns on PROs following MBIs.

OA09.04

Mind-Body Therapies for the Treatment of Fibromyalgia: A Scoping Review

Jeremy P. Steen¹, Vivek Kannan¹, Abdullah Zaidi¹, Holger Cramer², and Jeremy Y. Ng³

¹ (1) Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; (2) Bosch Health Campus, Stuttgart, Germany, Stuttgart, Baden-Wuerttemberg, Germany

² University of Tübingen, Stuttgart, Baden-Wuerttemberg, Germany

³ (1) Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; (2) Bosch Health Campus, Stuttgart, Germany; (3) Centre for Journalology, Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, Ottawa, ON

Contact: Jeremy Y. Ng, [e-mail]

Abstract

Purpose: Fibromyalgia affects 1 in 20 people globally and is characterized by chronic pain, muscle stiffness, fatigue, and sleep disturbance. Treatment is challenging and a multimodal therapeutic approach is recommended. Our objective is to understand the scope and nature of mind-body therapies use for the treatment of fibromyalgia, focusing on patient-important outcomes such as pain, fatigue, patient global impression of change, multidimensional function, sleep disturbance, depression, and anxiety.

Method(s): We followed the Joanna Briggs Institute (JBI) scoping review methodology. Searches were conducted on MEDLINE, EMBASE, PsycINFO, AMED, and CINAHL from inception to 02 June 2022. Studies on adults with fibromyalgia using mind-body therapy were eligible. We excluded articles with no meditation-specific therapy, such as cognitive behavioral therapy and educational programs.

Results: Our analysis included twenty-nine studies, comprising 23 randomized controlled trials, and 6 quasi-experimental studies that compared various mind-body therapies (including biofeedback, guided imagery, mindfulness-based stress reduction, progressive muscle relaxation, qigong, tai chi and yoga) to usual care, wait-list, or attention controls. More than 66% of eligible studies reported significant improvements in pain. More than 57% indicated improvements in fatigue and more than 42% in multidimensional function. Reduced sleep disturbance, depression and anxiety were each observed in more than 23% of the studies. Most studies provided two-to-four-month follow-up data. The included studies did not prioritize assessing safety, and no study explicitly reported any adverse events (AEs).

Conclusions: While mind-body therapies exhibit promise in improving pain, fatigue, and physical function among adults with fibromyalgia, further research is needed to investigate the persistence of these beneficial effects. Due to the notable absence of reported AEs, there is a need for systematic safety evaluations.

OA09.05

Effects of Live-Online, Group Mindfulness Training on Opioid Use and Craving, Anxiety, and Pain During Buprenorphine Treatment

Joseph Rosansky¹, Hannah Goodman², Javier Barria², Gareth Parry², A. Kiera Fredericksen², Paula Gardiner³, Benjamin Cook¹, Roger Weiss⁴, and Zev Schuman Olivier⁵

¹ Harvard Medical School/Cambridge Health Alliance, Cambridge, MA

² Cambridge Health Alliance, Cambridge, MA

³ Cambridge Health Alliance, Lexington, MA

⁴ Harvard Medical School/McLean Hospital, Belmont, MA

⁵ Harvard Medical School/CHA Center for Mindfulness and Compassion, Malden, MA

Contact: Joseph Rosansky, [e-mail]

Abstract

Purpose: Buprenorphine is a popular, evidence-based treatment for opioid use disorder (OUD), but comorbid substance use, anxiety and pain have been associated with relapse and treatment dropout. The Mindful Recovery OUD Care Continuum (M-ROCC) was developed to help address symptoms of substance use, anxiety, and pain during buprenorphine treatment. This 24-week randomized controlled trial compared the effects of M-ROCC to a gold-standard active control using evidence-based treatment approaches. The primary outcome was biochemically-confirmed opioid abstinence. Secondary and exploratory outcomes included reductions in benzodiazepine use, cocaine use, symptoms of anxiety, pain interference, and opioid craving.

Method(s): The control group was time- and attention-matched to the M-ROCC group, and all study procedures were conducted virtually. We enrolled patients from 16 US states and randomized N = 196 participants in a 1:1 ratio. We used generalized estimating equations with an intent-to-treat approach to evaluate differences between groups in drug abstinence (oral toxicology plus self-report) during weeks 13-24. We used difference-in-differences, intent-to-treat, repeated measures linear mixed effects models to estimate changes from baseline to week 24 in anxiety, pain, and opioid craving.

Results: The sample was mostly female (61%) and white (92%). There were no significant differences in opioid, cocaine, or benzodiazepine abstinence. Anxiety (d = -1.2, p < 0.001) and pain (d = -0.6, p < 0.01) were reduced within both arms, without significant between group differences. Participants in the M-ROCC group experienced a significantly greater reduction in opioid craving than those in the control group (d = -0.5, p = 0.027).

Conclusions: M-ROCC was similar to existing evidence-based group treatment in its impacts on substance use, anxiety, and pain interference. However, mindfulness-based groups may contribute to greater reductions in opioid craving than evidence-based group treatments.

Oral Abstract Session 10: Employee and Student Wellbeing

OA10.01

The Feasibility and Effectiveness of Virtual Yoga for Chronic Low Back Pain in a Large Healthcare System Employee Population

Devyn Gaskins¹, Hallie Tankha¹, Bo Hu¹, Ning Guo¹, and Robert Saper¹

¹ Cleveland Clinic, Cleveland, OH

Contact: Devyn Gaskins, [e-mail]

Abstract

Purpose: Low back pain (LBP) is a common condition with enormous impact on patient suffering, healthcare cost, and provider burden. Although studies show in-person classes are effective for managing chronic LBP, further research is needed to test virtual yoga classes. Additionally, the feasibility of implementing a virtual yoga intervention within the context of a large healthcare system is unknown.

Method(s): This study used a two-arm randomized control trial design. The study period was 24 weeks long and divided into two parts: an initial 12-week Treatment Phase followed by a 12-week Follow-up Phase. Adults 18-64 with LBP for ≥3 month were recruited from the Employee Health Plan (EHP) through letters and intranet postings. They were randomized 1:1 into weekly virtual live-streamed yoga classes (Yoga Now) or a wait-list control (Yoga Later) who received usual care during the study period. Feasibility was assessed through retention data. Co-primary outcomes were 12-week average pain intensity in the previous week using an 11-point numerical rating scale and back-related function using the 23-point modified Roland Morris Disability Questionnaire (RMDQ).

Results: One hundred-forty EHP members enrolled (M age= 47.8; SD= 11.7). Participants were primarily female (80.7%) and White (82.1 %). 12.1% were Black/African American and 5.7% Hispanic/Latinx. Mean baseline pain intensity and RMDQ reflected moderate back pain and impairment. At week 12, the two groups differed significantly in pain intensity (M group difference= -1.5, SE= 0.4, p<.001) and function (M group difference= -3.3, SE= 0.9, p<.001), favoring Yoga Now. Overall class adherence was 36.6%; data collection rate was 77.1% at week 12 and 75% at week 24.

Conclusions: Employees of a large health care system with chronic LBP enrolled, participated, and reported clinical benefit from a therapeutic virtual yoga program. Future studies to assess cost-benefit and barriers/facilitators of implementation are needed.

OA10.02

The Whole Health of Healthcare Professionals Matters: The Evolution of Mindfulness in Motion as Effective Mind/Body Programing Accessible During Work

Maryanna Klatt¹, Jacqueline Caputo², Catherine Quatman-Yates³, Beth Steinberg⁴, Marcus Williams², Justin Merrigan⁵, Ilyda Sen⁶, Angela Emerson⁵, Riley Summers², Slate Bretz⁶, Morgan Orr⁷, Yulia Mulugeta², and Joshua Hagan⁵

¹ Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

² The Ohio State University, Columbus, OH

³ School of Health and Rehabilitation Sciences, Division of Physical Therapy, The Ohio State University, Columbus, OH

⁴ Ohio State University Center for Integrative Health, College of Medicine, Department of Family and Community Medicine, Columbus, OH

⁵ Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, OH

⁶ The Ohio State university, College of Medicine, Dept. of Family and Community Medicine, Columbus, OH

⁷ Human Performance Collaborative, Columbus, OH

Contact: Maryanna Klatt, [e-mail]

Abstract

Purpose: Healthcare provider (HCP) burnout is costly to both individuals and organizations. The Mindfulness in Motion (MIM) program has responded to the escalating need to address this issue by producing data that shows its ability to adapt and consistently show significant reductions in burnout, perceived stress with significant increases in resilience and work engagement. This study examines the impact of adding mobile app access, biometric measures of sleep, and respite spaces on clinical floors to practice MIM.

Method(s): Pre-post changes in measures of burnout, resilience, perceived stress and work engagement for HCPs participating in MIM were measured from 2018-2023. This data was compared to 2023 HCP cohorts that included MIM enhancements.

Results: MIM 2018-2023 (n=577) demonstrated significant 23% reduction in HCPs qualifying as burnt out by program end. Total burnout was determined by scores on the subscales of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) of the Maslach Burnout Inventory (MBI): EE>27 or DP>13 or PA<31. By 8-week end, there was a highly significant decrease in the in EE (p<0.00001) and DP (p<0.0003), with highly significant increase in the PA (p<0.00001) MBI subscales compared to baseline. Additionally, resilience, as measured by the Connor Davidson Resiliency Scale (CDRS) significantly increased (p<0.00001), alongside a significant increase (p<0.00001) in Utrecht Work Engagement Score (UWES) and a highly significant decrease in scores on the Perceived Stress Scale (PSS) (p<0.00001). Adding MIM enhancements (mobile app, biometric sleep measure, respite spaces) produced a greater decrease in burnout (32%) MBI (n=100) pre/post MIM, stress (PSS) (n=98) decreased significantly (p<0.00001), while resilience (CDRS) increased significantly (n=99) (p<0.00001), as did work engagement (n=74) (UWES) (p<0.00001).

Conclusions: Mobile app, biometric measures of sleep, and respite spaces were effective enhancements augmenting MIM’s impact on burnout for HCPs.

OA10.03

Restful Nights & Revitalizing Hearts: Impact of a 12-week Meditation & Breath Intervention on Sleep and Cardiac Health in Indian Medical Professionals

Praag Bhardwaj¹ and Monika Pathania¹

¹ All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttaranchal, India

Contact: Praag Bhardwaj, [e-mail]

Abstract

Purpose: Healthcare providers (HPs) face considerable stress that impacts their sleep & heart rate variability (HRV), with potential repercussions for patient care. Interventions like yoga & meditation can help address these crucial issues. This randomized controlled trial aimed to investigate the impact of an mHealth-aided 12-week meditation & breathing intervention (MBI) on ballistocardiography (BCG) based sleep & cardiac health indices of HPs in a tertiary care hospital in North India.

Method(s): Consenting HPs (N=98) (62 males, 36 females) (age 28.26 – 3.547 years) were randomly assigned to either the MBI (n=46) or the waitlist control group (n=46). MBI included guided yoga breathing & meditation sessions delivered online for 12 weeks. Total time asleep, light sleep, deep sleep, REM sleep, & time awake, along with heart rate, breath rate, SDNN, RMSSD, & LF/HF, were measured overnight for each participant at baseline & again after 12 weeks with a BCG based proprietary health monitor.

Results: The two groups were found to be comparable at baseline. Parametric & non-parametric tests were applied as per the Shapiro-Wilk normality test’s results. HPs participating in MBI exhibited significant improvements in heart rate (p 0.043), SDNN (p 0.007), RMSSD (p 0.026), total time asleep (p <0.001), light sleep (p 0.002), deep sleep (p 0.007), & REM sleep (p 0.004) when compared to waitlist controls. Breath rate, LF/HF, & time awake also improved for MBI in comparison to controls.

Conclusions: mHealth-aided 12-week MBI improved HRV & enhanced sleep among HPs. Such low-cost & easy-to-do interventions can offer a promising approach to mitigating stress & sleep-related challenges faced by HPs, consequently contributing to their overall well-being & performance. Also, mHealth can help HPs incorporate yoga into their busy schedules by allowing ease of access for time & place of practice. Well-rested HPs can make better decisions & positively affect patients’ health outcomes.

OA10.04

Becoming WHOLE: Whole Health Operation for Learning and Empowerment for Caregivers Across a Large Health System

Roshini Srinivasan¹, Samuel N. Rodgers-Melnick², Jessica Surdam², Tracy Segall³, Jessica Jurcak⁴, Jeffery Dusek⁵, and Francoise Adan⁶

¹ University Hospitals Connor Whole Health, Durham, NC

² University Hospitals Connor Whole Health, Cleveland, OH

³ University Hospitals of Cleveland, Cleveland, OH

⁴ University Hospitals, Cleveland, OH

⁵ University of California - Irvine, Irvine, CA

⁶ University Hospitals Health System, Cleveland, OH

Contact: Roshini Srinivasan, [e-mail]

Abstract

Purpose: Background: Caregivers within health systems are at high risk for chronic stress and burnout. In response, University Hospitals Connor Whole Health has deployed integrative health and medicine (IHM) modalities including seated massage, music therapy, and acupuncture directly to caregivers. However, robust means of collating system-wide data on participant characteristics and immediate effectiveness were lacking.

Objectives: To assess data collection feasibility and immediate effects of delivering IHM modalities to caregivers across a large health system.

Method(s): Caregivers participating in IHM modalities were invited to participate over 7 months. Following consent, they were invited to complete pre-intervention symptom rating measures via REDCap. Post-intervention measures and demographics surveys were sent via text message immediately following session participation. A linear mixed model adjusting for the random effect of caregivers seen multiple times was used to assess changes among those with pre-intervention measures ≥1 (stress and tension) or ≤ 9 (coping and relaxation).

Results: There were 2023 participation units (instances of receiving IHM) among 1506 caregivers. Of these, 487/1506 (32.3%) enrolled in the study. The 261/487 (53.6%) who provided demographics (mean age 42.1 years, 87.4% female, 73.1% White) included nurses (35.5%) and other patient care professionals (21.8%). 578/2023 (28.6%) participation units were among study participants, including seated massage (60.6%), music therapy (34.6%), and acupuncture (4.8%). Clinically meaningful mean improvements were observed across all modalities in stress (-2.12), tension (-2.71), and relaxation (1.71) and are shown in Figure 1.

Conclusions: Implementing automated REDCap data collection for IHM modalities among caregivers is feasible, though consent procedures often hindered participation. IHM modalities are effective for improving stress, tension, and relaxation.

OA10.05

Mindfulness-Based Stabilization of Primary School Children: A Longitudinal Partial Cluster-Randomized Trial

Dennis Anheyer¹, Mirela-Ioana Bilc², Nils Altner³, Gustav Dobos⁴, and Holger Cramer⁵

¹ Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

² University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

³ Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany, Essen, Nordrhein-Westfalen, Germany

⁴ Center for Integrative Medicine and Planetary Health, University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany

⁵ University of Tübingen, Stuttgart, Baden-Wuerttemberg, Germany

Contact: Dennis Anheyer, [e-mail]

Abstract

Purpose: Teachers and students in schools face escalating challenges, including new stressors linked to the COVID-19 crisis, yet resources to address these issues are limited. This trial aimed to assess the effectiveness of a mindfulness-based training program in primary schools.

Method(s): The trial involved 990 children from nineteen primary schools. Teachers chose either immediate program engagement (preferred choice arm) or were randomly assigned to immediate training or a waitlist (randomized arm). Students completed standardized questionnaires on classroom climate (FEES3-4), health-related quality of life (Kidscreen10), and a concentration test (d2) at baseline, 6-month, and 12-month. Over the initial 6 months, teachers underwent a 20-hour mindfulness-based stress reduction course and integrated mindfulness techniques into daily routines. For wait-list group the program was delayed by 6-month.

Results: In the preferred choice arm, 508 children participated, while 482 children underwent cluster-randomization. After 6 months in the randomized arm, analysis revealed significant differences in three FEES 3-4 scales in both groups of the randomized arm. Concentration performance scores increased significantly from baseline to 12 months, with no between-group differences. In the preferred choice arm, significant changes were observed in almost all FEES 3-4 scales, and concentration performance scores increased from baseline to 12 months. A significantly improved general sense of health was observed in all participating children at 6 months.

Conclusions: The study suggests that teachers' introduction of mindfulness positively impacts social interaction and students' overall sense of health. However, due to the lack of significant group differences in most outcomes, it can be concluded that integrating mindfulness practices in the classroom does not significantly enhance the overall maturation and learning effects of children at this age.

Oral Abstract Session 11: COVID-19 Research

OA11.01

Use of Complementary Medicine and Uptake of COVID-19 Vaccination Among US Adults: A Nationally Representative Survey

Mirela-Ioana Bilc¹ and Holger Cramer²

¹ University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

² University of Tübingen, Stuttgart, Baden-Wuerttemberg, Germany

Contact: Mirela-Ioana Bilc, [e-mail]

Abstract

Purpose: Previous studies have shown lower flu vaccination rates among patients who visit certain complementary medicine (CM) practitioners, but whether these findings are directly applicable to the uptake of the novel COVID-19 vaccination is unclear. Accordingly, using data from the 2022 National Health Interview Survey (NHIS), we examined associations between use of various CM modalities and uptake of COVID-19 vaccination, and compared these with associations with flu vaccination uptake.

Method(s): The NHIS is an annual nationally representative survey of the US civilian non-institutionalized adult population (n=27,651). We used hierarchical logistic regression with relative weights to predict uptake of COVID-19 and flu vaccination in the past 12 months based on CM use, while also controlling for demographic and clinical characteristics associated with potential flu- and COVID-19-related complications.

Results: After controlling for potential confounders, the overall use of any CM did not significantly predict uptake of the COVID-19 (p=0.726) or the flu vaccination (p=0.139). Regarding specific CM modalities, individuals who visited a chiropractor (ps<0.001) or a naturopath (p=0.002, p=0.016) were less likely to receive the COVID-19 or the flu vaccine. Individuals who visited an acupuncturist were more likely to get both vaccines (p=0.002, p=0.012). Individuals who used mind-body medicine were more likely to receive the COVID-19 vaccine (p=0.002), and those visiting an art and/or music therapist were more likely to receive the flu vaccine (p=0.047). The remaining CM-related predictors were not significant.

Conclusions: The pattern of associations of CM use with COVID-19 vaccination uptake was comparable to that of flu vaccination uptake. This suggests that vaccination hesitancy or advocacy are not specific to the novel mRNA vaccines but more likely represent fundamental vaccination-related beliefs.

OA11.02

INTERdisciplinary CarE for long COVID-19 among PediaTrics (INTERCEPT)

David Miller¹, Samuel N. Rodgers-Melnick², Tracy Segall³, Nada Tharwat Deraz⁴, Amy Edwards⁴, and Jeffery Dusek⁵

¹ UH Connor Whole Health, Cleveland, OH

² University Hospitals Connor Whole Health, Cleveland, OH

³ University Hospitals of Cleveland, Cleveland, OH

⁴ Department of General Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH

⁵ University of California - Irvine, Irvine, CA

Contact: David Miller, [e-mail]

Abstract

Purpose: Data on pediatric Long COVID is currently limited to descriptive reports of symptom prevalence, estimated incidence, and demographics, with few studies describing integrative care or patient-reported outcomes (PROs). The University Hospitals (UH) Rainbow Pediatric COVID Recovery Clinic was established in March 2021 to provide interdisciplinary specialty care and included an integrative medicine physician. The purpose of this study was to describe the demographic, clinical, symptom severity, and intervention characteristics within this clinic.

Method(s): A retrospective review was conducted of patients age 4-25 with Long COVID seen within this interdisciplinary clinic. Clinical note data were extracted from the UH Electronic Data Warehouse using a search engine. A subset of patients completed validated PROs of wellbeing, fatigue, sleep-related impairment and disturbance, depression, and anxiety.

Results: 250 patients (mean age 14.62, 63% female, 81% White) were seen within the clinic between March 2021 and June 2023, with 34.4% providing PedsQL and 26.4% providing PROMIS measures. Common documented conditions included fatigue (81.6%), headache (72.4%), anxiety (62.4%), dizziness (60%), and nausea (54.8%). Common interventions included diet changes (76.0%), pacing (59.2%), sleep hygiene (55.2%), and other self-care techniques (44.4%). Patients reported mean PROs that were more severe than national norms in other pediatric chronic disease cohorts (e.g., chronic pain, cancer, sickle cell disease) for PROMIS sleep disturbance (61.8), sleep-related impairment (64.0), anxiety (58.1), and depression (58.2) as well as PedsQL total fatigue (40.2).

Conclusions: Pediatric patients with Long COVID report high symptom burden. This study provides a novel look as well into comparative symptom severity in addition to the presence or absence of symptoms. Future research is needed to evaluate outcomes of the integrative interdisciplinary care described in this study.

OA11.03

Recruitment and Enrollment in a Large Randomized Trial for Acute/Sub-Acute Low Back Pain During the COVID Pandemic

Linda Hanson¹, Roni Evans¹, Chris McFarland², Gert Bronfort¹, and Michael Schneider²

¹ University of Minnesota, Minneapolis, MN

² University of Pittsburgh, Pittsburgh, PA

Contact: Linda Hanson, [e-mail]

Abstract

Purpose: Recruiting diverse participants with acute/subacute pain for randomized studies is challenging under ideal circumstances. Successes and challenges recruiting participants during the COVID-19 pandemic will be discussed.

Method(s): PACBACK (NCCIH UH3AT008769) is a phase 3, hybrid type I RCT with a 1-year follow-up. Adults with acute/subacute low back pain (BP), at risk of developing chronic BP were randomized to 8 weeks of spinal manipulation (SMT), supported self-management (SSM), SSM+SMT or medical care. Participants were recruited from Pittsburgh and the Twin Cities (Nov 2018-May 2023). Plans aimed at maximizing generalizability and inclusion of people from ethnic and minority groups were implemented and modified, based on feedback from community stakeholders. Strategies included recruitment advisory committees, social media, community outreach (e.g., volunteerism), and printed and electronic media distributed in diverse communities. Participants gave consent, and ethical approval was obtained.

Results: 1000 participants were enrolled in the study. Average age of participants was 47 years, 58% were female, and 19% (184/987) were Hispanic or a person of color (POC). Social media advertisements were the most cost-effective and reached the most people (> 1.2 million). Referrals from family and friends and study materials distributed in diverse areas, yielded the largest proportion of POC enrollees, but were most costly.

Conclusions: Despite COVID-19, we enrolled sufficient numbers to ensure a high-quality trial. While nearly ⅕ of enrolled participants were from an ethnic or minority group, COVID-19 and the social unrest at this time, affected our ability to enroll those underrepresented in pain research. Targeted recruitment strategies may improve enrollment rates of racially and ethnically diverse persons. While critical for building trust and sustainable collaborations, community outreach is resource and time intensive; this should be considered in project planning.

OA11.04

Experience of Veterans with Chronic Pain Initiating CIH Therapies Across 18 VHA Medical Centers Following the Initial COVID-19 Pandemic

Xiaoyi Zhang¹, Steven Zeliadt², Gang Luo¹, Joy Toyama³, Scott Coggeshall⁴, and Stephanie Taylor⁵

¹ Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA

² VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

³ Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA

⁴ Veterans Health Administration, Seattle, WA

⁵ Veterans Health Administration, Los Angeles, CA

Contact: Xiaoyi Zhang, [e-mail]

Abstract

Purpose: Veterans Health Administration (VHA) has prioritized ensuring at least six Complementary and Integrative Health (CIH) therapies are available to veterans. These therapies include chiropractic care, acupuncture, massage therapy, Tai Chi/Qigong, yoga, and meditation. This quality improvement effort examined the types of therapies veterans used and perceived effectiveness associated with initiating use.

Method(s): Between March 2021 and July 2022, we conducted weekly queries on electronic medical records to identify 15,619 veterans who had moderate to severe chronic pain and were initiating any of the six CIH therapies. These veterans were invited to participate in a series of four longitudinal quality improvement surveys over a 6-month period to capture additional details about use of CIH therapies outside the VHA.

Results: The most frequently identified therapies during this period were chiropractic care (45%) and acupuncture (27%). The two least frequently initiated therapies were Tai Chi/Qigong (4%) and yoga (3%). Most patients confirmed having high impact chronic pain (82%) and 28% reported significant impact in healthcare access due to COVID-19. Many patients reported initial perceived improvement with initiating CIH therapies for pain (49%), mental health (38%), fatigue (27%), and general well-being (45%). Perceived improvements varied across therapies; for example, 59% of those initiating chiropractic care reported improvements in pain, compared to under 30% among patients initiating yoga, meditation, or Tai Chi/Qigong, possibly because they had only participated in a few sessions at the time of the initial survey.

Conclusions: This survey highlights varied use and effectiveness of CIH therapies among veterans, with notable differences between therapies and care settings. Additional use of CIH therapies over the subsequent 6 months and their associated outcomes are forthcoming.

Oral Abstract Session 12: Health Services Research

OA12.01

An Outpatient Clinic for Integrative Mental Health: Patient Characteristics and Health Outcomes Based on Patient Reported Outcome Monitoring

Rogier Hoenders¹, Ellen Visser², and Sanne Booij³

¹ CIP, Lentis, Zeegse, Drente, Netherlands

² University of Groningen, Groningen, Groningen, Netherlands

³ CIP Lentis, Groningen, Groningen, Netherlands

Contact: Rogier Hoenders, [e-mail]

Abstract

Purpose: There is an increasing interest in integrative (mental) health care and a growth in centers offering such whole health services, but a paucity of research on the type of patients and their symptoms, the effects of treatments and patient satisfaction.

Method(s): Analysis of patient characteristics, satisfaction and health outcomes were conducted, using patient reported outcome monitoring (PROM) data of psychopathology (OQ-45), quality of life (MANSA), resilience (BRS), client satisfaction (CQI) and happiness (HI). Linear mixed models (with intention-to-treat) were used to examine change over time in the outcome measures. Multilevel version of Cohen’s D was used to calculate effect sizes (ES).

Results: A total of 1629 patients were assessed, of which 1333 received treatment and 296 consultation. Of these 1333 patients, 992 to 1079 filled in baseline questionnaires (81% responders). Of these, 69% was female, with a mean age of 41 years, mean treatment duration of 493 days, and on average 90 treatment hours. Baseline clinical characteristics indicated severe pathopathology and impaired functioning: BRS 2.5, HI 4.7, MANSA 52 and OQ-45 79. Responders did not significantly differ from non-responders in age, sex or diagnoses, but had significant more psychopathology, and longer and more intensive treatments. A total of 688 (51%) completed all questionnaires at baseline and at follow-up (completers). Compared to non-completers they had significant more psychopathology, and longer and more intensive treatments.

Linear mixed model analysis showed large and significant (p<.001) improvements in symptomatology (ES 1.25), quality of life (ES 1.11), resilience (ES 0.93), and happiness (ES 1.17) at discharge compared to baseline.

Patient satisfaction ranged 7.9 to 9.3.

Conclusions: Patients seem to improve, with high satisfaction, but despite the large sample size and the high external validity, results should be interpreted with caution due to the lack of a control group, missing data and loss to follow up.

OA12.02

Whole Health Care is a Gateway to Evidence-Based Mental Health Treatment: A Retrospective Cohort Analysis from the Veterans Health Administration

Bella Etingen¹, Bridget Smith², Steven Zeliadt³, Jenesse Kaitz⁴, Anna Barker⁵, Justeen Hyde⁶, Gemmae Fix⁵, David Reed⁷, Ekaterina Anderson⁵, Timothy Hogan⁵, and Barbara Bokhour⁸

¹ Veterans Health Administration, Dallas, TX

² Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL

³ VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

⁴ VA Puget Sound Healthcare System, Seattle, WA

⁵ Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA

⁶ Veterans Health Administration, Bedford, MA

⁷ University of Washington, Seattle, WA

⁸ Veterans Health Administration, Seattle, WA

Contact: Bella Etingen, [e-mail]

Abstract

Purpose: Despite widespread availability across the Veterans Health Administration (VHA), Veteran engagement in evidence-based psychotherapy (EBP) remains low. This analysis aimed to examine the relationship between Veteran use of Whole Health (WH) services (including Complementary and Integrative Health therapies) and subsequent EBP engagement.

Method(s): We conducted a retrospective database analysis using VHA administrative records from 18 geographically diverse VHA facilities where WH is being implemented. We identified Veterans (n=265,364) with diagnoses of depression, posttraumatic stress disorder (PTSD) and/or anxiety in fiscal year (FY) 2018 who had a VHA mental healthcare encounter in the year prior to their index date (i.e., date of first WH visit in FY2019; first day of FY2019 for non-users) but no EBP use during that time. We used multiple logistic regression to examine the association between Veteran use of WH services and subsequent engagement in an EBP within one year following their index date.

Results: Among the Veterans in our cohort, 33,146 used WH services in FY2019 (12.5%) and 7,860 (3.0%) had EBP use within one year following their index date. When controlling for key demographic, health, and utilization variables, Veterans who had (vs. had not) used WH services had 2.4 times higher odds of EBP engagement within one year following their index date (CI95%: 2.2-2.5). Associations between use (vs. no use) of specific WH services and subsequent EBP engagement ranged from 1.6 (95% CI: 1.0–2.6) to 3.5 (95% CI: 3.2–3.9) across the different types of WH services/therapies used.

Conclusions: Our results indicate that receipt of WH services is associated with subsequent EBP engagement among Veterans with depression, anxiety and/or PTSD. This association was strongest for meditation, Tai Chi, and yoga. Integrative therapies and well-being services emphasizing mindfulness, mind/body connection, and mindful coping skills may be a gateway to EBP engagement.

OA12.03

Immediate Effects of Integrative Health and Medicine Modalities Among Outpatients with Moderate-to-Severe Pain, Stress, and Anxiety

Samuel N. Rodgers-Melnick¹, Roshini Srinivasan², Rachael L. Rivard³, Francoise Adan⁴, and Jeffery Dusek⁵

¹ University Hospitals Connor Whole Health, Cleveland, OH

² Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH

³ HealthPartners Institute, Minneapolis, MN

⁴ University Hospitals Health System, Cleveland, OH

⁵ University of California - Irvine, Irvine, CA

Contact: Samuel N. Rodgers-Melnick, [e-mail]

Abstract

Purpose: Patients seeking integrative health and medicine (IHM) modalities often present with multiple physical and psychological concerns. Research supports IHM’s effectiveness for addressing symptoms over longer time periods. However, few studies have evaluated immediate outpatient effects. The purpose of this study was to describe pre-encounter symptom clusters and examine the clinical effectiveness of single-encounter IHM modalities on pain, stress, and anxiety among outpatients with moderate-to-severe symptoms.

Method(s): A retrospective review was conducted of encounters among adults presenting to outpatient acupuncture, chiropractic, massage, integrative medicine consultation, or osteopathic manipulation treatment between January 2019 and July 2020. Encounters were included if patients reported pre-encounter pain, stress, or anxiety ≥4 on a numeric rating scale (NRS). Outcome analyses were adjusted for multiple sessions across patients using a mixed model.

Results: Across 7,335 clinical encounters among 2,530 unique patients (mean age: 49.14 years; 81.0% female; 75.9% White; 15.8% Black/African American), the most common symptom clusters were pain, stress, and anxiety ≥4 (32.4%); pain ≥4 only (31.3%); and stress and anxiety ≥4 (15.6%). Clinically meaningful single-encounter mean changes were observed across all modalities in pain (-2.45), stress (-3.23), and anxiety (-2.92).

Conclusions: Patients presenting to outpatient IHM with moderate-to-severe symptoms most often presented with pain, stress, and anxiety ≥4 on the NRS. Multiple IHM modalities yielded clinically meaningful (≥2 unit) immediate reductions in these symptoms within a single encounter. Future research is needed to understand longitudinal effectiveness and optimize the triage and coordination of IHM modalities to meet patients’ needs.

OA12.04

Preliminary Cost-Effectiveness of Transcendental Meditation (TM) for Treating Post-Traumatic Stress Disorder (PTSD)

Erik Groessl¹ and Thomas Rutledge²

¹ UC San Diego, Encinitas, CA

² UC San Diego, La Jolla, CA

Contact: Erik Groessl, [e-mail]

Abstract

Purpose: Post-Traumatic Stress Disorder (PTSD) afflicts millions of people globally. Behavioral PTSD treatments like Prolonged Exposure (PE) are effective, but trauma-focused therapy is not well-tolerated. Transcendental Meditation ™ is not trauma-focused and can effectively treat PTSD in veterans. This analysis examines the preliminary cost-effectiveness of TM for PTSD based on results from a recent trial.

Method(s): In 2018, 203 veterans with PTSD were randomized to either TM, PE, or to a PTSD health education (HE) control. Each group was offered 12 treatment sessions over 12 weeks. Results indicate that TM was non-inferior to PE for improving PTSD outcomes and both TM and PE were superior to HE, as hypothesized. The proportion of participants with a clinically significant improvement on the CAPS (≥10 point reduction) were TM=61%, PE=42%, and HE=32%. A Markov model was developed to estimate the cost-effectiveness of TM, using the above data as probabilities of a clinically significant response. Health care costs and health utility associated with response and non-response were derived from scientific literature. Costs were viewed from an organizational perspective and a 3-year time horizon (12 3-month cycles). Treatment costs were derived from the trial and literature.

Results: TM was the dominant treatment over both PE and HE in the base analysis. TM cost an estimated $1504 /12 sessions while PE and HE cost $1,549 and $330, respectively. Since higher health care costs were associated with non-response to therapy ($9,109/annually vs. $5,887 - responders) further cost-offset was expected to accrue in the future. For HE, the large difference in response rate led to lower health care costs in the future, more than offsetting the added cost of providing TM. Findings were robust to variability.

Conclusions: In summary, based on data from a single RCT, TM was found to both improve health outcomes and reduce total costs in this analysis. Further effectiveness trials and wider adoption of TM should be considered.

Oral Abstract Session 13: Natural Medicine Therapies

OA13.01

Chinese Herbal Medicine and COVID-19: A Qualitative Analysis of Approaches to Evidence-Based Practice by Licensed Acupuncturists in the United States

Belinda Anderson¹, Melissa Zappa², Barbara Glickstein³, and Lisa Taylor-Swanson⁴

¹ Pace University, New York, NY

² University of Utah, Salt Lake City, UT

³ Barbara Glickstein Strategies, New York, NY

⁴ University of Utah College of Nursing, Salt Lake City, UT

Contact: Belinda Anderson, [e-mail]

Abstract

Purpose: COVID-19 was a new disease with no known effective biomedical treatment strategies. This qualitative study aimed to understand how licensed acupuncturists in the United States (US) determined treatment strategies for patients with symptoms likely related to COVID-19 using Chinese herbal medicine (CHM), and the impact of the pandemic upon their clinical practice.

Method(s): A qualitative instrument was developed with questions aligned with when participants started treating patients with symptoms likely related to COVID-19 and the availability of information related to the use of CHM for COVID-19. Interviews took place between March 8 and May 28, 2021 and were transcribed verbatim by a professional transcription service. Inductive theme analysis and Atlas’s Web software were used to determine themes.

Results: Theme saturation was achieved after 14 interviews lasting 11 to 42 minutes. Treatment with CHM predominantly started before mid-March 2020. Four themes emerged (1) information sources; (2) diagnostic and treatment decision making; (3) practitioner experience; (4) resources and supplies.

Conclusions: Primary sources of information informing treatment strategies came from China through professional networks and were widely disseminated throughout the US. Scientific studies evaluating the effectiveness of CHM for COVID-19 were generally not deemed useful for informing patient care because treatment had been initiated before they were published, and because of limitations associated with the research and the ability to apply it to real world practice.

OA13.02

Dietary Supplements and Natural Product Use for Chronic Pain in a Low Back Pain Cohort

Nandie Elhadidy¹, Keturah Faurot², Natalia Morone³, Susan Gaylord², Tra Nguyen⁴, Suzanne Lawrence⁵, Jose Baez⁴, Holly Thomas⁵, and Paula gardiner⁶

¹ Universtiy of North Carolina at Chapel Hill, Chapel Hill, NC

² University of North Carolina at Chapel Hill, Chapel Hill, NC

³ Boston University/Boston Medical Center, Boston, MA

⁴ Boston Medical Center, Boston, MA

⁵ University of Pittsburgh, Pittsburgh, PA

⁶ UMass Medical School and Tufts Medical School, Lexington, MA

Contact: Nandie Elhadidy, [e-mail]

Abstract

Purpose: Dietary supplements (DS) and other natural products are marketed and recommended for pain treatment but little is known about their prevalence of use by chronic musculoskeletal pain patients. The purpose of this research is to understand the prevalence of DS and natural product use for pain among participants in a pragmatic online randomized controlled trial of mindfulness training compared to usual care for the management of chronic low back pain.

Method(s): Study staff at three sites were trained to administer a questionnaire based on the NHANES dietary supplement interview supplemented by questions about cannabidiol (CBD, cannabis), and natural topical products. Staff collected DS labels via texting photos of the products. DS collection is ongoing. Descriptive statistics and preliminary associations are reported.

Results: Of 311 participants with DS interviews, the mean age was 53 (SD 15), 69% were female, and 45% were Black or African Americans. The mean BMI was 33 (SD 9) and most (55%) were not employed. The mean pain severity and pain interference (PEG) score was 7(SD 2) and the mean pain catastrophizing score was 12 (SD 6). Of the respondents 211 (67.8%) reported no natural product use for pain. Twenty-three (7.4%) reported using dietary supplements (vitamins, minerals, herbals, and fatty acids) and 13.5% reported using cannabis or CBD. Another 8.7% reported using topicals (capsaicin or menthol) for pain. Aside from age, current or former opioid use predicted any natural product use, largely related to CBD/cannabis use. CBD/cannabis use decreased with age and BMI and increased with opioid use (adjusted OR 2.65, 95% CI: 1.30, 5.41). The PEG score and sex were not associated. The product mentioned most often was Biofreeze.

Conclusions: Dietary supplement use for pain was rare, despite the number of products marketed for pain. CBD and cannabis were more common, especially among those who were younger, leaner, and had a history of opioid use.

OA13.03

Veterans’ Experience, Concerns, and Lack of Disclosure about Natural Product Use for Chronic Pain: Results from a New Natural Products Survey

Karen Seal¹, Termeh Feinberg², Natalie Purcell³, Liliana Moore⁴, and Daniel Bertenthal³

¹ San Francisco VAHCS, University of California, San Francisco, San Francisco, CA

² Kelly Government Solutions, LLC, Rockville, MD

³ San Francisco VA Health Care System, San Francisco, CA

⁴ San Francisco Veteran's Affairs Medical Center, UCSF, NCIRE, San Francisco, CA

Contact: Karen Seal, [e-mail]

Abstract

Purpose: Although the use of natural products (NPs) for pain management is prevalent, little is known about NP use in veterans with chronic pain because no data collection tool exists for this population.

Method(s): After feedback from 2 veteran focus groups and 2 expert panels, an NP survey was developed and refined. The survey was piloted among 52 veterans with chronic pain who endorsed NP use in a parent trial. The survey was mailed to veterans, purposefully sampling women and race/ethnic minorities. Response rate was 77.6%; 67.3% returned by mail and 32.7% by phone when assistance was requested. All data were entered into REDCap research electronic data capture. The dataset was enriched with demographics and pain and medication data from the parent study. Frequencies and means were calculated.

Results: Mean age was 57.6 (SD+/-12.5); 42% identified as women, 63% White, 21% Black/African American, and 16% other race(s); 10% reported Hispanic/Latinx ethnicity. All had chronic pain: 85% experienced disabling pain every day; 15% were prescribed opioids. The mean number of NPs used in the prior 3 months for pain was 4.6 (SD+/-3.2), and 90% reported daily use. The most frequently reported categories were vitamins/minerals (94%), followed by herbals/botanicals (60%; 40% also reported cannabis use). The majority (55% each) endorsed safety beliefs/concerns: “I think natural products are less harmful than most medications,” and “I worry about natural products interacting with medications prescribed to me,” as well as concerns about NP/NP interactions. Nearly all (98%) endorsed the importance of discussing NP use with their providers; only 54% had disclosed using NPs.

Conclusions: Surveying veterans with chronic pain about use of specific NPs with a new comprehensive instrument revealed frequent use of multiple NPs, safety concerns, and a preference to discuss NP use with providers. Consideration should be given to piloting this as a paper or online survey with other populations in different clinical settings.

OA13.04

Natural Product Use Among Veterans with Chronic Pain: A Qualitative Study of Attitudes and Communication with Healthcare Providers

Liliana Moore¹, Nicole Woodruff², Karen Seal³, Termeh Feinberg⁴, and Natalie Purcell⁵

¹ San Francisco Veteran's Affairs Medical Center, UCSF, NCIRE, San Francisco, CA

² San Francisco VAHCS, NCIRE, University of Southern California, San Francisco, CA

³ San Francisco VAHCS, University of California, San Francisco, San Francisco, CA

⁴ Kelly Government Solutions, LLC, Rockville, MD

⁵ San Francisco VA Health Care System, San Francisco, CA

Contact: Liliana Moore, [e-mail]

Abstract

Purpose: Despite mixed evidence regarding the safety and efficacy of natural products (NPs), many are marketed for pain and related symptoms. Use of these products is prevalent among veterans, who have disproportionately high rates of chronic pain. To date, however, there is limited research on veterans’ beliefs and attitudes about NPs and their communication with healthcare providers about their NP use. Our study explored how veterans experiencing chronic pain make decisions about NP use, investigated veterans’ beliefs about the safety and efficacy of these products, and examined veterans’ experiences discussing NPs with their providers.

Method(s): This qualitative sub-study was conducted as a supplement to a pragmatic randomized controlled trial for chronic pain management. Participants included 20 veterans experiencing chronic pain who reported using NPs for pain management or related health concerns. Qualitative interviews with veterans were conducted over the phone and audio recorded. Interviews were guided by an original semi-structured interview guide and qualitative data were analyzed using a template-based rapid analysis technique.

Results: Many veterans with chronic pain perceive NPs as safer than medications and would prefer to use NPs whenever possible. Talking with providers about NPs is important to veterans, who would like information regarding the safety and potential for interaction of NPs with medications. However, veterans were frequently disappointed with these conversations. Veterans felt their providers demonstrated biases against NPs, which negatively impacted patient-provider relationships.

Conclusions: Veterans wish to have more productive conversations with providers about NPs. They value providers’ open-mindedness toward NPs and transparency about limitations in their knowledge. To improve providers’ comfort discussing the topic with their patients, it may be beneficial to offer basic training about NPs and encourage use of NP information databases.

Oral Abstract Session 14: Mind-body Interventions, Mechanisms, and Moderators

OA14.01

Clinically Meaningful Impact of Massage Therapy for Veterans with Chronic Neck Pain: Patient Centered Responder Analysis of an RCT

Niki Munk¹, Joanne K Daggy², James E Slaven², Trevor Foote³, Brian V Laws³, Mikayla K Garner³, Marianne Matthias⁴, and Matthew J Bair³

¹ Indiana University, School of Health & Human Sciences, Indianapolis, IN

² Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN

³ Richard L. Roudebush VA Medical Center; Center for Health Information and Communication, Indianapolis, IN

⁴ Indiana University, Indianapolis, IN

Contact: Niki Munk, [e-mail]

Abstract

Purpose: Clinically meaningful outcomes are among the most important yet RCT dissemination efforts tend to focus on statistical significance. Responder analysis in RCTs for clinically meaningful change provides patient centered insight for intervention effectiveness and impact. Focus on clinical impact for complementary therapies in integrative care is particularly important as whole health-focused policy makers and administrators make resource and accessibility decisions.

Method(s): The TOMCATT RCT (N=290) examined a 12-week, bi-weekly, 60-min therapist-delivered massage intervention (TT-M,n=144) vs. waitlist control (WL-C,n=146) for Veterans with chronic neck pain. Responsiveness analysis for primary pain outcomes were examined for clinically meaningful change at 1-, 3-, and 6-months; >5 point improvement in neck pain with disability and >30% decrease in pain severity are clinically meaningful for Neck Disability Index (NDI) and Brief Pain Inventory (BPI), respectively.

Results: A greater proportion (OR 1.8p=.017) of TT-M experienced clinically meaningful benefit in neck pain with disability at 3-months (35%v16%; OR 2.9p=.002). TT-M participants experienced higher proportions (OR 2.9p<.001) of clinical benefit in pain severity at 1- (26%v15%; OR 2.0 p=.040), 3- (42%v16%; OR 3.9p<.001), and 6-months (36%v16%; OR 3.1p=.004). Participant baseline and 3-month NDI composites for super and average responders illustrate the patient centered and specific impact therapist-provided massage had for Veterans with chronic neck pain.

Conclusions: Veterans with chronic neck pain received clinically meaningful benefit from a series of therapist-delivered massage sessions within the VA hospital environment as part of the TOMCATT randomized control trial. Massage therapy is now included in the Veteran health benefit package which should increase Veteran accessibility beyond the research setting to this whole health focused and effective complementary approach to pain.

OA14.02

Secondary Outcomes and Moderation Effects of a Meditation-Based Lifestyle Modification Program in Mild to Moderate Depression

Holger C. Bringmann¹, Anne Berghöfer², Michael Jeitler³, Andreas Michalsen³, Stefan Brunnhuber⁴, and Heidemarie Haller⁵

¹ Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin, Berlin, Germany, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin, Berlin, Germany

² Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin, Berlin, Berlin, Germany

³ Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Berlin, Germany

⁴ Department of Psychiatry, Psychosomatics, and Psychotherapy, Diakoniekliniken, Zschadrass, Sachsen, Germany

⁵ Center for Integrative Medicine and Planetary Health, University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany

Contact: Heidemarie Haller, [e-mail]

Abstract

Purpose: Understanding the relevance of religion and spirituality (R/S) in the treatment of mental disorders is central to clinical and academic psychiatry. In this secondary analysis of a randomized controlled trial, associations of R/S with depression were investigated with respect to new a second-generation mindfulness-based intervention, the Meditation Based Lifestyle Modification (MBLM) program.

Method(s): Different aspects of spirituality, spiritual coping, and spiritual engagement were assessed in 81 patients with a diagnosis of mild to moderate depression. Treatment effects on R/S as well as predictor and moderation effects of R/S were calculated at 8 weeks (MBLM versus CONTROL (drug continuation therapy) versus TAU (inpatient treatment as usual)) and 6 months (MLBM+TAU versus TAU).

Results: At both time points, significant differences between MBLM versus TAU and CONTROL were found in a range of R/S outcomes in favor of MBLM. Baseline interest in spirituality (p=.001) and baseline spiritual mind-body practice (p=.017) were identified as independent predictors of change in depression severity at 6 months. Moderation analyses found that patients reporting often/regular spiritual mind-body practice at 6 months did not benefit differently from TAU+MBLM versus TAU (p=.437) regarding their change in depression severity and stress, while those reporting no/seldom spiritual mind-body practice at 6 months benefited significantly worse from TAU than form TAU+MBLM (p=.002).

Conclusions: Participation in the MBLM program resulted in significantly greater spirituality in depressed patients than standard therapy. Interest in spirituality and engagement in spiritual mind-body practices at baseline were positive predictors of clinical outcome in both groups. Patients of any group who regularly performed spiritual mind-body practices benefited equally in terms of antidepressant outcomes, underlining the benefit of these practices within a general therapeutic framework.

OA14.03

Whole-Health Factors as Mechanisms of Chiropractic Care for Low Back Pain in US Active-Duty Military

Zacariah Shannon¹, Cynthia Long², Elizabeth Chrischilles³, Christine Goertz⁴, Robert Wallace³, Carri Casteel³, and Ryan Carnahan³

¹ Palmer College of Chiropractic, Davenport, IA

² Palmer College of Chiropratic, Davenport, IA

³ University of Iowa, Iowa City, IA

⁴ Duke, Durham, NC

Contact: Zacariah Shannon, [e-mail]

Abstract

Purpose: To evaluate whole-health factors as mechanisms of the effect of chiropractic care on low back pain (LBP) interference and intensity for US active-duty military members.

Method(s): We performed secondary analyses of de-identified data from a multi-site, pragmatic clinical trial comparing the effect of 6 weeks of chiropractic care plus usual medical care to usual medical care alone for 6- and 12-week outcomes in 750 active-duty US military members. Mediation of effect difference by 6-week values of PROMIS-29 physical, mental, and social subdomains on 12-week outcomes of PROMIS-29 LBP interference and intensity was evaluated using adjusted, natural effect, multiple-mediator models. Individual and sequential models were also examined to determine the contribution of each subdomain.

Results: Improvement in pain interference occurring through whole-health factors (indirect effect= -1.59, 95% CI= -2.28 to -0.88) was 56% (95% CI= 34.5 to 95.7) of the total effect difference (-2.82, 95% CI= -3.98 to -1.53). Improvement in pain intensity occurring through whole-health factors (indirect effect= -0.32, 95% CI= -0.50 to -0.18) was 26.4% (95% CI= 15.4 to 41.8) of the total effect difference (-1.23, 95% CI= -1.52 to -0.88). Physical and social health factors were mechanisms of improvement of pain interference, but neither social nor mental health factors added to the mediation of pain intensity by physical factors.

Conclusions: Effects on whole-health factors appeared to be mechanisms by which US military members’ pain interference improves when adding chiropractic care to usual medical care. Improvement in pain intensity appeared to occur through a more direct effect on pain intensity. This elucidates potential mechanisms of a multi-component pain intervention and may guide military provider and patient expectation of improvement due to chiropractic care.

OA14.04

Biomarkers of Response to Yoga for Prevention of Cognitive Decline in Older Women

Helen Lavretsky¹, Prabha Siddarth², Adrienne Grzenda¹, Beatrix Krause¹, and Monica Cappelletti¹

¹ UCLA, Los Angeles, CA

² University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA

Contact: Helen Lavretsky, [e-mail]

Abstract

Purpose: Yoga training may produce positive effects on cognitive functions in older adults at risk for cognitive decline. In this study (NCT03503669), we investigated neural and peripheral biomarkers therapeutic response in older women with subjective cognitive decline (SCD) and cerebrovascular risk factors (CVRFs) following 3- months of yoga training compared to memory enhancement training (MET) with 6 month follow up.

Method(s): 79 participants (YOGA=40; MET=39) were randomized and 63 completed the 24-week follow-up (Mean age=66.5 years and mean MMSE=28.4). We conducted a randomized, controlled trial to assess the efficacy of Kundalini yoga (YOGA) and memory enhancement training (MET) on mood and subjective and objective cognitive functioning in older women 55+ y.o. with CVRFs and SCD. RNA sequencing and cytokine/chemokine assays and changes in AD biomarker levels including Aβ40, Aβ42, and tau were associated with changes in outcomes at 24 weeks were analyzed as well as a multimodal MRI (Siemens 3T Prisma scanner).

Results: At 12-weeks and 24-weeks, both interventions demonstrated improvement in frequency of forgetting (MFQ-Factor 1) (F (1, 76) = 0.2, p=0.7). At 24-weeks, YOGA participants demonstrated improvements in seriousness of forgetting/MFQ-Factor 2 (effect size (95% CI) = -0.73 (-1.26, -0.19)). As 12- and 24-weeks follow-up, YOGA uniquely modulated targets related to interferon signaling and innate and adaptive immunity, while MET participants displayed higher Eotaxin-1 levels (F (2,67) =3.94, p=0.02). On sMRI, MET showed reductions in GMV in several regions, and right hippocampal volume increased with YOGA. A left anterior hippocampal subregion (DMN) showed greater increases in connectivity on fMRI with YOGA (p<.001) in associations with lower stress (p<.05). Baseline levels of Aβ40 were significantly associated with an increase in subjective memory (r = 0.27, p=0.04). An increase in Aβ40 levels was significantly associated with a decrease in BDI-depression (r = -0.33, p=0.02).

Conclusions: These results suggest clinical, neural, and biological benefits of YOGA compared to MET in post-menopausal women with SCD at risk for AD documenting changes in neural and peripheral biomarkers of inflammaging and brain aging.

Oral Abstract Session 15: Cancer Care

OA15.01

Chairside Yoga Therapy for Patients Concurrently Receiving Cancer Infusions: A Promising Feasibility Study

Tina Walter¹ and Jeanene Robison²

¹ UC Health University of Cincinnati, Cincinnati, OH

² St. Elizabeth Healthcare, Edgewood, KY

Contact: Tina Walter, [e-mail]

Abstract

Purpose: Few studies exist describing the role of chairside yoga therapy used in outpatient infusion settings for the relief of cancer patient symptoms as part of chemotherapy/immunotherapy administration. The purpose of this pilot study was to evaluate effectiveness of chairside yoga therapy on perceptions of fatigue, pain, nausea, anxiety, and distress among oncology patients concurrently receiving outpatient cancer infusion therapy. Qualitative data was also examined to determine participants' overall experience with the yoga therapy intervention.

Method(s): This prospective pilot study used pre/post survey design in convenience sample of cancer patients in outpatient setting. Researchers developed and administered the Outpatient Cancer Symptom Assessment Scale (OCSAS) comprised of cancer or treatment-related symptoms commonly reported in the oncology population (nausea, pain, fatigue, anxiety, and distress). Following IRB approval, symptoms were rated using Likert scale of 0 (not present) to 10 (severe) before and after chairside yoga therapy delivered concurrently with outpatient infusions. Qualitative data was collected related to patients’ overall infusion experience.

Results: Participants (n=82) reported positive patient experiences and statistically less pain (p<0.001), fatigue (p<0.001), anxiety (p<0.001), and distress (p<0.001) following the yoga intervention compared to baseline. Nausea was not significantly impacted by the yoga intervention.

Conclusions: Yoga therapy received concurrently during outpatient cancer infusion is consistent with holistic and integrative approach to care for the oncology population. Yoga therapy offers promise for reducing symptoms which negatively impact quality of life, including pain, fatigue, anxiety, and distress. Qualitative data suggests patients’ overall infusion experience was enhanced with yoga therapy. Consistent with whole person approach to health, nurses can collaborate with yoga therapists to integrate yoga therapy into patient care.

OA15.02

Perceptions of Integrative Care Services from Patients and Clinicians at a Comprehensive Cancer Center (CCC)

Elyssa Kim¹, Shabeer Siddiqui¹, Jessica Cheng¹, Jamie Fertal¹, Barbara Greenwell¹, Sarah Ku¹, Frank Munoz¹, Anne Reb¹, Christy Roames¹, Seyma Saritoprak¹, Amy Truong¹, Edyssa Uy¹, and Richard Lee²

¹ City of Hope, Irvine, CA

² Cherng Family Center for Integrative Oncology, Irvine, CA

Contact: Elyssa Kim, [e-mail]

Abstract

Purpose: Integrative care services help optimize health and healing for patients with cancer. This study characterizes and compares the perceptions of these services among cancer patients and clinicians.

Method(s): A cross-sectional, multi-site survey of patients and clinicians was conducted at a CCC in 2023. The 5-point Likert scale survey assessed familiarity, perceived importance, frequency of use, accessibility, and barriers of 10 integrative oncology services: acupuncture, art therapy, exercise counseling, integrative medicine consultation (IMC), massage, music therapy, mind-body medicine, pet therapy, tai chi/qi gong, and yoga.

Results: A total of 513 patients (93%) and 102 clinicians (70%) completed the survey. The patient respondents were primarily female (59%), Caucasian (75%), with a mean age of 62 (±14.6). The most prevalent cancer diagnoses were breast (39%), prostate (16%), and colorectal (16%). Clinician respondents were predominantly nurses (56%), followed by physicians (27%), and advanced practice providers (13%) with a mean age of 42.3 (±8.9) years. Patients and clinicians were most familiar with massage (24% vs. 29%), followed by acupuncture (23% vs. 29%) and IMC (12% vs. 34%), respectively. Patients reported exercise counseling (53%) as most important, followed by massage (52%). Clinicians reported IMC was the most important (75%), followed by exercise counseling (70%). Clinicians most frequently referred their patients to IMC (15%) and exercise counseling (12%). Lack of awareness was the most common barrier reported by both patients (69%) and clinicians (59%). Other reported barriers include lack of understanding (19% vs. 9% respectively), insurance coverage (10% vs. 10%), cost (12% vs. 11%), and time (12% vs. 10%).

Conclusions: Both patients and clinicians found IMC and exercise counseling most important, accessible, and utilized. The findings suggest a desire for integrative services and a need for improved education for everyone.

OA15.03

Multidisciplinary Insurance Based Integrative Oncology Symptom Management Clinic

Santosh Rao¹, Francoise Adan², and Samuel N. Rodgers-Melnick³

¹ University Hospitals Case Medical Center, Pepper Pike, OH

² University Hospitals Health System, Cleveland, OH

³ University Hospitals Connor Whole Health, Cleveland, OH

Contact: Santosh Rao, [e-mail]

Abstract

Purpose: The University Hospitals Connor Whole Health Integrative Oncology (IO) Symptom Management Clinic delivers multi-disciplinary care for common symptoms among patients with cancer using NCCN guideline-driven approaches to symptoms such as pain, fatigue, anxiety, depression, neuropathy, arthralgias, hot flashes, insomnia, xerostomia, and post-radiation dysphagia.

Method(s): The program provides acupuncture and massage therapy within a novel delivery model that allows for the oncologist to bill for services within a shared medical appointment structure. Furthermore, using a collaborative approach across IO specialties, the program offers education on natural products that may further assist patients with their symptom management needs. Electronic patient-reported outcome measures including the PROMIS-29 and Perceived Stress Scale-4 are obtained at baseline and every 2 months using an internally-developed platform and Epic MyChart. Edmonton Symptom Assessment Scale (ESAS) measures are obtained pre- and post-treatment to assess immediate and longitudinal symptom changes.

Results: Data analysis is ongoing as the program was initiated in June 2023. We already have approximately 50 patients enrolled in the program and will report demographics, oncology diagnoses, and longitudinal changes in PROMIS-29 and ESAS measures for all IO Symptom Management Clinic patients as part of our presentation. We will also share results of a patient satisfaction survey at the time of the 2024 meeting.

Conclusions: This novel approach to multi-disciplinary IO care provides a framework for practice that satisfies patients’ needs and health systems’ productivity requirements within a collaborative evidence-based approach. This program provides a scalable and sustainable model for offering guideline-driven care without relying on non-billable services or financially burdensome fee-for-service models.

OA15.04

The Effects of Yoga Therapy (YT) Consultations for Alleviating Symptom Burden in Inpatient Cancer Care

Smitha Mallaiah¹, Lois Ramondetta¹, Santhosshi Narayanan¹, Andrew Cusimano¹, Richard Wagner¹, Rigert Jillian¹, Gabriel Lopez¹, and Lorenzo Cohen¹

¹ The University of Texas M D Anderson Cancer Center, Houston, TX

Contact: Smitha Mallaiah, [e-mail]

Abstract

Purpose: Extended periods of hospitalization can lead to fatigue, sleep disturbance, anxiety, depressive symptoms, and functional decline in cancer patients. This study examined the processes and effects of one-on-one Yoga Therapy (YT) consultations in addressing symptom burden in cancer inpatients at a large academic cancer center.

Method(s): Inpatient YT consultations were provided from January 2020 to March 2023, and data was extracted for evaluation. Information on demographics, reasons for referral, and self-reported symptom burden pre-post YT using the Edmonton Symptom Assessment Scale (ESAS) were collected. The Wilcoxon signed-rank test evaluated changes in ESAS individual symptoms, and effect size (ES) was reported.

Results: 130 initial YT consults were completed, yielding 88 ESAS responses. The majority of patients were women, 88 (67.7%), white 101 (77.7%), with a mean age of 53.1. The most common diagnosis was leukemia (19.2%), and 40.8% had metastatic disease. The most common referral reasons were fatigue (76.9%), anxiety/stress reduction (76.2%), and quality of life (62.3%). The highest symptoms pre-YT were Fatigue ( $\overline{\mathrm{x}}$ = 5.26), Well-Being ( $\overline{\mathrm{x}}$ = 4.89), and Sleep ( $\overline{\mathrm{x}}$ = 4.66). Following YT, participants reported clinically and statistically significant reductions in Fatigue (mean difference (MD)=-1.62, p<0.001, ES=0.82), Anxiety (MD=-1.56, p<0.001, ES=0.78), and Pain (MD=1.44, p<0.001, ES=0.79), with statistically significant reductions in all other components except Financial Distress and Spiritual Pain. Figure 1 reports change scores for patients scoring ≥4 on a specific symptom pre-YT, revealing even larger improvements and effect size for changes.

Conclusions: A single inpatient YT intervention significantly improved symptom burden, especially for those reporting high symptom burden at the start of the session. The duration of improvement needs further exploration. Inpatient YT merits further study as a non-pharmacologic intervention to improve symptom burden in this underserved population.

Oral Abstract Session 16: Lifestyle Medicine

OA16.01

Integration of Whole Health Lifestyle in Women Veterans Primary Care Clinic: A Feasibility Study

Davinder Bhullar¹, Megan French², Lori Leonard¹, Jessica Joswiak¹, Katherine Dignan³, and Curtis J. Donskey¹

¹ Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH

² Kent State University, Kent, OH

³ Veteran Affairs Administration, Cleveland, OH

Contact: Davinder Bhullar, [e-mail]

Abstract

Purpose: Comprehensive integrated holistic clinical care programs provide education on lifestyle modifications and relevant Whole Health integrative treatment modalities as a part of a personalized health care plan. Such programs empower patients to promote and sustain their own health based on what matters most to them. The goal of this pilot study was to assess the impact of a newly developed Whole Health program in a VA healthcare system.

Method(s): At the VA Northeast Ohio Healthcare System, 19 women veterans completed an initial detailed in office lifestyle evaluation, including assessment of anxiety (GAD7), depression (PHQ9), Life satisfaction scores (LSS), neuroplasticity (AAQ-II) and VA pain scores. During a 14-week period, each participant received evidence-based lifestyle Whole Health interventions and personalized whole food plant-based nutrition prescriptions with physical activity prescriptions including introduction to mindfulness practice. They were provided resources such as recipe books, pantry lists and a blender. The participants attended virtual shared medical appointments (SMAs) in which science-based health education topics were presented by subject matter experts and culinary education was provided by a Physician, Registered Dietician, a Whole Health Coach. Paired t-tests were used to compare scores before versus after the intervention.

Results: The participants at the end of the study had statistically significant (P<0.05) improvements in depression (decreased 49%), anxiety (decreased 50%), neuroplasticity (decreased 19%), and pain scores (decreased 20%). At the end of the program, all participants felt they had the knowledge to heal and were empowered to take care of their own health.

Conclusions: Implementation of the Whole Health Lifestyle Model of care with patient empowerment through education has the potential to improve health outcomes in the veteran population.

OA16.02

Effectiveness of a Lifestyle Intervention Program in Improving Mental Health Outcomes among Adults with Type 2 Diabetes Patients in India

Pramod Tripathi¹, Baby Sharma¹, Nidhi Kadam¹, Pournima Kulkarni, Diptika Tiwari¹, Thejas Kathrikolly¹, Anagha Vyawahare Vyawahare¹, and Mayurika Biswas

¹ Freedom from Diabetes Research Foundation, Pune, Maharashtra, India

Contact: Pramod Tripathi, [e-mail]

Abstract

Purpose: The study aims to assess the effectiveness of a holistic lifestyle intervention program in improving mental health outcomes in patients with type 2 diabetes.

Method(s): Data (medical history, anthropometric, and biochemical parameters) were collected on 698 T2D patients (18-65 years old) enrolled in an online diabetes management program at the Freedom from Diabetes Clinic, India between June 2021 and June 2023. Pre-intervention, GAD7 and PHQ9 were used to assess anxiety and depression, respectively, and re-administered after six months of intervention. The intervention integrated an individualized plant-based diet (alongside intermittent fasting), exercise and yoga therapies (for muscle activation, strength, weight loss and mental stability), stress management (mind-body therapies like MBSR, hypnotherapy, law of attraction, concepts of ikigai, and spiritual healing practices like Pranic healing, mudras, yoga asanas, meditation), and medical management.

Results: The median age, duration of diabetes, and HbA1c were 50 years, 9.3 years, and 7.5%, respectively. At baseline, the prevalence of anxiety and depression (score >10) was 17.5% and 18.9%, which reduced to 8.6% and 8.3% post-intervention, respectively (p<0.05). A significant reduction was seen in the total score for both anxiety and depression (Median score; 4 to 2) (p<0.05). Age, self-reported stress before diabetes detection, duration of diabetes, presence of comorbidities, use of insulin, and poor glycaemic control (HbA1c≥7) were significantly associated with anxiety and depression at baseline (p<0.05). Post-intervention, a statistically significant association was observed between improved glycemic control and depression (p<0.05).

Conclusions: The holistic lifestyle program significantly improved anxiety and depression in the present cohort. Including mental health support as part of diabetes management programs may help improve mental health outcomes in patients with T2D. Further large-scale studies may help corroborate our findings.

OA16.03

Transdiagnostic Oncology Program (TOP), a Combined Lifestyle Intervention for Cancer Survivors: A Controlled Pilot Study in Primary Care

Sanne Booij¹, Amy Pieper², Christianne Wester¹, Ute Bultmann³, Elkana Waarsenburg⁴, and Rogier Hoenders⁵

¹ CIP Lentis, Groningen, Groningen, Netherlands

² CIP Lentis, Tolbert, Friesland, Netherlands

³ UMCG, Groningen, Groningen, Netherlands

⁴ Dokter Drenthe, Assen, Drente, Netherlands

⁵ CIP, Lentis, Zeegse, Drente, Netherlands

Contact: Elkana Waarsenburg, [e-mail]

Abstract

Purpose: There is a need for interdisciplinary primary care-led aftercare programs for the common (transdiagnostic) problems cancer survivors experience to increase their quality of life. The aim of this controlled before-and-after pilot study was to examine the feasibility and effectiveness of a transdiagnostic, family doctor-led interdisciplinary program to increase quality of life in a heterogeneous group of cancer survivors.

Method(s): The intervention group (N=19) followed a 12-month interdisciplinary aftercare program in the primary care setting, consisting of: family doctor consultation, physical exercise, mind-body therapy, sleep hygiene, dietary recommendations, and optional psychological therapy. Eligible cancer survivors who declined participation, were included as controls (N=16). The primary outcome was quality of life, as measured with the EORTC-QOL-C30, covering global health status, and various forms of functioning and symptoms. Secondary outcomes included assessments of fatigue, mental health, happiness, and work ability. Assessments took place at baseline (T0), and 6 months (T1) and 12 months post-baseline (T2). Intention-to-treat multilevel analyses were conducted.

Results: At baseline, the intervention group scored significantly worse on several indices of quality of life, and on secondary outcomes, compared to controls. The intervention group showed significantly larger increases at T2 in physical and social functioning, and decreases in fatigue and anxiety, compared to the control group.

Conclusions: The results suggest that this primary care-led aftercare program is feasible and acceptable in a primary care setting in the Netherlands, for a heterogeneous group of patients. The significant improvements in physical and social functioning, fatigue, and reduction in anxiety carefully suggest that this interdisciplinary program improves the overall quality of life of cancer survivors. A randomized controlled trial is warranted.

OA16.04

Health Coaching Impacts Stage-Specific Transitions in Multiple Health Behaviors for Patients at High Risk for Cardiovascular Disease & Type 2 Diabetes

Chiyoung Lee¹, Qing Yang², Allison Vorderstrasse³, and Ruth Q. Wolever⁴

¹ University of Washington Bothell, Bothell, WA

² Duke University School of Nursing, Durham, NC

³ Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA

⁴ Osher Center at Vanderbilt, Nashville, TN

Contact: Ruth Q. Wolever, [e-mail]

Abstract

Purpose: Multiple behavior change interventions have gained traction in the behavioral health space. Yet, previous studies on health coaching focused on testing its effect on stages of change for individual health behaviors. This study examined the effects of health coaching on stages of change across multiple health behavior domains among patients at high risk of coronary heart disease and type 2 diabetes using multi-group latent transition analysis (LTA).

Method(s): This secondary analysis of a randomized clinical trial included 200 primary care patients who completed transtheoretical model-based questionnaires related to weight reduction, exercise, healthier eating, and stress management. Multi-group LTA compared the stage of change distributions and transitions over time between health coaching and controls at baseline, mid-point of the intervention (3 months), and post intervention (6 months).

Results: Three distinct categories of behavior change were identified (“Contemplation,” “Preparation to Action,” and “Action”), and membership in these categories changed over time as a function of intervention exposure. Both the health coaching and control groups exhibited positive transitions through stages of change from baseline to 3 months. Pronounced intervention effects emerged from 3 to 6 months, revealing larger differences in transition probabilities between the groups. In particular, health coaching increased patients' likelihood of transitioning from “Contemplation” to both “Preparation for Action” and “Action,” as well as from “Preparation for Action” to “Action.” The control group remained stagnant during the same period.

Conclusions: While health coaching produces changes across multiple behavioral domains, it was most effective for patients who were reluctant or ambivalent about changing their behaviors.

Oral Abstract Session 17: New and Novel Research

OA17.01

Patient Acceptability of Acupuncture in the Emergency Department

Amanda Luff¹, Eva Chang², John Burns¹, Diana Bottari¹, Nancy Conway¹, and Michael Fendrich¹

¹ Advocate Aurora Health, Milwaukee, WI

² Advocate Aurora Health, Chicago, IL

Contact: Amanda Luff, [e-mail]

Abstract

Purpose: To assess the acceptability of acupuncture offered in three emergency departments (EDs) in a large midwestern health system at no out-of-pocket cost to patients.

Method(s): Patients presenting to a participating ED between 4/17/2023—8/31/2023 were eligible to receive acupuncture if they presented with a non-life-threatening issue, did not have a contraindication to acupuncture, and could consent to treatment. Surveys, offered in English and Spanish, asked patients to report on satisfaction, willingness to receive acupuncture again in the ED, and pain medication use. We assessed frequencies and percentages for categorical variables and means and standard deviations for continuous variables. We used linear regression to assess relationships between pain medication use and patient satisfaction scores.

Results: Acupuncture was offered to patients at 813 ED encounters, 520 treatments were provided, and 332 patients completed surveys (87% English, 13% Spanish). Among respondents, 89% reported it was their first-time receiving acupuncture. Most (97%) reported willingness to receive acupuncture again in the ED, and 63% said they would pay out-of-pocket for this treatment. On a scale of 1(lowest) to 10(highest), the mean satisfaction was 9.2 (SD 1.4). Satisfaction was higher among those who had not received pain medication before treatment (mean: 9.3; SD: 1.4) compared to those who had (mean: 9.1; SD: 1.5; p=0.17), and among those who reported they did not want pain medication at discharge (mean: 9.4; SD: 1.1), compared to those who desired medication (mean: 9.0; SD: 1.6; p=0.08); however, these differences were not statistically significant.

Conclusions: Patient satisfaction was high, and most patients would desire acupuncture again in the ED. We are collecting medical record data to assess changes in pain, and to compare patients receiving acupuncture to those who qualified for acupuncture but did not receive it. These results will be available before the meeting.

OA17.02

Barriers and Facilitators to Use of Tai Chi for Knee Osteoarthritis in Large Healthcare Systems: A Qualitative Study

Eric Roseen¹, Elise Coash², Cora Pereira³, Rocky Reichman⁴, Ryan Wexler⁵, Ellaina Reed⁶, Michelle Bravatti⁶, Ludovic Trinquart⁶, Weijun Zhang⁷, Timothy McAlindon⁶, Brian Mittman⁸, Lance Laird³, Helen Lavretsky⁷, Robert Saper⁵, and Chenchen Wang⁹

¹ Boston University School of Medicine and Boston Medical Center, Boston, MA

² Center for Integrative Medicine at Tufts at Tufts Medical Center, Tufts University School of Medicine., Boston, MA

³ Boston University, Boston, MA

⁴ Boston Medical Center, Boston, MA

⁵ Cleveland Clinic, Cleveland, OH

⁶ Tufts Medical Center, Boston, MA

⁷ UCLA, Los Angeles, CA

⁸ Kaiser Permanente Southern California, Pasadena, CA

⁹ Center for Integrative Medicine at Tufts Medical Center, Tufts University School of Medicine, Boston, MA

Contact: Eric Roseen, [e-mail]

Abstract

Purpose: While clinical practice guidelines from the American College of Rheumatology strongly recommend Tai Chi for knee osteoarthritis (OA), its availability in healthcare systems is limited. In preparation for a large NIH-funded pragmatic trial of remotely delivered Tai Chi for knee OA, we evaluated barriers/facilitators to Tai Chi adoption in four healthcare systems.

Method(s): We conducted 30- to 60-minute semi-structured, in-depth interviews of patients with knee OA, primary care providers (PCPs), Tai Chi instructors, and healthcare system leaders. Participants were asked about factors that influence use of in-person or remotely delivered Tai Chi. Interviews were recorded and transcribed. Content analysis of interview memos generated preliminary themes using an a priori codebook informed by the Consolidated Framework for Implementation Research.

Results: Thirty-one participants from four healthcare systems (4 patients, 8 PCPs, 9 instructors, 10 leaders) completed interviews. Half of participants (age range=38-80, 48% women) reported non-White race or Hispanic ethnicity. Participants reported that logistical barriers to in-person practice (e.g., transportation time/costs) would be reduced by remote delivery. By contrast, instructor form correction and social interaction of in-person group Tai Chi were perceived as facilitators that may be diminished by remote delivery. Participants perceived a relative advantage of meditative movement over other higher intensity exercise. However, PCPs expressed limited knowledge or low self-efficacy when recommending Tai Chi when compared to other familiar treatments (e.g., pain medications, physical therapy). Furthermore, PCPs/leaders indicated the ability to refer to or communicate with instructors was not facilitated by their electronic health record.

Conclusions: In-depth stakeholder interviews in four healthcare systems revealed key barriers/facilitators that will guide the design of tailored implementation strategies to increase adoption of Tai Chi for knee OA.

OA17.03

Partners for Pain & Wellbeing Equity: A Phased Study of Community Supported Complementary and Integrative Health Self-Management for Back Pain

Roni Evans¹, Brent Leininger², Linda Hanson¹, Douglas Kennedy³, Amy McGarness¹, Craig Schulz¹, Alexander Haley¹, and Robin Austin¹

¹ University of Minnesota, Minneapolis, MN

² University of Minnesota, Wanamingo, MN

³ University of Minnesota--Twin Cities; Integrative Health & Wellbeing Research Team, Minneapolis, MN

Contact: Brent Leininger, [e-mail]

Abstract

Purpose: Back pain (BP) is the most common pain condition in the U.S. Racial and ethnic minoritized groups are disproportionately impacted, yet there is little research with diverse populations, perpetuating inequity in BP care. The purpose of this NIH HEAL R61/R33 project is to increase access to effective, complementary self-management strategies.

Method(s): A community engaged feasibility study in preparation for a randomized type II effectiveness-implementation trial comparing a 9-week BP self-management program to a contextually matched control. A multifaceted engagement plan was used to prioritize connecting researchers with community members, building trust through transparency, and co-learning to build mutually beneficial relationships. Community champions helped raise awareness and co-develop culturally tailored study materials. Intervention programs were offered remotely via telehealth and in-person. Programs consisted of 9, 90 minute weekly educational and skill building sessions.

Results: 171 individuals were screened, with 51 were enrolled, 78% identifying as a member of a racial or ethnic minoritized group. Participants had high pain levels (51% had high impact chronic pain that limited activities) and faced significant socio-economic challenges including annual household income below $25,000/year (48%), food insecurity (60%), and delayed health care (30%). Engagement was high with 94% taking part in at least 6 intervention sessions and 80% satisfied with both programs; only 2% reported possibly related severe or serious adverse events. Follow up data collection exceeded 90%. Qualitative data provided important suggestions for future study optimization.

Conclusions: Marginalized individuals face complex socio-economic barriers that must be considered by researchers seeking to advance health equity. This requires more attention to relational alliances, additional resources, as well as scrutiny of study processes and researcher skills and beliefs, to facilitate equitable participation.

OA17.04

Food as Medicine, Community as Medicine: Mental Health Effects of Group Visits and Produce Prescriptions

Ariana Thompson-Lastad¹, Dorothy Chiu³, Denise Ruvalcaba², June Tester³, Lan Xiao⁴, Ben Emmert-Aronson⁵, Steven Chen⁶, and Lisa G. Rosas⁴

¹ UCSF, Berkeley, CA

² UCSF Osher Center for Integrative Health, San Francisco, CA

³ University of California San Francisco, San Francisco, CA

⁴ Stanford University, Stanford, CA

⁵ Open Source Wellness, Oakland, CA

⁶ Alameda County Health Care Services Agency, Oakland, CA

Contact: Ariana Thompson-Lastad, [e-mail]

Abstract

Purpose: Food as Medicine programs address food insecurity and nutrition-sensitive chronic conditions; few studies examine their mental health impact. This article assesses mental health-related impact of Recipe4Health, a partnership between county government, community health centers (CHCs), and non-profit organizations, that included a ‘Food Farmacy’ (FF) (16 weeks of fresh produce delivery) with or without 16 sessions of weekly integrative group medical visits (IGMVs) in Spanish or English.

Method(s): Four CHCs in Northern California implemented Recipe4Health for patients with food insecurity and/or cardiometabolic or mental health conditions. We used a convergent mixed-methods design including 1) Subgroup analysis of pre- and post-program survey data in participants meeting depression and/or anxiety criteria at baseline, and 2) Qualitative interviews with 14 patients and 26 partner organization staff. We examined pre/post changes in mental health symptoms over 4 months using linear mixed effects models with repeated measures. Semi-structured interviews were conducted with select patients and staff, and analyzed using codebook thematic analysis.

Results: 190 participants met criteria for depression (PHQ9 >10) and/or anxiety (GAD7 >10) at baseline. Participants were middle-aged (mean age 47.1, SD), primarily women (75%), from diverse racial/ethnic backgrounds (33% Black, 23% Latine, 26% White). Depression and anxiety significantly improved among 122 FF-only participants (PHQ9 -2.8 ; GAD7 -3.8 post-intervention. FF+IGMV participants (n=176) experienced greater improvements in depression (PHQ9 -4.2 ; and anxiety GAD7 -4.6 , p <.001 for all findings). In interviews, staff and patients endorsed the benefits of a) food prescriptions for addressing food insecurity and b) IGMVs for reducing social isolation.

Conclusion: Food as medicine programs, with or without group social support, can yield mental health benefit.

Oral Abstract Session 18: Basic Science

OA18.01

Decoding Bioelectric Signals at Acupuncture Points: Insights from the Electroacugram (EAG) Device

Jianliang Zhang¹, Mariana Muñoz Alba, Mathew Rathbun, Xiaolin Deng², Kaixuan Zou, Deng-Shan Shiau, Chen Xu, Mushtaq Memon, and Huisheng Xie

¹ CHI University, Reddick, FL

² Mainland Acupuncture Center, Gainesville, FL

Contact: Jianliang Zhang, [e-mail]

Abstract

Purpose: The dynamics of bioelectric signals are crucial for well-being and are central to the effectiveness of acupuncture. However, the absence of specialized devices for studying these signals at acupuncture points has limited progress in the field. A prototype device called "electroacugram" (EAG) has been developed in Chi university. Unlike electroencephalograms or electrocardiograms, which focus on brain or heart activity, EAG is designed to capture bioelectric activity specifically at acupuncture points.

Method(s): The EAG device comprises three key components: 1) electrodes for signal capture, 2) an amplifier with filters for signal enhancement, and 3) a data recorder with a computer algorithm for pattern recognition. Research using this device has revealed unique bioelectric signals from acupuncture points, even those not directly related to neural or muscular systems. For example, distinct wave patterns were identified in Heart-7 (HT-7) and HT-9 acupoints in both horses and humans. These patterns suggest that the Heart meridian, covering HT-1 to HT-9, could influence the nervous system and may have implications for emotional and physical health, including stress and heart-related issues.

Results: Three types of spike patterns were observed: 1) an upward sharp wave linked to non-stimulation, 2) a spike-and-wave pattern associated with stimulation, and 3) a downward sharp wave often seen in sham points. The device also detected bioelectric potentials in connective tissue cells, validating its capability for EAG recordings.

Conclusions: The EAG device is a significant innovation in acupuncture research, particularly beneficial for conditions like anxiety, depression, and pain. It is compact, reliable, and user-friendly, requiring minimal training for operation. Its applications range from precise acupuncture point localization to monitoring treatment effectiveness and assessing various conditions. This advancement holds promise for elevating acupuncture therapy to new heights.

OA18.02

Exploring the Nexus between Depression, HIV, and Gut Microbiota: Unveiling Translational Prospects

Yannan Li¹, Meixiang Huang², Shinji Sakamoto³, Kaitlyn Huizar⁴, Mizuho Obayashi⁵, Yuto Hasegawa⁵, Vesna Tran⁵, Feiyi Xiong⁵, David Volsky⁶, Barbara Slusher⁴, Atsushi Kamiya⁵, and Xiaolei Zhu⁷

¹ Johns Hopkins University School of Medicine, Baltimore, MD

² Department of Neurology, Baltimore, MD

³ Department of Neuropsychiatry, Okayama, Okayama, Japan

⁴ Johns Hopkins Drug Discovery, Baltimore, MD

⁵ Department of Psychiatry and Behavioral Sciences, Baltimore, MD

⁶ Department of Medicine, New York, NY

⁷ JHU, BALTIMORE, MD

Contact: Yannan Li, [e-mail]

Abstract

Purpose: The study aims to explore the role of gut microbiota, specifically the reduced abundance of Christensenella, in mediating HIV-induced neurobehavioral deficits, providing insights into potential integrative medicine interventions for HIV-associated depression.

Method(s): We utilized the EcoHIV-infected C57BL/6 mouse model to examine HIV-induced neurobehavioral phenotypes. Using a three-chamber social interaction test, we tested the sociability phenotypes of mice subjected to EcoHIV infection. We examined the impact of EcoHIV infection on the gut bacterial communities in both genders of mice using whole-genome shotgun metagenomic sequencing. Using ELISA, we also examined the level of circulating inflammatory cytokines in EcoHIV-infected mice.

Results: We found that social interaction ratio (SIR) decreased in both male (P < 0.01) and female (P < 0.05) EcoHIV-infected mice compared with sham mice. The result of whole-genome shotgun metagenomic sequencing shows that the relative abundance of Christensenella was reduced in EcoHIV-infected male mice compared to male sham mice (P < 0.01). The relative abundance of Christensenella was highly correlated with the SIR (P = 0.0230, r = 0.3877) and peripheral TNF-α level (P = 0.0772, r = 0.2568) in EcoHIV-infected male mice.

Conclusions: These results indicate that EcoHIV infection induces social avoidance, and a reduced abundance of Christensenella may mediate EcoHIV-induced social avoidance in the male mice. Further therapeutic evaluation of Christensenella's potential in HIV-associated depression, holds promise in advancing novel interventions. This study underscores compelling evidence and translational potential, shedding light on innovative pathways for addressing HIV-associated depression.

OA18.03

Outcomes of In-Vitro Fertilization (IVF) After Implementation with Pranic Healing: A Pilot Study

Jason Yuan¹, Glenn Mendoza², and Marianne Chung³

¹ Pranic Healing Research Institute, Jersey City, NJ

² Pranic Healing Research Institute, Paramus, NJ

³ Pranic Healing Research Institute, Atlanta, GA

Contact: Glenn Mendoza, [e-mail]

Abstract

Purpose: In-vitro fertilization (IVF) utilizes a series of procedures to assist implantation of a fertilized egg in the uterus with the objective of establishing pregnancy. Pranic Healing (PH) is a complementary energy healing technique that has been shown to be safe in clinical research and it has been applied to numerous conditions including pregnancy but its effect on IVF has not been documented. The purpose of this study is to evaluate the outcomes of IVF with Pranic Healing in an active hospital-based IVF Program. This study was performed at the Motherhood Women and Child Care Hospital in Sola, Ahmedabad, India over a one-year period.

Method(s): This was a single center, prospective study of 251 women who received IVF from February 2018 to August 2019. 126 of the 251 women without the application of PH were compared to the remaining 125 women with the application of PH. The study was approved by Ethics Committee. PH treatment was performed at the entry into the IVF Program (up to egg retrieval, before and after egg implantation, fertilization stage, up to post-implantation) and men prior to sperm collection. The study was concluded after the last woman delivered. Stepwise logistic regression analysis was used to identify prognostic variables among the preselected variables.

Results: The primary outcome is live birth and the secondary outcome is a viable intrauterine pregnancy. 92 of 251 patients (37%) had successfully delivered a live birth while 159 patients did not. Of those 92 women who delivered, 57 women (62%) were treated with PH while 35 women did not. Of the 159 women who had failed IVF, 68 women (43%) were treated with PH while 91 were not. The effects of PH on the success rate of IVF was statistically significant (p = 0.004).

Conclusions: PH as an adjuvant therapy with IVF medical management can increase the chance of a successful pregnancy. Further research is needed to implement PH as a therapy in hospital-based IVF programs.

OA18.04

Metagenomics Indicates an Interplay of the Microbiome and Functional Proteins in Parkinson's Disease

Sarah Park¹, Baris Ozdinc², Dana Walsh², Samantha Evans³, Kelly Moffat², Devon J. Fox⁴, Margaret Boomgaarden⁵, and Laurie Mischley⁴

¹ Harvard Medical School, Boston, MA

² Cosmos ID, Los Angeles, CA

³ Seattle Integrative Medicine, Boston, MA

⁴ Bastyr University, Seattle, WA

⁵ Bastyr University, San Diego, CA

Contact: Sarah Park, [e-mail]

Abstract

Purpose: Parkinson’s disease (PD) is a protein malformation disease involving the gastrointestinal and central nervous systems. PD may arise in one system and spread to the other. It is progressive in nature and impacts motor and nonmotor systems. Gastrointestinal symptom development preceding or paralleling the motor symptom prognosis suggests a link between the gut and PD. Hence, microbiome and functional metagenomic variations in the gut of PD patients may reveal PD microbiome signatures or biomarkers. This study aims to illuminate the gut-linked mechanisms of Parkinson’s disease (PD) in patients from the USA by identifying microbial and translational biomarkers of PD.

Method(s): We compared microbial and functional metagenomic variations between the gut microbiomes of 57 PD (this study) and 42 healthy (Asnicar et al. 2020) patients through alpha diversity, beta diversity, and differential abundance analyses, using shotgun metagenomic data.

Results: Bacterial alpha (p-value < 0.004) and beta diversity (p-value = 0.001) between gut microbiomes of healthy and PD patients were significantly different. Gut microbiome functional metagenomics of healthy and PD patients were also significantly different in alpha (p-value = < 0.001), beta (p-value = 0.001, Fig. 1) diversities and differentially abundant functional genes. Viral richness was significantly limited in the PD cohort compared to healthy controls.

Conclusions: With further experimental validation, the significant differences observed in this PD versus healthy gut microbiome comparison may illustrate PD disease biomarkers and mechanisms.

Poster Abstracts

Topic Area 01 - Basic Science

P01.01

Comparative Effects on Heart Rate Variability of Hatha Yoga’s Sun Salutations Against Mild Intensity Stationary Cycling Exercise: A Pilot Study

Varun Malhotra¹, Francisco Cidral-Filho², Santosh Wakode³, Tanusha Pathak, and Danish Javed⁴

¹ All India Institute of Medical Sciences (AIIMS), Bhopal, Bhopal, Madhya Pradesh, India

² Integrative Wellbeing Institute, Windermere, FL

³ AIIMS Bhopal, Bhopal, Madhya Pradesh, India

⁴ (AYUSH) All India Institute of Medical Sciences, Bhopal, M.P., Bhopal, Madhya Pradesh, India

Contact: Varun Malhotra, [e-mail]

Abstract

Purpose: This study evaluated the effect of the Sun Salutations (Surya Namaskar, SN - a sequence of 12 Hatha yoga postures with coordinated breathing) against mild intensity Stationary Cycling Exercise (SCE), on parameters of heart rate variability (HRV).

Method(s): Study was conducted in Department of Physiology and AYUSH, AIIMS, Bhopal, MP (India) after obtaining ethics approval.

50 participants (30 in SN group and 20 in untrained male adults SCE group, aged 46.5+/-3.5 years were enrolled in the study. Baseline HRV, body metrics, and blood pressure were assessed. Participants were randomly divided into 2 groups: SN and SCE.

SN group was subjected to 14 rounds of fast-paced SN in about 20 minutes; SCE group to a 20-minute mild-intensity stationary cycling session (30-50% maximal heart rate).

Additional assessments were conducted pre-exercise, during exercise intervals, and post-exercise recovery. HRV was assessed with the Neuralchek device (Braintap INC, New Bern, NC, USA).

Results: SN led to increased SDNN, pNN50, RMSSD, and total power, indicating improved autonomic balance, cardiovascular health, and parasympathetic dominance. Conversely, SCE decreased SDNN, pNN50, and RMSSD, suggesting immediate post-exercise sympathetic dominance. Spectral analysis of HRV highlighted autonomic balance differences, with SN increasing LF% reflecting both sympathetic and parasympathetic dominance, while exercise reduced HF% due to sympathetic activation. Minimal changes were observed in HF%. (Table 1).

Conclusions: SN positively impacted HRV, promoting parasympathetic dominance and cardiovascular well-being, while exercise induced sympathetic activation with potential recovery benefits. Monitoring HRV offers insights into cardiovascular fitness and well-being. The study underscores the merits of incorporating yoga like SN into physical activity routines.

P01.02

Comparative Effects on Heart Rate Variability of Slow Deep Breathing (SDB) against Fast Paced Breathing (FPB)

Varun Malhotra¹, Francisco Cidral-Filho², Santosh Wakode³, and Danish Javed⁴

¹ All India Institute of Medical Sciences (AIIMS), Bhopal, Bhopal, Madhya Pradesh, India

² Integrative Wellbeing Institute, Windermere, FL

³ AIIMS Bhopal, Bhopal, Madhya Pradesh, India

⁴ (AYUSH) All India Institute of Medical Sciences, Bhopal, M.P., Bhopal, Madhya Pradesh, India

Contact: Varun Malhotra, [e-mail]

Abstract

Purpose: The objective of this study was to investigate the effects of Slow Deep Breathing (SDB) against Fast Paced Breathing (FPB, also known as Kapalbhati) on Heart Rate Variability (HRV).

Method(s): Study was conducted in Department of Physiology and AYUSH, AIIMS, Bhopal, MP (India) after obtaining ethics approval. 40 healthy adult participants of mean age 44.6+/- 3.5 were randomly divided into two groups: a) SDB group and b) FPB group. Participants were then submitted to a five-minute Slow deep breathing or Fast paced breathing session. HRV was assessed pre and post breathing session with the Neuralchek device (Braintap INC, New Bern, NC, USA) The collected data was analyzed using IBM-SPSS version 23.0.

Results: There are no statistically significant differences between the HRV Parameters in resting state of the two groups before FPB and SDB. Significant statistical difference was found during the manoeuvre. FPB shifts to sympathetic dominance, SDB to parasympathetic dominance (Table 1). The present study found increased LF power in HRV during SDB, which may be due to the mechanical effect of breathing. At the same time, increased time domain parameters and reduced HF power due to respiratory modulation led to transient and rapid excitation of cardiovascular autonomic centres.

Conclusions: SDB may be used as a relaxation technique (as it increases parasympathetic activity or reduced sympathetic activity) whereas FPB may be used to activate metabolism and perhaps in weight loss programs (as it induces sympathetic activation).

P01.03

Fat Concentration of the Gastrocnemius Muscle and Its Relationship With Physical Activity Intensity in Children With Cerebral Palsy

Junsoo Lee¹, Christopher Modlesky¹, and Trevor Batson¹

¹ University of Georgia, Athens, GA

Contact: Junsoo Lee, [e-mail]

Abstract

Purpose: Children with cerebral palsy (CP) have a high concentration of fat in the lower limb muscles. It is suspected that the higher degree of fat concentration is related to their low participation in physical activity (PA). This study aimed to determine if the fat concentration of the gastrocnemius muscle (GA), as reflected by echo intensity (EI), is related to physical activity in ambulatory children with CP.

Method(s): Twenty-seven ambulatory children with spastic CP (5 - 11 y; GMFCS I-II) and 27 sex- and race-matched typically developing children (Con) in the same age range participated in this study. EI of the GA was assessed using ultrasound on the more and less affected limbs of children with CP and the dominant and non-dominant limbs of Con. Total, sedentary, light, and moderate-to-vigorous PA were assessed using accelerometer-based PA monitors worn on the hip for four days.

Results: EI was significantly higher in the GA of the more affected (40 %) and less affected (19 %) limbs in children with CP compared to the non-dominant and dominant limbs, respectively, in Con (both p < 0.05). Children with CP had significantly lower total (19 %) and light (14 %) PA and higher sedentary (5 %) PA (all p < 0.05). In children with CP, EI in the GA of the more affected leg was inversely related to moderate-to-vigorous PA (r _s = -0.388; p < 0.05). EI in the GA of the less affected leg was inversely related to total (r _s = -0.398) and moderate-to-vigorous (r _s = -0.415) PA (both p < 0.05). In Con, EI in the GA of the non-dominant leg was inversely related to total PA (r _s = -0.385) and directly related to sedentary PA (r _s = 0.391; both p < 0.05). EI in the GA of the dominant leg was inversely related to total PA (r _s = -0.480; p < 0.05) and directly related to sedentary PA (r _s = 0.521; p < 0.05).

Conclusions: The elevated concentration of fat in the GA of ambulatory children with spastic CP is more strongly related to low moderate-to-vigorous and total physical activity than high sedentary physical activity.

P01.04

Effects of Ketogenic Diet on Brain Tumor Metabolism

Jacquelyne Motta

Do terra science, Union City, NJ

Contact: Jacquelyne Motta, [e-mail]

Abstract

Purpose: Establish dietary-induced ketosis in one oncology patient to determine if a ketogenic state would decrease glucose availability to certain tumors, thereby potentially impairing tumor metabolism without adversely affecting the patient's overall nutritional status.

Method(s): Case report: One pet male with advanced stage brain tumor. This patient was followed as outpatients for 1 year. Ketosis was maintained by consuming a 60% medium chain triglyceride oil-based diet. Some cancers cannot metabolize ketone bodies, due to mitochondrial dysfunction and down-regulation of enzymes necessary for ketone utilization. Tumor glucose metabolism was assessed by MRI (Magnetic resonance imaging), before and following the trial period.

Results: Within 60 days of initiating the ketogenic diet, blood glucose levels declined to low-normal levels and blood ketones were elevated. Results of MRI indicated a 50% average decrease uptake at the tumor site in subject. The patient exhibited significant clinical improvements in seizures, neurological deficits, and new skill development during the treatment. He continued to use the ketogenic diet remaining free of disease progression.

Conclusions: While this diet does not replace conventional antineoplastic treatments, these preliminary results suggest a potential for clinical application which merits further research.

P01.05LB

Correlation Analysis of the Effect of Maxing Shigan Decoction on Intestinal Flora and Metabolites in Rats with Lung Injury

Chen Bai¹, Jiayao Zhao¹, Hui Liu¹, Su Chen¹, Tiegang Liu¹, and Xiaohong Gu¹

¹ Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Chen Bai, [e-mail]

Abstract

Purpose: To explore the mechanism of action of intestinal flora in the treatment of pneumonia with Maxing Shigan Decoction.

Method(s): A rat model of pneumonia injury was prepared using the LPS aerosol inhalation method. High-throughput sequencing and metabolomics were used to detect animal intestinal contents, and changes in intestinal flora and metabolites after intervention with Maxing Shigan Decoction were analyzed. The results of metabolomics and high-throughput sequencing were jointly analyzed, with a focus on the KEGG pathways mapped by omics and high-throughput techniques.

Results: After treatment with Maxing Shigan Decoction, there was a significant improvement in lung injury in the animal lung tissue. Among the intestinal contents, the dominant bacterial species included Staphylococcaceae, Gemellaceae, Lactobacillaceae, etc. The significantly upregulated metabolites included erucic acid, succinic acid semialdehyde, eicosadienoic acid, etc. There was a notable correlation between bacteria such as Veilonella, Aerococcus, and metabolites like carbamoyl phosphate, succinic acid semialdehyde, vitamin D2, palmitic acid, and maleic acid.

Conclusions: Maxing Shigan Decoction can alleviate inflammatory injury in lung tissue, and its mechanism of action is related to the regulation of metabolites such as palmitoleic acid, maleic acid, phosphoric acid, 1-methylhistidine, and 3-dehydroshikimic acid through the intestinal flora.

P01.06LB

Electroacupuncture Facilitates Vascular Normalization by Inhibiting Glyoxalase1 of Endothelial Cells in Triple-Negative Breast Cancer

Yuxiang Wan¹, Xuewei Qi², Yanyan Lian¹, Zeyu Liu³, Hui Wang¹, Yuqin Qiu⁴, Chunguang Zhang¹, Wenna Li¹, Honglin Jiang¹, Donghua Yang⁵, Wei Zhao⁶, Zhesheng Chen⁷, and Jinchang Huang¹

¹ The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China

² Beijing Tsinghua Changgung Hospital, Beijing, China

³ Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China

⁴ The First Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China

⁵ New York College of Traditional Chinese Medicine, Mineola, NY

⁶ Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China

⁷ St. John's University, Queens, NY

Contact: Yuxiang Wan, [e-mail]

Abstract

Purpose: The study aims to explore the therapeutic potential and molecular mechanisms of peri-tumoral electroacupuncture as a non-pharmacological intervention for triple-negative breast cancer (TNBC), focusing on endothelial cell metabolism rather than traditional vascular growth factors.

Method(s): The research employed a combination of in vivo and in vitro techniques, including the use of 4T1 breast cancer xenografts in mice and an in vivo matrigel plug angiogenesis assay. Multi-omics analysis was utilized to investigate molecular pathways, and the study also involved the genetic manipulation of Glyoxalase 1 (Glo1) in a zebrafish model and human umbilical vein endothelial cells.

Results: Peri-tumoral electroacupuncture was found to effectively reduce microvasculature density and enhance vascular functionality in 4T1 breast cancer xenografts, with the most significant effects observed on the third day post-treatment. When combined with the chemotherapy drug paclitaxel, electroacupuncture showed an amplified anti-tumor efficacy. The key molecular mediator identified was Glo1, along with the methylglyoxal-glycolytic pathway. The study further demonstrated that the inhibition of Glo1 through electroacupuncture or genetic manipulation led to reduced angiogenesis, while Glo1 overexpression resulted in increased blood vessel formation.

Conclusions: The study highlights the crucial role of Glo1 in the efficacy of peri-tumoral electroacupuncture for TNBC. By demonstrating the ability of electroacupuncture to modulate vascular normalization through the Glo1 pathway, this research opens a promising avenue for improving TNBC treatment outcomes, suggesting that peri-tumoral electroacupuncture can be an effective adjunct therapy in TNBC management.

P01.07LB

Fecal Microbiome changes after Micronutrients in Attention Deficit Hyperactivity Disorder: The MADDY Study

Hayleigh Ast¹, Matthew Hammer¹, Ryan McClure², Lydia Norby-Adams¹, Priya Srikanth¹, Yulia Farris², Alisha Bruton¹, Irene E. Hatsu³, Lisa M. Robinette³, Brenda Leung⁴, L Eugene Arnold³, Jonathan Swann⁵, Lisa Karstens¹, and Jeni Johnstone¹

¹ Oregon Health and Science University, Portland, OR

² Pacific Northwest National Laboratory, Richland, WA

³ OSU, Columbus, OH

⁴ University of Lethbridge, Lethbridge, AB

⁵ University of Southampton, Southampton, Hampshire, United Kingdom

Contact: Hayleigh Ast, [e-mail]

Abstract

Purpose: Micronutrients (vitamins and minerals) have demonstrated promise in managing inattention and emotional dysregulation in children with attention-deficit/hyperactivity disorder (ADHD). The mechanism by which micronutrients improve these symptoms remains unknown, but changes in the microbiome are hypothesized to play a role in treatment response. The focus of this investigation is to analyze changes in the composition of the gut microbiome before and after micronutrient treatment in children with ADHD, which may shed light on the compositional change responsible for the behavioral response to micronutrients in children with ADHD.

Method(s): A sub-sample of children (n= 44) ages 6-12 selected from the Micronutrient for ADHD in Youth (MADDY) study, an 8-week double-blind, randomized, controlled trial with an open-label extension, provided stool samples for microbial analysis. A clinician-rated Clinical Global Impression-Improvement scale with ratings 1 to 7 determined micronutrients responders as very much improved (score 1) or much improved (score 2). Stool samples collected at enrollment, week 8, and week 16 were analyzed using 16S rRNA amplicon sequencing targeting the V4 hypervariable region. Pairwise compositional analyses served as the primary means for investigating changes in gut microbiome composition following treatment.

Results: Following micronutrient treatment, the phylum Actinobacteriota was significantly decreased compared to placebo (mean % change = -2.44; p = 0.033). Behavioral responders who received the micronutrients had an increase in two butyrate producing, bacterial families, Rikenellaceae (1.26; p=0.043) and Oscillospiraceae (1.62; p=0.0032), compared to non-responders. No change in microbial diversity, as measured by alpha diversity, was observed following micronutrients at any taxonomic level.

Conclusions: Micronutrients modulated the gut microbiome composition leading to bacterial changes like decreased Actinobacteriota previously seen as elevated in children with ADHD.

P01.08LB

Pharmacological Mechanisms of Ma Xing Shi Gan Decoction in Treating Influenza Virus-Induced Pneumonia: Intestinal Microbiota and Pulmonary Glycolysis

Chen Bai¹, Lin Jiang¹, Jingru Zhu¹, Su Chen¹, Yang Wang¹, Hui Liu¹, Qianqian Li¹, Xueying Qin¹, Xiaohong Gu¹, and Tiegang Liu¹

¹ Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Chen Bai, [e-mail]

Abstract

Purpose: This study aimed to investigate the mechanism of action of Ma Xing Shi Gan Decoction in an animal model of influenza virus-induced pneumonia. Specifically, we aimed to elucidate how Maxingshigan Decoction modulates intestinal microbiota structure and lung tissue glycolysis to exert its therapeutic effects on pneumonia.

Method(s): We established a mouse model of influenza virus-induced pneumonia through intranasal infection with H1N1 influenza virus. Ma Xing Shi Gan Decoction formula granules were administered orally for six consecutive days. We observed changes in body weight, lung index, lung tissue pathology, and serum inflammatory cytokine levels and conducted 16S rRNA sequencing. Additionally, targeted metabolomics was performed to analyze lung tissue glycolytic metabolites, and western blot and enzyme-linked immunosorbent assays were performed to assess glycolysis-related enzymes, lipopolysaccharides (LPSs), HIF-1a, and macrophage surface markers. Correlation analysis was conducted between the LPS and omics results.

Results: Ma Xing Shi Gan Decoction reduced the abundance of gram-negative bacteria in the intestines, such as Proteobacteria and Helicobacter, leading to reduced LPS contents in the serum and lungs. This intervention also suppressed HIF-1a activity and lung tissue glycolysis metabolism, decreased the number of M1-type macrophages, and increased the number of M2-type macrophages, effectively alleviating lung damage caused by influenza virus-induced pneumonia.

Conclusions: The mechanism by which Ma Xing Shi Gan Decoction affects influenza virus-induced pneumonia involves reducing the relative abundance of gram-negative bacteria in the intestinal contents, decreasing enterogenous LPS entering the bloodstream, which inhibits glycolysis, regulating macrophage polarization, reducing pro-inflammatory cytokine secretion, and increasing anti-inflammatory cytokine secretion. This study supports the use of traditional Chinese medicine for respiratory infections.

P01.09LB

Investigating the Effects of Centella Asiatica Water Extract on Cerebrovascular Function in Mice

Benjamin Zimmerman¹, Amala Soumyanath², Nora Gray², Martin Pike², and Anusha Mishra²

¹ National University of Natural Medicine, Portland, OR

² Oregon Health & Science University, Portland, OR

Contact: Benjamin Zimmerman, [e-mail]

Abstract

Purpose: Scientific evidence has supported the reputed ability of the botanical Centella asiatica to promote healthy cognitive function in aging. However, the biological mechanisms mediating these beneficial effects are not well understood. Elucidating these mechanisms is critical to optimizing products derived from botanicals and assessing appropriate biomarkers of target engagement in clinical trials. One potential mechanism underlying the benefit of C. asiatica is through effects on the tone of cerebral small vessels, which could support cognition by increasing cerebral blood flow.

Method(s): We treated 2-month-old or 17-month-old C57BL/6 mice with an aqueous extract of C. asiatica for five weeks and then assessed cerebrovascular function in vivo using arterial spin labeling MRI to measure resting brain perfusion and cerebrovascular reactivity to a hypercapnic challenge. Control mice received drinking water with no additives. In the same mice, we then assessed the vasomotor response of capillaries to an oxidative stress challenge ex vivo using brain slice preparations. We applied 1 mM H₂O₂ and assessed the resultant change in diameter of capillaries. Finally, in separate experiments, we examined whether CAW exhibits acute vasodilatory effects ex vivo.

Results: We found that CAW treatment did not change resting perfusion but did result in a significant increase in hypercapnia-evoked cerebrovascular reactivity compared to control animals. We observed both age and treatment effects in the capillary responses to H₂O₂, with older mice showing larger constrictions than young mice, and a stronger loss of late-stage constriction in controls compared to CAW treated mice. However, capillaries showed no significant acute dilation in response to CAW at 50 µg/ml or 100 µg/ml in brain slices.

Conclusions: Overall, CAW appears to exert some beneficial effects on cerebrovascular function, which may be mediated through resilience to oxidative stress rather than acute vasodilatory effects on the cerebral microvasculature.

P01.10LB

YQHX Decoction Protects Ischemic Myocardium by Inhibiting Endoplasmic Reticulum Stress Followed by Attenuation of Pyroptosis

Hui Wang¹, Tianhui Du², Haolin Yang¹, Shuwen Guo³, and Jinchang Huang¹

¹ The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, Beijing, China

² School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

³ Fangshan Hospital Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Hui Wang, [e-mail]

A bstract

Purpose: It was designed to investigate protective efficacy as well as modulation mechanism for ischemic myocardium after myocardial infarction indicated by YQHX Decoction.

Method(s): YQHX Decoction components were analyzed by UPLC-QE-Orbitrap-MS. The mechanism of YQHX Decoction protecting ischemic myocardium was predicted by network pharmacology. Acute myocardial infarction model (AMI) was constructed, and cardiac function was evaluated by echocardiography, H&E, and serum biochemical tests. Transmission electron microscopy was used to observe myocardial mitochondria and pyroptotic bodies, and Western blotting, immunohistochemistry and ELISA experiments were performed to clarify the pyroptosis of cardiomyocytes.Caspase-12 immunohistochemistry and Western blotting were used to determine ATF6, p-PERK/PERK, p-IRE1a/IRE1a proteins, and to observe the changes in endoplasmic reticulum function. Following, H9C2 cells were selected for ex vivo experimental studies. The pathological mechanism of ERS induced pyroptosis was clarified by fluorescence microscopy and Western blotting with ERS inhibitors.

Results: 72 chemical components of YQHX Decoction were screened. Network pharmacological analysis showed that the mechanism of YQHX Decoction to protect ischemic myocardium was related to pyroptosis.YQHX Decoction improved the cardiac function of AMI rats, reduced the levels of serum cTnT, SOD, CK-MB, LDH, and MDA, and decreased the expression of Nppa and Nppb in the cardiac tissue, which alleviated the damage of ischemic myocardium. YQHX Decoction has shown inhibitory effects on ERS and cellular pyroptosis throughout in vivo and vitro experiments.

Conclusions: The cardioprotective effects of YQHX Decoction depend on multiple components. Inhibition of ERS and reduction of TXNIP/NLRP3 induced cellular pyroptosis are the underlying mechanisms by which YQHX Decoction attenuates ischemic myocardial injury after AMI.

P01.11LB

PD-1 Inhibitor Combined With Peritumoral Electroacupuncture Induces Remodeling of Cold Tumor Immune Microenvironment in 4T1 Mouse Model

Hui Wang¹, Yuxiang Wan¹, Haolin Yang¹, Wenna Li¹, Mengyang He², and Jinchang Huang¹

¹ The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, Beijing, China

² Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Yuxiang Wan, [e-mail]

Abstract

Purpose: The aim of this study was to explore the role and mechanism of electroacupuncture perimetry in remodeling the immune microenvironment of cold tumors in triple-negative breast cancer (TNBC).

Method(s): In this study, we combined in vivo animal and ex vivo cell experiments, observed the effect of electroacupuncture periapical on the immune microenvironment of TNBC by flow cytometry and immunohistochemistry, verified that electroacupuncture periapical improves the efficacy of PD-1 by small animal in vivo imaging, and survival analysis experiments, and clarified the mechanism of action of electroacupuncture periapical on remodeling of cold tumors through the inhibitors of M-CSF, GM-CSF, and GSTP1.

Results: Peritumoral electroacupuncture was found to remodel the cold tumor immune microenvironment of 4T1 breast cancer xenografts, promote M1 infiltration, and resist infiltration of tumor-associated immunosuppressive cells. Peritumoral electroacupuncture demonstrated stronger anti-tumor effects than monotherapy when combined with PD-1 inhibitors. The antitumor efficacy of peritumoral electroacupuncture for M1 polarization was closely related to GSTP1. The study further demonstrated that regulating GSTP1 expression in tumor-associated macrophages could promote their M1-type polarization and improve cold tumor status.

Conclusions: It demonstrated that electroacupuncture perimetry improves the efficacy of PD-1 inhibitors in TNBC by promoting M1 polarization to reprogram the cold tumor immune microenvironment. These results provide a basis for clinical electroacupuncture perimetry to reprogram the immune environment to improve the efficacy of PD-1 inhibitors. Electroacupuncture perimetry is safe, economical, and a promising strategy for clinical synergistic treatment of TNBC.

Topic Area 02 - Clinical: Acupuncture

P02.01

Acupuncture After Valve Surgery is Feasible and Shows Promise in Reducing Post-operative Atrial Fibrillation: The ACU-HEART Pilot Trial

Kim L. Feingold¹, Judith Moskowitz¹, and Melinda Ring²

¹ Northwestern University, Chicago, IL

² Osher Center for Integrative Health at Northwestern University, CHICAGO, IL

Contact: Kim L. Feingold, [e-mail]

Abstract

Purpose: Acupuncture is an effective treatment for arrythmias and post-operative symptoms but has not been investigated after cardiac surgery. Acupuncture After Heart Surgery (ACU-Heart) is a prospective, randomized, controlled pilot trial of daily inpatient acupuncture (ACU) or standard care (SC) following valve surgery with the primary endpoint being feasibility and secondary endpoints being reduction in POAF incidence and post-operative symptoms.

Method(s): 100 patients without history of AF underwent primary valve surgery via sternotomy, randomized 1:1 to ACU (51) or SC (49). ACU patients received daily inpatient sessions starting POD1. Post-operative symptoms (pain, nausea, stress, anxiety) were assessed once daily in SC and pre/post daily intervention in ACU. The groups were comparable except for age (ACU: 55.6±11.4, SC: 61.0±9.3; p=.01).

Results: ACU-Heart met primary and secondary endpoints. There were no adverse events. An average of 3.8(±1.1) ACU sessions were delivered per patient, during a mean 4.6(±1.3)-day hospital stays. ACU was associated with a reduction in pain, nausea, stress and anxiety after each session (p<.0001) and ACU patients had reduced post-op stress and anxiety across admission compared to SC (p=.049 and p=.036, respectively). ACU was associated with reduced POAF incidence, fewer discharges on amiodarone, and fewer hours in the ICU (ACU: 30.3±10.0, SC: 37.0±22.5; p=.057).

Conclusions: Acupuncture after valve surgery is feasible, well tolerated and has clinical benefit. The reduction noted in POAF incidence will inform larger trials designed to further investigate the impact of ACU on POAF and medical outcomes.

P02.02

Acupuncture Treatment for Chronic Post-Traumatic Headache in Individuals with Mild Traumatic Brain Injury

Amanda A. Herrmann¹, Ella A. Chrenka², Kerri W. Chung Schreiber³, Sophia G. Bouwens⁴, Ellie K. Tansey⁴, Lixin Qin⁵, Ayla A. Wolf⁶, Michael Koziol⁶, Samantha J. Sherman⁴, Aleta L. Svitak⁴, Marny T. Farrell⁴, Steven D. Jackson⁴, and Leah R. Hanson²

¹ HealthPartners Institute, St. Paul, MN

² HealthPartners Institute, Bloomington, MN

³ Minneapolis VA Health Care System, Minneapolis, MN

⁴ HealthPartners Neuroscience Center, St. Paul, MN

⁵ HealthPartners, St. Paul, MN

⁶ Healing Response Acupuncture & Functional Neurology, Lake Elmo, MN

Contact: Amanda A. Herrmann, [e-mail]

Abstract

Purpose: The primary goal of this study was to determine the effect of a low vs. high dose of acupuncture treatment in individuals with chronic post-traumatic headache (CPTH) after a mild traumatic brain injury (mTBI). Secondary and tertiary aims were to determine the safety and tolerability of acupuncture, and to explore the effects of acupuncture on sleep, quality of life (QOL), number of headache days, and medications.

Method(s): A total of 39 people with CPTH were enrolled. Individuals were randomized into two groups: 1) Low Acupuncture (5 treatments) and 2) High Acupuncture (10 treatments) over 5 weeks. The 18 acupuncture points were selected for their classical indications, anatomical locations, effect on pain networks, and influence on cerebral blood flow. Participants were recruited using multiple methods including referrals from physicians, therapists, and community organizations.

Results: Of the 39 people enrolled in the study, 2 are in follow up, 27 completed the study, 6 were withdrawn due to lost to follow up, 1 was withdrawn because they did not meet the inclusion/exclusion criteria, and 3 participants chose to withdraw. Of the 3 participants who withdrew, one withdrew due to discomfort during acupuncture, one was unable to commit to the appointment schedule, and one had unrelated medical issues. The mean age was 45 years (SD = 13). Participants were more likely to be female (n = 30, 77%), White (77%), and non-Hispanic (97%). Most participants were single (n = 18, 46%) or married (n=14, 36%) and employed either full time (n=16, 41%) or part time (n=11, 28%). The mean time between mTBI diagnosis until enrollment was 9.2 months (SD = 5.8). The mean number of headache days reported in the 4 weeks prior to acupuncture treatment was 22 days (SD = 6.8).

Conclusions: Recruitment for this study was slow due to the pandemic, which may also have affected our retention rate. Final analyses will be completed in October 2023. The baseline headache rate in this study is similar to previously reported studies.

P02.03

Characterizing the Clinical Delivery of Acupuncture and Impacts upon Patient Reported Outcomes During In Vitro Fertilization

Rebecca Lu¹, Samuel N. Rodgers-Melnick², Rebecca Flyckt³, Sung Tae Kim⁴, Roshini Srinivasan⁵, Jeffery Dusek⁶, and Christine Kaiser²

¹ Case Western Reserve University School of Medicine, Cleveland, OH

² University Hospitals Connor Whole Health, Cleveland, OH

³ University Hospitals Department of OBGYN Reproductive Endocrinology and Infertility, Cleveland, OH

⁴ University Hospitals Fertility Center, Cleveland, OH

⁵ University Hospitals Connor Whole Health, Durham, NC

⁶ University of California - Irvine, Irvine, CA

Contact: Rebecca Lu, [e-mail]

Abstract

Purpose: The number of in vitro fertilization (IVF) cycles in the US has grown rapidly, but only 37% of cycles nationally are successful. Undergoing fertility treatment poses significant stress, with 40% of patients who discontinue treatment citing psychological burden. Many infertility patients also use Whole Systems Traditional Chinese Medicine (WS-TCM), including acupuncture. We aimed to characterize clinical delivery and assess effects on patient-reported outcomes (PROs) of pain, anxiety, and stress among patients receiving acupuncture while undergoing IVF within an academic medical center.

Method(s): We conducted a retrospective review of acupuncture treatments provided to patients who received ≥1 acupuncture treatment associated with ≥1 embryo transfer at our center. A linear mixed model adjusting for the random effect of patients seen over multiple treatments was used to calculate PRO changes among those with pre-treatment PROs ≥1, reported on a 0-10 numeric rating scale.

Results: 1896 acupuncture treatments were provided during 202 embryo transfers among 146 patients. Patients (median age 36, range 27-48) were predominantly white (81.1%) and 27% had a documented mental health diagnosis. Reproductive health diagnoses included dysmenorrhea (19%), recurrent pregnancy loss (14%), endometriosis (8.9%), and polycystic ovarian syndrome (6.2%). Of the 202 embryo transfers, 64.9% included pre-transfer treatment, 88.6% included day-of-transfer treatment, and 32.2% included post-transfer treatment. Patients reporting pre-treatment PROs ≥1 reported clinically significant mean reductions in pain (-1.38, 95% CI: -1.70, -1.07), stress (-2.11, 95% CI: -2.47, -1.74), and anxiety (-2.11, 95% CI -2.63, -1.81) within a single treatment.

Conclusions: This study describes real-world acupuncture delivery alongside IVF and supports the acute effects of acupuncture for reducing pain, stress, and anxiety. WS-TCM may improve patient experiences and be a useful treatment for psychosocial concerns that often accompany IVF.

P02.04

Characterizing the Clinical Features of Traditional Chinese Medicine (TCM) Syndrome Differentiation in Patients with Sickle Cell Disease

Andrew Pucka¹, David Wang², Andrew O'Brien¹, Steven Harte³, Richard Harris⁴, and Ying Wang¹

¹ Indiana University School of Medicine, Indianapolis, IN

² Ohio State University, Columbus, OH

³ University of Michigan Medical School, Ann Arbor, MI

⁴ University of California at Irvine, Irvine, CA

Contact: Andrew Pucka, [e-mail]

Abstract

Purpose: Pain presents a debilitating and poorly understood challenge in sickle cell disease (SCD). Pain management relies heavily on opioids, impacting patients' quality of life (QoL). Acupuncture has shown promise for SCD pain management. However, current clinical research in this area lacks Traditional Chinese Medicine (TCM) guidance using “syndrome differentiation” for tailored treatment. This study aims to characterize clinical features among patients with SCD diagnosed with different TCM syndromes.

Method(s): 52 patients with SCD along with 28 age- and sex-matched healthy controls (HCs) were enrolled in an ongoing randomized sham-controlled acupuncture trial (ClinicalTrials.gov Identifier: NCT05045820). At the baseline, participants completed several pain- and QoL-related questionnaires and underwent standardized TCM diagnostic assessments, including “Observation,” “Listening and Smelling,” “Inquiry,” and “Pulse-feeling and palpation.” Group differences were analyzed by one-way ANOVA followed by Tukey post hoc testing.

Results: TCM diagnosis criteria classified patients with SCD into one of three TCM syndromes: a) “Stagnation greater than deficiency” (“Stagnation”), b) “Deficiency greater than stagnation” (“Deficiency”), and c) “Equal stagnation and deficiency” (“Equal”). The “Stagnation” group showed higher pain interference, physical dysfunction, nociplastic pain, fatigue, anxiety, depression, and lower sleep quality and QoL compared to the “Equal” group. Few differences were observed between HCs and the “Equal” SCD group across outcomes. “Deficiency” and “Stagnation” groups were differentiated with observed- and patient-reported clinical manifestations (Table 1).

Conclusions: We are the first to study TCM syndromes in patients with SCD. These findings suggest that TCM-diagnosed syndromes in SCD can be differentially characterized using validated objective and patient-reported outcomes, which may facilitate clinical acupuncture effectiveness.

P02.05

Clinical Observation of the Treatment of Shoulder-Hand Syndrome After Stroke With Giant and Miu Acupuncture

Jing Ning

Beijing University of Chinese Medicine, Beijing, China

Contact: Jing Ning, [e-mail]

Abstract

Purpose: Shoulder-hand syndrome (RSD) is a condition in which a patient suffers from sudden swelling and pain in the hand and shoulder joint, and limitation of hand function. RSD can be primary or induced by different diseases. This article focuses on peripheral nerve damage caused by stroke and RSD caused by central nervous system disorders.

Method(s): According to existing statistics, the Giant acupuncture method is often used for periarthritis of the shoulder, and the Miu acupuncture can be used for syncope syndrome, and the Giant acupuncture and Miu acupuncture are the specific applications of the method of “treat the right part for left side diseases, and treat the left side diseases for right side diseases”. “Regulating yang to treat yin diseases and regulating yin to treat yang diseases” to adjust Yin and Yang. Generally, acupoints should be selected and acupunct on the healthy side corresponding to the pain and movement disorder of the affected side, so as to achieve the purpose of regulating Qi and blood by acupuncture, and the affected side can also be supplemented with activities to promote adhesion, restoration of stiffness. Patients were admitted to the ward of the acupuncture department of Huguosi Traditional Chinese Medicine Hospital affiliated to Beijing University of Chinese Medicine with the chief complaint of stroke and post-stroke RSD. Patients were selected to undergo the treatment of Giant acupuncture and Miu acupuncture, and the changes of various indicators before and after treatment were compared.

Results: Compared with before treatment, Kozin, VAS, FMA, ADL and grade score of hand edema were significantly decreased after treatment (P < 0.05), indicating that the symptoms of patients with post-stroke RSD were significantly improved after treatment.

Conclusions: According to the results of various tests, it can be concluded that the Giant and Miu acupuncture have obvious effects on improving the pain of the affected side.

P02.06

Efficacy of Integrative Medicine Therapies on Chronic Headache Severity: A Retrospective Study

Nithya Trichy¹, Olivia Dillman², Harini Pallerla³, Conner Funke³, Sian Cotton¹, and Mladen Golubic⁴

¹ University of Cincinnati College of Medicine, Cincinnati, OH

² Ohio University Heritage College of Medicine, Athens, OH

³ University of Cincinnati, Cincinnati, OH

⁴ University of Cincinnati College of Medicine Family Medicine Integrative Medicine, Cincinnati, OH

Contact: Olivia Dillman, [e-mail]

Abstract

Purpose: Headaches are among the most common neurological disorders, with a worldwide prevalence of 46% in adults. The current standard of care for patients with chronic headaches (CH) is primarily medication-based treatment. Patients with unrelieved pain often seek additional, nonpharmacologic interventions like Integrative Medicine (IM). This study investigates the potential for IM modalities, including acupuncture, yoga, tai chi, mindfulness, and lifestyle changes, to decrease pain severity.

Method(s): A retrospective review of electronic medical records of patients diagnosed with CH and prescribed IM therapies between February 2020 to June 2023 was conducted. Patient demographics, IM usage, number of visits, and self-reported pain values were collected on a secure, online database. Descriptive statistics and t-tests were completed using SPSS 28.

Results: Among 98 patients reviewed, 24 patients with documented self-reported pre- and post-pain values met the study criteria. Frequently used IM therapies included acupuncture (92%), massage (29%), tai chi (21%), yoga (17%), and lifestyle modifications (42%). 75% had a primary diagnosis of CH; furthermore, 71% identified as white, and 92% identified as female. The average age of the study population was 44. Analysis of pre- and post-pain data collected from office visits and acupuncture session notes showed a decrease (p=0.01) in pain value from the first visit (M=6.3, SD=2.4) to the last visit (M=4.4, SD=2.9). Furthermore, a significant decrease (p=0.02) was found when comparing the first pain value (M=6.3, SD=2.4) to the average pain value (M=5.0, SD=2.5) from subsequent provider visits.

Conclusions: Patients suffering from CH who utilized IM modalities alongside standard treatment plans reported clinically meaningful decreases in pain intensity. Our findings add to the growing body of evidence in support of integrating IM modalities with the current standard of care to alleviate pain severity.

P02.07

Exploring Protocols for Electroacupuncture in the Treatment of Peripheral Neuropathy: An Analysis of one Acupuncturist’s Protocol and Experiences

Larry Wu¹ and David Wang¹

¹ The Ohio State University, Columbus, OH

Contact: Larry Wu, [e-mail]

Abstract

Purpose: Dr. David Dehui Wang from The Ohio State University has unique expertise in utilizing electroacupuncture (EP) to treat peripheral neuropathy. He possesses a medical background in both allopathic medicine and traditional Chinese medicine, and has over 30 years of clinical experience in acupuncture. Our aim is to analyze Dr. Wang's experiences in utilizing EP for treating peripheral neuropathy to identify associations in factors such as patient symptoms, demographics, and neuropathy etiology, with treatment outcome. Through this analysis, we hope to develop more standardized intake and treatment protocols to improve quality of care for patients presenting to our acupuncturists for treatment of peripheral neuropathy.

Method(s): All patients who were treated by Dr. Wang at least 3 times with EP with a primary treatment diagnosis of peripheral neuropathy in the last 5 years were included. Demographic data, presenting symptoms, neuropathy etiology, and concurrent treatments for neuropathy were identified. Subjective status of the neuropathy symptoms was recorded in each patient encounter: no improvement, mild improvement, and significant improvement of symptoms, which was used to identify outcome results taken at various treatment intervals.

Results: Preliminary results after analysis of 20 patients: 18 reported some level of improvement of their peripheral neuropathy, with four reporting significant improvement. Two had no improvement of symptoms. Three required over 20 treatments before benefit, while 11 had some level of improvement by 10 treatments. Both patients who had no benefit had neuropathy symptoms for less than 1 year. No patients reported adverse effects from EP.

Conclusions: Based on preliminary data, Dr. Wang’s EP treatment protocol has promise to improve symptoms from peripheral neuropathy of any etiology. With a treatment response of 90%, further investigation with a more rigorously designed study is warranted to address confounding factors prior to standardized use in the clinic.

P02.08

Implementation of a Battlefield Acupuncture Clinic at VA Northeast Ohio Healthcare System (VANEOHS)

Alecia Smalheer¹, Darshana Patel¹, Michelle Treasure¹, Rosalie Diaz¹, Jennifer Smith¹, Cheryl Thompson¹, and Patricia Kiefer¹

¹ Louis Stokes Cleveland VA Medical Center, Cleveland, OH

Contact: Darshana Patel, [e-mail]

Abstract

Purpose: Pain in cancer patients is attributed to various factors including tumor size and location, antineoplastic treatment, and diagnostic or therapeutic interventions¹. Battlefield acupuncture (BFA) is a form of auricular acupuncture that is used as a non-pharmacological way to manage pain. Whole health and oncology at a Northeast Ohio VA collaborated to implement a BFA clinic for oncology patients in an outpatient infusion clinic setting.

Method(s): Key Stakeholders created a workgroup that included guidance from the VA national lead acupuncturist. A BFA trained provider was approved for a Friday morning clinic. A national templated note was utilized along with a patient education handout that was modified to meet local facility needs. Information was disseminated to staff and patients.

Results: The BFA clinic opened in June 2023. A post-implementation data review included 34 procedures with 24 unique patients. Patients with an active cancer diagnosis (n = 7) and walk-in patients (n = 17) with varying diagnoses (rheumatology, gastrointestinal, etc.). Using a numeric pain scale (0 – 10), average pain score pre-intervention was 7.7 and post 4.6. Overall, 71% of oncology patients noted a decrease in pain, with an average 3.1-point decrease in pain scores. Using a scale of 0 to 10, patients were also asked to score how pain interfered with activity, sleep, mood, and stress over the past 24 hours. Average scores demonstrated: activity (8), sleep (5.9), mood (5.3), stress (5.6).

Conclusions: While early, this clinic is helping to strategize the integration of BFA into an infusion clinic. Limitations include a low volume of initial and recuring appointments. Limited studies exist on BFA in cancer patients. Next steps involve a pilot clinical trial with protocoled BFA, as well as protocoled and standardized symptom and quality of life (QOL) assessments. The primary endpoint of the study will be change in pain score, with an exploratory analysis on BFA effects on symptoms and QOL in cancer patients.

P02.09

Integrative Approaches to COVID Long Haul Syndrome with Special Emphasis on Mitochondrial Support

Bill Reddy

Integrative Health Policy Consortium, Alexandria, VA

Contact: Bill Reddy, [e-mail]

Abstract

Purpose: The emergence of the COVID-19 pandemic has resulted in an unprecedented global health crisis, with millions of individuals affected by the virus. While the acute symptoms of COVID-19 are well-documented, a growing number of people continue to experience a constellation of symptoms even after recovering from the initial infection. This condition, commonly referred to as COVID Long Haul Syndrome (CLHS) or Long COVID, poses significant challenges to both patients and healthcare professionals.

Method(s): This presentation aims to explore integrative approaches to managing CLHS, with a special emphasis on the role of mitochondrial dysfunction in the pathogenesis and symptomatology of the condition and the overlap of symptoms associated with myalgic encephalomyelitis/chronic fatigue syndrome. Mitochondria play a crucial role in energy production and cellular metabolism and COVID tends to up-regulate carbon metabolism, decreasing oxidative phosphorylation and decreasing energy yield of the mitochondrion. However, emerging evidence suggests that COVID-19 infection may result in mitochondrial dysfunction, leading to persistent symptoms in some individuals. The first part of the presentation will provide an overview of the clinical manifestations and prevalence of CLHS, highlighting the diverse range of symptoms reported by affected individuals, followed by an exploration of the potential mechanisms underlying mitochondrial dysfunction in CLHS. The presentation will delve into the impact of viral invasion, immune dysregulation, oxidative stress, and inflammation on mitochondrial function, and how these factors may contribute to the development and persistence of CLHS symptoms.

Results: The second part of the presentation will focus on integrative approaches to managing CLHS. The multidimensional nature of CLHS calls for a comprehensive and holistic approach, combining conventional medical interventions with complementary and alternative therapies. The presentation will discuss the potential benefits of various modalities, such as acupuncture, homeopathy, nutritional interventions, stress management techniques, physical activity, and targeted supplements, in addressing mitochondrial dysfunction and alleviating CLHS symptoms.

Conclusions: Each individual may present with a unique combination of symptoms and underlying factors, necessitating personalized medicine and tailored treatment plans. The integration of diverse therapeutic modalities, informed by the principles of precision medicine, may hold promise in optimizing outcomes and improving quality of life for individuals living with CLHS.

P02.10

Is Pediatric Acupuncture Safe? Results of a Scoping Review

Aiko Bailey¹, Rachel Blume², Dan Cherkin³, Brenda Loew⁴, and Iman Majd⁵

¹ University of Washington, Osher Center for Integrative Health, Seattle, WA

² University of Washington, Seattle, WA

³ Osher Center for Integrative Health, Dept of Family Medicine, U. Washington, Seattle, WA

⁴ University of Washington, Department of Family Medicine, Osher Center for Integrative Health, Seattle, WA

⁵ Osher Center for Integrative Medicine, University of Washington, National Certification Commission for AOM (NCCAOM), Medical Acupuncture Research Foundation, Seattle, WA

Contact: Brenda Loew, [e-mail]

Abstract

Purpose: The use of acupuncture for children has been increasing in the U.S. in recent years. It is not clear how much evidence there is for the safety of acupuncture for pediatric conditions. We are conducting a scoping review on the safety of pediatric acupuncture to clarify the state of knowledge and to identify priorities for further research.

Method(s): Two acupuncture teaching associates and a librarian from the University of Washington conducted an initial scoping review between June and September 2023 using MEDLINE. Published articles were scanned using MeSH-based keywords. RCTs, clinical trials, systematic reviews, meta-analyses, narrative reviews, and case reports conducted in the last ten years were included. Population over age 20 was excluded. Articles identified were further screened and analyzed with a systemic review management system called Covidence. Any abstract, full text available in English, which did not focus on acupuncture as the main intervention or mention safety in the method or study results were excluded.

Results: We identified 393 relevant abstracts. Two reviewers screened these abstracts individually and voted for further review as needed. Only 47 articles met our baseline criteria. Summary of characteristics of identified articles:

• Most publications involved randomized clinical trials.

• The most mentioned condition was pain.

• No serious adverse effects were reported by systematic review, RCT, nor meta-analysis.

• There were only two isolated case reports of major adverse effects which involved dry needling.

Conclusions: Based on the preliminary results of this scoping review, there is a clear need for more focused studies on the safety of pediatric acupuncture. Such information, in concert with scientifically rigorous evidence for the effectiveness of acupuncture for specific pediatric conditions, will provide the evidence needed for making informed decisions about whether further inclusion of pediatric acupuncture in health care is justified.

P02.11

Pressure Pain Sensitivity and Perceived Impact of Pain Differentially Predict Short-Term and Long-Term Analgesia Following Acupuncture in Fibromyalgia

Anne Murphy¹, Anne Arewasikporn², Lisa Taylor-Swanson³, David Williams², and Richard Harris⁴

¹ University of Michigan, Ann Arbor, MI

² University of Michigan Medical School, Ann Arbor, MI

³ University of Utah College of Nursing, Salt Lake City, UT

⁴ University of California at Irvine, Irvine, CA

Contact: Lisa Taylor-Swanson, [e-mail]

Abstract

Purpose: In fibromyalgia, acupuncture is often considered as a treatment for chronic pain, however predictors of short-term analgesic response and long-term analgesic response especially, are not well understood.

Method(s): In this study a secondary analysis of a single center, blinded, sham-controlled, randomized longitudinal acupuncture clinical trial in fibromyalgia was performed. Baseline characterizations included pressure pain tolerance and pain interference with residualized change in pain intensity as the outcome measure. Participants were randomized to verum (n=36) or sham (n=29) acupuncture treatment over 12 weeks (18 treatments). Participants were then followed 24 weeks post treatment.

Results: As we found in our prior analyses, lower pressure pain tolerance at baseline predicted greater analgesia in the sham treatment group, while those with higher pressure pain tolerance had greater analgesia with verum treatment (B= -13.43, p=0.001). Additionally, greater perceived impact of pain at baseline was predictive of greater short-term analgesia irrespective of treatment. Pressure pain tolerance was not found to be predictive of long-term differential treatment response (B= -1.71, p=0.66). In the long-term, those with greater perceived impact of pain displayed improved analgesia in the verum group while those in the sham group showed no relationship between the perceived impact of pain at baseline and subsequent change in clinical pain (B = -11.37, p = 0.004).

Conclusions: Our results support the use of a self-reported pain outcome in predicting long-term analgesia following acupuncture in fibromyalgia.

P02.12

Precision in Locating an Acupuncture Point Affects Enhancement of Local Blood Circulation by Acupressure Treatment

Shin Lin¹, Caitlin Lee¹, Anthony Troung¹, Anthony Tran¹, Eileen Pham¹, Shannon Stolaruk¹, Johnson Jiang¹, and Melinda Ly¹

¹ Dept. of Developmental & Cell Biology and Susan Samueli Integrative Health Institute, University of California, Irvine, Irvine, CA

Contact: Shin Lin, [e-mail]

Abstract

Purpose: The purpose of this study is to determine how the precision in locating an acupuncture point might affect the effectiveness of acupressure treatment on enhancement of local blood circulation.

Method(s): A dozen healthy males and females of college age were subjects in this study. Acupressure was applied to the PC6 acupoint on the forearm with the eraser end of a pencil attached to a Beslands SF500 Digital Push/Pull Dynamometer at a force of 6 Newtons for 1 minute. Local blood flow/perfusion/circulation was measured continuously as “Flux” at the acupoint before (to establish baseline) and after the treatment with a Moor DRT4 laser Doppler flowmetry instrument.

Results: In a typical experiment, blood flow went from baseline to a level ∼8X higher at PC6 immediately after a 1-minute acupressure treatment, falling back down steadily and approaching baseline asymptotically in ∼10-20 minutes. The mean of all values recorded immediately after acupressure for all subjects was 245±48SD in arbitrary units, significantly higher (p=0.02) than 187±48 when acupressure was applied to a sham point 1 cm proximal to PC6. The duration for blood flow dropping 50% towards baseline was quite variable. This time period on average was not significantly different (p=0.89) for PC6 compared to sham point (2.83±1.62 and 2.91±2.49 minutes, respectively).

Conclusions: This pilot study shows that stimulation of acupoint PC6 by acupressure treatment resulted in several fold of increase in local blood flow and that a deviation of only 1 cm away from that point produced a significantly lesser effect. This result suggests that for acupressure treatment, applying force precisely to the acupoint would produce the best result. The time interval for the increased blood flow from acupressure to drop back to baseline was quite variable. Determination of whether there is any significant difference between the time course of blood flow at PC6 and the sham point following acupressure requires a larger sample size in future studies.

P02.13

Understanding the Role of Interpersonal Mindfulness and Other Foundations of Healing in a Traditional Chinese Medicine encounter: A Qualitative Study

Timothy Chen¹, David Victorson², Bruriah Horowitz¹, Christina Sauer¹, Varsha Ganesh³, Yashoswini Chakraborty², and Arin Budhiraja⁴

¹ Northwestern University Feinberg School of Medicine, Chicago, IL

² Northwestern University, Evanston, IL

³ New York University, New York, NY

⁴ Northwestern University, Los Angeles, CA

Contact: Timothy Chen, [e-mail]

Abstract

Purpose: To explore ways in which interpersonal mindfulness and other foundations of healing are manifested during the TCM encounter and how they may affect the practitioner-patient relationship and support health equity and quality of life.

Method(s): US-based TCM practitioners with the following licenses–L.Ac., O.M., C.H.,–were recruited to participate in a 45-minute recorded Zoom interview about their professional background, practitioner-patient interactions, and the role mindfulness may play in their professional practice. Using a Grounded Theory approach, research team members engaged in open coding to create an initial codebook from the first transcript, and passed an interrater reliability test (Kappa >.70) before coding subsequent transcripts. Group-based axial coding was then used to create higher-order categories and themes from the original codes. Saturation was documented.

Results: In total, 5 TCM practitioners were interviewed, resulting in 135 unique codes. Saturation was met for 89% of the codes. Axial coding yielded 15 higher-order categories, and four overarching themes: 1) Foundations of TCM Healing, which included the roles of the therapeutic relationship, ethics in building trust, emotional balance, mindful awareness, and energy exchange among others; 2) Essentials of TCM Diagnosis, including inquiry, observation, and touch; 3) Bridging Cultural Gaps in Education and Understanding, highlighting TCM’s medical integration and modern acceptance and; 4) Practice Motivators & Logistics for practitioners.

Conclusions: This study offers important insights directly from TCM practitioners on the importance they place on creating an empathic and compassionate environment based on trust, awareness, and connection in order for healing to occur. This is consistent with TCM theory, which emphasizes mindful qualities, supporting holistic healing in physical and mental health.

P02.14LB

Fidelity to ACUITY Acupuncture Protocol: Expanding the Gold Standard of STRICTA and CONSORT Guidelines

Jeffery Dusek¹, Arya Nielsen, PhD², Natalie L Dyer³, Claudia Lechuga⁴, and M. Diane McKee⁵

¹ University of California - Irvine, Irvine, CA

² Icahn School of Medicine at Mount Sinai, New York, NY

³ Connor Whole Health, University Hospitals, Cleveland, OH

⁴ Albert Einstein College of Medicine, Bronx, NY

⁵ Department of Family Medicine and Community Health, University of Massachusetts Chan School of Medicine, Worcester, MA

Contact: Jeffery Dusek, [e-mail]

Abstract

Purpose: Roughly 80% of emergency department (ED) visits involve acute pain, where pain medication use increases the risk of adverse effects. Acupuncture shows promise as an effective nonpharmacologic option to reduce acute pain in the ED. Following CONSORT and STRICTA guidelines, randomized controlled trials (RCTs) report intervention details and acupoint options, yet few RCTs track fidelity, which is critical to reliability in intervention research.

ACUITY is an NCCIH-funded, multi-site feasibility RCT of acupuncture, using a consensus acupuncture manualization. Here we report fidelity to the ACUITY acupuncture intervention protocol.

Method(s): Using a modified Delphi process, our team developed an acupuncture protocol with expanded standardized point options that are replicable while providing flexibility to respond to unique pain presentations. ACUITY acupuncturists were trained in study design, protocols, study logistics and real-time recording of session details via REDCap forms.

Results: Across 3 recruiting sites, 79 participants received acupuncture: 51% women, 43% Black/African American, and with various acute pain presentation (36%: low back, 22%: abdominal, 13: leg, 12%: headache). Systematic review found 99% adherence to the acupuncture manualization protocol, with fidelity to tracking of pain location, treatment location, participant position, session staging, number of insertion points (M = 13.2, range = 2-22), needle retention time (M = 23.5 min, range 4-52), total session time (M = 40.3 min, range 20-93), and frequency of usage of each acupuncture point. Pragmatically, participants were treated in common areas (52%), private rooms (39%), and semi-private rooms (9%) in the ED.

Conclusions: For the first time, our RCT reports fidelity to an acupuncture protocol. Fidelity monitoring will be fundamental for ACUITY2, our planned future, multi-site, definitive RCT of AQ in the ED. We recommend that intervention fidelity assessment/reporting be added to CONSORT and STRICTA research guidelines.

P02.15LB

Intranasal Acupuncture Therapies for Allergic Rhinitis: A Systematic Review and Meta-Analysis

Xiaoying Chen¹, Xinyan Jin¹, Jianping Liu², and Huangying Tan³

¹ Beijing University of Chinese Medicine, Beijing, Beijing, China

² Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

³ Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, Beijing, China

Contact: Jianping Liu, [e-mail]

Abstract

Purpose: Allergic rhinitis (AR) is prevalent allergic condition affecting the nasal mucosa Intranasal acupuncture (IA), an innovative therapy involving precisely inserting acupuncture needles into specific nasal acupoints under the guidance of an intranasal scope, demonstrates potential effectiveness in managing AR. We aimed to evaluate the effectiveness and safety of IA in the management of AR.

Method(s): Nine databases were systematically searched for randomized controlled trials (RCTs) from their inception to January 2024. We included participants diagnosed with AR who received IA treatment alone or as add-on treatment to usual care. Two authors independently screened articles and extracted data. The Cochrane risk of bias tool was applied to assess methodological qualities. Meta-analysis was performed using RevMan 5.4.0 software. Effect estimates were presented as risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) using random effects model.

Results: Nineteen RCTs with 1549 participants were included. The methodological quality was generally low. Compared to nasal corticosteroids, IA showed a significant improvement on total effective rates (RR1.15, 95%CI 1.04 to 1.27, 6 trials, 390 participants). Compared to antihistamines, IA appeared to have potential effect on toal nasal symptom score (TNSS) (MD-1.23, 95%CI -2.47 to 0.01, 2 trials, 120 participants) and total non-nasal symptom (TNNSS) (MD-0.45, 95%CI -0.7 to -0.2, 2 trials, 135 participants). No significant difference was found on the Rhino-conjunctivitis Quality of Life Quality (RQLO) and Immunoglobulin E. The difference between usual care used alone and IA combined with usual care was not statistically significant. No serious adverse event was reported in all included trials.

Conclusions: Limited evidence suggests a potential positive impact of IA on AR, while the safety of IA remains inadequately reported. Further high quality, rigorously designed and well-reported trials are required.

P02.16LB

Global Trends of Acupuncture Clinical Research on Analgesia from 2010 to 2023: A Bibliometric and Visualization Analysis

Zhiqiang Li¹ and Jianping Liu²

¹ Beijing University of Chinese medical, Beijing, Beijing, China

² Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Jianping Liu, [e-mail]

Abstract

Purpose: Acupuncture, a potent non-pharmacological therapy, is frequently employed to alleviate pain. Despite its widespread use, there is a lack of overarching bibliometric analysis of the clinical research on acupuncture analgesia. We aimed to summarize current patterns, hotspots, and development trends of this domain through bibliometric analysis.

Method(s): We evaluates academic publications on acupuncture analgesia in clinical settings from the Web of Science (2010-2023). All primary and secondary studies on humans were included. To track global developmental trends, we employed CiteSpace, Excel, VOSviewer, and R software for analyzing annual publication volumes, countries/regions, institutions, authors, cited authors, journals, cited journals, references, and keywords and to draw collaborative networks and reference co-citation network maps.

Results: 7,190 relevant studies, with a gradual increase in annual publications, including 1,263 randomized controlled trials (RCTs) and 1,293 systematic reviews and meta-analyses. Among countries and institutions, China (2139) and Chengdu University of Chinese Medicine (258) ranked first. Liang FR (89) emerged as the most prolific author, while MacPherson H (604) was the most cited author. MEDICINE was the most productive journal, while Pain ranked first ranking first in both frequency and centrality of cited journals. Notably, the most frequently cited reference was a systematic review of individual patient data on acupuncture for chronic pain that published by Vickers Andrew J in 2012 (156). Burst analysis identified frontier research areas: network meta-analysis, case reports, dry needling, lumbar disc herniation, cancer, postherpetic neuralgia, insomnia, and bibliometric analysis.

Conclusions: This study outlines current trends and potential future research hotspots in clinical acupuncture analgesia over the past decade. Findings emphasize the necessity for enhanced international collaboration to enhance research output and translation.

Topic Area 03 - Clinical: Herbs

P03.01

An Open, Randomized Exploratory Study For Non Motor Symptoms Of Idiopathic Parkinson’s Disease With An Oil Based, Enema-Like Ayurveda Therapy

Namyata Pathak¹, Ashok Vaidya², and Rama Vaidya²

¹ Ayu.Care, Fremont, CA

² Kasturba Health Society-Medical Research Center, Mumbai, Maharashtra, India

Contact: Namyata Pathak, [e-mail]

Abstract

Purpose: The prevalent treatment goals for Idiopathic Parkinson’s Disease in mainstream care have been to increase striatal dopamine levels. Though predominantly perceived as a motor disease, Parkinson’s disease (PD) is now being understood as a complex multi-system, neurodegenerative disease originating in the gut years before it affects the basal ganglia. Its manifestations include debilitating non-motor features like constipation, sleep disorders, fatigue, anxiety, painful sensations. These are frequently missed, unaddressed and significantly affect the quality of life.

Method(s): Based on this understanding and an Ayurvedic rationale, we chose an oil- based enema therapy. 15 patients of Idiopathic Parkinson’s Disease identified by Queen’s Brain Bank criteria were selected and divided into two groups. Group A (n=8) received Mashadi Taila Basti (Sesame oil prepared with black lentils and herbs like Withania somnifera and Mucuna pruriens) and Group B (n=7) received Murchhita Tila Taila (Sesame oil). Assessment was done using the 70-point scale − Movement Disorder Society Task Force (MDS – UPDRS) with four components: Non-Motor (NMEDL) and Motor Experiences of Daily Living (MEDL), Motor Examination (ME) and Motor Complications (MC).

Results: By the student’s paired t test, Group A showed a significant response in the total MDS UPDRS score (p<0.002), NMEDL (p<0.003), MEDL (p<0.01). Clinical features that responded most significantly were constipation, anxiety, sleep disturbances, fatigue, painful sensations. Motor symptoms of global spontaneity of movement and tremor experience also improved significantly. Group B responses were not significant except symptoms like constipation and fatigue (p≈ 0.05).

Conclusions: These early encouraging results provide a possible addition to the therapeutic armamentarium for IPD if confirmed by larger studies.

P03.02

Chinese Herbal Medicine for Anxiety Disorders and Obsessive-Compulsive Disorder: A Systematic Review with Meta-Analysis

Yoann Birling¹, Wingyu Yu², Paul Fahey³, and Rogier Hoenders⁴

¹ NICM Health Research Institute, Western Sydney University, Penrith, Western Australia, Australia

² Western Sydney University, Penrith, Western Australia, Australia

³ School of Health Sciences, Western Sydney University, Penrith, Western Australia, Australia

⁴ CIP, Lentis, Zeegse, Drente, Netherlands

Contact: Rogier Hoenders, [e-mail]

Abstract

Purpose: Chinese Herbal Medicine (CHM) is a potential alternative to antidepressant and benzodiazepine drugs in the treatment of anxiety disorders and obsessive-compulsive disorder (OCD) as there seem less concerns with adverse events and dependence issue. However, there is uncertainty about its effectiveness and safety.

Method(s): A systematic review and meta-analysis of randomized controlled trials (RCT's), including risk of bias assessment.

Results: A total of 90 studies involving 6833 participants were included. Compared to participants who received anxiolytic drugs, participants with GAD who received CHM had lower anxiety levels at end-of-intervention (Hamilton Anxiety Rating Scale Mean Difference = -1.58 points, 95% CI -2.33 to -0.81, p < 0.001) and fewer participants experienced adverse events (Risk Ratio = 0.35, 95% CI 0.25 to 0.45, p < 0.001). These results were supported by studies with low risk of bias. The benefit/risk profile of CHM seemed more favorable compared to anxiolytic drugs for panic disorders and OCD, however there was no study with low risk of bias to support these results.

Conclusions: This systematic review suggests CHM are more effective than anxiolytic drugs in treating generalized anxiety disorder, with low risk of bias. Therefore, CHM could be considered as an alternative of anxiolytic drugs in clinical psychiatry. Studies with low risk of bias are still required to confirm the effectiveness of CHM for panic disorders, phobic disorders and OCD, and to confirm the benefit/risk profile.

P03.03

Herbal Medicine for Treating Psoriasis – Systematic Review and Meta-Analysis

Dennis Anheyer¹, Holger Cramer², Thomas Ostermann³, and Melanie Anheyer⁴

¹ Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

² University of Tübingen, Stuttgart, Baden-Wuerttemberg, Germany

³ Department for Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany, Witten, Nordrhein-Westfalen, Germany

⁴ Clinic for Pediatrics and Adolescent Medicine, Elisabeth Hospital Essen, Essen, Germany., Essen, Nordrhein-Westfalen, Germany

Contact: Dennis Anheyer, [e-mail]

Abstract

Purpose: Psoriasis is a chronic, immune-mediated skin disease with a strong genetic predisposition, although environmental factors can exacerbate the disease. Due to limited efficacy and side effects of conventional therapies, many patients with psoriasis use complementary and integrative medicine (CIM). Prevalence estimates for CIM use in psoriasis vary from 42-69% with herbal medicine appearing to be the most common. The aim of this review is therefore to provide an overview of the current state of evidence in the field of herbal medicine.

Method(s): Pubmed/MEDLINE, The Cochrane Library and Scopus were searched to March 2023. Randomized controlled trials (RCTs) were eligible if they included patients with diagnosed psoriasis and compared a single herbal preparation or an herbal complex agent to either a passive comparator (placebo) or an active comparator (other herb, usual care). When appropriate, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Results: 20 RCTs investigating 12 different herbs or herbal complex agents (aloe vera, avocado, curcuma, indigo naturalis, St. John’s word, chamomile, kukui nut, mahonia aquifolium, evening primrose oil, neem oil, sea buckthorn) met the inclusion criteria. Studies revealed no statistically significant group difference in Psoriasis Area Severity Index (PASI) for aloe vera in comparison with triamcinolone acetonide (SMD: -0.21; 95%: -0.66 to 0.25) and for avocado oil in comparison with calcipotriol (SMD: 0.01; 95%: -0.75 to 0.78). Studies revealed a statistically significant group difference in PASI for indigo naturalis (SMD: -1.55; 95%: -2.32 to -0.77) in comparison with placebo. If reported, safety data were comparable to conventional therapies.

Conclusions: Herbal medicine represents a promising therapeutic option for psoriasis, as some herbs showed comparable effects to conventional therapies. However, further rigorous studies are necessary to finally judge the evidence of the herbs included in this review.

P03.04

Phytochemical and Activity Studies on Geranium Subcaulescens

Burçin Özüpek¹, Didem Şöhretoğlu², Michal Šoral³, Fikriye Özgencil, Gökçen Eren¹, and Didem Deliorman Orhan¹

¹ Gazi University, Ankara, Ankara, Turkey

² Hacettepe University, ANKARA, Ankara, Turkey

³ Slovak Academy, Bratislava, Bratislavský kraj, Slovakia

Contact: Burçin Özüpek, [e-mail]

Abstract

Purpose: In this research, it was aimed to carry out activity-oriented isolation studies in order to determine the antidiabetic activity of the Geranium subcaulesens plant and the compounds responsible for the effect, according to ethnobotanical studies, and then to determine the interactions of the isolated compounds with the relevant compounds by using the molecular docking method.

Method(s): In this study, the antidiabetic, antiobesity and anticholesterol effects of G. subcaulescens were investigated using in vitro enzyme systems (α -glucosidase, α -amylase, pancreatic lipase and pancreatic cholesterol esterase). Additionally, antioxidant activity was investigated by DPPH radical scavenging effect, metal chelating capacity, total antioxidant capacity and ferric reducing power experiments. In line with the data obtained, the methanolic extract of G. subcaulescens root parts was evaluated in terms of in vivo antidiabetic activity. Chromatographic analysis such as HPLC, TLC were used for phytochemistry throughout the study. Methods such as NMR, LC-QTOF-MS were used in structure determinations. Additionally, molecular docking was applied to reveal the enzyme-receptor relationship of the isolated pure substances.

Results: The antidiabetic effect, in vitro, in vivo and molecular docking were investigated for the first time in this species. The extract showed inhibitory effects close to the reference substances. Through isolation studies, substances coded G1, G2, G3, G4 and G5 were isolated from this type for the first time. Geraniin (G3) has been determined to have strong effects on enzyme systems in vitro, in diabetes models in vivo, and to have strong interactions with enzymes in molecular docking studies. It has also been determined that it is the main ingredient of the plant in terms of quantity.

Conclusions: When both literature data and scientific studies were examined, it was concluded that Geranium species are a genus that should not be ignored in terms of their antidiabetic effects.

P03.05

Traditional Chinese Medicine for Cough Related to COVID-2019: A Systematic Review and Meta-Analysis

Jiale Wang¹, Xuehan Liu¹, Chunli Lu², Xinyan Jin¹, and Jianping Liu³

¹ Beijing University of Chinese Medicine, Beijing, Beijing, China

² Guangdong Pharmaceutical University, Guangzhou, Guangdong, China

³ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Xuehan Liu, [e-mail]

Abstract

Purpose: COVID-19 is an infectious disease caused by SARS-CoV-2 infection and cough is one of its typical symptoms. Traditional Chinese medicine (TCM) in the treatment of chronic cough has the advantages of significant effectiveness, few adverse reactions and low recurrence rate. Our aim was evaluating effectiveness of TCM for cough related to COVID-19.

Method(s): We searched for randomized controlled trials (RCTs) on cough related to COVID-19 in 8 databases from their inception to May 2023. We included patients diagnosed with COVID-19, who received TCM therapy alone or combined with conventional treatment (CT). We extracted data, and used the Cochrane “Risk of bias” tool to assess methodological quality. Effect was presented as relative risk (RR) or mean difference (MD) with 95% confidence interval (CI) using RevMan 5.4.

Results: Fifty-one RCTs involving 5750 patients with cough related to COVID-19 were included. Forty-six studies were in the infected phase and five was in the convalescent phase. Methodological quality was of high risk of bias in blinding of participants, personnel and outcome assessment and unclear of bias in allocation concealment. TCM therapy combined with CT is superior to CT alone in cough symptom disappearance rate (Chinese decoction: RR=1.88, 95%CI , 2 RCTs, n=54; Chinese patent medicine: RR=1.29, 95%CI , 7 RCTs, n=597), cough symptoms disappearance time (MD=-2.99, 95%CI , 7 RCTs, n=540), and cough symptom score (Chinese decoction subgroup: MD=-0.80, 95%CI , 5 RCTs, n=397; Chinese patent medicine : MD=-1.16, 95% CI , 2 RCTs, n=406).

Conclusions: Chinese decoction, Chinese patent medicine and other TCM therapy combined with CT can improve the cough disappearance rate of patients, reduce the time of symptom disappearance. Multi-center, large-sample, high-quality RCTs are still needed to determine the effectiveness and safety of TCM therapy in the treatment of cough related to COVID-19.

P03.06LB

The Rational Dose for MaXingShiGan Decoction Is Crucial for Its Clinical Effectiveness in Treating Bronchial Pneumonia

Wenjie Sun¹, Xuedong An, and Fengmei Lian

¹ Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, Beijing, China

Contact: Wenjie Sun, [e-mail]

Abstract

Purpose: To evaluate the impact of adjusting the total dose, gypsum fiber (ShiGao, SG) dose and Prunus armeniaca L. (KuXingRen, KXR) dose on the efficacy of Ma Xing Gan Gan Decoction (MXSG) in the treatment of bronchopneumonia (wind-heat obstructing lung) in children, in order to provide selection of rational clinical doses of MXSG provides strategies supported by high-quality evidence.

Method(s): Based on the basic dose of MXSG, we conducted 3 randomized, double-blind, dose-parallel controlled, multi-center clinical trials, involving adjustments to the total dose, SG dose and KXR dose, and each included 120 cases of bronchopneumonia (wind-heat obstructing the lungs) sick children. Patients were divided into low, medium and high dose groups according to the ratio of 1:1:1, with 40 cases in each group. The intervention period lasted 10 days. The primary outcome was clinical cure rate, and secondary outcomes included effectiveness in relieving the main symptoms of bronchopneumonia, including fever, cough, dyspnea, and sputum congestion. and record the occurrence of adverse events.

Results: There were no significant differences among the dose groups within each study. For the study adjusting the overall dose of MXSG, both the medium-dose group and high-dose group had significantly higher clinical cured rates compared to the low-dose group (p = 0.0111). For the study adjusted the SG dose in MXSG, the high-dose group had the highest clinical cured rate, but the inter-group difference was not statistically significant (p = 0.1864). In comparing the complete defervescence time, both the high-dose group (p < 0.0001) and the medium-dose group (p = 0.0015) achieved faster than the low-dose group. The high-dose group slightly outperformed the medium-dose group (0.50 (0.50, 0.80) vs. 0.80 (0.40, 1.40)). For the study adjusted the KXR dose in MXSG, both the medium-dose group and high-dose group had significantly higher cured rates compared to the low-dose group (p < 0.0001). However, there was no significant benefit comparing the high-dose group to the medium-dose group (90.00% vs. 92.50%). Regarding clinical symptoms, the results indicated that for cough (p = 0.0460) and phlegm congestion (p = 0.0243), the AUC for both the medium-dose group and high-dose group were significantly lower than in the low-dose group.

Conclusions: For children with bronchopneumonia (wind-heat obstructing the lungs), the basic clinical dose of MXSG may represent the optimal intervention dose based on the accumulated clinical experience of physicians. If the dose is insufficient, clinical efficacy may be compromised, but benefit is not significantly increased with higher doses. For different symptoms, increasing the overall formula dose has a beneficial effect on improving sputum congestion, increasing SG can effectively improve symptoms such as fever, cough, and dyspnea, while a higher dose of KXR can effectively relieve cough and sputum congestion. These findings suggest that, for MXSG, reaching the optimal intervention dose is critical to obtain better clinical efficacy. For both SG and KXR, if certain symptoms are more severe, consideration may be given to increasing the dose within a safe range, which can result in significant clinical benefit in terms of symptom improvement.

P03.08LB

Chinese Patent Medicine for Children With Acute Cough Associated With Upper Respiratory Tract Infection: A Retrospective Treatment Outcome Survey

Xiaowen Zhang¹, Merlin Willcox², Xiao-yang (Mio) Hu², Xiao-Wei Zhang³, and Jianping Liu⁴

¹ Beijing University of Chinese Medicine, Beijing, China

² Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK, SO16 5ST, Southampton, Hampshire, United Kingdom

³ Department of Pediatrics, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, Beijing, China

⁴ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Xiaowen Zhang, [e-mail]

Abstract

Purpose: To explore the use of Chinese patent medicine (CPM) for pediatric acute cough associated with upper respiratory tract infections (URTIs), and assess the improvement of symptoms with CPM, antibiotics or other treatment to screen the potential CPM for reducing or replacing antibiotics.

Method(s): This survey was open to parents with experience of caring for children < 18 years old with acute cough in pediatric outpatient departments of two tertiary hospitals in China. Questionnaires were collected through social media and face-to-face with snowball sampling from April to December 2023. The design of the questionnaire included consent, basic information, initial symptoms, treatment(s), and improvement of symptoms. The frequencies and percentages of medication were analyzed by Microsoft excel and SPSS. This study has been approved by Ethics Committee of Beijing University of Chinese Medicine (No. 2023BZYLL1007).

Results: With 87% response rates, 328 questionnaires out of 375 were collected. For children with URTIs, 73% prescriptions applied CPM, and the top 3 commonly used CPM were Child Chiqiao Qingre granules (42%), Bai Rui granules (38%), and Ambroxol Hydrochloride oral solution (29%). The most commonly used antibiotics were ceftriaxone sodium and other cephalosporins (45%), azithromycin and other macrolides (36%). Symptoms scores all decreased to different degrees, which means improvement, and there was no significant difference between CPM alone, antibiotics alone, or combined medication on cough improvement based on the current data. Combined with the CPM, manual therapies like nose scraping and spine pinching for children under 6 years old were also commonly used and showed improvement on the related symptoms.

Conclusions: CPMs were well-accepted in the tertiary hospitals in China. They have the potential to reduce or replace antibiotics with appropriate application for URTIs with acute cough in children.

P03.09LB

Effects of Ginseng on Amphetamine-Type Stimulant Use Disorder: A Systematic Review and Meta-Analysis

Yunna Kim¹, Do Young Kwon², and Seung-Hun Cho²

¹ Kyung Hee University Medical Center, Seoul, South Korea

² Kyunghee University, Seoul, Seoul Teugbyeolsi, South Korea

Contact: Yunna Kim, [e-mail]

Abstract

Purpose: The escalating prevalence of Amphetamine-Type Stimulant (ATS) Use Disorder poses a significant public health challenge. In the United States, 7 million people reported taking methamphetamine (METH) and/or prescription stimulants in 2020, without or not following medical guidance. The purpose of this systematic review is to evaluate the efficacy of ginseng and its derivatives in treating ATS use disorder in animal models, a prevalent psychostimulant with limited effective therapeutic options.

Method(s): This systematic review and meta-analysis focused on ginseng and ginsenosides in animals under repeated administration of ATS. It involved searching PubMed, Embase, Web of Science, and Cochrane Library for publications until October 2023. The main intervention was ginseng or its derivatives, and the outcomes measured were behavioral tests and biological or pharmacological effects. Risk of bias was assessed using SYRCLE’s risk of bias tool and the CAMARADES checklist.

Results: Our findings indicate that ginseng, particularly compounds like ginsenoside Rb1, Rg1 and pseudoginsenoside F11, exhibits a protective effect against METH-induced neurotoxicity and attenuates addictive behaviors. Eleven included studies were all conducted on the METH-induced addiction model. Significant findings include decrease in drug-seeking behaviors and reduction in METH-induced hyperactivity. The meta-analysis was conducted on conditioned place preference (CPP), taking into account the types of interventions and METH concentrations as controls. Ginseng demonstrated neuroprotection by reducing oxidative stress, neuroinflammation, and neuron apoptosis, mainly in the striatum.

Conclusions: Ginseng and its derivatives appear effective in reducing METH-induced behavioral effects in animal models, suggesting their potential as therapeutic agents for amphetamine-type stimulant use disorders, warranting further investigation in clinical settings.

P03.10LB

Traditional Chinese Herbal Medicine for Opioid-Induced Constipation: A Systematic Review and Meta-Analysis

Nan Yang¹, Jing Cui¹, and Jianping Liu²

¹ Beijing University of Chinese Medicine, Beijing, Beijing, China

² Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Nan Yang, [e-mail]

Abstract

Purpose: Opioid-induced constipation (OIC) is one of the most common and serious adverse events in patients receiving long-term opioid therapy with cancer-related and non-cancer-related pain. To supplement integrative approaches to OIC management, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of herbal medicines for OIC.

Method(s): We searched Pubmed, Cochrane Library, Embase and Chinese databases (CNKI, CQVIP, CBM, and WanFang Data) through January 12, 2024. We included randomized controlled trial (RCT), and Eligible comparators were usual care, placebo and active treatment. RCTs were evaluated for methodological quality using the Cochrane Risk of Bias Assessment Tool (ROB). Clinical outcomes included laxative effect, analgesic effect, quality of life and adverse events (AEs). Quantitative analyses were conducted using a random-effects model.

Results: This study included 65 RCTs (n=5616 participants). OIC commonly occurs in patients with cancer pain (62 articles, 95.4%). Herbal medicines mainly include decoctions (60 articles,92.3%) and prepared prescriptions (5 articles, 7.69%). Comparators included lactulose oral liquid, phenolphthalein tablet, enema, etc. Compared to lactulose, meta analyses show that traditional Chinese herbal medicine can significantly reduce the score of 1) Cleveland Constipation Scale (CCS) (MD=6.09, 95%Cl , I²=95%); 2) the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) (MD=17.98, 95%Cl , I²=99%); 3) numerical rating scale (NRS) (MD=0.27, 95%Cl, I²=17%) ; and can effectively improve the symptoms of constipation.

Conclusions: Traditional Chinese herbal medicine have currently shown promise in randomized trials concerning opioid-induced constipation in cancer and advanced illness. However, more studies with higher methodological quality should be conducted to ascertain not just the relative therapeutic efficacy but also the cost-benefit analyses.

P03.11LB

Jinlida Granules Combined With Metformin Improved the Standard-Reaching Rate of Blood Glucose and Clinical Symptoms of Patients With Type 2 Diabetes

Yuting Sun¹, Xiaomin Kang¹, and Fengmei Lian²

¹ China Academy of Chinese medical Sciences, Beijing, Beijing, China

² Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China

Contact: Yuting Sun, [e-mail]

Abstract

Purpose: Previous studies found that Jinlida granules could significantly reduce blood glucose levels and enhance the low-glucose action of metformin. However, the role of Jinlida in the standard-reaching rate of blood glucose and improving clinical symptoms has yet to be studied. We aimed to elaborate on the efficacy of Jinlida in type 2 diabetes (T2D) patients who experience clinical symptoms based on secondary analysis of a randomized controlled trial.

Method(s): Data were analyzed from a 12-week, randomized, placebo-controlled study of Jinlida. The standard-reaching rate of blood glucose, the symptom disappearance rate, the symptom improvement rate, the efficacy of single symptoms, and the total symptom score were evaluated. The correlation between HbA1c and the improvement of clinical symptoms was analyzed.

Results: For 12 weeks straight, 192 T2D patients were randomly assigned to receive either Jinlida or a placebo. The treatment group showed statistically significant differences in the standard-reaching rate of HbA1c < 6.5% (p = 0.046) and 2hPG (< 10 mmol/L, 11.1 mmol/L) (p < 0.001), compared with the control group. The standard-reaching rate of HbA1c < 7% (p = 0.06) and FBG < 7.0 mmol/ L (p = 0.079) were not significantly different between the treatment and control groups. Five symptoms exhibited a statistical difference in symptom disappearance rate (p < 0.05). All the symptoms exhibited a significant difference in symptom improvement rate (p < 0.05). The mean change in total symptom score from baseline to week 12 was −5.45 ± 3.98 in the treatment group and −2.38 ± 3.11 in the control group, with statistically significant differences (p < 0.001). No significant correlations were noted between symptom improvement and HbA1c after 12 weeks of continuous intervention with Jinlida granules or placebo.

Conclusions: Jinlida granules can effectively improve the standard-reaching rate of blood glucose and clinical symptoms of T2D patients, including thirst, fatigue, increased eating with rapid hungering, polyuria, dry mouth, spontaneous sweating, night sweat, vexing heat in the chest, palms, and soles, and constipation. Jinlida granules can be used as an effective adjuvant treatment for T2D patients who experience those symptoms.

P03.12LB

NAOQ19, a Polyherbal Ayurvedic Formulation, is an Effective Treatment against COVID-19

Vatsav Raman¹, Jaishree Garhyan², Saumya Subramanian³, and Divya Kanchibotla³

¹ The Art of Living Foundation, Boston, MA

² Stanford University, Palo Alto, CA

³ Sri Sri Institute for Advanced Research, Bengaluru, Karnataka, India

Contact: Vatsav Raman, [e-mail]

Abstract

Purpose: We explored the efficacy of a polyherbal Ayurvedic formulation, NAOQ19, in the treatment of COVID-19.

Method(s): We evaluated CC50 and EC50 of NAOQ19 in-vitro using anti-viral assays with the Nluc reporter system in Vero E6, Huh7.5.1 ACE2 TMPRSS2 and A549-hACE2 cell line models for SARS-CoV-2 infection. We then tested the efficacy of NAOQ19 in hamsters that were infected with SARS-CoV-2 by evaluating lung pathology and morphology and reduction of viral load after a 3-day intervention. Finally, we conducted a randomized double blinded clinical trial on 100 mild-moderate COVID-19 patients recruited in New Delhi. For primary outcomes we monitored alleviation of COVID-19 as determined by a negative RT-PCR test. For secondary outcomes we measured the inflammatory marker C-reactive protein (CRP) and carried out kidney and liver function tests.

Results: NAOQ19 was found to inhibit SARS-CoV-2 in vitro with EC50 values of 0.3321 mg/ml in Vero E6, 0.2665 mg/ml in A549-hACE2 and 0.06196 mg/ml in Huh7.5.1 ACE2 TMPRSS2. Gross pathological observations of lungs in hamsters infected with SARS-CoV-2 showed significant improvement in lung edema, hemorrhage and congestion in the NAOQ19 treated group compared to the untreated control group. NAOQ19 treated hamsters also lost less body weight and showed a reduction in viral load of 78%. 34% of human patients treated with NAOQ19 became RT-PCR negative for SARS-CoV-2 by Day 3 (vs 0% in placebo control) in the human trials. 100% turned RT-PCR negative by Day 5 (vs 34% in placebo control). Patients became asymptomatic in 3.18 days in treatment arm vs 6.1 days in placebo control. CRP levels were found to be significantly reduced in the treatment arm.

Conclusions: NAOQ19 is a potent inhibitor of the SARS-CoV-2 virus in-vitro as shown by the reporter assays in the cell line models. NAOQ19 is also effective against COVID-19 as shown by the significant difference in improvement of primary outcomes as compared to the placebo control, while also reducing inflammation.

P03.13LB

Ophiocordyceps sinensis Preparations Combined With Renin-Angiotensin System Inhibitor for Diabetic Kidney Disease: An Umbrella Review of Systematic Re

Xue Xue¹, Xinyan Jin², Xinglan Ye¹, Keying Li¹, Jia-Xuan Li¹, Xuehan Liu², Juan Bai¹, Qiang Liu³, Bingrui Zhang², Xinrong Zou³, Jun Yuan⁴, Chunli Lu⁵, Fangfang Zhao⁶, Jianping Liu⁷, and Xiaoqin Wang³

¹ Hubei University of Chinese Medicine, Wuhan, Hubei, China

² Beijing University of Chinese Medicine, Beijing, Beijing, China

³ Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China

⁴ Renmin Hospital of Wuhan University, Wuhan, Hubei, China

⁵ Guangdong Pharmaceutical University, Guangzhou, Guangdong, China

⁶ China Academy of Chinese Medical Sciences, Beijing, Beijing, China

⁷ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Xue Xue, [e-mail]

Abstract

Purpose: This study aims to synthesize the evidence of the comparative effectiveness and safety of different Ophiocordyceps sinensis (OS) preparations combined with renin-angiotensin system inhibitors (RASi) for diabetic kidney disease (DKD).

Method(s): We searched a total of eight Chinese and English databases from their inception to May 2023. Systematic reviews (SRs) of OS preparations combined with RASi for DKD were identified. Randomized controlled trials (RCTs) from included SRs and additional searching were performed for data pooling. We would evaluate the methodological quality of RCTs and SRs using Cochrane risk-of-bias tool (RoB2) and AMSTAR-2, respectively. A Bayesian network meta-analysis was performed to compare the add-on effect and safety of OS preparations for DKD. The certainty of evidence was graded by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results: Fourteen SRs covering a total of 5 varieties of OS preparations were included, whose methodological quality were assessed as high (1/14) or critically low (13/14). After combining additional searching, 157 RCTs were included, involving 13 143 participants. The quality of RCTs showed some concerns (155/157) or high risk (2/157). Jinshuibao capsules and tablets, Bailing capsules and tablets, and Zhiling capsules were evaluated. Compared to RASi, adding either of the five OS preparations was relative to decreased 24 hours urinary total protein. OS preparations ranked differently in each outcome. Jinshuibao capsules plus RASi showed beneficial in reducing urinary protein, serum creatinine, serum urea nitrogen, and blood glucose levels, with moderate-certainty evidence. No serious adverse events were observed after adding OS to RASi.

Conclusions: There are some favorable effects in decreasing urinary protein in DKD patients by OS preparations plus RASi. Our results need to be supplemented and improved by more high-quality and larger sample RCTs with longer follow-up in the future.

P03.14LB

SaiLuoTong (SLT) for Cognition in Older Adults with Mild Cognitive Impairment: A 12-Week Randomised, Double-Blind, Placebo-Controlled Trial

Dennis Chang¹, Genevieve Steiner-Lim², Alan Bensoussan², Elana R. Andrews-Marney², Mahmoud A. Al-Dabbas², Adele Cave², Christine Chiu³, Katerina Christofides², Frances M. De Blasio², Lauren S. Dewsbury², Naomi L. Fagan², Jack S. Fogarty⁴, Lena C. Hattom², Mark Hohenberg², Deyyan Jafar³, Diana Karamacoska², Chai K. Lim³, Jianxun Liu⁵, Najwa-Joelle Metri², D. Vincent Oxenham³, Holly Ratajec², Nikita Roy², Danielle G. Shipton², and David Varjabedian²

¹ NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia

² Western Sydney University, Penrith, New South Wales, Australia

³ Macquarie University, Macquarie Park, New South Wales, Australia

⁴ Nanyang Technological University, Singapore, Singapore

⁵ Xiyuan Hospital, Beijing, Beijing, China

Contact: Dennis Chang, [e-mail]

Abstract

Purpose: There are currently no approved pharmacological treatments for mild cognitive impairment (MCI). This study aimed to evaluate the efficacy and safety of a complex herbal formula, SaiLuoTong (SLT), on cognitive function in people with MCI. SLT comprises standardised extracts of Panax ginseng, Ginkgo biloba, and Crocus sativus. It was hypothesised that a 12-week treatment of SLT would improve cognitive outcomes, compared to placebo, in older adults living with MCI.

Method(s): Community-dwelling adults with MCI aged ≥ 60 years (N = 78) were enrolled into a randomised, double-blind, placebo-controlled phase II clinical trial. Participants received either 180mg/day SLT or placebo for 12 weeks.

Results: Thirty-nine participants were randomised to each group, and 65 completed endpoint and were analyzed (SLT N = 33; placebo N = 32). After treatment, the between-groups difference in Functional Activities Questionnaire was 1.21 (95% CI: -0.21 to 2.63; P ≤ 0.001 after controlling for baseline scores); Rey Auditory Verbal Learning Test delayed recall was 1.37 (95% CI: -0.10 to 2.84; P = 0.034); Delis-Kaplan Executive Function System Trail Making Test Condition 4 switching and contract scaled scores were 1.42 (95% CI: -0.15 to 2.99; P = 0.038) and 1.56 (95% CI: –0.09 to 3.20; P = 0.032), respectively; and Logical Memory delayed recall scores was 1.40 (95% confidence interval : 0.22 to 2.58; P = 0.010). Adverse events did not differ between groups. Common adverse events included dizziness and nausea, gastrointestinal discomfort, and headaches.

Conclusions: SLT was well tolerated and may be useful in supporting aspects of executive function and memory retrieval in older adults with MCI. This is consistent with the outcomes observed in phase II vascular dementia clinical trials.

P03.15LB

The Protective Effects and Mechanism of Heracleum Moellendorffii Hance on Alcohol-induced Cognitive Degeneration in Mice

Do Young Kwon¹, Woohee Parka¹, Yunna Kim¹, and Seung-Hun Cho¹

¹ Kyunghee University, Seoul, Seoul Teugbyeolsi, South Korea

Contact: Do Young Kwon, [e-mail]

Abstract

Purpose: Chronic and continuous alcohol consumption increases the risk of cognitive decline, and long-term alcohol exposure may result in alcohol-related dementia in older adults. Heracleum moellendorffii Hance root extract (HME) is a traditional edible plant used for treating headaches and skin diseases. Its neurological and anti-inflammatory effects suggest that HME may contribute to alcohol-related cognitive impairment.

Method(s): C57BL/6 mice were administered alcohol for eight weeks to induce ethanol-induced cognitive impairment. The mice were treated with 100 mg/kg and 200 mg/kg of HME for 18 days. To evaluate the HME effects on cognitive functions and depression, behavioral tests were performed. Western blotting was performed to assess neural plasticity in the hippocampus, which is related to memory improvement. To confirm the status of alcohol metabolism in the liver, H&E staining and western blotting for the expression of ADH1 in liver tissue were conducted.

Results: The HME 200 mg/kg-treated group significantly increased spontaneous alternations in the Y-maze test and decreased immobility in the forced swimming test (FST) compared to the vehicle-treated group, implying that HME restores memory deficits and reverses depressive symptoms caused by chronic alcohol consumption. The HME 100 mg/kg-treated group showed statistical significance only in the FST. Consistent with the behavioral changes, the HME 200 mg/kg-treated group upregulated protein expression of BDNF, phosphorylated ERK1/2 and phosphorylated CREB in hippocampus. It also reduced lipid vacuolations in the liver tissue and reversed ADH1.

Conclusions: The administration of 200 mg/kg of HME have beneficial effects on improving cognitive impairment and reversing depressive symptoms caused by alcohol consumption, and this was followed by restoration of neural plasticity and alcohol metabolism in the liver. HME is a promising drug for the treatment of alcohol-related disorders of the brain.

P03.16LB

Integrative Approach of Topical Traditional Chinese Herbal Medicine in Healing Acute Musculoskeletal Injury – A Phase I Randomized Controlled Trial

Chuan LU¹, Wan-Yi Lin², Chia-Wei Chang³, and Yuan-Chieh Yeh⁴

¹ Harvard T. H. Chan School of Public Health, Allston, MA

² Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan

³ Orthopedic Department, Spine Section, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan

⁴ Program in Molecular Medicine, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taipei, Taiwan

Contact: Chuan LU, [e-mail]

Abstract

Purpose: Traditional Chinese herbal medicine (TCM) sustains a thousand-year history healing localized musculoskeletal injuries in topical formulations. However, a lack of scientific evidence has been the hurdle of incorporating TCM into standard care, particularly for affected populations ineligible for surgical treatment. Thus, this pilot study aimed to investigate the safety and efficacy of pre-established topical TCM formulas in patients with upper extremity fractures accompanied by acute soft tissue injuries.

Method(s): This four-arm single-centered randomized controlled trial (ID: NCT04593849) was conducted from September 2020 to May 2023. Patients age over 18, under diagnosis of simple, inoperable upper extremity fractures and classified by Tscherne C0 or C1 tissue injury, were enrolled and randomized to one of the interventions (topical WYGJJW, RYJHS, and Placebo treatment) or control group (oral analgesic treatment). Outcomes were measured by a blinded-assessor after a 7-day treatment course. Primary outcomes included swelling (affected limb circumference) and adverse skin reaction (DASI); secondary outcomes included pain (VAS) and functional performance (Quick DASH). Paired-t test and Kruskal-Wallis’s test were used as the main intra-group and inter-group comparisons, respectively.

Results: A total of 24 participants were equally randomized into four study groups. As study ended, WYGJJW group showed significant improvement in swelling(Δcm:1.35) and functionality(Δ:10.34), as well as the greatest pain relief(ΔVAS:2.92) relative to baseline among all groups. Both RYJHS and WYGJJW group showed statistically more favorable efficacy of swelling reduction than either Placebo or control group, while WYGJJW endorsed better safety regarding allergic reaction (16.7% versus 50%).

Conclusions: The study substantiates a crucial therapeutic role of integrative topical TCM for patients with acute, inoperable musculoskeletal injuries. Future larger clinical study is warranted to provide validation.

Topic Area 04 - Clinical: Manual Therapies

P04.01

Affecting Whole-Person Health of US Military Members Through Effects of Chiropractic Care on Low Back Pain: A Mediation Analysis

Zacariah Shannon¹, Cynthia Long¹, Elizabeth Chrischilles², Christine Goertz³, Robert Wallace², Carri Casteel², and Ryan Carnahan²

¹ Palmer College of Chiropractic, Davenport, IA

² University of Iowa, Iowa City, IA

³ Duke, Durham, NC

Contact: Zacariah Shannon, [e-mail]

Abstract

Purpose: To evaluate improvement in low back pain (LBP) intensity and interference as mechanisms by which chiropractic care affects US active-duty military members’ whole-person health.

Method(s): A secondary, mediation analysis of a pragmatic, multi-site clinical trial comparing 6 weeks of treatment with chiropractic care plus usual medical care vs. usual medical care alone for 6- and 12-week outcomes in 750 US active-duty military members with LBP was conducted. Adjusted, natural effect, multiple-mediator modeling estimated the mediation effect of 6-week values of PROMIS-29 pain interference and LBP intensity on 12-week outcomes of other PROMIS-29 physical, mental, and social subdomains. Separate models evaluated overall and individual factor contribution and were adjusted for baseline age, sex, LBP duration, LBP intensity, and mediator and outcome values.

Results: Much of the effect of chiropractic care on physical function (proportion mediated=0.77, 95%CI= 0.43 to 2.00), fatigue (0.62, 95%CI= 0.31 to 1.65), sleep disturbance (0.49, 95%CI= 0.31 to 1.49), and social roles (0.81, 95%CI= 0.50 to 1.97) occurred through improvement in pain interference and pain intensity. Pain interference did not add to the proportion mediated of the effect occurring through pain intensity on whole-health factors.

Conclusions: Pain intensity improved moderately and appeared to be the mechanism by which much of the change in whole-health factors occurred when chiropractic care was added to usual medical care. Improvement in pain intensity may be a key clinical indicator for the impact on whole health for US military members receiving chiropractic care.

P04.02

Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study

Robert Trager¹, Jordan Gliedt², Collin Labak³, Clinton Daniels⁴, and Jeffery Dusek⁵

¹ Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

² Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI

³ Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH

⁴ Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, WA

⁵ University of California - Irvine, Irvine, CA

Contact: Robert Trager, [e-mail]

Abstract

Purpose: Patients who undergo lumbar discectomy may have ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR ≥1 year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over 2 years’ follow-up.

Method(s): We searched a United States network of de-identified, linked health records and administrative claims (TriNetX, Inc.) for adults aged ≥18 years with LSR and lumbar discectomy ≥1 year prior, without lumbar fusion or instrumentation, from 2003-2023. We divided patients into two cohorts: 1) chiropractic SMT, and 2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), explored cumulative incidence of reoperation, and the number of SMT follow-ups.

Results: After propensity matching there were 384 patients per cohort (mean age 61±15 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT=7%; usual care=14%), yielding an RR (95% CIs) of 0.50 (0.32-0.78; P=.0015). Per cumulative incidence graph, the comparatively reduced incidence persisted throughout follow-up. In the SMT cohort, 73% of patients had ≥1 follow-up SMT visit (median=6).

Conclusions: This study found that adults with LSR ≥1 year after lumbar discectomy who received SMT were half as likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance.

P04.03

Can Abdominal Myofascial Release Therapy Help Pediatric Patients With Irritable Bowel Syndrome?

Robin Miccio¹, Maria Mascarenhas¹, Tiffany Silliman Cohen, Alain Benitez, Jordan Dourlain, Zoe Rosoff-verbit, Anish Rana, Xingmei Wang², and Jennifer Evans

¹ Children's Hospital of Philadelphia, Philadelphia, PA

² University of Pennsylvania, Philadelphia, PA

Contact: Maria Mascarenhas, [e-mail]

Abstract

Purpose: Irritable bowel syndrome (IBS) is characterized by abdominal pain and altered defecation patterns affecting quality of life (QoL). Limited treatments may not completely relieve symptoms. Myofascial release therapy (MFR) is a hands-on technique that has shown to improve abdominal pain and QoL in adults, yet its effect on children with IBS is unknown. We evaluated the effect of abdominal MFR on symptoms and QoL in children with IBS.

Method(s): Children with IBS were enrolled under an IRB approved protocol. Participants received weekly one-hour abdominal MFR sessions for six weeks by an MFR massage therapist and performed self-MFR on non-therapy days. The PedsQL™ Gastrointestinal Symptoms Module (PedsQL™-GI) and the Pediatric Quality of Life Inventory™ (PedsQL™) Core were administered at baseline, end of intervention, and one month post intervention. Outcomes were analyzed using Mixed Model for Repeated Measures method.

Results: Fourteen children consented to screening and 8 (mean age 16 years, 67% female) completed all MFR sessions, and questionnaires. On average, self-MFR was practiced at home four times per week for at least 7 minutes per day. Teen PedsQL™-GI score improved between baseline and end of intervention (+13.3, p=0.008) and one month post intervention (+7.6, p=0.019), specifically, abdominal pain (p=0.034), and gas and bloating (p<0.05). Teen PedsQL™ Core scores improved between baseline and end of intervention (+7.9, p=0.013), and one month post (+7.9, p=0.008). Parent reported PedsQL™-GI scores improved from baseline to end of intervention (+7.6, p=0.03) and one month after (+11.5, p<0.0001). No adverse events were reported.

Conclusions: MFR is well-tolerated and feasible in children with IBS. Preliminary results suggest MFR may improve symptoms and QoL in this population up to one month following the intervention. Larger longitudinal case-control studies are needed to validate these findings.

P04.04

Chiropractic Spinal Manipulation and Gabapentin Prescription in Adults With Radicular Low Back Pain: Propensity Matched Retrospective Cohort Study

Robert Trager¹, Zachary Cupler², Roshini Srinivasan³, Regina Casselberry⁴, Jaime Perez⁴, and Jeffery Dusek⁵

¹ Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

² Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, PA

³ Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH

⁴ Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH

⁵ University of California - Irvine, Irvine, CA

Contact: Robert Trager, [e-mail]

Abstract

Purpose: In the United States (US), radicular low back pain (rLBP) is often treated off-label with gabapentin, and via chiropractic spinal manipulative therapy (CSMT). We hypothesized that adults receiving CSMT for a new rLBP diagnosis would have reduced odds of gabapentin prescription over one-year follow-up.

Method(s): We queried a US network (TriNetX, Inc.) of medical records and medical/pharmacy claims of >122 million patients attending 84 healthcare organizations, on June 15, 2023, with data from 2017-2023. We included adults aged 18-49 at their first rLBP diagnosis, excluding serious pathology (e.g., malignancy, cauda equina syndrome), other conditions (e.g., spine surgery), and gabapentin indications (e.g., seizures) and contraindications. Patients were split into CSMT or usual medical care cohorts based on care received on the rLBP diagnosis date. Propensity matching controlled for variables associated with gabapentin use (e.g., demographics, opioid use) and any prescription over the prior year. We calculated odds ratios (ORs) for gabapentin and a negative control outcome of gastrointestinal medication prescription and explored cumulative incidence of gabapentin prescription.

Results: There were 1,635 patients per cohort after matching (mean age 36±9 years). Gabapentin prescription was significantly less in the CSMT cohort vs. usual medical care cohort over one-year follow-up (OR 0.53 p<.0001). Cumulative incidence curves diverged early and did not overlap, suggesting this finding persisted throughout follow-up. There was no significant difference in gastrointestinal prescription (OR 0.89) suggesting sufficient control for care preference.

Conclusions: Our findings suggest that US adults receiving CSMT for a new diagnosis of rLBP have significantly reduced odds of receiving a gabapentin prescription over one-year follow-up compared to those receiving usual medical care. These findings should be corroborated by prospective studies and replicated in other settings.

P04.05

Chiropractic Spinal Manipulation and Likelihood of Tramadol Prescription in Adults With Radicular Low Back Pain: A Retrospective Cohort Study

Robert Trager¹, Zachary Cupler², Roshini Srinivasan³, Regina Casselberry⁴, Jaime Perez⁴, and Jeffery Dusek⁵

¹ Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

² Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, PA

³ Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH

⁴ Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH

⁵ University of California - Irvine, Irvine, CA

Contact: Robert Trager, [e-mail]

Abstract

Purpose: Patients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management. However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored. We hypothesized that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over one year follow-up, compared to those receiving usual medical care.

Method(s): We queried a United States medical records, medical claims, and pharmacy claims dataset of >115 million patients attending academic health centers (TriNetX, Inc.) on June 28, 2023, to identify opioid naïve adults aged 18-50 with a new diagnosis of radicular LBP. Patients with serious pathology and tramadol use contraindications were excluded. Patients were divided into two cohorts dependent upon treatment received on the index date of radicular LBP diagnosis (CSM or usual medical care). Variables associated with tramadol prescription were controlled via propensity matching. We calculated the risk ratio (RR) for tramadol prescription and explored the cumulative incidence of prescription over one year follow-up.

Results: After propensity matching, there were 1,108 patients per cohort (mean age 35±8 years). Tramadol prescription was significantly lower in the CSM cohort compared to the usual medical care cohort, yielding an RR (95% CI) of 0.34 (0.19-0.62; P=0.0002). A cumulative incidence graph demonstrated that the reduced incidence of tramadol prescription in the CSM cohort relative to the usual medical care cohort was maintained throughout one year follow-up.

Conclusions: This study found that US adults initially receiving CSM for radicular LBP had a reduced likelihood of receiving a tramadol prescription over one-year follow-up. These findings should be corroborated by a prospective study to minimize residual confounding.

P04.06

Development of a Web-Based Diagnostic and Clinical Management Support Tool for Low Back Pain

Robert Vining¹, Robert Rudin², and Patricia M Herman³

¹ Palmer Center for Chiropractic Research, Davenport, IA

² RAND Corporation, Boston, MA

³ RAND Corporation, Sonoma, CA

Contact: Robert Vining, [e-mail]

Abstract

Purpose: This project aims to create a user-friendly electronic decision-support tool for clinicians performing manual therapy. The tool records key exam findings, generates evidence-based working diagnoses, and offers treatment and patient education information for non-pathological low back pain (LBP).

Method(s): We employed user-centered design methods to identify core requirements and preliminary software specifications. We used published evidence for LBP diagnosis and generated a list of inputs comprising key symptoms derived from patient interviews and exam findings. Outputs included working diagnoses and related treatment recommendations. High-fidelity wireframes visually illustrated key functionality using a user interface design product (Figma, Inc.) and an example patient scenario. We then developed design session guides and recruited chiropractic clinical educators to obtain contextual information about workflows and mental models for LBP. We audio-recorded design session interviews, summarized findings, incorporated input into design specifications, and worked with a software developer to code a prototype tool.

Results: We held design sessions with 3 chiropractic clinical educators (2 males, 1 female) who commonly treat LBP. Mean clinical experience was 13 years. All believed the tool would be useful, especially for initial examination and reassessment. Working diagnosis generation and corresponding evidence-based treatments were viewed as potentially useful to help confirm diagnoses, guide care planning, serve as a reminder of therapeutic options, and aid patient education. Feedback resulted in clarifying input questions, grouping input questions to improve usability, and improving readability of patient education text.

Conclusions: A prototype design for a clinical decision-support tool for LPB shows promise for improving LPB care. Next, we will complete prototype development, conduct iterative user testing, test use with clinical care, and release for public use.

P04.07

Evaluating the Efficacy of Tuina for Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial in the USA

Juan Yang¹, Alexander Do¹, Tony Chon¹, Molly Mallory¹, Sara Bublitz¹, Jason Calva¹, Mark Jensen¹, Kate Fleming¹, Jennifer Soderlind¹, Jeffrey Brault¹, and Brent Bauer¹

¹ Mayo Clinic, Rochester, MN

Contact: Juan Yang, [e-mail]

Abstract

Purpose: To assess the efficacy of Tuina therapy in the management of Chronic Non-Specific Low Back Pain (CNLBP).

Method(s): This study will hold from Feb 2020 to December 2023 at the Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester MN. 204 CNLBP patients will be randomized into three groups: Tuina (TN) group, physiotherapy (PT) group, and Tuina combined with physiotherapy (T&P) group. Outcomes will be measured at baseline, 2- and 5-months post-treatment. The primary outcome is Visual analogue scale (VAS). Secondary outcomes include Oswestry Disability Index (ODI), Spinal range of motion (Spinal ROM), 36-Item Short Form Survey (SF-36), Traditional Chinese Medicine (TCM) syndrome score and Adverse events (AEs) throughout the whole trial. Participants’ Study satisfaction survey is also collected by the end of this trial.

Results: The study will recruit voluntary participants aged 21 to 65 years old who meet specific diagnostic criteria for CNLBP. Adverse events, including any discomfort or side effects, will be recorded throughout the study. The primary outcome measure is the effectiveness of Tuina compared to PT in managing CNLBP. Secondary objectives include exploring the effectiveness of Tuina combined with PT and assessing the long-term follow-up outcomes compared to routine PT management.

Conclusions: This large-scale, high-quality clinical trial will provide high-quality evidence regarding the effectiveness of Tuina therapy in the treatment of CNLBP. The study results will contribute to the understanding of Tuina's role in managing CNLBP and may inform future treatment guidelines for this prevalent condition.

P04.08

Massage Clinician Attitudes and Understanding of Mental Health: Initial Consideration of Potential Contributions to the Whole Health Approach

Samantha Zabel¹ and Niki Munk²

¹ Indiana University, Indianapolis, IN

² Indiana University, School of Health & Human Sciences, Indianapolis, IN

Contact: Samantha Zabel, [e-mail]

Abstract

Purpose: Mental health (MH) is a growing area of need in many populations with limited access and referral to effective MH support. Massage clinicians are in a unique position to identify MH needs in clients for care referral, but little is known about their attitudes and understanding of MH.

Method(s): A REDCap online survey of massage clinicians from MassageNet practice-based research network (PBRN) was conducted Feb-May 2023. Respondent demographics and attitudes and knowledge of MH using the Community Attitudes toward Mental Illness (CAMI) scale and Mental Health Literacy Scale (MHLS) respectively were collected. CAMI high/low score variables determined post hoc by score means (High 184-200; Neutral 154-183; Low 40-153) due to high collected mean. MHLS score based on established validity testing (High 141-160, Average 116-140, Low 35-139). Descriptive statistics and ꭕ² tests compared score categories by age, years in practice, and frequency addressing MH with clients to characterize respondents and generate hypotheses about practice implications.

Results: N=69 survey responses from email invitations to 385 MassageNet PBRN members. Respondents were mostly white (95.2%) women (78.5%), averaging 15.4 years in practice. Nearly all (95%) reported talking to clients about MH sometimes or often. MHLS scores showed good understanding of MH. Nearly half (43%) scored “High” understanding and 54% scored “Average”. A majority scored “Neutral” (64%) or “High” (19%) on CAMI. A significant relationship was found between MHLS and CAMI scores (p=0.003). No relationships were evident between score categories and respondent descriptors.

Conclusions: The importance of MH was recognized by massage clinicians as evidenced by positive MH attitudes and high understanding scores. Massage clinicians may be well positioned to play a crucial role in the whole health care team to help identify MH-related client needs. Additional research is needed to determine clinician readiness to support client MH care in a whole health context.

P04.09

Massage Therapy for Children, Adolescents, and Young Adults: Clinical Delivery and Effectiveness in Hematology and Oncology

David Miller¹, Samuel N. Rodgers-Melnick², Jeffery Dusek³, Sanjay Ahuja⁴, Mandy Bartolovich⁵, Neha Desai⁴, Smitha Hosahalli Vasanna⁴, Rachael L. Rivard⁶, and Amma Owusu-Ansah⁴

¹ UH Connor Whole Health, Cleveland, OH

² University Hospitals Connor Whole Health, Cleveland, OH

³ University of California - Irvine, Irvine, CA

⁴ Rainbow Babies and Children's Hospital, Cleveland, Ohio, Cleveland, OH

⁵ UH Connor Whole Health/Rainbow Babies and Children's Hospital, Cleveland, OH

⁶ HealthPartners Institute, Minneapolis, MN

Contact: David Miller, [e-mail]

Abstract

Purpose: Children, adolescents, and young adults with hematologic and/or oncologic conditions experience multiple, significant symptoms (e.g., pain, stress, and anxiety), which may be addressed by nonpharmacologic approaches such as massage therapy (MT). The purpose of this study was to describe the clinical delivery of MT provided by a Certified Pediatric Massage Therapist (CPMT) and assess effectiveness in two patient groups: those with sickle cell disease (SCD) or hematologic and/or oncologic conditions excluding SCD (HemOnc).

Method(s): Investigators conducted a retrospective review of MT sessions provided to patients 0-39 years with hematologic and/or oncologic conditions at a large pediatric academic medical center.

Results: Between October 2019 and December 2021, 3015 MT sessions were provided to 243 patients (171 HemOnc; 72 SCD) and documented in the electronic health record. Patients (mean age: 12.21 ± 7.19) were generally white (49.4%) or Black/African American (43.2%), non-Hispanic (94.2%), and 52.3% female. Patients in the SCD group (vs. patients in the HemOnc group) reported significantly higher (p<.05) pre-treatment pain (6.95 vs. 4.46), stress (6.47 vs. 4.58), and anxiety (6.67 vs. 4.59). All patients reported clinically and statistically significant (p<.001) mean reductions in pain (-2.25 ± 1.86), stress (-2.49 ± 1.73), and anxiety (-2.53 ± 1.69), with patients in the HemOnc group reporting greater mean pain change (-2.54 vs. -1.87) than patients in the SCD group.

Conclusions: This study supports the clinical effectiveness of MT for addressing acute pain, stress, and anxiety among youth with hematologic and/or oncologic conditions. Future research is needed to identify optimal MT utilization.

P04.10

The Impact of Veterans Health Administration Chiropractic Care on the Use of Prescription Pain Medications for Veterans with Low Back Pain

Kelsey Corcoran¹, Brian Coleman², Xiwen Zhao³, Lori Bastian⁴, Cynthia Brandt⁵, and Anthony Lisi⁶

¹ Yale School of Medicine & VA Connecticut HCS, New Haven, CT

² Yale School of Medicine & VA Connecticut, New Haven, CT

³ Yale Center for Analytical Sciences, New Haven, CT

⁴ VA Connecticut Healthcare System, West Haven, CT

⁵ Yale School of Medicine/VA Connecticut, New Haven, CT

⁶ Yale University, New Haven, CT

Contact: Anthony Lisi, [e-mail]

Abstract

Purpose: To determine if Veterans with low back pain (LBP) using on-station Veterans Health Administration (VA) chiropractic services differed in downstream prescription pain medications receipt compared to non-users.

Method(s): We identified a cohort of Veterans at VA facilities with on-station chiropractic clinics with LBP visits to any service between 10/01/2016-9/31/2017, no LBP visits for the 6 months prior, at least 1 primary care visit in the year prior and 2 years after LBP index. Receiving chiropractic care was defined as ≥1 chiropractic visits within 6 months of the index LBP visit. Downstream pain medication receipt was defined as ≥1 pain-related prescription filled from 7 to 24 months after the index visit. Chiropractic users were matched to non-users by propensity scores calculated with a logistic regression model that included demographics, comorbidities, index pain scores and prior-year healthcare utilization as variables. The matching process used a 1:1 greedy nearest-neighbor method within each VA facility. A generalized linear mixed models (GLMM) was used to examine the odds of individual medication groups, with VA facility included as a random effect.

Results: There were 193,151 Veterans identified who met the inclusion criteria. There were 21,836 Veterans included in the analysis cohort including 10,918 chiropractic users. Chiropractic users had a decreased odds of receiving opioid analgesics (OR 0.86, CI 0.76-0.97, p=.014), gabapentin (OR 0.88, CI 0.83-0.93, p<0.001), and pregabalin (OR 0.82, CI 0.72-0.92, p=0.001). There were no significant differences identified in receipt of non-opioid analgesics, skeletal muscle relaxants, or benzodiazepines between the 2 groups.

Conclusions: We identified several differences in pain medication use between VA chiropractic users and non-users. Further study is warranted to explore these differences, which may inform clinical care pathways for LBP.

P04.11LB

A Comparative of Complex and Simple Chuna Manual Therapy for Low Back Pain Patients with Pelvic Misalignment: Pilot Study on Safety and Effectiveness

Yeongjae Shin¹, Byung-Cheul Shin¹, Eui-Hyoung Hwang¹, Man-Suk Hwang¹, In Heo¹, Sun-Young Park¹, and Yeon-Woo Lee¹

¹ Pusan National University Hospital, Korean Medicine Hospital, Busan, Gyeongsangnamdo, South Korea

Contact: Yeongjae Shin, [e-mail]

Abstract

Purpose: Health insurance limits for Chuna manual therapy(CMT) have increased its demand, yet current insurance policies and diagnostic methods by Korean medicine doctor are insufficient, restricting complex CMT to specific diseases, which may not address a broader range of lower back pain issues effectively. Therefore, this pilot study designed to compare the safety and effectiveness of simple CMT and complex CMT in non-acute lower back pain patients before the main study commences.

Method(s): This study recruited adults aged 19-65 years suffering from non-acute lower back pain, where diagnoses were established through a combination of X-ray imaging, manual examination, and 3D body shape analysis for enhanced precision in detecting misalignment. Participants were randomly assigned to either simple or complex CMT. The interventions lasted four weeks, with follow-up evaluations at the 5,12, and 24 weeks. The study aimed to assess the relative therapeutic efficacy of the two CMT approaches, with a specific focus on their impact on pelvic alignment and symptom relief in the context of lower back pain management.

Results: 3D analysis provided objective pelvic misalignment indicators, and complex CMT outperformed simple therapy in pain reduction in NRS (Numeric Rating Scale)(p<0.001) and functional recovery, with sustained effects during follow-up as per ODI(Oswestry Disability Index) (p<0.05) and PGIC(Patients' Global Impression of Change) scores(p<0.001).

Conclusions: In this study, we employed a 3D body shape analysis to establish diagnostic criteria for pelvic misalignment in lower back pain patients. We conducted a randomized comparison between simple and complex CMT. Initial results suggest complex CMT's potential superiority in treating non-acute lower back pain, supporting the need for objective diagnostic criteria and expanded insurance coverage based on therapy effectiveness. Future research will delve deeper into these findings to enhance clinical applicability and treatment methodologies for lower back pain.

P04.12LB

Chiropractic Spinal Manipulation and Fall Risk in Older Adults with Spinal Pain: Matched Retrospective Cohort Study Using United States Data

Wren Burton¹, Robert Trager², Julia Loewenthal³, Jaime Perez⁴, Anthony Lisi⁵, Matthew Kowalski¹, and Peter Wayne¹

¹ Osher Center for Integrative Medicine at Harvard Medical School and Brigham & Women's Hospital, Boston, MA

² Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

³ Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

⁴ Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH

⁵ Yale University, New Haven, CT

Contact: Wren Burton, [e-mail]

Abstract

Purpose: Existing research suggests that spinal manipulative therapy (SMT) may have a positive impact on balance, but its connection to falls has not been thoroughly investigated. We hypothesized that older adults undergoing chiropractic SMT for spinal pain would experience a decreased risk of falling during a 13-month follow-up compared to matched controls.

Method(s): We searched over 116 million de-identified, aggregate patient records from TriNetX, Inc. (2013-2023) to identify adults aged ≥65 with spinal pain. After excluding individuals with major fall risk factors, SMT and non-SMT cohorts were formed, utilizing propensity score matching to control for variables such as age, sex, and comorbidities. Risk ratios (RR) with 95% confidence intervals (CI) and p-values were calculated for primary (falls) and secondary (limb fractures) outcomes over 13-months. Additionally, cumulative incidence and negative control outcomes (colonoscopy, vital signs, diabetes, nicotine/tobacco screening) were explored.

Results: Following matching, each cohort contained 1,666 patients with a mean age of 72. The SMT cohort exhibited a lower fall incidence compared to the non-SMT cohort (3.8% vs. 5.4%), resulting in an RR of 0.71 (; p=0.0319). Cumulative incidence showed a brief lag in fall incidence for the SMT cohort. No significant difference was observed in limb fractures (1.16; p=0.3153) and negative control outcomes were similar between cohorts.

Conclusions: This study supports our hypothesis that older adults undergoing SMT for spinal pain have a reduced risk of falls compared to those not receiving SMT. However, due to limitations in exploring fall-related injuries and similar limb fracture incidence between cohorts, the clinical significance remains uncertain. Further research should investigate injurious falls, care utilization, pain, and associated costs.

P04.13LB

The Effects of Massage Therapy in Decreasing Pain and Anxiety in Post-Surgical Patients with Breast Cancer: A Systematic Review and Meta-Analysis

Jill Cole¹, Anne D. Olson¹, and Esther E. Dupont-Versteegden¹

¹ University of Kentucky, Lexington, KY

Contact: Jill Cole, [e-mail]

Abstract

Purpose: Background: Massage therapy is an effective non-pharmacological intervention in treating pain and anxiety of patients with cancer. Prior studies have reviewed the benefits of massage therapy in patients with breast cancer undergoing chemotherapy, radiation, and other patient specific cancer treatments. What has yet to be examined is the effects of massage therapy on the pain and anxiety of patients with breast cancer after surgery.

Objective: The purpose of this systematic review and meta-analysis was to examine the effect of massage therapy on post-surgical pain and anxiety in patients with breast cancer.

Method(s): Systematic searches were performed using databases PubMed, CINAHL, and Medline (EBSCO), with no date constraint through September 30, 2023, to identify randomized control trials, randomized pilot, and quasi-experimental studies. The database searches retrieved 1205 titles, and after screening, 7 studies were chosen for full analysis using Cohen’s d, 95% Confidence Interval (CI), and effect size. The heterogeneity of the studies was calculated in the meta-analysis using Cochran’s Q equation.

Results: Massage therapy techniques reported were massage therapy, classic massage, reflexology, myofascial release, and myofascial therapy, and were performed at day 0 up to 16 weeks post-surgery. Massage therapy decreased pain and anxiety for patients in the massage group. Analyses showed a positive effect size using massage therapy as an intervention for pain and anxiety in women with breast cancer post-surgery. Overall effect size for pain was 0.795 with a p-value of <0.0001, and overall effect size for anxiety was 0.363 with a p-value of <0.0001.

Conclusions: The current evidence in this study reflects that massage therapy is effective as a non-pharmacological tool in decreasing post-surgical pain and anxiety in women with breast cancer.

P04.14LB

World Health Organization Global Patient Safety Action Plan: Considerations for Chiropractic and Integrative Care Professionals

Katherine Pohlman¹, Brian Coleman², Sidney Rubinstein³, Stacie Salsbury⁴, Michael Swain⁵, and Richard Brown⁶

¹ Parker University, Dallas, TX

² Yale School of Medicine & VA Connecticut, New Haven, CT

³ Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands

⁴ Palmer Center for Chiropractic Research, Davenport, IA

⁵ Macquarie University, Sydney, New South Wales, Australia

⁶ World Federation of Chiropractic, Toronto, ON

Contact: Katherine Pohlman, [e-mail]

Abstract

Purpose: This project outlines the World Health Organization (WHO) Global Patient Safety Action Plan with priority setting for safer healthcare delivery by the chiropractic profession.

Method(s): The World Federation of Chiropractic (WFC) Global Patient Safety (GPS) Task Force was recently chartered to instill a robust patient safety culture throughout the chiropractic profession. Our project adopted the WHO GPS Action Plan as its guiding framework. The executive committee reviewed the plan to outline considerations and action steps for the chiropractic profession.

Results: The WHO GPS Action Plan provides a structured framework and roadmap for the chiropractic profession to cultivate an inclusive culture which prioritizes patient safety. Seven strategic objectives serve as focal points. Objective 1 leverages each clinical interaction to enhance patient safety through continuous learning by providers and organizations. Objective 2 urges implementation of high-reliability systems to dismantle systemic obstacles, reduce human error, and fortify safety procedures. Objective 3 seeks optimal communication pathways and clinical processes to keep patients safe. Objective 4 encourages patient and family engagement in safety initiatives. Objective 5 recognizes chiropractors as a workforce that requires specialized training in patient safety. Objective 6 promotes data-driven approaches to patient safety monitoring and research. Objective 7 fosters collaborative partnerships to elevate patient safety in chiropractic and integrative care settings.

Conclusions: This project presents comprehensive approaches to align the chiropractic profession with the WHO Global Patient Safety Action Plan. The WFC GPS Task Force advocates for the chiropractic community to embrace this framework and make concerted efforts to implement these strategic objectives in clinical settings. We encourage our integrative health colleagues to undertake similar work to prevent avoidable harm across healthcare settings.

Topic Area 05 - Clinical: Mind Body

P05.01

A Concise Fidelity Tool to Assess Treatment Fidelity & Engagement in Online Mindfulness-Based Intervention

Graham Dore¹, Carol Greco¹, Suzanne Lawrence¹, Janice Weinberg², Holly Thomas¹, Isabel Roth³, Ruth Rodriguez⁴, Megan Mcgillis², and Natalia Morone⁵

¹ University of Pittsburgh, Pittsburgh, PA

² Boston University, Boston, MA

³ University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC

⁴ Boston Medical Center, Boston, MA

⁵ Boston University/Boston Medical Center, Boston, MA

Contact: Graham Dore, [e-mail]

Abstract

Purpose: Fidelity measurement in MBI trials is important but often overlooked. We describe the development and implementation results of a MBI fidelity tool currently in use in OPTIMUM, a 3-site pragmatic clinical trial conducted entirely online that includes an adapted MBSR program plus group medical visits with a primary care clinician.

Method(s): A concise, simple-to-use fidelity tool was developed based on the team’s mindfulness teaching and research expertise and informed by literature. The 9-item tool consists of four domains – Session Logistics, Content Elements, Participant Engagement, and Technology Obstacles. Content elements include meditation, discussions, breakout sessions with clinician, and home practice. Engagement and Tech Obstacles are rated on Likert scales reflecting the extent of participant engagement, and extent to which technology obstacles hindered participants’ engagement. Two raters each viewed 26 recorded sessions and interrater reliability was assessed using percent agreement. OPTIMUM session fidelity ratings take place on an ongoing basis.

Results: OPTIMUM participants’ (N=309) average age is 52 years; 70% are female, 43% are Black, 47 are White, and 4% Hispanic or Latin. On the 26 interrater reliability sessions, percent agreement ranged from 77% to 100% for each of the session elements, and 69-88% on the Likert ratings of Engagement and Tech Obstacles. Session elements were rated as present in 95-100% of 180 OPTIMUM sessions, and engagement in sessions was rated as ‘Quite a bit’ or ‘Very much’ in over 90% of sessions. There were tech obstacles to engagement in over 50% of sessions (see table). Raters could provide details in open comment fields in the fidelity tool. The tool takes 1-2 minutes to complete.

Conclusions: The Concise Fidelity MBI (CoFi MBI) tool has adequate interrater reliability, is simple to use, and can be adapted for other online MBI trials and use in clinical settings. The tool is freely available for use.

P05.02

Abbreviated and Remotely-Delivered MBCT for Depressive Symptoms and Quality of Life in People with Migraine

Annie Kate Reeder¹, Jacob Hill², Pallavi Visvanathan³, Rebecca Wells⁴, Richard Lipton⁵, Mia Minen⁶, Jodi Scharf⁶, Amanda Shallcross², and Elizabeth Seng⁷

¹ Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY

² Cleveland Clinic, Cleveland, OH

³ Manhattan Center for Mindfulness Based Cognitive Therapy, New York, NY

⁴ Wake Forest University School of Medicine, Winston Salem, NC

⁵ Albert Einstein College of Medicine, Bronx, NY

⁶ NYU Langone Health, New York, NY

⁷ Yeshiva University, New York, NY

Contact: Annie Kate Reeder, [e-mail]

Abstract

Purpose: The purpose of this study was to evaluate the impact of an abbreviated and remotely-delivered Mindfulness Based Cognitive Therapy protocol (MBCT-brief) on depressive symptoms, quality of life, and mindfulness in adults with migraine.

Method(s): Participants (n=16) with 4-14 headache days/month and depressive symptoms (PHQ-9 scores 5-14) were recruited via the electronic medical record of an academic medical center. Participants received the 8-week MBCT intervention, which was based on the standardized protocol and was abbreviated to 1hr/week (rather than 2.5 hrs./week) and was adapted for migraine. Clinical outcomes were assessed pre- and post-intervention: depressive symptoms (NIH PROMIS Depression Short Form (PROMIS-D)), quality of life (Migraine-Specific Quality of Life Questionnaire v2.1 (MSQ)), and mindfulness (Five Facet Mindfulness Questionnaire (FFMQ), which contains five subscales: Observing, Describing, Acting with Awareness, Non-Judging of Inner Experience, and Non-Reactivity to Inner Experience). Related-Samples Wilcoxon Signed Rank Tests were used to evaluate changes in clinical outcomes from pre-treatment baseline to post-intervention.

Results: Participants (n = 16) were all women with a mean age of 45 (SD = 13). Pre- to post-intervention, changes showed significant reductions in depressive symptoms (PROMIS-D: p = .025) and significant increases in quality of life (MSQ: p= .006). We also observed significant increases in total mindfulness (FFMQ Total: p = .004), as well as significant increases in the FFMQ subscales Non-Judging of Inner Experience (FFMQ Non-Judging of Inner Experience: p = .009), Observing (FFMQ Observing: p = .012), and Non-Reactivity to Inner Experience (FFMQ Non-Reactivity to Inner Experience: p = .015).

Conclusions: Remotely-delivered MBCT-brief reduced depressive symptoms and improved quality of life and mindfulness in adults with migraine. Future studies are needed to test this intervention in a randomized controlled trial.

P05.03

Age Differences in the Effects of a Mind-Body Program for Chronic Pain

Jonathan Greenberg¹, Lisa LaRowe¹, Jafar Bakhshaie², and Ana-Maria Vranceanu³

¹ Massachusetts General Hospital, Boston, MA

² Harvard Medical School / Massachusetts General Hospital, Boston, MA

³ MGH/HMS, Boston, MA

Contact: Jonathan Greenberg, [e-mail]

Abstract

Purpose: Improving physical function is key to decreasing the burden of chronic pain across the lifespan. Although mind-body interventions show promise in increasing physical function in chronic pain, very little is known about whether older and younger adults derive similar benefit. Indeed, older adults experience higher rates of chronic pain and greater impacts of pain on physical function compared to younger adults. Therefore, additional work is needed to determine the extent of benefit older versus younger adults receive from a mind-body intervention. Here we examined age differences in the effects of two mind-body and walking programs on pain and multimodal physical function.

Method(s): Participants were 82 individuals with heterogenous chronic musculoskeletal pain (66% female, 57% aged ≥50 years) who participated in a feasibility randomized controlled trial of two mind-body interventions. They completed self-reported (WHODAS 2.0), performance-based (6-minute walk test), and objective (accelerometer-measured step count) measures of physical function, as well as self-report measures of pain intensity, before and after the intervention.

Results: Adults aged ≥50 (vs. adults aged <50) demonstrated greater improvements in performance-based physical function (6-minute walk test) and reductions in pain during activity. No age differences in the effects of the intervention on self-reported or objectively measured physical function were observed.

Conclusions: Collectively, findings suggest that older adults can achieve equivalent or greater benefits from mind-body programs for chronic pain, despite facing unique challenges to chronic pain management.

P05.04

Constipation Status and Low Back Pain: Using the Traditional Indian Medicine Model to Understand Associations Between the Gut-Brain Axis and Pain

Ayumi Saito¹, Alyson Littman¹, Amy Cizik², Janna L. Friedly³, Adam Goode⁴, Patrick J. Heagerty⁵, Maggie Horn⁶, Jeffrey G. Jarvik⁷, Sandra Johnston¹, Johanna W Lampe⁸, Eric Meier⁹, Stephen J. Mooney⁸, Monica Smersh¹, Pradeep Suri¹⁰, Prasad Vinjamury¹¹, and Sean D. Rundell¹⁰

¹ University of Washington, Seattle, WA

² Population Health Sciences, The University of Utah, Salt Lake City, UT

³ Rehabilitation Medicine, University of Washington, Seattle, WA

⁴ Clinical Research and Epidemiology, Department of Orthopedic Surgery / Duke University, Durham, NC

⁵ Department of Biostatistics / University of Washington, Seattle, WA

⁶ Duke University School of Medicine, Durham, NC

⁷ Departments of Radiology, Neuroradiology, Health Services and Neurological Surgery/ University of Washington, Seattle, WA

⁸ Department of Epidemiology, University of Washington, Seattle, WA

⁹ Department of Biostatistics, University of Washington, Seattle, WA

¹⁰ Department of Rehabilitation Medicine / University of Washington, Seattle, WA

¹¹ Southern California University of Health Science, Whittier, CA

Contact: Ayumi Saito, [e-mail]

Abstract

Purpose: In Traditional Indian Medicine (TIM, Siddha and Ayurveda), constipation aggravates low back pain (LBP), and laxatives are used for LBP relief. Scientific studies indicate the gut-brain axis is associated with chronic pain and spine conditions. Since constipation prevalence is 20% in the general population, constipation relief for LBP could also be integrated into Western medical practice as a paradigm shift to Whole Health. We explored the association between constipation and LBP perceptions in people with symptomatic lumbar spinal stenosis (LSS) using a TIM-based conceptual model.

Method(s): We sampled cross-sectional data from a prospective cohort study of adults ≥50 years with symptomatic LSS (PROSPECTS; R01AG069891). Constipation status in the past week was determined by PROMIS Constipation T-scores. Scores <55 were defined as no constipation; 55-<60 as mild; 60-70 as moderate; >70 as severe constipation. Back and leg pain intensities were measured on an 11-point Numeric Rating Scale (NRS), and pain interference was assessed by PROMIS T-scores. Linear regression models adjusted for age, sex, and self-reported opioid or non-opioid pain medication use were fit to determine the associations between constipation and LBP perceptions.

Results: 99 participants (mean age: 67; SD: 10) were included in the analysis. The mean constipation T-score was 48 (range 37-65), and 17% had constipation (14% mild, 3% moderate, 0% severe). After adjustment, the moderate constipation group had significantly higher LBP than the non-constipation group (3.6 NRS pts, 95%CI: 0.005, 7.29). Mild constipation was not significantly associated with LBP. Leg pain or pain interference were not significantly associated with mild or moderate constipation.

Conclusions: LBP was greater in symptomatic LSS participants with moderate constipation compared to those with no constipation, though the confidence intervals were wide due in part to the small sample size. These preliminary findings warrant our future research with larger sample sizes for more precise estimates.

P05.05

Computerized Study on Dose-Response of Tai Chi and Qigong on Enhancement of the Flow of Blood and Electricity at Acupuncture Points

Shin Lin¹, Anthony Troung¹, Anthony Tran¹, Eileen Pham¹, Caitlin Lee¹, Shannon Stolaruk¹, Johnson Jiang¹, and Melinda Ly¹

¹ Dept. of Developmental & Cell Biology and Susan Samueli Integrative Health Institute, University of California, Irvine, Irvine, CA

Contact: Shin Lin, [e-mail]

Abstract

Purpose: The purpose of this pilot study is to test technologies for establishing a dose-response relationship between the level of performance of Tai Chi/Qigong exercises and the enhancement of the flow of blood and energy measured as electricity.

Method(s): Four healthy males/females of college age participated in this study. “Flux” of blood was followed at PC 8 acupoint on the right palm with Moor DRT4 laser Doppler flowmeter and flow of energy was monitored continuously as “Pre-polarization Conductance” at Lu1 on the same hand using Motoyama's AMI system. In each of 2-3 trials, the subject performed Tai Chi’s Needle at Bottom of the Sea (NBS), starting with body and outstretched arms straight up (0⁰), and then body bending forward and arms lowering towards the floor (180⁰) in 10 seconds. The subject repeated this movement 3 more times but lowering the body and arm to lesser angles. For Qigong’s Eagle Stretching Wings (ESW), the subject's body and right arm started straight up (0⁰) and then the body bending and arm lowering sideways towards the floor (180⁰). A Microsoft Kinect Camera recorded the movements and angles of the right arm of the digital skeleton from up to down positions were measured with IC Measure software.

Results: The closer a subject performed NBS according to tradition (up-down=1800), the greater the effect on the coordinated flow of blood (45⁰=136 ± 20 SD, arbitrary units; 90⁰=164 ± 26; 135⁰=180 ± 39; 180⁰=214 ± 56) and electricity (45⁰=3190 ± 248 SD, arbitrary units; 90⁰=3219 ± 246; 135⁰=3244 ± 248; 180⁰=3321 ± 291). Similar results were obtained for ESW (blood flow: 45⁰=101 ± 41; 90⁰=121 ± 27; 135⁰=126 ± 24; 180⁰=119 ± 42. Electrical flow: 45⁰=2956 ± 508; 90⁰=3072 ± 437; 135⁰=3197 ± 381; 180⁰=3245 ± 384).

Conclusions: This study shows the dose-response relationships between the level of performing Tai Chi/Qigong exercises and the effects on the flow of blood and electricity, the latter implicated in the wound healing process in vivo. Such data should be useful for future researchers and students of these practices.

P05.06

Development of a Novel Diabetes Self-Management Intervention for Youth with Type 2 Diabetes: The INTEND Intervention

David Miller¹, Molly McVoy², Irina Bransteter³, Jessica Surdam¹, Tracy Segall⁴, Paul McGuigan⁵, Roshini Srinivasan¹, Rose Gubitosi-Klug⁶, Jeffery Dusek⁷, and Martha Sajatovic⁸

¹ University Hospitals Connor Whole Health, Cleveland, OH

² Department of Psychiatry, Case Western Reserve University School of Medicine; Division of Child Psychiatry, University Hospitals of Cleveland, Cleveland, OH

³ Department of Psychiatry, Case Western Reserve University School of Medicine; Division of Child Psychiatry, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH

⁴ University Hospitals of Cleveland, Cleveland, OH

⁵ Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH

⁶ Department of Pediatric Endocrinology, University Hospitals Rainbow Babies and Children’s Hospital: Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH

⁷ University of California - Irvine, Irvine, CA

⁸ Department of Psychiatry and Neurology, Case Western Reserve University School of Medicine; Neurological and Behavioral Outcomes Center University Hospitals Cleveland Medical Center, Cleveland, OH

Contact: David Miller, [e-mail]

Abstract

Purpose: (1) To develop a mind-body intervention (MBI) to support adolescents and young adults (AYAs) with type 2 diabetes (T2D); and (2) to pilot this intervention via a single-arm clinical trial.

Method(s): Focus groups and semi-structured interviews were conducted with stakeholders, including AYA with T2D, their parents/guardians, and clinical providers. to understand current gaps in caring for AYA with T2D. Qualitative thematic analysis identified key barriers to and facilitators of disease management. Subsequently, these findings informed development of a T2D self-management intervention curriculum for AYA with T2D. Next, a research advisory board (RAB) was convened to review and provide feedback used to refine the curriculum, named INTEND (InterveNTion for Early oNset type 2 Diabetes). INTEND is currently being piloted in a group of 6 AYA with T2D and their parents/guardians in a single-arm clinical trial. Primary outcome measures are feasibility and acceptability (recruitment and retention rates; quantitative and qualitative feedback from participants). Secondary outcome measures include quality of life, anxiety and depressive symptoms, and T2D biomarkers.

Results: Feedback from qualitative assessments and an RAB informed modification of an evidence-based adult T2D self-management intervention, with the addition of a mind-body component, for AYA with T2D. INTEND is practical virtual curriculum including 6 sessions for AYA with T2D and 2 sessions for their parents/guardians, designed to be concise and implementable by personnel typically embedded in clinical settings. The intervention is co-led by a clinician educator trained in both T2D self-management and MBIs and a peer educator with early onset T2D. INTEND is ongoing.

Conclusions: The INTEND intervention is a novel T2D intervention designed for AYA with T2D, emphasizing a mind-body component. While empirical evidence among adults with T2D supports the value of MBIs, results from this trial will provide the first evidence in young people.

P05.07

Differential Effects on Depression Outcomes Following a Brief Mindfulness-Based Intervention in Patients with Migraine and Depressive Symptoms

Jacob Hill¹, Elizabeth Seng², Annie Kate Reeder³, Pallavi Visvanathan⁴, Rebecca Wells⁵, Richard Lipton⁶, Mia Minen⁷, Ning Guo¹, and Amanda Shallcross¹

¹ Cleveland Clinic, Cleveland, OH

² Yeshiva University, New York, NY

³ Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY

⁴ Manhattan Center for Mindfulness Based Cognitive Therapy, New York, NY

⁵ Wake Forest University School of Medicine, Winston Salem, NC

⁶ Albert Einstein College of Medicine, Bronx, NY

⁷ NYU Langone Health, New York, NY

Contact: Jacob Hill, [e-mail]

Abstract

Purpose: Up to 60% of people with migraine have elevated depressive symptoms. Mindfulness-Based Cognitive Therapy (MBCT) reduces depressive symptoms in people with migraine. However, the full-length MBCT protocol has a burdensome time commitment (8 weekly, 2.5-hour, in-person group sessions). We developed a remotely delivered abbreviated MBCT program (MBCT-brief) that includes 8 weekly 1-hour group sessions. We tested MBCT-brief in patients with migraine and elevated depressive symptoms. Given the heterogeneity of depression in terms of affective, cognitive, and somatic symptoms, we examined effects of MBCT-brief on two different depressive symptom inventories: 1) the Patient Reported Outcomes Measurement Information System-Depression 8a (PROMIS-D), a unidimensional measure of affective symptoms of depression; and 2) the Quick Inventory of Depressive Symptomatology-16 (QIDS), which indexes 9 diagnostic domains, including affective, cognitive, and somatic symptoms.

Method(s): In a single-arm pilot trial, 16 participants completed MBCT-brief. Total and domain means (QIDS only, range 0-3) were calculated pre/post intervention.

Results: Mean pre/post intervention change for QIDS = 4.33 (SD 4.29, Cohen’s d 1.29) and PROMIS-D = 7.74 (SD 11.58, Cohen’s d 0.92). The QIDS domains with the largest pre/post change were cognitive (self-criticism (1.00, SD 1.25)), somatic (energy/fatigue (0.87, SD 0.83)), and affective symptoms (interest/affect (0.67 SD 0.82)).

Conclusions: Our study supports the preliminary efficacy of a remotely delivered and scalable version of MBCT. The strength of effects varied based on the depression outcome measure; effects were larger for QIDS vs. PROMIS-D. MBCT had the largest effects on the QIDS cognitive symptom domain, which aligns with cognitive reactivity as a primary target of MBCT. Our study also highlights the need to consider outcome measures for depression that capture the range of depressive symptoms that may be improved by MBCT.

P05.08

Do Mindfulness Interventions Cause Harm? Findings from the Learning to Apply Mindfulness to Pain (LAMP) study

Diana Burgess¹, Collin Calvert¹, Ann Bangerter¹, Mariah Branson¹, Lee Cross¹, Roni Evans², John Ferguson², Jessica Friedman¹, Emily Hagel Campbell¹, Alexander Haley², Sierra Hennessy¹, Colleen Kraft¹, Mallory Mahaffey¹, Marianne Matthias³, Laura Meis¹, Greg Serpa⁴, Stephanie Taylor⁵, and Brent Taylor¹

¹ Minneapolis VA Health Care System, Minneapolis, MN

² University of Minnesota, Minneapolis, MN

³ Indiana University, Indianapolis, IN

⁴ VHA, Los Angeles, CA

⁵ Veterans Health Administration, Los Angeles, CA

Contact: Diana Burgess, [e-mail]

Abstract

Purpose: Although mindfulness-based interventions (MBIs) are widely used in clinical and nonclinical settings, there has been little systematic study of their potential risks. To address this gap, we examined differences in psychological and physical worsening among participants in the usual care and intervention conditions of a three-group, randomized pragmatic trial (Learning to Apply Mindfulness to Pain; LAMP) that tested the effectiveness of two approaches to delivering MBIs to patients with chronic pain.

Method(s): The sample consisted of 374 male and 334 female patients with chronic pain enrolled in the LAMP trial, who completed a 10-week follow-up survey, 61% of whom had a mental health diagnosis. Psychological and physical worsening was assessed by a checklist asking if participants experienced specific symptoms since beginning the study. We used multivariable logistic regression models with imputed data to determine whether predicted probabilities of increased symptoms differed between usual care and the two MBIs.

Results: Participants in usual care were more likely to report experiencing increased psychological and physical worsening than those in the MBIs, including an increase in disturbing memories; sadness, anxiousness, fatigue; isolation and loneliness; and feeling more upset than usual when something reminded them of the past.

Conclusions: MBIs do not appear appeared to cause harm, in terms of increased symptoms, for this population of patients with chronic pain and high levels of mental health comorbidities.

P05.09

Dynamic Changes in Cardiac Function During Shamanic Journeying: A Case Study

Emma Huels¹, Lily Carter¹, Gang Xu¹, Jimo Borjigin¹, and Richard Harris²

¹ University of Michigan, Ann Arbor, MI

² University of California at Irvine, Irvine, CA

Contact: Emma Huels, [e-mail]

Abstract

Purpose: Shamanism is an ancient spiritual practice used to heal others by interacting with elements of the spirit world, such as power animals. Many traditions cite the heart as playing a key role in the shamanic journey, suggesting cardiac function as a tool for characterizing this state. We recorded electrocardiogram (ECG) signals from a single shamanic practitioner during 14 shamanic journeys using the Electrocardiomatrix (ECM) Mobile Device—a proprietary prototype developed in the Borjigin laboratory.

Method(s): The shamanic practitioner used rhythmic drumming to enter the shamanic state. Each journey was visually inspected for 30-120 seconds of data for the following events, which were identified by the practitioner’s notes and visual patterns in the ECM: rest, drumming, shapeshift into power animal, and post-shapeshift. All segments were analyzed for temporal measures of beats per minute (BPM), standard deviation of RR interval (SDRR), root mean square of successive RR interval differences (RMSSD), and the percentage of successive RR intervals that differ by more than 50 milliseconds (pNN50). Segments longer than 65 seconds were evaluated for frequency measures, including the absolute power of the low (LF: 0.04 – 0.15Hz) and high (HF: 0.15Hz – 0.4Hz) frequency bands and the ratio of LF to HF power (LF/HF). Paired t-tests were used to compare measures during rest and drumming, as well as compare drumming to shapeshift and post-shapeshift periods.

Results: Shamanic drumming led to decreased BPM (p < 0.01) and increased SDRR (p < 0.0001), RMSSD (p < 0.001), pNN50 (p < 0.01), LF (p < 0.0001) and LF/HF (p < 0.001). Upon shapeshifting, BPM (p < 0.0001) SDRR (p < 0.01), and RMSSD (p = 0.02) all increased. BPM remained elevated during the post-shapeshift period (p < 0.0001) and the LF/HF decreased (p = 0.03).

Conclusions: These results suggest the shamanic journey involves dynamic, widespread changes in cardiac function and physiology. Future studies are needed to determine their clinical significance.

P05.10

Effects of Tai Chi Versus Waitlist on Anxiety and Stress of Diabetic and Hypertensive Brazilian Patients: A Randomized Controlled Trial

Lais Renata Almeida Cezario Santos¹, Anderson Taíra², Marcelo de Castro Meneghim³, Paola Lavin⁴, Soham Rej⁴, Gláucia Ambrosano³, Karine Laura Cortellazzi³, and Rosana Possobon³

¹ FOP-UNICAMP, PIRACICABA, Sao Paulo, Brazil

² Sociedade Brasileira de Tai Chi Chuan e Cultura Oriental, PIRACICABA, Sao Paulo, Brazil

³ University of Campinas, PIRACICABA, Sao Paulo, Brazil

⁴ McGill University, Montreal, QC

Contact: Lais Renata Almeida Cezario Santos, [e-mail]

Abstract

Purpose: To investigate the effects of Tai-Chi practice over 13 weeks on anxiety and perceived stress levels in hypertensive and diabetic individuals.

Method(s): Ninety-one patients with DM and/or hypertension followed up at a primary care center were randomized to tai-chi (TC) intervention (n=45) or waitlist (n=46) for 13 weeks. Outcome measures were collected at baseline, 6 and 13 weeks on anxiety (State-trait Anxiety Inventory- STAI) and Perceived Stress Scale (PSS14). We used a linear mixed-effects model to analyze the primary and secondary outcomes, considering the treatment group and time as covariates and treating the subject as a random effect.

Results: After 13 weeks, the TC group had lower scores of anxiety (STAI EST=-6.421; SD=2.679; CI=-11.615,-1.224; p=0.018) and stress (PSS14 EST=-9.290; SD=2.262; CI=-13.678,-4.906; p=<0.001).

Conclusions: A 13-week Tai-Chi intervention effectively lowered the scores of anxiety and perceived stress of patients with DM and hypertension and can be used in primary care centers as an adjunct therapy.

P05.11

Employing EEG To Explore the Role of Touch in Somatic Meditation: A Mixed Methods Proof-of-Concept Study

Dana Dharmakaya Colgan¹, Cynthia Price², Dan Klee³, and Barry Oken³

¹ OHSU, Portland, OR

² University of WA, Seattle, WA

³ Oregon Health Sciences University -, Portland, OR

Contact: Dana Dharmakaya Colgan, [e-mail]

Abstract

Purpose: Mindful awareness in body-oriented therapy (MABT) is an evidenced-based intervention to teach interoceptive awareness and is unique in its focus using therapist-assisted touch. The role of touch in training; however, has not been explored. The aim of this mixed methods proof-of-concept study was to investigate subjective experiences and neurophysiological correlates of somatic meditation with and without therapist-assisted touch.

Method(s): A multiple-crossover ABCABC single case design without blinding was employed. Scalp electroencephalography (EEG) activity was recorded during sustained somatic meditations guided with therapist-assisted touch, somatic meditations without touch (active control), and reminiscing about a travel experience (passive control). Replication of interventions was conducted three times and the order of the interventions during each replication was randomized. A Fast Fourier Transform was used to extract power from each segment in each condition and used to export mean activity per spectral line, measured in power (uV^2) for theta (4-8 Hz), alpha (8-13 hz), beta (13-30 Hz). Interviews were conducted following each replication and post-intervention. Qualitative data were analyzed using conventional content analysis.

Results: Three therapist-participant dyads completed the protocol. Visual analyses indicated somatic mediation with therapist-assisted touch was associated with increased frontal and central alpha power, when compared to active and passive controls, and attenuated theta when compared to the passive, but not the active control. Less consistent effects were found in beta activity. Nonparametric tests provided additional support for findings. Qualitative results indicated the use of touch was associated with improved ability to sustain awareness on internal bodily sensations, and resulted in greater quality of interoceptive attention.

Conclusions: Findings indicate the need for further study of touch in somatic meditation.

P05.12

Examining the Trauma Landscape among Individuals in Medication Treatment for Opioid Use Disorder

Monique Rodriguez¹, Dana Dharmakaya Colgan², Sarah Leyde³, Joseph Merrill³, and Cynthia Price³

¹ University of New Mexico, Albuquerque, NM

² OHSU, Portland, OR

³ University of Washington, Seattle, WA

Contact: Monique Rodriguez, [e-mail]

Abstract

Purpose: This study aimed to investigate the incidence of trauma exposure among men and women undergoing medication treatment for opioid use disorder (MOUD) throughout their lives. The study was conducted as a randomized control trial, which involved training individuals undergoing MOUD treatment in mindful body awareness. Mind-body approaches have a high level of perceived effectiveness by patients with OUD who take MOUD. This provided an opportunity to assess the prevalence of self-reported lifetime trauma exposure and to explore variations in trauma exposure among individuals with and without chronic pain and between genders.

Method(s): Data for this project was collected at baseline prior to randomization to study treatment groups. The Trauma Life Events Questionnaire (TLEQ) and the Posttraumatic Stress Disorder Checklist for DSM 5 (PCL-5) were used to examine trauma exposure and PTSD. The Brief Pain Inventory (BPI) assessed pain severity. The analysis includes independent sample t-tests, linear regression, and logistic regression.

Results: Participants (n=303) ages ranged from 21-73, with almost equivalent numbers identified as men (48%) and women (52%). Men (n=144) and women (n=157) had extensive trauma histories, including interpersonal and non-interpersonal traumas. Women reported more trauma in categories like intimate partner violence and adult sexual assault, while men reported more trauma in witnessing and physical assault. When compared to those with and without chronic pain, individuals with chronic pain reported significantly more trauma.

Conclusions: The study reveals the intricate connection between trauma exposure, Opioid Use Disorder (OUD), gender, post-traumatic stress disorder (PTSD) symptoms, and chronic pain. It sheds light on the prevalence of trauma across genders and its potential impact on individuals undergoing medications for opioid use disorder (MOUD). The findings provide valuable insights into the need for improved gender-specific interventions and approaches for OUD patients.

P05.13

Exploring Yoga Adherence and Barriers in the Medical University Community

Fauzia Nausheen¹, Shazia Sheikh², and Paul Lyons²

¹ CUSM, Redlands, California, CA

² CUSM, Colton, CA

Contact: Fauzia Nausheen, [e-mail]

Abstract

Purpose: This study investigates the feasibility of promoting yoga adherence among the medical community. Objectives: 1) Develop a safe, easy, and user-friendly yoga program, including simple poses and guided meditation. 2) Evaluate recruitment processes, attrition rates, daily adherence, and barriers to yoga. 3) Create effective models for promoting long-term yoga adherence.

Method(s): We created a 30-minute video of pre-yoga stretches, basic asanas, yogic breathing, and guided meditation, accessible on phones and computers with closed captioning and audio options. The PI, an MD and yoga instructor, provided guidance and sent weekly motivational messages and reminders. First 4 weeks of the study collected data through biweekly surveys, assessing daily adherence, reasons for missed sessions, and post-practice feelings. Ethical approval: CUSM IRB (#HS-2023-32).

Results: 15 candidates consented to participate following initial meeting with the Principal Investigator. The study cohort included 3 medical students, 6 staff and 6 faculty members. After the meeting, participants were introduced to yoga through instructional videos. 3 participants discontinued practice, representing an attrition rate of 20%. The analysis of results revealed: On average, participants engaged in yoga practice for 4 days per week. 2 participants (17%) practiced yoga for 7 days. 7 (58%) participants reported sessions lasting more than 20 minutes. 9 (60%), reported feeling relaxed and happy after yoga. The most frequently mentioned barriers are “No Time” (33%), “Lack of Motivation” (20%), and a preference for alternative workouts (20%). Additionally, participants provided other reasons (46.6%) through free responses, including concerns about the type of yoga, not liking virtual practice and space constraints.

Conclusions: Strong motivation and close alignment of desired outcome, e.g., improving sleep and menopausal symptoms, reducing anxiety and depression, and enhancing physical and cognitive functions is crucial for consistent yoga practice.

P05.14

Fasting Insulin is Associated with Serum Cortisol, but Not Perceived Stress in Latino Adolescents

Fatimata Sanogo¹, Marc Weigensberg², Richard Watanabe¹, Victoria Cortessis¹, and Avaion Ruth¹

¹ Keck School of Medicine of USC, Los Angeles, CA

² University of Southern California, Los Angeles, CA

Contact: Fatimata Sanogo, [e-mail]

Abstract

Purpose: It is hypothesized mind/body practices (MBP) improve insulin resistance (IR) through stress pathway. Research on relationship between stress and IR is inconsistent in adults and limited in adolescents. Purpose: Determine associations between IR and stress in predominantly Latino adolescents.

Method(s): We used 229 adolescents (mean age=15.8 yrs., 76 males) from Imagine HEALTH study. We used baseline and 12-week follow up measures of Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and fasting insulin as indices of IR; BMI and Bioelectrical impedance analysis (BIA) used as distant proxies of IR. We measured stress with 14-item PSS questionnaire, serum cortisol, salivary Cortisol Awakening Response (CAR: 30-minute post-awakening - awakening), Diurnal Cortisol Slope (DCS: evening-awakening). We used multivariable linear regressions for baseline associations, GLS-random effect regressions for 12-week longitudinal associations. We examined baseline associations between HOMA-IR and PSS and cortisol biomarkers. We assessed baseline and longitudinal associations between fasting insulin, BMI, BIA, with perceived stress and cortisol biomarkers. Analyses were adjusted for age, sex, and BMI.

Results: There were no significant associations between HOMA-IR and PSS or cortisol biomarkers (all ps >0.11). Fasting insulin showed no significant baseline associations with PSS (p=0.22) or cortisol biomarkers (all ps>0.29), but a significant association over 12 weeks between change in fasting insulin and serum cortisol (p = 0.004). Log mean fasting insulin increased 4.9 x10-4pg/ml ± 1.7 x10-4 for every nmol/l increase in serum cortisol over 12-week period. There were no significant associations between BMI or BIA with PSS, or cortisol biomarkers at baseline or over time (all ps >0.10).

Conclusions: In predominantly Latino adolescents, change in serum cortisol is associated with change in fasting insulin, suggesting lifestyle interventions, such as MBP that lower serum cortisol may improve insulin resistance.

P05.15

Feasibility and Acceptability of Tai Chi for Pain Management Among Adults With HIV

Eugene Dunne¹, Christina Mitchell¹, Gloria Yeh², and Michael Carey³

¹ Temple University, Philadelphia, PA

² BIDMC, Boston, MA

³ Brown University, Providence, RI

Contact: Eugene Dunne, [e-mail]

Abstract

Purpose: Prior research suggests that (a) chronic pain is a common comorbidity among adults with HIV, (b) this pain is not well-managed, and (c) complementary and integrative approaches for pain management are understudied in this population. Therefore, this randomized controlled trial (RCT) examined the feasibility and acceptability of Tai Chi for adults with HIV and chronic pain.

Method(s): Adults with HIV and chronic pain were recruited from university-affiliated health clinics in the northeastern United States. Participants signed informed consent, completed a baseline survey, and were randomized to 10 weekly sessions of Tai Chi or health coaching (time-matched control). Follow-up assessments were conducted post-intervention and 3-months later. Measures included pain severity, pain interference, depressive symptoms, perceived stress, and quality of life. Feasibility metrics included participant recruitment, enrollment, attendance, and retention at follow-up. Participant satisfaction was also assessed post-intervention.

Results: Participants (N=36) were 67% female and 72% Black or African American, with a mean age of 61 (SD=7). Participants reported significant pain at baseline (range 0-10, M=7, SD=2). Attendance was bimodal, with overall attendance of 47% of sessions but increasing to 81% of sessions among participants who attended at least two sessions (n=20). The Tai Chi and health coaching groups were well received, with 84% reporting overall satisfaction and 92% would recommend the program. Participant retention was 91% at post-intervention and 88% at 3-month follow-up assessments.

Conclusions: Data from this RCT suggest feasibility to recruit and retain adults with HIV and chronic pain. Both Tai Chi and health coaching were acceptable and rated favorably. Notably, first impressions were critical, as participants who returned after their first session attended more than 80% of intervention sessions. A larger trial is needed to examine efficacy of Tai Chi for pain management among adults with HIV.

P05.16

Feasibility and Patient Perceptions of a Telehealth Mindfulness-Based Intervention after Lumbar Spine Surgery

Carrie Brintz¹, Amir Abtahi¹, Shannon Block¹, Stephen Bruehl¹, Erin Connors¹, Rogelio Coronado¹, Rishabh Gupta², Roisin O'Donnell¹, Michelle Pearce¹, Geneva Polser-Crabtree³, Amanda Priest¹, Bethany Rhoten⁴, Jacob Schwarz¹, Byron Stephens¹, Sarah Whitaker⁵, Scott Zuckerman¹, and Kristin Archer¹

¹ Vanderbilt University Medical Center, Nashville, TN

² University of Minnesota Medical School, Minneapolis, MN

³ University of Denver, Denver, CO

⁴ Vanderbilt University, Nashville, TN

⁵ Virginia Commonwealth University School of Medicine, Richmond, VA

Contact: Carrie Brintz, [e-mail]

Abstract

Purpose: Up to 40% of patients undergoing lumbar spine surgery experience persistent back and/or leg pain after surgery. This preliminary study evaluated the feasibility and patient perceptions of a telehealth mindfulness-based intervention (MBI) for chronic pain delivered following elective lumbar spine surgery.

Method(s): A prospective, cohort study was undertaken of 23 adults scheduled for elective lumbar spine surgery due to a degenerative spine condition at an academic medical center. The MBI was modeled on Mindfulness-Based Cognitive Therapy for Chronic Pain and included 8 weekly, 75-minute telehealth sessions. Sessions were delivered one-on-one by a trained facilitator and completed within 12 weeks of hospital discharge. Participants completed a post-intervention satisfaction survey and semi-structured interview about their perceptions of the overall MBI and its components.

Results: 12 (52%) of participants (58% female, mean age 54 years, 100% non-Hispanic, 83% White) completed the intervention, survey and exit interview. Participants rated the MBI as helpful to overall surgical recovery (M=8.1 out of 10, SD=2.0), and as important for improving pain intensity (M=4.0 out of 5, SD=1.0), pain bothersomeness (M=4.4/5, SD=1.0), physical wellbeing (M=4.7/5, SD=0.9), emotional wellbeing (M=4.9/5, SD=0.3), and need to take pain medications (M=3.9/5, SD=1.0). Qualitative analyses indicated positive perceptions of the MBI and its components, with themes identified such as: 1) mindful movement: more emphasis and earlier in the program; 2) home practice: too much assigned after return-to-work; 3) reduced reactivity to pain; and 4) reduced fear of movement.

Conclusions: A telehealth MBI was acceptable to patients recovering from lumbar spine surgery and qualitative methods identified patient-driven adaptations to optimize acceptability. Participants reported pain-related and other recovery-related benefits. A pilot randomized trial comparing the refined MBI to education control is currently underway.

P05.17

Implementation of Virtual Yoga Therapy Shared Medical Appointments (SMA) At Academic Medical Center within Mixed Diagnosis Oncology Population

Michelle Loy¹ and Lisa Tatham²

¹ Integrative Health/Weill Cornell Medical/NYP Hospital, New York, NY

² New York Presbyterian Hospital, New York, NY

Contact: Michelle Loy, [e-mail]

Abstract

Purpose: Yoga is widely desired by patients, endorsed by US/European oncology clinical practice guidelines, valued by National Cancer Institute; yet access barriers remain. Virtual Integrative Oncology SMAs are cost/time-efficient and increase access to care. Virtual Yoga SMAs piloted with oncology population at academic medical center to assess feasibility and acceptability.

Method(s): Recruitment via referrals, flyers, and hospital events page. Trauma-informed Hanna Somatic yoga teacher and integrative medicine physician co-led yoga SMAs weekday afternoons via web conferencing. Content: Conscious self-regulating practices including breathing, movement, visualization, meditation, chanting, guided relaxation. Audio/video links provided for home practice. Pre/Post survey assessment.

Results: 71 SMA sessions 3/11/21-8/17/23. 60 unique participants; 363 total visits. Average age: 62 years (range: 18-93; SD 15) Gender: 82% Female, 18% Male. Ethnicity: White 72% Asian 15% Black 7% Hispanic 3% Primary Residence: Manhattan 41%, Bronx/Brooklyn/Queens 21%, Suburbs/Upstate 20%, Harlem/Chinatown 8% NJ/CT 8%. Attendance 2-10 participants; mean/median 5. Attendance: 1 session (37%); 2-6 sessions (37%), 7-17 sessions (18%); >22 sessions (8%). Diagnoses: Cancer (77%), Anxiety/Depression (38%), Pain (38%), Cardiovascular (32%), Osteoarthritis (15%), Osteoporosis (15%). Pre-series concerns: anxiety, pain, weakness, neuropathy, lymphedema, sleep, fatigue. Post-series reports: improvements in anxiety/fear, pain, fatigue, sleep, neuropathy, brain fog, isolation, weakness, flexibility, balance. Changes incorporated into daily routine reported: mindfulness, breathing techniques, somatic skills, weight training, yoga. 86% reported goals met/recommend program. 57% preferred telehealth, 42% hybrid, 0% in-person. Participants appreciated new skills, community, remote delivery, instructors.

Conclusions: Virtual yoga SMA among mixed diagnosis oncology population is feasible and acceptable. RCT with longer follow-up recommended.

P05.18

Integrating Whole-body Hyperthermia and Cognitive Behavioral Therapy in the Treatment of Depression: Results from the HEATBED Study

Ashley Mason¹, Charles Raison², Wendy Hartogensis⁶, Chelsea Siwik³, Leena Pandya¹, Rhonda Patrick⁴, Patty Moran¹, Osnat Lupesko-Persky⁵, Anoushka Chowdhary⁶, Claudine Anglo⁵, Stefanie Roberts¹, Christopher Lowry⁷, and Rick Hecht⁵

¹ University of California San Francisco, Osher Center for Integrative Health, San Francisco, CA

² University of Wisconsin-Madison, Madison, WI

³ Cleveland Clinic, Department of Wellness & Preventative Medicine, Cleveland, OH

⁴ FoundMyFitness, San Diego, CA

⁵ University of California San Francisco, San Francisco, CA

⁶ University of Arizona, Department of Psychology, Tucson, AR

⁷ University of Colorado Boulder, Boulder, CO

Contact: Ashley Mason, [e-mail]

Abstract

Purpose: There is a pressing need for effective treatments for major depressive disorder (MDD). Current treatments have important limitations in efficacy and, in the case of medication, substantial side-effects. There is thus a compelling need for additional effective, well-tolerated treatments. We examined the feasibility, acceptability, and initial efficacy of an integrated mind-body MDD treatment combining cognitive behavioral therapy (CBT) and whole-body hyperthermia (WBH).

Method(s): In this single-arm trial, 16 adults with MDD were assigned to receive 8 weekly CBT sessions and either 8 weekly or 4 bi-weekly (every other week) WBH sessions. We assessed pre-post intervention changes in depression symptoms using the Beck Depression Inventory-II (BDI-II) and MDD response using structured clinical interviews. We assessed changes in mood and cognitive processes using the Brief Mood Introspection Scale (BMIS), the Automatic Thoughts Questionnaire-Revised, and the Cognitive Flexibility Inventory. We also assessed early treatment responses and their predictive value.

Results: Among 4 participants who withdrew, 2 cited time requirements as unfeasible. For the 12 completers, the average pre-post-intervention BDI-II reduction was 15.8 points (95% CI: –0.97, –9.70), p<0.0001, with 11 no longer meeting MDD criteria. Thirteen participants (81.3%) completed > 4 WBH sessions. We observed statistically significant improvements in negative automatic thinking; improvements in cognitive flexibility did not achieve statistical significance. Improved mood from pre-post the initial WBH session predicted pre-post treatment BDI-II change (36.2%; rho=0.60, p=0.038); mood changes pre-post the first CBT session did not.

Conclusions: An integrated mind-body intervention comprising CBT and WBH showed promise in MDD treatment. Improved mood pre-post the initial WBH session predicted treatment response. Results warrant future research with larger sample sizes and control conditions.

P05.19

Mind-Body Interventions for Youth with Chronic Medical Conditions: A Systematic Review of the Literature

Roshini Srinivasan¹, Molly McVoy², Mandy Neudecker³, Mina Kumari Divan⁴, Amy Wu⁴, Michelle Cascio⁵, Jeffery Dusek⁶, and David Miller⁷

¹ University Hospitals Connor Whole Health, Durham, NC

² Department of Psychiatry, Case Western Reserve University School of Medicine; Division of Child Psychiatry, University Hospitals of Cleveland, Cleveland, OH

³ University Hospitals Rainbow Babies and Children's, Cleveland, OH

⁴ University Hospitals Cleveland Medical Center, Cleveland, OH

⁵ Tennessee Department of Health, Nashville, TN

⁶ University of California - Irvine, Irvine, CA

⁷ UH Connor Whole Health, Cleveland, OH

Contact: Roshini Srinivasan, [e-mail]

Abstract

Purpose: Mind-Body Interventions (MBIs) encompass therapeutic practices such as meditation, yoga, tai chi, imagery, and biofeedback. MBIs have been shown to benefit patients with pain, cancer, and psychiatric conditions. However, little is known about the applicability, utilization, and effectiveness of MBIs for conditions that are not predominantly pain, neoplastic, or psychiatric in nature, particularly in pediatric patients. This systematic review describes the research pertaining to MBIs in children with a non-pain, non-cancer, non-psychiatric-predominant chronic medical condition.

Method(s): Searches of CINHL, Cochrane, Central, SCOPUS, and MEDLINE were conducted through PubMed for research investigating MBIs in children under 18 years old with non-pain, non-cancer, non-psychiatric predominant chronic medical conditions. Articles published between 2010 and 2020 were included. Abstracts were screened by three authors for inclusion, and disagreement was resolved by a designated author. Selected full-text articles were divided among all authors for review.

Results: Our search yielded 1010 titles with 15 meeting final inclusion criteria, studying a total of 641 children. Table 1 shows study and intervention characteristics. Study participants ranged in age from 6 to 19 years (however, some included studies had <18 years data reported separately); 61.5% were female (n=394). All included studies were interventional MBIs. The two most common conditions studied were asthma and irritable bowel syndrome, with yoga being the most popular intervention. Overall, MBIs showed promising preliminary evidence for improving symptoms and quality of life in children with chronic medical conditions.

Conclusions: MBIs have been successfully delivered and show promise in symptom palliation and quality of life improvement for children with a variety of chronic medical conditions. More data from high-quality randomized controlled trials are needed to further characterize the effectiveness of specific MBIs for specific conditions.

P05.20

Yoga and Meditation for Menopausal Symptoms in Breast Cancer Survivors: A Qualitative Study Exploring Patients’ Experiences

Mirela-Ioana Bilc¹, Nina Pollmann¹, Analena Buchholz¹, Romy Lauche², and Holger Cramer³

¹ University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

² Southern Cross University, Lismore, New South Wales, Australia

³ University of Tübingen, Stuttgart, Baden-Wuerttemberg, Germany

Contact: Mirela-Ioana Bilc, [e-mail]

Abstract

Purpose: Breast cancer survivors commonly experience menopausal symptoms, specifically when undergoing antihormonal therapy. Unfortunately, these women often have a restricted range of treatment options available to alleviate menopausal symptoms. The objective of this qualitative study was to explore patients’ experiences and effects of a yoga and meditation intervention.

Method(s): This qualitative study was embedded in a larger randomized controlled trial which evaluated the efficacy and safety of a 12-week yoga and meditation intervention on menopausal symptoms in breast cancer survivors. To this end, semi-structured interviews were conducted following the yoga intervention.

Results: Nine women were interviewed and the following themes emerged: 1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention (at emotional, physical, behavioral, spiritual level); (4) differences between the study yoga intervention and other physical activities.

Conclusions: This study provides a unique perspective into breast cancer survivors’ experiences following a traditional yoga and meditation intervention. Consistent with previously reported RCT findings, this study shows that yoga may represent a promising complementary intervention addressing menopausal symptoms in breast cancer survivors. Additionally, it informs future studies regarding aspects such as the importance of extending outcome measures beyond specific cancer-related complains, the advantages of addressing homogenous groups (i.e. breast-cancer specific) rather than cancer patients in general or considering that different intervention components might need different scaffolding to encourage long-term use.

P05.21

Pre-Operative Meditation Education and Adoption of Meditation Practice Hastens Resolution of Postoperative Pain After Breast Cancer Surgery

Anusha Wijeyakumar¹, Heather Macdonald², and Joni Ladawn Ricks-Oddie³

¹ Hoag Hospital, Newport Beach, CA

² Hoag, Irvine, CA

³ UCI, Irvine, CA

Contact: Anusha Wijeyakumar, [e-mail]

Abstract

Purpose: To determine the impact of newly adopted meditation practice on peri operative pain among newly diagnose breast cancer patients undergoing breast cancer surgery.

Method(s): Twenty-six women with newly diagnosed breast cancer and no previous regular mediation practice were enrolled in a feasibility trial of pre-operative meditation education intervention. Study participants were given two five-minute pre-recorded guided meditations at a preoperative meditation induction and coaching session. Morning meditation focused on breathwork for pain management, increased energy and stress reduction. Evening meditation focused on a guided visualization to promote deeper relaxation and rest. Patients were followed for twelve post operative weeks with daily pain logs, medication logs and meditation logs. Rates of adoption of meditation practice and impact on post operative pain were analyzed.

Results: At time of breast cancer diagnosis, twenty patients completed a preoperative meditation education and were inducted into a daily practice. At twelve weeks post breast cancer surgery, fourteen patients maintained a regular meditation practice, three had stopped meditating, three were lost to follow up or dropped out of the study due to additional surgery required. Among the patients who reported ongoing regular meditation practice, minutes spent in daily meditation positively correlated with return to preoperative baseline pain scores.

Conclusions: A preoperative meditation intervention at time of breast cancer diagnosis results in increased adoption of sustained meditation practices and was associated with faster recovery from post operative pain at twelve weeks after breast cancer surgery.

P05.22

Reiki Certification: A Novel Approach of Blended Learning and Interprofessional Education for Healthcare Providers

Lisa Squires¹, Kerri Crowley¹, Allison Moomaw¹, Tonia Kulp, Maria Mascarenhas¹, and Maureen Heil¹

¹ Children's Hospital of Philadelphia, Philadelphia, PA

Contact: Lisa Squires, [e-mail]

Abstract

Purpose: Reiki is widely utilized as a non-pharmacological method for decreasing pain and anxiety, increasing comfort and supporting healing. Traditionally, it is taught by Reiki Master Teachers, who may not have a healthcare background. Classes are several days long and expensive. After seeing patient benefits, inpatient staff contacted us to provide training. Aims: To increase the number of trained Reiki providers, decrease training costs and allow participants to pace their learning.

Method(s): An interprofessional team collaborated to develop Reiki level 1 and 2 courses. The initial education pilot was taught in-person in two-hour classes over the course of four weeks. Due to scheduling challenges, the training was changed to a blend of computer-based learning and reflection followed by in-person attunement and practice. Course included a participant guide, reflection exercises, videos and references. User feedback allowed refinement of the course. The course is offered to staff members and has been adapted for patients' families and caregivers.

Results: Since May 2023, 4 level 1 and 4 level 2 classes were scheduled with 23 completers. Classes in 2024 are available. The family program was released on September 12, 2023, and 2 families participated as part of pilot testing. Participants reported that they would be more likely to refer their patients for integrative health services and would offer Reiki to their patients as part of comfort care on a routine basis. All felt the course met their expectations and they felt well prepared to offer Reiki to patients and colleagues. Staff received 8.0 contact hours for their participation.

Conclusions: Reiki can be successfully taught in a blended learning model to healthcare providers, increasing the availability of trained staff in the hospital. Family members are interested in learning Reiki to help their children and family.

P05.23

Relationship Between Melanoma Location and Reported Emotional Trauma as an Expression of the Mind-Body Connection in Cutaneous Melanoma Patients

Aneta Lazarov¹, Dawson Church², and Yael Benyamini³

¹ Dermatology Clinic for early detection of skin cancer, Herzelya, HaMerkaz, Israel

² National Institute for Integrative Healthcare, Fulton, CA, USA, Fulton, CA

³ Bob Shapell School of social Work, Tel Aviv University, Tel Aviv, HaMerkaz, Israel

Contact: Aneta Lazarov, [e-mail]

Abstract

Purpose: To investigate a possible connection between emotional trauma and the location of cutaneous melanoma on the meridian system of Traditional Chinese Medicine.

Method(s): Melanoma (MM) survivors received short tutoring on the link between emotions and meridians as described in literature including the main meridians with their associated emotions. Then they were asked to describe traumatic events in their lives, which in their opinion could be relevant to melanoma development. Clinical data, reported felt emotions, and mapping of MM on the skin meridians were recorded. The emotional issues described by the patients were compared with the meridian’s associated emotions at the site of MM location.

Results: Fifty-two melanoma patients (67.3% females and 32.7% males) with MM in situ (42,3%) and Breslow thickness up to 1,1 mm (57.7%) were included. The most frequent location of MM on the meridians included the Bladder (30.8%), Tripple Energizer (15,4%), and Large Intestine, Stomach, and Gallbladder Meridians (11.5% each). The most commonly reported emotions in the context of a significant traumatic event possibly related to MM were anger (19.6%), frustration (17.5%) sadness (14.3%) and fear (8.2%). A positive meaningful correlation between the patient’s felt emotions and the meridian’s associated emotions at the site of MM location was found in 82.7% of the cases.

Conclusions: Our study shows the existence of an association between patients’ felt emotions and the precise MM location as mapped on the corresponding meridians. This points out the possible significance of traumatic events and felt emotions as triggering cofactors in the multifactorial development of the patient’s cancer disease. Consequently, a holistic approach including acknowledgement of emotional trauma is needed in the management, treatment, and prevention of MM.

P05.24

Spiritual Experience and Interoceptive Awareness in a Study of Mindful Awareness in Body-Oriented Therapy for People in Opioid Use Disorder Treatment

Megan Sherman¹ and Cynthia Price²

¹ University of Washington, Bellingham, WA

² University of WA, Seattle, WA

Contact: Megan Sherman, [e-mail]

Abstract

Purpose: Studies indicate that spiritual experience and interoceptive awareness are associated with improvements in substance use disorder treatment. However, the relationship between personalized spiritual experience, interoceptive awareness, and substance use recovery are poorly understood. This clinical case study characterizes spiritual experiences of participants in a NIH-funded RCT for people in medication treatment for opioid use disorder (MOUD). This project examined Mindful Awareness in Body-oriented Therapy (MABT), a mind-body intervention that teaches and develops the capacity for interoceptive awareness to improve self-awareness and emotion regulation. The role of MABT in facilitating these spiritual experiences, and implications for the relationship between interoceptive awareness and spiritual experience in SUD treatment are explored, based on four clinical case vignettes.

Method(s): Of the 303 participants in this study, 142 were assigned to receive the MABT intervention. Measures included the Multidimensional Assessment of Interoceptive Awareness (MAIA); and 2 items from the Nondual Awareness Dimensional Assessment (NADA) scale specific to spiritual experience during MABT sessions. Descriptive statistics and results from linear mixed model were used to report these results. Content analysis was used to examine transcripts of digitally recorded MABT sessions for analysis of the clinical vignettes.

Results: There was a significant increase in interoceptive awareness (p<.001) for MABT vs. control, and 93% positively endorsed spiritual experience during MABT sessions. Five thematic groupings characterize spiritual experiences in a sub-set of participants who received the MABT intervention, including Experiencing Wholeness, Awakening Inner Knowing, Animas (true nature), My Body is Nurturing Me, and This is Healing.

Conclusions: High endorsement of spiritual experience with related themes that emerged in intervention sessions, suggest a synergistic relationship between spiritual experience and the processes of learning interoceptive awareness. MABT appears to play a role in facilitating spiritual experiences, which may strengthen MABT effects for those engaged in MOUD.

P05.25

Supported Biopsychosocial Self-Management for Back-Related Leg Pain: The Support Feasibility Trial

Brent Leininger¹, Roni Evans², Carol Greco³, Linda Hanson², Michael Schneider³, Craig Schulz², and Gert Bronfort²

¹ University of Minnesota, Wanamingo, MN

² University of Minnesota, Minneapolis, MN

³ University of Pittsburgh, Pittsburgh, PA

Contact: Brent Leininger, [e-mail]

Abstract

Purpose: Nearly a third of those with back pain develop back-related leg pain (BRLP), which is associated with greater pain severity and poorer quality of life. Chronic BRLP is complex, influenced by interrelated physical, psychological, and social factors. While guidelines advocate several complementary modalities for chronic LBP, there is little high-quality research on treatments for BRLP, especially ones that promote healthy pain management behaviors. The purpose of this project was to conduct a pilot study to assess the feasibility of a future multi-site randomized clinical trial comparing an individualized, whole person, behavioral targeted approach for self-management of chronic BRLP to guideline informed medical care.

Method(s): Feasibility was assessed using prespecified goals for recruitment and enrollment (number/month, % female, % minorities), intervention acceptability and credibility (% not receiving treatment, % satisfied, % receiving prohibited treatments), participant adherence to interventions (visit attendance, home practice or medication adherence), provider fidelity (protocol adherence at study visits), and data collection (% completing monthly and weekly surveys on time).

Results: A total of 42 participants were enrolled and completed study interventions. Adverse events possibly related to study interventions were minimal and expected. Adherence to study interventions was high in both groups (>90%) as were data collection rates (90% for monthly and 86% for weekly measures). All pre-specified feasibility goals were exceeded except for minority enrollment (20% actual vs 25% goal). The SBSM intervention also met important behavioral needs with high percentages of participants noting the program met their individual capability, opportunity, and motivational needs for engaging in self-management behaviors.

Conclusions: We demonstrated feasibility for a trial of a novel individualized, whole person, behavioral targeted approach for the self-management of chronic BRLP.

P05.26

The Association Between Stressful Life Events and the Occurrence of Skin Cancer

Yael Benyamini¹, Noa Shidlo², and Aneta Lazarov³

¹ Bob Shapell School of social Work, Tel Aviv University, Tel Aviv, HaMerkaz, Israel

² Tel Aviv University, Tel Aviv, HaMerkaz, Israel

³ Dermatology Clinic for early detection of skin cancer, Herzelya, HaMerkaz, Israel

Contact: Aneta Lazarov, [e-mail]

Abstract

Purpose: To investigate the link between skin cancer occurrence and stressful life events (SLEs) in childhood and adulthood and the impact of resource losses/gains following significant SLEs, based on the Conservation of Resources Theory.

Method(s): The study involved 268 participants, primarily female (64%), recruited from a skin cancer detection clinic. These participants fell into three groups: 87 had a history of melanoma, 80 - a history of non-melanoma skin cancers (BCC/SCC), and 101 - at risk for skin cancer (the "control" group). Demographics were similar, except for the control group, which was slightly younger (average age 62±13) compared to the cancer groups (average age 67±11). Participants completed questionnaires, covering demographics, skin cancer risk factors, childhood life events (adverse events and SLEs before age 18), SLEs after age 18, and resource losses/gains following the most significant adult SLE.

Results: The melanoma group reported more SLEs in both childhood and adulthood compared to the other groups. After adjusting for age and skin cancer risk factors, only the difference in childhood events was significant. Multinomial regression showed a 36% higher melanoma risk compared to the control group for each additional childhood event. Loss of resources following the most significant adulthood SLE significantly increased melanoma risk (aOR = 1.61, p < .01), while resource gains were marginally associated with a decrease in risk (OR = 0.77, p = .059). Resource loss mediated the childhood events and cancer occurrence association, but only in the melanoma group (Estimate = 0.07, SE = 0.03, p = 0.02).

Conclusions: Stressful and adverse childhood events may have lasting effects into adulthood, increasing melanoma skin cancer risk directly and indirectly by making it more challenging to cope with SLEs in adulthood. This underscores the importance of including trauma management, stress reduction education, and self-regulation techniques facilitating coping with SLEs in cancer prevention.

P05.27

The Impact of Loving-Kindness Meditation on Psychological Functioning and Quantitative EEG: A Comparative Study of Experienced and Non-Meditators

Jason Yuan¹, Glenn Mendoza², and Marianne Chung³

¹ Pranic Healing Research Institute, Jersey City, NJ

² Pranic Healing Research Institute, Paramus, NJ

³ Pranic Healing Research Institute, Atlanta, GA

Contact: Glenn Mendoza, [e-mail]

Abstract

Purpose: Meditation on Twin Hearts (MTH) is a metta meditation practiced worldwide. MTH focuses on the activation of energy centers to elicit expansion of consciousness. The study evaluates the effects of MTH on subjects’ self-reported psychological functioning, P300 responses, and sLORETA patterns in specific brain regions.

Method(s): A 19-electrode quantitative EEGs from twelve (12) novice and twelve (12) experienced meditators (over 1000 hours of MTH) were collected and assessed. Brumel Mood Scale and State Anxiety Inventory; P300 metrics to assess brain cognitive functioning (speed and power of brain response to an external stimulus) were collected.

Results: The differences in pre-meditation levels of anxiety, happiness, calmness, and coping self-efficacy suggest that experienced meditators may manage difficulties in their lives better. Also, the decreases in anxiety following MTH for both groups suggest that MTH is a potentially effective anxiety management tool for meditators of any experience level. The novice group reported significant increases in happiness following MTH while experienced meditators did not likely due to the ceiling effect from baseline scores.

At the anterior cingulate cortex (ACC), experienced meditators increased gamma waves at all points compared to novice meditators. At the right insula area involved in emotion and increased lovingkindness showed a similar pattern to that of ACC. At the posterior cingulate cortex, novice meditators showed increase in alpha1 activity. Experienced meditators showed decreased alpha1 activity implying that their minds are active and focused. Stronger P300 responses in experienced meditators reflect improved cognitive function.

Conclusions: MTH may be a beneficial practice in improving emotional regulation and cognitive functioning by reduced anxiety, increased happiness, and better coping self-efficacy through the activation of different brain regions and stronger P300 responses.

P05.28

The Protective Role of Body Responsiveness in the Relationship Between Pain Intensity and Depression

Hallie Tankha¹, Devyn Gaskins¹, and Amanda Shallcross¹

¹ Cleveland Clinic, Cleveland, OH

Contact: Hallie Tankha, [e-mail]

Abstract

Purpose: Chronic pain is extremely common and causally linked with depression, which is up to 3 times more common in people with chronic pain. While mind-body treatments are effective for treating pain, many are not widely accessible. Thus, identifying self-regulatory strategies for coping with pain is needed to help people who do not have access to treatment. Body responsiveness (BR) is a self-regulatory strategy that involves awareness of body sensations, including pain, and responding to these sensations with deliberate and adaptive vs. impulsive and avoidant behaviors. We explored the moderating role of BR in the relationship between pain and depression.

Method(s): A racially and ethnically diverse sample of healthy adults (n = 388) completed surveys on pain, depression, and body responsiveness (33.5% Black/non-Hispanic, 32.2% Hispanic, and 34.3% White). The sample was 71.4% female with a mean age of 32.7 (SD = 10.9). The current study explores the moderating role of BR (Body Responsiveness Questionnaire) in the relationship between pain intensity (PROMIS Pain Intensity) and depressive symptoms (Beck Depression Inventory – II).

Results: BR significantly moderated the relationship between pain intensity and depressive symptoms (b = -.01, p = .03). Simple slopes analyses revealed that at both low and high levels of BR, higher pain intensity was associated with higher depressive symptoms (low BR: b = 0.41, p <.001; high BR: b = 0.2539, p <.001). However, the slope was less steep for high BR, indicating that participants higher in BR reported lower levels of depressive symptoms across low and high pain intensity.

Conclusions: We present a novel finding that supports that BR may act as a protective factor in the relationship between pain intensity and depressive symptoms in a large racially and ethnically diverse sample. Results highlight the importance of self-regulatory strategies to manage pain and may also inform intervention adaptation/development for individuals with chronic pain and depression.

P05.29

The Shape of Pain: Mixed-Methods Assessment of an 8 Week Phone App-Based Attention Practice to Manage Chronic Low Back Pain

Wolf Mehling¹, Irina Strigo², Veronica Goldman¹, Wendy Hartogensis¹, Shelley Adler³, and Rick Hecht¹

¹ UCSF, San Francisco, CA

² UCSF, San Francisco Veterans Affaires Medical Center, San Francisco, CA

³ University of California San Francisco School of Medicine, San Francisco, CA

Contact: Wolf Mehling, [e-mail]

Abstract

Purpose: People commonly cope with chronic low back pain (cLBP) by ignoring and distraction. Can a mindful interoceptive exposure to the sensation of pain itself and its phenomenological components be an alternative approach?

Method(s): We performed a single-arm feasibility study in patients with cLBP using a 2-minute attention exercise guided by a smartphone app several times per day over 8 weeks. We assessed feasibility, pre-post pain, function and psychological parameters by standard questionnaires and EMA. We used reflexive thematic qualitative analysis for exit interviews that included micro-phenomenology technique (Petitmengin).

Results: Screened 301 patients, 38 eligible/consented, 31 enrolled, 29 completed, mostly female, mean age 48, majority pain for >5 years. Mean pain intensity improved from 4.8 ±1.7 to 3.1 ±1.9 (p <.001); mean PEG score (intensity and interference with daily life; range 0-30) 13.7 ±6.2 to 8.4 ±6.6 (p <.001); pain impact (9 items incl physical function) 22.3 ±8.7 to 19.7 ±8.1 (p =.004). 21 of 29 improved PEG score >30%. There were significant improvements in PCS Rumination and MAIA Not-Worrying. Participants became aware of their usual habit of avoidance and the challenge of and resistance to focusing attention on pain. They were surprised how their pain sensations varied over time, and that pain intensity could change by focusing on it. They described a variety of 3D pain shapes (football, pool ball, rod, nail, brick, stars ...) with a variety of colors, transparency, temperature, and density that for some changed dramatically with a mindful attention focus. Most struggled to find appropriate words for how they regulated their attention, reported on using regulation of breathing, and--importantly--found that the threat value of their pain diminished.

Conclusions: Mindful interoceptive exposure to the sensations of their cLBP using a simple 2-minute attention exercise with a phone app—rather than ignoring and distracting from it—may be a beneficial intervention for cLBP.

P05.30

Transcendental Meditation Reduces Burnout and Enhances Resilience among Georgetown University Medical Students

Chloé Jammes¹, Isaac Heiman², and Hakima Amri³

¹ Baystate Medical Center, Springfield, MA

² Georgetown University Medical Center, Washington, DC

³ Georgetown University, Washington, DC

Contact: Hakima Amri, [e-mail]

Abstract

Purpose: Studies comparing matriculating medical students to similar-age college graduates indicate that medical students had lower rates of burnout prior to entering medical school. These findings support concerns that the training process and environment contribute to the deterioration of mental health. Transcendental Meditation (TM) has been shown to reduce burnout and stress. To date, no data have been published on the benefits of TM for medical students. Our objective was to assess the efficacy of TM practice in reducing burnout and increasing resilience among medical students.

Method(s): Forty-two medical students enrolled and 39 completed the TM training, practice, and follow-up assessments with the recommended regimen of meditating for 20 minutes twice a day. Measures of burnout, depression, anxiety, insomnia, well-being, and resilience, of which burnout and resilience were the primary outcomes, were collected.

Results: Significant changes were found at 3 months for both MBI emotional exhaustion (14.85, 95% CI 1.67 to 5.46, p = 0.001) and resilience (3.73, 95% CI 0.14 to 0.57, p = 0.002). Increases in scores for personal accomplishment were not significant. Reductions with effect sizes (ES) for emotional exhaustion (Cohen’s d = -0.61), anxiety (Cohen’s d = -0.71), and insomnia (Cohen’s d = -0.53), as well as increased resilience (Cohen’s d = 0.53), at three months were observed. There was a significant correlation between meditation frequency and the 3-month change in MBI emotional exhaustion (r = -0.477, p = 0.002), suggesting a dose effect. Other significant relationships with meditation practice frequency were found for MBI depersonalization (r = -0.388, p = 0.015), depression (r = -0.319, p = 0.048), anxiety (r = -0.394, p = 0.013), and insomnia (r = -0.493, p = 0.001).

Conclusions: This is the first study to use TM among medical students. These preliminary results suggest that future implementation of this practice will have health benefits that will help students cope with the academic stress.

P05.31

Virtual Reality and Its Psychological Effect on Cancer Patients in Rehabilitation

Meredith Peng

University College London, Nanjing, Jiangsu, China

Contact: Meredith Peng, [e-mail]

Abstract

Purpose: Rehabilitation plays a significant role during the whole treatment of cancer patients since people with cancer tend to have impaired immune systems after undergoing chemotherapy or other surgeries. Besides common strategies such as taking specific medicine, the mental support of cancer patients also needs to be paid attention to. Virtual reality technology, including immersive and non-immersive VR, has been introduced to intervene during the treatment of cancer patients by presenting ideal environments and scenarios. It has been shown that the VR technology acts as a distraction tool in relieving fear and pressure in several painful procedures for cancer patients. However, the psychological effect of virtual reality which turns into positive hints that patients given to themselves shouldn’t be ignored. This paper offers a narrative review of how virtual reality is used to enhance the perceived self-efficacy of cancer patients themselves and discusses the potential possibilities of combining virtual reality and regenerative therapy in rehabilitation using current existing research.

Method(s): By using around 30 typical researches on Pubmed from 2019-2023 about virtual reality and rehabilitation.

Results: Existing research’s focus on the impact of VR on the management of physical rehabilitation and negative emotions. Yet, more research needs to be carried out to investigate how VR can be designed to trigger the positive emotions including motivation and bravery of cancer patients to conquer the disease.

Conclusions: Although the existence of a wide range of studies have shown VR has a positive effect on the perceptivity and physical qualities of cancer patients, more innovation focused on inner body perception can be introduced in designing the contents of VR in combine with mental therapies for people with cancer.

P05.32

Yoga Among Men and Women: Barriers and Motivators Across Practitioner Status in a COVID-19-Altered Landscape

Camille Garnsey¹, Katherine Gnall¹, and Crystal Park²

¹ University of Connecticut, Storrs, CT

² Department of Psychological Sciences, University of Connecticut, Storrs, CT

Contact: Camille Garnsey, [e-mail]

Abstract

Purpose: Despite the many health benefits of yoga, estimates suggest that only 9% of Americans have practiced in the past year. The vast majority (75%) of these practitioners are women. Some previous research has examined barriers and motivators for yoga practice, but men are frequently under-represented in these studies, limiting our understanding of gender differences of gender-specific factors preventing engagement. This study examines barriers and motivators among men and women across the spectrum of practitioner status (regular, infrequent, and non-practicing), and also explores potential shifts in yoga practice subsequent to the COVID-19 pandemic.

Method(s): 351 undergraduate students, split evenly by gender, completed an online survey in April of 2022. Data are disaggregated and results are presented across gender and practitioner status.

Results: Seventy-nine percent (79%) of men and 57% percent of women reported no yoga practice in the past six months. Among men who did not practice yoga, lack of interest was the primary barrier to engagement (47%), followed by a preference for other forms of exercise (22%), and a lack of time (20%). For women who did not practice, lack of time was the primary barrier (47%), followed by a lack of interest (20%), and a preference for other forms of exercise (11%). Across practitioner status, women tended to cite more emotional/mental health motivators for engaging in yoga practice, while men were more likely to cite physical fitness/health motivators. Although 41% of individuals who reported practicing yoga in the past six months had started practicing during/after the pandemic, few shifts in mode of practice were reported in relation to COVID-19.

Conclusions: While men and women cited similar barriers and motivators to yoga practice, differences were observed in the factors that were most salient for each group. Findings can inform the creation of targeted interventions to address barriers and increase engagement in yoga generally, but particularly among men.

P05.33

Mind-Body Therapies from Traditional Chinese Medicine: Evidence Map

Lissandra Zanovelo Fogaça¹, Caio Portella², Ricardo Ghelman³, Carmem Veronica Mendes Abdala⁴, and Mariana Cabral Schveitzer⁵

¹ ESCOLA PAULISTA DE MEDICINA - UNIVERSIDADE FEDERAL DE SÃO PAULO, São Paulo Brazil., São Paulo, Sao Paulo, Brazil

² Brazilian Academic Consortium for Integrative Health, São Paulo, Sao Paulo, Brazil

³ CABSIN, Sao Paulo, Sao Paulo, Brazil

⁴ BIREME/OPAS/WHO, Sao Paulo, Sao Paulo, Brazil

⁵ UNIFESP and CABSIN, São Paulo, Sao Paulo, Brazil

Contact: Ricardo Ghelman, [e-mail]

Abstract

Purpose: Mind-body therapies consider the interactions between the brain, mind, body, and behavior and understand that emotional, mental, social, and spiritual factors can directly affect health. Tai Chi and Qi Gong are recognized for their physical and mental health benefits and stress relief. Evidence Maps (EM) demonstrates quality assessment, interventions' effects, and health outcomes.

Method(s): We used the 3iE Evidence Gap Map methodology. The (P) general population, (I) Mind-Body therapies from Traditional Chinese Medicine, (C) no comparator, and (O) health-related outcomes guided the search on seven databases until November 2019 and included systematic reviews only. The AMSTAR 2 was applied.

Results: This EM is based on 160 systematic reviews. Quality assessment was 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 outcome effects were classified: 421 as potential positive, 237 as positive, 21 as inconclusive, one as potential negative. Some reviews had more than one effect. Interventions were Tai Chi, Qi Gong, Baduanjin, Traditional Chinese Exercises, Shiatsu, and Tuina. The two most common populations were people with chronic disease and older adults. The positive effects related to chronic diseases, depression, anxiety, well-being, dementia, balance, physical function, mobility, exercise capacity, quality of life, and fall prevention. Positive potential effects were related to Parkinson’s, fibromyalgia, joint pain, and sleep quality. Inconclusive effects justify more research on Tai Chi and Qi Gong for stroke and schizophrenia. Some studies reported MBTTCM to cancer pain had no effect.

Conclusions: Gaps that justify more research were related to the heterogeneity of participants, time, frequency, and duration of interventions. This EM indicates 421 positive and promising health outcomes. EM methodology provides valuable information for patients, health practitioners, and policymakers, moreover, it demonstrates TCIM evidence-based.

P05.34LB

Work Smarter, Not Harder: Self-Care is Health-Care – Examining a Group Based Approach to Wellbeing

Theresa Van Iseghem¹ and Lei Guo²

¹ Veterans Healthcare Organization, St. Louis, MO

² VA St. Louis HealthCare System, St. Louis, MO

Contact: Theresa Van Iseghem, [e-mail]

Abstract

Purpose: The aim of this proposal is threefold. 1. To introduce a group body mind healing (BMH) protocol for foundational wellbeing, aligning with integrative health self-care goals, introducing a range of CIH offerings, & promoting personalized treatment plans through consistent, intentional self-care practices 2. To evaluate the BMH outcome data. 3. To highlight the ways real-world data (RWD) & patient report outcomes (PRO) integrated with Social Determinants of Health (SDOH) can drive personalized & proactive healthcare transformation.

Method(s): This proposal analyzed preliminary outcome data from 60 veterans who participated in the 8-week virtual wellbeing class this virtual wellbeing group between 2022-2023. Chart reviews were completed to identify specific demographic and SDOH variables. Data was analyzed by t-test and ANCOVA in SPSS.

Results: Participants exhibited clinically significant reductions to perceptions of stress (PSS scores reduced by 2.6 compared to the pre-intervention level), improved experience of wellbeing (SWEMWBS increased by 7.8 at the baseline), and fatigue scores reduced by an average of 4.9 (P < 0.1). Race impacted stress scores, with Black Veterans showing less improvement than White counterparts. Service connection and reported history of Military Sexual Trauma (MST) significantly affected pain, anxiety, and pain interference symptoms. We also found that virtual delivery of care positively conditioned veterans for continued use of self-care practices within their home, leading to more personalized self-care practices.

Conclusions: Preliminary data supports BMH reduces veteran stress, improve mental wellbeing, and promotes the intentions behind self-care wellbeing programs. RWD and PRO data can inform practitioners and stakeholders while SDOH data offers insight of mitigating outcomes. More qualitative research is needed to explore class participation's impact on continued program engagement which influence health outcomes & proactive care.

P05.36LB

Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Literature Review

Tanya Bentley¹, Gina D’Andrea-Penna¹, Marina Rakic¹, Nick Arce¹, Michelle LaFaille¹, Rachel Berman¹, Katherine Cooley¹, and Preston Sprimont¹

¹ Health and Human Performance Foundation, Los Angeles, CA

Contact: Tanya Bentley, [e-mail]

Abstract

Purpose: Stress and anxiety plague populations worldwide, placing a substantial burden on population health and healthcare systems. Voluntary regulated breathing practices, an emerging tool in integrative medicine, may help ameliorate this epidemic. We examined peer-reviewed published literature to understand how these effects vary across populations, practices, and implementation approaches and to identify criteria for optimizing outcomes.

Method(s): PubMed and ScienceDirect were searched to identify clinical trials evaluating isolated breathing-based interventions with psychometric stress/anxiety outcomes. Two independent reviewers conducted all screening and data extraction. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness.

Results: Of 2904 unique articles, 731 Abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies’ 72 interventions were effective. Effective breath practices avoided fast-only breathing and sessions <5 min, and included human-guided training, multiple sessions, and long-term practice. Not associated with effectiveness were variations in population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective.

Conclusions: We identified simple yet important criteria to guide breath practice implementation for effective stress and anxiety reduction across broad populations. Our evidence-based framework highlights the importance of slow breathing, adequate training, and continued practice for optimizing outcomes associated with this accessible, whole health strategy.

P05.37LB

Feasibility and Acceptability of Yoga for Adolescents with Juvenile Idiopathic Arthritis

Adina Dawoud¹, Jill Blitz¹, and Steffany Moonaz²

¹ Children's Hospital Los Angeles, Los Angeles, CA

² Southern California University of Health Sciences, Whittier, CA

Contact: Steffany Moonaz, [e-mail]

Abstract

Purpose: Yoga is effective for adults with arthritis but unstudied in adolescents with juvenile idiopathic arthritis (JIA), which involves lower activity and different psychosocial challenges than healthy peers. This project aimed to determine feasibility and acceptability of an 8-week group yoga intervention for adolescents with JIA.

Method(s): Participants were ages 14-18 years with diagnosed JIA, spoke and understood English, and could get on and off the floor independently. All were cleared by a rheumatologist. Each 75-minute session included breathing techniques, relaxation, mindfulness, and modified yoga postures, using assorted props and a yoga rope wall. An online video was available for home practice. Outcomes measured at baseline and 8 weeks were physician global assessment with joint count, visual assessment with a joint damage assessment index, Pediatric Quality of Life Arthritis Module 3.0 (Peds QL), and the Visual Analog Scale for pain. An anonymous satisfaction survey was administered after week 8. Descriptive statistics were used to summarize patient characteristics and Wilcoxon signed-rank tests assessed change in outcomes.

Results: Of the 25 patients who consented, 13 attended at least one class with mean attendance of 5.7±2.2 classes. Common reasons for non-enrollment included distance, schedule conflicts, and lack of interest. Average distance to classes was 29.0±41.7 miles (range 5-202 mi.). For those who attended, there was a trend toward improvement for the Pain and Hurt domain of the Peds QL (p=.16), but no other outcomes approached significance. Satisfaction data (n=8) was high in all areas, including pain improvement, program enjoyment, and likelihood of continuing yoga.

Conclusions: Adolescents with JIA who attended yoga classes reported enjoyment, pain reduction, and interest in continued practice. No adverse events were reported. Future studies should consider stakeholder engagement to understand and reduce barriers to participation, and larger sample sizes to test effectiveness.

P05.39LB

Self-Managed Complementary and Integrative Health Approaches for Chronic Pain and PTSD: A Systematic Review of Reviews

Belle Zaccari¹, Travis Lovejoy¹, Kansagara Devan², Vanessa Somohano¹, Joshua Kaplan², and Maya O'Neil¹

¹ VA Portland Health Care System, Portland, OR

² Oregon Health & Science University, Portland, OR

Contact: Belle Zaccari, [e-mail]

Abstract

Purpose: Our objective was to summarize recent, high quality systematic reviews of self-managed CIH modalities for chronic pain or PTSD.

Method(s): We registered our study with the International Prospective Register of Systematic Reviews (CRD42022369478). We conducted a literature search from October 2022-March 2023 of Ovid MEDLINE ALL, Ovid APA PsycInfo, Ovid EBM Reviews Cochrane Central Register of Controlled Trials, and EBSCOHost CINAHL Plus Full Text. Our population was adults with chronic primary pain or PTSD. We extracted search dates, sample description, number of articles and subjects, study aim, patient population, interventions, comparators, outcomes, symptom reduction, and risk of bias data.

Results: 333 titles and abstracts revealed 14 reviews of CIH for chronic pain (n=7) or PTSD (n=7) meeting our criteria. Secondary outcomes included quality of life, mood, and functioning. Chronic pain interventions included Yoga (n=3), meditation/mindfulness-based interventions (n=2), Tai Chi (n=1), and multiple CIH interventions (n=1). Comparators were other named therapies or non-specific. PTSD interventions included meditation/mindfulness-based interventions (n=3), multiple CIH interventions (n=3), and Yoga (n=1). Comparators were none, active, and non-specific. Qualitatively synthesized findings suggest that CIH works better than active and non-specific controls for pain intensity and disability related to back, neck, and knee pain with additional benefits to quality of life and functioning. CIH was superior to non-specific controls for PTSD, mood, and quality of life. In two reviews, CIH outperformed active controls for PTSD and mood. Overall, the reviews reported low strength evidence.

Conclusions: Systematic reviews of CIH interventions studied for their effectiveness on chronic pain and PTSD used mindfulness, Yoga, and Tai Chi. Future studies should include long-term follow-up. Protocolized treatments specifying duration and type of CIH interventions are needed to improve research and clinical practice.

P05.41LB

The Association Between Changes in Self-Compassion and Changes in Emotional Well-Being Following a Yoga Intervention

Camille Garnsey¹, Katherine Gnall¹, and Crystal Park²

¹ University of Connecticut, Storrs, CT

² Department of Psychological Sciences, University of Connecticut, Storrs, CT

Contact: Katherine Gnall, [e-mail]

Abstract

Purpose: An emerging body of research points to yoga’s potential to support emotional well-being (EWB), though evidence regarding the mechanisms through which mind-body interventions such as yoga improve EWB is sparse. Yoga interventions have been demonstrated to improve self-compassion (i.e., relating to oneself with mindfulness, self-kindness, and a recognition of common humanity), and higher self-compassion has also been consistently associated with greater EWB. Yet, whether yoga’s salutary effect on EWB can be explained through improved self-compassion remains unknown. The present study aims to fill this gap by examining self-compassion as a mechanism of improvement in three domains of EWB (meaning in life, sense of inner peace, and ability to pursue goals) following a yoga intervention.

Method(s): Highly stressed adults (N = 84, M_age = 39.4, 70.2 % female) participated in a 12-week Kripalu yoga intervention. Participants completed self-report measures of self-compassion and each EWB domain (i.e., meaning in life, sense of inner peace, and ability to pursue goals) at baseline and post-intervention. Standardized residuals were obtained by regressing scores from the later time point on scores from the earlier timepoint for self-compassion and each EWB outcome (e.g., T2 scores regressed on T1 scores). Pearson's r correlations were conducted between standardized residuals of self-compassion and each EWB outcome.

Results: Changes in self-compassion were positively associated with changes in meaning in life (r = .46, p = .004) and sense of inner peace (r = .54, p < .001). Changes in self-compassion were not significantly associated with changes in ability to pursue goals (r = .14, p = .42).

Conclusions: Findings suggest that changes in self-compassion are linked to changes in the EWB domains of meaning in life and sense of inner peace in the context of a yoga intervention. Results suggest emphasizing self-compassion in yoga interventions might bolster yoga’s effect on improved EWB.

P05.42LB

The Effect of Sudarshan Kriya Yoga on Oxidative Stress: A Literature Review

Dilasha Sethi¹, Mithila Vasudev², Praag Bhardwaj³, and Monika Pathania³

¹ Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore, Karnataka, India

² Division of Yoga & Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru, Karnataka, India

³ All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttaranchal, India

Contact: Dilasha Sethi, [e-mail]

Abstract

Purpose: Sudarshan Kriya Yoga (SKY), a sequential set of rhythmic yoga breathing techniques, has been shown to improve physiological, immunological, & cognitive functions among practitioners. Literature shows oxidative stress as a contributor for psychological & physiological pathologies. Thus, countering OS before disease onset can act as a preventive measure. Therefore, we reviewed the effects of SKY on OS, as a possible preventive measure for various conditions.

Method(s): A systematic search of clinical trials was conducted on PubMed, Cochrane Library, & Google Scholar for relevant studies published up to 2023. Inclusion criteria included clinical trials conducted among healthy & diseased populations undergoing SKY intervention of any duration, delivered offline/online & assessing OS-related outcomes in comparison to any intervention, standard care, or no intervention.

Results: From the literature, it is evident that OS is a common denominator in the pathophysiology of many diseases & has been the focus of many interventional studies, including SKY, which has shown significant improvements within & between comparator groups with respect to both antioxidant defense systems (antioxidant enzymes & vitamins, total antioxidant capacity & status) & OS biomarkers (OS-related gene expression, blood lactate levels, & malondialdehyde (MDA)). Nine studies (548 participants) on SKY intervention with both clinical & non-clinical populations have evidently shown a reduction in OS. One study showed greater improvements in antioxidant status with SKY intervention than with 500 mg/day of vitamin E.

Conclusions: SKY can thus play a much-needed role in prevention as well as management of different disorders by demonstrating down-regulation of OS indicators & up-regulation of antioxidant defense systems. Its potential to reduce OS can be a promising prospect for overall well-being & we thus hypothesize this as its mechanism to tackle dysfunctions in both the physical & mental planes.

P05.43LB

Using a Breath Based Intervention to Improve Burnout and Mental Health Outcomes for Healthcare Professionals

Somya Ramrakhyani¹ and Jordan Zawaydeh²

¹ Healing Breaths, Cocoa Beach, FL

² Healing Breaths, San Francisco, CA

Contact: Jordan Zawaydeh, [e-mail]

Abstract

Purpose: Due to the “crisis levels” of burnout among healthcare professionals (HCPs), low-cost, high-impact, evidence-based behavioral interventions that address burnout & associated symptoms are desired. Here, we present findings that highlight the positive impact of SKY, a breath-based intervention, on burnout & associated mental health challenges in HCPs.

Method(s): SKY was taught to 165 HCPs across various organizations between May 2022 and Jan 2024. Surveys were administered immediately before (pre) and immediately after (post) the program. The survey included measurements of Anxiety (Scale: STAI-6), Burnout (Scale: Mini-Z), Sleep Quality (Scale: Likert), and several other outcomes. Data of 107 participants were eligible for analysis. A meta-analysis of aggregate data was executed using paired t-test to obtain significance between pre- and post-intervention scores. A value of p < 0.05 was considered significant. Effect size was calculated using Cohen’s d. Means of intervention groups were compared to interpret results. Means were chosen as a measure due to no incidence of extreme outliers.

Results: The Anxiety (STAI-6) scores decreased favorably from 47.642 to 32.107 (32.61% decrease), which represents a drop from clinical levels of anxiety to normal range. Effect size was large (Cohen’s d = 1.196), and results were highly significant (p = 5.72E-16). Burnout scores increased favorably from 3.243 to 3.869 (19.308% increase), with a medium effect size (Cohen’s d = 0.726) and high degree of statistical significance (p = 1.641E-07). Sleep scores increased favorably from 4.056 to 4.972 (22.51% increase), with a low approaching medium effect size (Cohen’s d = 0.498) and high degree of statistical significance (p = 0.000169).

Conclusions: SKY positively impacts Anxiety, Burnout, and Sleep Quality with moderate to large effect sizes and high statistical significance in HCPs. It can therefore be considered a high-impact intervention for anxiety, burnout, and other mental health outcomes in HCPs.

P05.44LB

Validating Novel Biomarkers or Stress, Resilience & Social Isolation in a Social-Emotional Learning Youth Mental Health Intervention

Ronnie Newman¹, Kanwaljeet anand², Cynthia R Rovnaghi³, Susan Ramsundarsingh⁴, Jordan Kupono Holck Vedelli², Sa Shen⁵, and Elizabeth Reichert⁵

¹ International Association for Human Values, Washington, D.C., DC

² Stanford Medical School, Palo Alto, CA

³ Child Wellness Laboratory (CWL), Stanford School of Medicine, Palo Alto, CA

⁴ University of Victoria, Victoria, BC

⁵ Stanford School of Medicine, Palo Alto, CA

Contact: Ronnie Newman, [e-mail]

Abstract

Purpose: Adverse childhood experiences (ACEs) can lead to HPA-axis dysregulation, posing significant risk to youth’s lifelong physical & mental health. There is urgent need for adolescent resilience training & validated assessment tools. Our purpose is to a) to test the sensitivity of a panel of adolescent self-report instruments to track chronic stress & resilience building longitudinally; b) validate novel physiological biomarkers of stress/resilience in adolescents c) to evaluate (dis)agreement between subjective reporting compared to objective biomarkers in underserved youth undergoing resilience/wellness training.

Method(s): 7^th graders in a socially disadvantaged school district (93% low-income, 86% Latinx w/high rates of suspensions & absenteeism) enrolled in SKY Schools; an evidence based program that integrates into its Social-Emotional Learning curricula a standardized set of breathing practices shown to rapidly quiet the stress response, inducing autonomic homeostasis. Students were tested at baseline (T1), post SKY Schools intervention (T2), & at 6 month follow up (T3). Validated psychosocial measures of ACE’s, stress, depression, anxiety & self-esteem were used. Biomarkers of stress and resilience consisted of hair protein concentrations (HPC), hair cortisol concentrations (HCC), & hair oxytocin concentrations (HOC).

Results: Sign. improvements were found in emotion regulation, anxiety, self-esteem & academic satisfaction. This correlated with the HCC & HPC Stress recovery from HPA axis exhaustion noted at T1, when post tested at T2 & T3. HOC recovery also correlated at T2 (insufficient samples prevented HOC analysis at T3).

Conclusions: We found an association between objective hair biomarker content & subjective measures of stress &wellbeing in underserved students taking an SEL program. This suggests needed assessment tools. SKY Schools shows promise for programs that can provide resilience and mental health tools to large numbers of youth in school settings, narrowing health disparities.

P05.45

Determinants of Cardiometabolic Health & Sudarshan Kriya Yoga (SKY): A Systematic Review

Dilasha Sethi¹, Praag Bhardwaj², Mithila Vasudev³, and Monika Pathania²

¹ Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore, Karnataka, India

² All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttaranchal, India

³ Division of Yoga & Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru, Karnataka, India

Contact: Monika Pathania, [e-mail]

Abstract

Purpose: Cardiovascular & metabolic diseases pose significant global health challenges. Sudarshan Kriya Yoga (SKY) is a popular non-pharmacological intervention for well-being whose specific impact on determinants of cardiometabolic health remains a subject of investigation. This systematic review aims to comprehensively evaluate & provide valuable insights regarding SKY’s impact on cardio-metabolic risk factors (CMRF).

Method(s): PubMed, SCOPUS, & the Cochrane Library were searched using relevant keywords. Studies in English, published from inception to May 2023, utilizing SKY intervention & assessing any of the CMRF outcomes (BP, blood glucose, lipid levels, & obesity) were included. The Quality Assessment Tool for Quantitative Studies by EPHPP was used to rate papers qualitatively. This review was registered prospectively with PROSPERO (CRD42022292430).

Results: From 1200 search results, 225 were assessed for eligibility. The 21 studies reviewed included 9 RCTs, 3 controlled clinical trials, 1 double-arm pre-post study, 1 case-control study, & 7 single-arm studies, constituting 1716 participants (18–70 years). Interventions ranged from <1–24 weeks, with 6 studies having additional co-interventions. Significant improvements (p<0.05) were seen in 13 trials in lipid parameters, 6 in BP, 4 in blood sugar, & 2 in obesity parameters. SKY also significantly improved overall well-being in both healthy & at-risk populations by improving quality of life, sleep, dietary practices, cardio-pulmonary functions, immunity, & by alleviating stress, anxiety, & depression. SKY also reduced oxidative stress & improved antioxidant levels. However, the overall quality of the studies was moderate for 6 & weak for 15.

Conclusions: The SKY technique shows no side effects, suits the FITT nomenclature, & can be easily applied as a cost-effective intervention. The authors recommend future research on SKY with robust longitudinal RCTs that will help unearth its potential as an adjunct treatment for cardio-metabolic disorders.

P05.46

Impact of Rajyoga Meditation on Stress and Psychological Wellbeing During COVID-19 in India: A Randomized Control Trial

Divya Jain¹, Vivek Verma², and Usha Kiran¹

¹ Postgraduate Institute of Child Health, Sec 30, Uttar Pradesh, India

² Assam University, Silchur, Uttar Pradesh, India

Contact: Divya Jain, [e-mail]

Abstract

Purpose: Even with control measures in place there was a persistence of psychological issues among healthcare workers with resultant collateral damage. Alternative approaches like exercising, music therapy, meditation, tai chi, yoga, etc. are gaining popularity worldwide to address these issues. “Rajyoga meditation” as practiced in the Brahmakumaris World Spiritual University is the science of harmonizing spiritual, mental, and physical energies through the connection with the supreme source of spiritual energy, God. The present study was designed to determine the effectiveness of Rajyoga meditation in reducing anxiety, and perceived stress, and improving quality of life among healthcare workers during the current COVID-19 pandemic as compared to music therapy.

Method(s): Online google forms were circulated using snowball sampling keeping COVID restrictions in mind for recruiting participants from April 2021 to January 2022. Following a single-blinded procedure, healthcare professionals were randomly allocated to one of the two groups, intervention or control. Here, the intervention group received Rajyoga meditation while the control group got relaxation music online. A validated questionnaire, such as the Generalized Anxiety Disorder (GAD)Scale, Corona Anxiety Scale (CAS), Perceived Stress Scale (PSS), and WHO well-being index, were used to measure the effect on stress and anxiety both pre- and post-intervention (1 month) in both groups.

Results: There was a significant difference observed in both control and intervention groups on various psychological parameters; i.e., the GAD, PSS, and WHO well-being index post intervention. The improvement in CAS was significant in the Rajyoga group only.

Conclusions: The study confirms the effectiveness of the Rajyoga mediation technique in controlling anxiety, and stress and maintaining well-being among healthcare workers, who were under pressure and stress during the pandemic. The Rajyoga can be explored as lifestyle modification in healthcare workers.

Topic Area 06 - Clinical: Other

P06.01

A Traditional Medicine Approach to Whole Health

Patricia StandTal Clarke

University of Arizona Medical School - Phoenix, Phoenix, AZ

Contact: Patricia StandTal Clarke, [e-mail]

Abstract

Purpose: During the peak of the COVID epidemic, the Navajo Nation turned to Traditional Medicine for evidence-based integrative whole-person, whole community, whole earth health care when Western Medicine provided no relief. Devastating social determinants of health, limited treatment without useful conventional medicines, and prevention without vaccines forced providers to heal in ways as old as time itself and known over the globe. I wish to tell this story.

Method(s): Observational study of Traditional Medicine healers providing treatment to COVID patients on the Navajo Nation.

Results: Patients reported an overwhelming benefit from the Traditional Medicine healer’s treatment. They returned with other family members.

Conclusions: More than 80% of the world’s population uses a form of Traditional Medicine to treat primary health. WHO held its first Traditional Medicine Summit in August 2023 and defines Traditional Native American Medicine as “ancient wisdom,” the sum total of knowledge, skills and practices based on case studies and experiences indigenous (precolonization) to North America of 1000 generations that have continued use to maintain health, as well as to prevent, diagnose, and treat physical, mental, and spiritual illnesses. Traditional Medicine has always had a whole person approach: body, mind, and soul. This view of healing encompasses all our living relatives: the human community, the land, water, air, and all life within. The world saw the highest incidence of infection and death from COVID in the Navajo Nation. When Western Medicine had nothing to offer for treatment or prevention, the Traditional Medicine healers provided observable relief. They used botanical medicine, osteopathic medicine, nutritional medicine, environmental medicine, thorn puncture, meditation, breath work, and most importantly ceremony. Indeed, one might argue that they used all the original roots of integrative medicine.

P06.02

Association of Frailty with Sleep Quality and TCM body Constitution Among Older Adults – A Pilot Study

Chin Ee Ho¹, Yong Yang², Zirui Kok³, Pei Si Teo³, Yan Zhao⁴, Queenie Hui-En Choo⁴, and Han Seong Ng²

¹ Academy of Chinese Medicine, Singapore, Singapore, Singapore

² Singapore General Hospital, Singapore, Singapore

³ Kwong Wai Shiu Hospital, Singapore, Singapore

⁴ Nanyang Technological University, Singapore, Singapore

Contact: Zirui Kok, [e-mail]

Abstract

Purpose: To assess the burden of frailty and investigate the association among frailty, imbalanced Traditional Chinese Medicine Body Constitution (TCMBC) and sleep quality of elderly in Singapore.

Method(s): A cross-sectional pilot study was conducted with data collected via Google Forms using snowball sampling. Community dwelling adults aged 60 and above living in Singapore with sufficient cognitive function were recruited with consent. Tilburg Frailty Index (TFI), Pittsburg Sleep Quality Index (PSQI), and Constitution in Chinese Medicine Questionnaire (CCMQ) were used to measure frailty, sleep quality and TCMBC.

Results: A total of 100 subjects were recruited. Subjects with imbalanced TCMBC were more likely to have frailty (34.0% vs 7.5%, p<0.001) and poor sleep quality (68.1% vs 26.4%, p<0.001) compared with subjects with balanced TCMBC. Logistic regression model analysis showed that both TCMBC (OR 5.2, imbalanced vs balanced, 95% CI 1.1-23.8, p<0.033) and sleep quality (OR 4.7, CI 1.1-20.4, p<0.042) were significant and independent predictors of frailty after adjustment of age group, gender, education level, marital status and co-morbidities.

Conclusions: The pilot study provides preliminary evidence that imbalanced TCMBC and poor sleep quality are important factors to frailty in older adults. Frailty as an age-related risk state characterized by multisystem deficits with loses of physiologic reserves, increases vulnerability in elderly. TCMBC is an integrated, metastable, and natural uniqueness of individuals in physical, physiological and psychological functions, affecting one's susceptibility to diseases and disease progression. Understanding TCMBC may provide insights to delay the onset of frailty in the older population by providing tailored TCM recommendations for one to regain balanced TCMBC.

P06.03

Effect of a Single Low Level Laser Intervention on Carpal Tunnel Syndrome: Open Label Pre-Post Intervention Pilot Trial

Francisco Cidral-Filho¹ and Richard Amy²

¹ Integrative Wellbeing Institute, Windermere, FL

² Integrative Wellbeing Institute, Belmont, NC

Contact: Francisco Cidral-Filho, [e-mail]

Abstract

Purpose: To evaluate the therapeutic efficacy of a one-time Low-Level Laser Therapy (LLLT) session on individuals diagnosed with Carpal Tunnel Syndrome (CTS) based on measures of pain, hand grip strength, and self-reported symptom severity and functional status.

Method(s): 15 male and female participants diagnosed with CTS were recruited. They were pre-screened according to predefined inclusion and exclusion criteria. After securing informed consent, participants were subjected to baseline evaluations. Treatment comprised a single LLLT session targeting multiple areas associated with chronic pain. Assessments were conducted pre- and post-intervention. Additionally, pain and self-reported symptom severity and functional status were gauged 2 days post-treatment using VAS and BCTQ, respectively. Data were statistically analyzed using various methods to determine parametricity and to evaluate the effect of the intervention.

Results: The datasets for pain, numbness, and tingling did not pass normality tests. Significant statistical improvements were observed in all evaluations after LLLT, except for the VAS measure of pain during the 2-days post-treatment interval (based on One-Way ANOVA analysis). However, a significant difference was still noted when a paired T-test was applied.

Conclusions: A single session of Low-Level Laser Therapy appears to yield beneficial effects on individuals with Carpal Tunnel Syndrome, as evidenced by improvements in hand grip strength and self-reported symptom severity. Although pain reduction was observed, the statistical significance varied based on the test applied, suggesting the need for further studies with larger sample sizes.

P06.04

Foot Pressure Variation of LBAT (Taijiquan/ Taichi) Practitioners in a Stable, Upright Posture

Scott Yam¹, Daniel Mroz², and Dominik Barz¹

¹ Queen's University, Kingston, ON

² University of Ottawa, Ottawa, ON

Contact: Scott Yam, [e-mail]

Abstract

Purpose: Across the world exist regimes of low-impact, balanced-based, aerobic trainings (LBAT) of Eastern and Western traditions that emphasize balanced, slow fluid movement, breathing, and the alignment of human skeletal frame (e.g. yoga, Taijiquan/Taichi, cross country skiing). Many practitioners have attributed the training to a higher quality of life in terms of mindfulness and physical fitness. While these practices are gaining popularity with an increasingly aging demographic that prefer less strenuous training, the teaching and translation of these practices have remained nearly the same over the last one thousand years, namely the students’ imitation of the instructors’ visual movements. Given the non-quantitative approach, the translation process has been inefficient, leading to injuries and attrition. Towards a more quantitative approach, this article summarizes the distinctive signature difference in the foot pressure change associated with breathing for Taichi practitioners of different levels.

Method(s): Human Taijiquan (Taichi) subjects were recruited to measure their foot pressure variation during their respiration cycles in an upright, stable posture.

Results: Preliminary results confirm that advanced Taijiquan (Taichi) practitioners, when engaged in diaphragmic breathing, have a distinctive foot pressure variation different from that of beginners.

Conclusions: To the author’s knowledge, this is the first report of foot pressure variation of LBAT (Taijiquan/Taichi) practitioners at different skill levels during their respective respiration cycles in stable, upright posture. The result demonstrates the promise of insole foot sensors as a non-intrusive breath sensor during LBAT practice to provide real-time feedback. This can accelerate the translation process. It is also easier to deploy compared with current breath sensors such as chest straps and other bioimpedance based devices.

P06.05

Gait Health in Individuals with Chronic Non-Specific Neck Pain

Wren Burton¹, Matthew Kowalski¹, Cynthia Long², Robert Vining³, Brad Manor⁴, Pamela Rist⁵, Jeffrey M. Hausdorff⁶, and Peter Wayne¹

¹ Osher Center for Integrative Medicine at Harvard Medical School and Brigham & Women's Hospital, Boston, MA

² Palmer College of Chiropractic, Davenport, IA

³ Palmer Center for Chiropractic Research, Davenport, IA

⁴ Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA

⁵ Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, Boston, MA

⁶ Tel Aviv Sourasky Medical Center at Tel Aviv University, Tel-Aviv, Tel-Aviv, Israel

Contact: Wren Burton, [e-mail]

Abstract

Purpose: Measures of gait, such as speed and stride time variability (STV), can help predict markers of health including fall risk, lifespan, cognitive decline, and function during daily activities. Musculoskeletal pain has been shown to adversely impact mobility, but few studies have specifically evaluated the impact of chronic non-specific neck pain (CNNP) on gait health (GH). This cross-sectional study explores relationships between CNNP, GH, and outcomes related to physical and mental function.

Method(s): We recruited asymptomatic controls and participants with CNNP, and collected physical, cognitive, and emotional health outcomes including pain severity and disability. GH measures were collected under usual walking and dual-task conditions. Linear regression models were adjusted for age and sex.

Results: 34 controls (mean age 41±17.7; 80% females) and 45 participants with CNNP (mean age 38.4±16.7; 61.8% females) were enrolled. Mean differences between groups were observed for PROMIS-29 physical function (CNNP: 17.4±2.9, controls: 19.2±3.3), working memory (CNNP: 16.9±4.1, controls: 18.6±4.1) and kinesiophobia (CNNP: 37.1±4.8, controls: 30.6±6.5). The adjusted mean difference in gait speed (cm/s) between the control and CNNP group was -2.9 (95% CI: -0.2 to -5.5) for usual walking and -4.5 (-1.4 to -7.7) for dual-task walking. The adjusted mean difference in STV (%CV) between the control and CNNP group was 0.03 (-0.14 to 0.20) for usual walking and 0.21 (-0.20 to 0.62) for dual-task walking. Other GH measures showed differences between CNNP and control groups, with worse values in the CNNP group.

Conclusions: Preliminary results indicate that people with CNNP have poorer GH outcomes across preferred walking and dual-task walking conditions. These findings shed light on intricate relationships between pain, mobility and cognitive factors. Further analyses are planned to explore mediators of these relationships, to confirm and extend preliminary findings, and better inform management of CNNP.

P06.06LB

A Systematic Review and Meta-analysis of Tibetan Herbal Pain Relieving Plaster for Musculoskeletal Pain: Compared to Diclofenac Diethylamine Emulgel

Jing Cui¹, Nan Yang¹, and Jianping Liu²

¹ Beijing University of Chinese Medicine, Beijing, Beijing, China

² Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Jing Cui, [e-mail]

Abstract

Purpose: Tibetan traditional medicine CheeZheng Pain-Relieving Plaster(CZPRP) is widely used in the treatment of musculoskeletal pain as external analgesic. However, its clinical efficacy and safety compared to diclofenac diethylamine emulgel has not been evaluated.

Method(s): We searched Pubmed, Cochrane Library, Embase and Chinese databases (CNKI, CQVIP, CBM, and WanFang Data) through October 18, 2023. Topical diclofenac diethylamine emulgel was concerned as eligible comparator. We included clinical trials including randomized controlled trial (RCT) and non-randomized controlled trial (Non-RCT). Clinical outcomes included pain severity, functional scores, adverse events (AEs). RCTs and Non-RCTs were evaluated for methodological quality using the Cochrane Risk of Bias Assessment Tool (ROB) and ROBINS-I tool, respectively. Quantitative analyses were conducted using a random-effects model.

Results: This study included 15 RCTs and 8 non-RCTs (n=5005 participants). The diseases treated by CZPRP included knee osteoarthritis (8 articles), traumatic arthritis of the elbow (2 articles), periarthritis of shoulder joint (2 articles), etc. Compared with diclofenac diethylamine emulgel, CZPRP significantly reduced VAS scores (MD=1.11, 95% Cl), but there was statistically significant heterogeneity between the study results (I²=95%). The CZPRP was comparable to diclofenac diethylamine emulgel in improving knee HSS scores among knee osteoarthritis patients (MD=0.31, 95% Cl), with no statistically significant heterogeneity (I²=0%). CZPRP may be more advantageous in elimination of tenderness and swelling.

Conclusions: CZPRP is associated with improved musculoskeletal pain outcomes compared to diclofenac diethylamine emulgel. However, due to the moderate to high risk of bias of the studies, future rigorous randomized controlled trials are needed to Cl) evaluate the effects of CZPRP.

P06.07

Implementation of Tai Chi using VA Virtual Care (VVC) at Northeast Ohio Healthcare System (VANEOHS)

Patricia Kiefer

Louis Stokes Cleveland VA Medical Center, Cleveland, OH

Contact: Patricia Kiefer, [e-mail]

Abstract

Purpose: Whole Health is VA’s cutting-edge approach to care that supports a Veterans health and well-being. Whole Health centers around what matters to you, not what is the matter with you (VA, 2022a). The Veterans Health Administration (VHA) directive required that “list one” complimentary integrative health (CIH) approaches must be made available to Veterans across the system, either within a VA medical center (or via Telehealth) or in the community (plus * chiropractic care). Tai chi is among the CIH modalities on “list one” advancing the Whole Health transformation within the VA. Tai chi is a form of mind-body movement therapy that has been practiced in traditional Chinese medicine for more many years. Although there are many different styles of tai chi, most consist of slow gentle movement, breathing techniques, and meditation.

In March of 2020 the VA issued an emergency response to the global COVID 19 pandemic ceasing all face-to-face CIH modalities.

Method(s): To overcome the challenges of the pandemic the Key Stakeholders transformed the face-to-face modalities into a virtual format with guidance from our health system specialists. This was accomplished using VA Virtual Care modalities which aim to increase Veteran access to services; improve workflow and workload of VA clinical team members; and engage and support Veterans to participate in their care.

Results: Tai Chi was offered virtually in July of 2021 with 139 Veterans attending the virtual sessions. In 2022, 464, and to mid-September of 2023, 422 Veterans attended virtual sessions.

Conclusions: The VA directive was addressed, but most importantly, the Veterans were able to experience the benefits of Tai Chi during the global COVID 19 pandemic. The Veterans stated they enjoyed the ability to attend a class with fellow Veterans in the convenience of their homes especially when faced with distance and mobility issues.

P06.08

Potential Cannabis-Gene Interactions in a Sample of Patients Taking Oral Cannabis

Jessica Wright¹, Linda Huang¹, Basant El-Fetouh Katamesh¹, Siddhant Yadav¹, Abhinav Singla¹, Ivana Croghan¹, Brent Bauer¹, Michael Schuh², Eric Matey¹, Razan El Melik¹, Adrijana Kekic³, Elisa Houwink¹, and Ann Vincent¹

¹ Mayo Clinic, Rochester, MN

² Mayo Clinic, Jacksonville, FL

³ Mayo Clinic, Phoenix, AZ

Contact: Jessica Wright, [e-mail]

Abstract

Purpose: The major cannabinoids present in cannabis (THC and CBD) are metabolized by highly polymorphic drug metabolizing enzymes (CYP2C9 and CYP2C19). The objective of this study is to describe the incidence of genetic variants encoding cytochrome P450 enzymes in a sample of patients who have completed pharmacogenomic testing and report taking oral cannabis.

Method(s): Participants were selected if there was sufficient documentation on the use of the oral formulation of cannabis. We collected data regarding patients’ CYP2C9, CYP2C19, CYP3A4 and CYP3A5 phenotypes, the predominant enzymes involved in THC and/or CBD metabolism. Phenotype data was analyzed to determine the overall predicted effect on THC and CBD metabolism (increased, decreased, or net zero difference in metabolism). We further analyzed the predicted effect of the metabolism changes on THC and CBD blood levels. This allowed us to determine if the patient may have had the potential to be at increased risk of adverse effects or decreased efficacy of THC or CBD.

Results: Out of 164 charts reviewed, a total of 71 (43.3%) patients were identified with a history of oral cannabis use. Reduced CYP2C9, CYP2C19, and CYP3A4 metabolism was found in 31 (44%), 23 (32%), and 6 (8%) of patients, respectively. Increased metabolism of CYP2C19, and CYP3A5 was found in 14 (20%) and 15 (21%) of patients, respectively. Thirty-three of 71 (46%) and 21/71 (29%) of patients had decreased THC and CBD metabolism, respectively, and thus may be at varying degrees of increased risk of adverse effects. Nine of 71 (13%) and 19/71 (27%) of patients had increased THC and CBD metabolism, respectively, and thereby may be at risk of decreased efficacy. Twenty nine of 71 (41%) and 31/71 (44%) of patients had a predicted net zero change in THC and CBD metabolism.

Conclusions: Clinicians should be aware of the potential for genetic variants to impact how patients metabolize cannabinoids. This can result in unexpected effects including changes in efficacy and/or adverse outcomes.

P06.09

Predicted Drug Interactions in a Sample of Cannabis Using Patients

Linda Huang¹, Jessica Wright¹, Siddhant Yadav¹, Abhinav Singla¹, Basant El-Fetouh Katamesh¹, Ivana Croghan¹, Brent Bauer¹, Michael Schuh², Eric Matey¹, Razan El Melik¹, Adrijana Kekic³, Elisa Houwink¹, and Ann Vincent¹

¹ Mayo Clinic, Rochester, MN

² Mayo Clinic, Jacksonville, FL

³ Mayo Clinic, Phoenix, AZ

Contact: Siddhant Yadav, [e-mail]

Abstract

Purpose: Cannabis is known to have multiple drug interactions mediated through CYP450 pathways and through direct effects on the central nervous system (CNS). The objective of this study is to describe a sample of known oral cannabis users, including the assessment of potential drug interactions as reported in the electronic medical record (EMR) at the time of cannabis initiation documentation.

Method(s): Participants were selected if there was sufficient documentation to indicate they take an oral formulation of cannabis. From the EMR, we collected data including demographics, level of education and the number of medications at the time of oral cannabis use was first documented, including use of CNS depressants. We further assessed the potential for drug interactions based on known CYP450 pathways of the major cannabinoids tetrahydrocannabinol (THC) and cannabidiol (CBD).

Results: Out of the 164 medical records reviewed, a total of 71 (43.3%) patients met study entry criteria. The average age at time of cannabis initiation is 68.5 years, and the sample composed of mostly women (73.2%), predominately white (94.4%) and non-Hispanic (95.8%). Over half (53.5%) of our study population reported completion of a Bachelor’s degree or above. The mean number of medications was 8.1, and an average of 3.1 medications per patient could be impacted by the use of cannabis. The types of medications most affected were antihypertensives, statins, antidepressants, and opioids. In addition, 8% of patients were on a medication that could change levels of THC, and 11% of patients were on a medication that could change levels of CBD. The average patient had at least 1 CNS depressing medication in addition to cannabis.

Conclusions: Clinicians should be aware of the potential for drug interactions with cannabis. More data is needed to determine its safety profile. In the meantime clinicians should document cannabis use and monitor for changes in effects with medications in patients who use cannabis.

P06.10

RCT and Open Label Results on Efficacy and Safety of a Multinutrient Treatment of Children with ADHD: The MADDY Study

Brenda Leung¹, Priya Srikanth², Jeni Johnstone², Lisa M. Robinette³, Irene E. Hatsu³, and L Eugene Arnold³

¹ University of Lethbridge, Lethbridge, AB

² OHSU, Portland, OR

³ OSU, Columbus, OH

Contact: Brenda Leung, [e-mail]

Abstract

Purpose: Background: ADHD is the most prevalent behaviour disorder in children and medication treatment effectiveness and safety remain uncertain. This study compared post-RCT open label extension (OLE) of a multinutrient treatment by duration (8 weeks vs 16 weeks) on ADHD and emotional-dysregulation symptoms and physiological response from the Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youth (MADDY) study.

Method(s): Method: Children aged 6-12 years with ADHD and emotional dysregulation, first randomized to multinutrients vs. placebo for 8 weeks (RCT), then received 8-week OLE for a total of 16 weeks. Assessments included the Clinical Global Impression-Improvement (CGI-I), Child and Adolescent Symptom Inventory-5 (CASI-5), and Pediatric Adverse Events Rating Scale (PAERS), and anthropometric measures (height and weight).

Results: Results: There were 103 (81%) children who completed the OLE from the 126 in the RCT. In the placebo group, CGI-I responders increased from 23% in the RCT to 64% in the OLE, compared to the multinutrients group that had 16 weeks exposure, they increased from 53% (RCT) to 66% responders (OLE). Both groups improved on the CASI-5 composite score and subscales from week 8 to week 16 (all p-values<0.01). The group that took 16 weeks of multinutrients had marginally greater height growth (2.3 cm) than those who took 8 weeks (1.8 cm) (p=0.07). No difference in AEs between groups was found.

Conclusions: Conclusion: Children receiving 8 weeks of multinutrients (after placebo) showed similar response rate as those who received 16 weeks. However, having extended exposure to active treatment (16 weeks) also further improved the response rate. As well having longer exposure to the multinutrients did not result in greater AEs, confirming an acceptable safety profile. Thus mulitnutrients may have clinical implications for children with ADHD.

P06.11

Retrospective Study: Homeopathic Treatment for Female Thyroid Disorders - A 10-Year Analysis of 120 Patients

Shailendra Vaishampayan

Dr.V'aishampayan Clinic for advanced research in thyroid and Cancer Palliation/ Department of Materia medica DYPHMC&PG institute Pune, Mumbai, Maharashtra, India

Contact: Shailendra Vaishampayan, [e-mail]

Abstract

Purpose: This retrospective study aimed to assess the effectiveness of homeopathic treatment in managing thyroid disorders among female patients in light of the increasing global incidence

Method(s): This retrospective study assessed the effectiveness of homeopathic treatment in managing thyroid disorders among female patients. Data were collected over a 10-year period from 120 female patients, both online and offline, who had received homeopathic treatment for thyroid disorders. The assessment was conducted through a comprehensive evaluation that considered clinical parameters, lab investigations, imaging, and homeopathic assessment.

Results: Out of 120 patients, 20% dropped out within a few months. 10% revisited later. 56 patients (47%) achieved complete remission for over five years. 16 patients (13%) are in the recovery phase. 15% continued both modern medicine and homeopathy. Another 15% experienced recurrence and required retreatment. The age group of 12 to 50 yielded the best outcomes.

Conclusions: This retrospective study underscores the potential of homeopathic treatment as an effective approach for enhancing the well-being of female patients with thyroid disorders. While complete remission may not be attainable in certain cases, the individualized nature of homeopathy empowers patients to lead more fulfilling lives despite their thyroid condition. Furthermore, this study offers valuable insights into the factors contributing to the increasing prevalence of thyroid disorders among women. The proposed comprehensive treatment mechanism provides both a methodology and a roadmap that could guide us in the long-term management of many other autoimmune disorders in females as well. It also reaffirms how homeopathy, as an integrated science, considers every aspect of a person's health, rather than merely addressing a diseased. it also offers a quality of life even if the medicine is not used as standalone. A muti- centric or institutionalized clinical trial could be conducted based upon the results of this study.

P06.12

Supporting Those Whole Support Employees at VA Medical Centers

Stacy Olson¹, Tamara Schult², and Charles Gray³

¹ Veterans Health Administration OPCC & CT Employee Whole Health, Milwaukee, WI

² Veterans Health Administration, Hastings, MN

³ Department of Veterans Affairs, Chillicothe, OH

Contact: Stacy Olson, [e-mail]

Abstract

Purpose: The Office of Patient Centered Care & Cultural Transformation (OPCC&CT) held virtual listening sessions with Employee Whole Health (EWH) Coordinators to better understand how to support them in the work they do. The purpose of this study was to understand what support looks like from their perspective and to understand the obstacles they face locally implementing an EWH program.

Method(s): To evaluate the perceptions of EWH Coordinators around implementing an EWH program and supporting them, OPCC&CT developed a brief script of questions to discuss with the participants. Thirty-four coordinators participated in six listening sessions. Saturation was reached after the third listening session, however, the sessions continued to confirm the themes identified. The responses were captured in writing and coded for emerging themes and patterns.

Results: These listening sessions identified several themes around supporting those who support the health and well-being of employees. Those themes are: 1) mentorship programs help coordinators to grow and develop in their profession; 2) ongoing training is a key part of becoming an effective coordinator at a Medical Center, 3) coordinators face common barriers around implementing a program, which are, a) lack of dedicated space for activities, b) lack of dedicated funding for employee health and well-being work, and c) lack of dedicated time for employees to participate in activities; and 4) there is often a struggle to “measure” the impact of employee facing interventional work and activities.

Conclusions: OPCC&CT is taking the listening session feedback and using the information to formulate strategy moving forward. For example, currently EWH Coordinators attend an initial training provided by OPCC&CT on the coordinator role and how to implement a program, however given that coordinators would like access to ongoing training, OPCC&CT plans to host a face-to-face training for coordinators already in the role in the coming fiscal year.

P06.13

The Impact of an Animal-Assisted Intervention (AAI) on Healthcare Worker (HCW) Well-being in the Inpatient Hospital Setting

Beth Steinberg¹, Mary Justice², Aimee Mitchell³, and Maryanna Klatt⁴

¹ Ohio State University Center for Integrative Health, College of Medicine, Department of Family and Community Medicine, Columbus, OH

² The Ohio State University College of Nursing, Columbus, OH

³ The Ohio State University Wexner Medical Center, Columbus, OH

⁴ Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

Contact: Beth Steinberg, [e-mail]

Abstract

Purpose: The purpose of this study was to 1) refine a therapy dog intervention for HCWs working in inpatient units; 2) test the feasibility of regularly integrating the intervention into clinical workflows; 3) assess effects of the intervention on participant mood, perceived stress, burnout, and work engagement; and 4) assess participant acceptability of and engagement with the therapy dog intervention.

Method(s): Using a quasi-experimental, waitlist control design, HCWs from paired medical intensive care and medical-surgical units served as intervention and waitlist control groups and were offered the AAI 3 times a week for 8 weeks with visits ranging from 20 to 60 minutes. Measures of stress, burnout, and work engagement were obtained pre- and post-intervention. Self-reported mood rating was collected before and after each intervention with participants reporting weekly participation. Intervention acceptability was measured post-intervention. Acceptability and participation were measured descriptively. Differences between pre- and post-intervention measures of mood, stress, burnout, and work engagement were assessed with paired and independent samples t-tests.

Results: Acceptability of the therapy dog intervention, rated on a scale of 1 to 10, was high for HCWs in both intervention (M=8.92; SD=1.256) and waitlist control (M=9.57; SD=.787) groups. Weekly participation, 1 to 2 per week, was similar for both groups. While there were non-significant improvements in stress, burnout, and work engagement, self-reported mood increased significantly for the intervention group as a result of the intervention (p=.046).

Conclusions: Our findings suggest that an AAI was feasible and acceptable in these busy inpatient settings. Further, these types of therapy dog interventions may offer immediate benefit to support HCW mental health and well-being through improved mood. Further research is needed to understand long-term effects of these types of interventions on individual HCW and organizational outcomes.

P06.14

The Impact of Psilocybin-Induced Neuroplasticity on Personality Changes in Healthy Human Participants

Dola Greene¹ and Jessica Nielson

¹ University of Minnesota Department of Psychiatry & Behavioral Sciences, Minneapolis, MN

Contact: Dola Greene, [e-mail]

Abstract

Purpose: Given the emerging literature on how psilocybin can promote neuroplasticity in rodents, previous work showing the relationship between personality domains and depression, and studies showing psilocybin can induce rapid and persistent changes in personality domains, this study tests the hypothesis that psilocybin induces neuroplasticity in the human brain in regions implicated in depression, as a function of changes in personality domains linked to the visual system.

Method(s): In a cross-over design, eligible participants received both psilocybin(25mg) or niacin(100mg). Evaluation included the Revised Mystical Experience Questionnaire and the 5-factor personality inventory. MRI scans conducted post-dosing unveiled the neurobiological landscape through neurite orientation dispersion and density imaging. A multivariate analysis of variance was used on 40 regions of interest (ROI) as dependent variables, with drug order group assignment as the fixed factor, correcting for covariates (age, sex, personality shifts, and mystical experiences). ROIs that were sufficiently powered (1 - ß∓0.8), had medium to large effect sizes, significant p-values, and passed correction for multiple comparisons(5%FDR).

Results: Two ROIs passed criteria, including the right ventral visual cortex(R-VVC), connected to color perception and object recognition, exhibited a substantial and persistent impact. Similarly, this was also found in left parahippocampal area 1(L-PHA1), tied to the visual system and hippocampus. Drug A first group mean for R-VVC was .006(95% CI .003, .010), contrasting with Drug B first -0.021(95% CI -.025, -0\.017), yielding η² = 0.677. For L-PHA1, Drug A first group mean was .015(95% CI .006, .024), while Drug B first was 0.029(95% CI-.039, -.019), with a large effect size (η² = 0.449).

Conclusions: We hypothesized that psilocybin's effects involve nuanced processes. Our results underscore the context-dependent nature of psilocybin's modulatory effects on the brain, which help inform depression treatments.

P06.15

The Impact of the Personal Health Plan on Physician’s Perspective of Patient Complexity: A Quality Improvement Study

Radhika Agarwal¹, Meena Visvanathan¹, Stephanie Brown-Johnson², and Luci Strong³

¹ Atlanta VA Medical Center/Emory University School of Medicine, Atlanta, GA

² Atlanta VA Healthcare System, Atlanta, GA

³ Atlanta VA Medical Center, Atlanta, GA

Contact: Luci Strong, [e-mail]

Abstract

Purpose: The VA Whole Health Program has developed a Personal Health Plan (PHP) to center care around the patients. The PHP is a set of questions which asks patients about their mission, aspiration, or purpose and long-term goals. While studies have shown that the PHP has a positive effect on the patient’s perception of care, physician perception has not been explored. The purpose of this pilot quality improvement study is to evaluate physician perception of patient complexity after completion of a PHP.

Method(s): Complex patients nominated by providers were contacted by telephone and a personal health plan was completed and documented in the electronic medical record. The provider completed a pre-survey for each patient which queried the reason for complexity and a Leichert rating of patient difficulty. The providers then read the documented PHP and completed a post-survey which queried if understanding of the patient and care could be impacted by the PHP, along with a repeat Leichert scale.

Results: As of September 2023, 13 patients from 7 providers at the Atlanta VA were identified as complex and were contacted. Of these 13 patients, 6 surveys have been completed by the provider. Average provider perception of difficulty decreased by 1 point for these patients. When asked to rate if the PHP improved understanding of their patient and if the PHP could change the care for the patient, 4 out of 6 provider responses were “a good amount”. Among other feedback, providers reported they could better help patients navigate concerns after reading the note.

Conclusions: Initial results reveal that provider perception of patient difficulty decreases and understanding of their patient increases after completion of a PHP. In the next two months, we hope to have a total of 15-20 surveys completed in this pilot study.

P06.16

The Potential Therapeutic Role of MDMA as a Healing Modality for Unaddressed Mental Suffering and PTSD: A Case Study

Benjamin Taber¹, Mikhail Kogan², Misty Embrey², Yael Flusberg³, and Umair Ashraf²

¹ George Washington University School of Medicine and Health Sciences, Washington, DC

² George Washington University, Takoma Park, MD

³ George Washington University School of Medicine and Health Sciences, Center for Integrative Medicine, Washington, DC

Contact: Benjamin Taber, [e-mail]

Abstract

Purpose: To demonstrate the potential therapeutic roles of MDMA as a healing modality for unaddressed mental suffering and PTSD.

Method(s): We present the case of a patient with longstanding and debilitating peripheral neuropathy, anxiety, fatigue, insomnia, brain fog, and PTSD with several failed trials of multiple pain medications, SSRIs, and antipsychotics prescribed by 8 different psychiatrists, who was also seen by over a dozen different physicians including rheumatologists, neurologists, functional medicine and regenerative doctors across a span of five years. Patient subsequently participated in an MDMA psychotherapy healing ceremony during the winter of 2022. This ceremony was preceded by the oral intake of Ketamine 30 minutes prior with the goal of increasing receptivity and openness to the MDMA experience. Additionally, a harm reduction protocol was implemented and included supplements taken both before and after the ceremony.

Results: After the ceremony, patient shared a journal entry outlining their profound experience while on MDMA. They discussed vivid and detailed explorations of the underlying sources of their suffering and trauma. Patient also expanded on the perspective the experience provided and discussed realizations they attained regarding forgiveness and steps for additional healing. Over the following months, patient was able to find their way to constitutional homeopathy, reporting significant decreases in symptoms of anxiety and mental suffering.

Conclusions: Our case demonstrates the tremendous potential of psychedelic healing ceremonies as a unique opportunity for patients to better explore, understand, process, and cope with underlying and unaddressed mental suffering. These highly individualized ceremonies establish and foster conditions appropriately suited for individual growth and profound emotional healing. Psychedelic psychotherapy offers a broader and more holistic means of treating unaddressed suffering and assists in restoring equilibrium and overall well-being.

P06.17

The Role of the Chief Well-being Officer (CWO) in Veterans Health Administration

Mary Gallagher-seaman¹, Tamara Schult², Kavitha Reddy³, Jana Boehmer⁴, Susan Stockdale⁵, and David Mohr⁶

¹ VHA, Halesite, NY

² Veterans Health Administration, Hastings, MN

³ Veterans Health Administration, St. Louis, MO

⁴ VHA OPCC&CT, Tampa, FL

⁵ VHA, Los Angeles, CA

⁶ VHA OPCC&CT, Washington, DC

Contact: Tamara Schult, [e-mail]

Abstract

Purpose: An 18-month pilot to evaluate the role of the Chief Well-being Officer (CWO) was undertaken in Veterans Health Administration (VHA). The purpose of the new role in VHA is to create and sustain an engaged and resilient clinical workforce and mitigate burnout.

Method(s): A work unit survey measuring general well-being, professional fulfillment, and perceptions of culture was administered pre- and post-intervention. The annual organizational census survey, All Employee Survey (AES), was examined to assess changes in key organizational metrics by workgroup over time. Qualitative interviews with the CWOs and workgroup leaders were conducted. Qualitative semi-structured telephone interviews were conducted during the early-implementation phase with CWOs (n=10) and participating frontline employees (n=26), and with CWOs post-implementation (n=10). A rapid analysis approach was used to summarize implementation progress, strategies, barriers and facilitators. Work unit survey data was collected from sites at 2 time points. The 1st data collection wave happened between Jan & April 2022. The subsequent data collection period was between April & June 2023. Responses to the work unit survey were linked to responses to the AES which was administered in June 2022.

Results: A total of 252 valid responses were provided to the work unit survey in the first wave & 85 responses were recorded for the second wave, a 34% response rate. When examining valid work unit changes between waves 1 and 2, improvements in interpersonal disengagement, culture of health and well-being, and change readiness were observed. One work unit showed a particularly favorable improvement in turnover intentions. Important correlations were observed between select work unit survey measures and system-important measures on the AES.

Conclusions: Pilot results indicate potential for the role of CWO in VHA - implementing the CWO role and SMPF components seems promising and feasible but appears to require dedicated resources.

P06.18

Treating Major Depressive Disorder with an Integrated Mind-Body Intervention: Whole-Body Hyperthermia and Cognitive Behavioral Therapy, a Case Report

Chelsea Siwik¹, Anoushka Chowdhary², Claudine Anglo³, Leena Pandya⁴, Stefanie Roberts⁵, Osnat Lupesko-Persky³, Patty Moran⁴, Wendy Hartogensis³, Christopher Lowry⁵, Charles Raison⁶, Rhonda Patrick⁷, Rick Hecht³, and Ashley Mason⁴

¹ Cleveland Clinic, Department of Wellness & Preventative Medicine, Cleveland, OH

² University of Arizona, Department of Psychology, Tucson, AR

³ University of California San Francisco, San Francisco, CA

⁴ University of California, San Francisco, Osher Center for Integrative Health, San Francisco, CA

⁵ University of Colorado Boulder, Boulder, CO

⁶ University of Wisconsin-Madison, Madison, WI

⁷ FoundMyFitness, San Diego, CA

Contact: Chelsea Siwik, [e-mail]

Abstract

Purpose: Major depressive disorder (MDD) is a critical health issue that is inadequately addressed with currently available treatments, indicating a need for novel treatment approaches. This case report describes a patient’s outcomes after completing an integrated mind-body depression intervention that combined cognitive-behavioral therapy (CBT) administered by a clinician with whole-body hyperthermia (WBH) administered using an infrared sauna device.

Method(s): The patient, a 37-year-old adult assigned male sex at birth who identified as agender and Asian, completed eligibility screening and a baseline assessment that included a semi-structured clinical interview and self-report measures of mood and emotional health. The intervention included 8 weekly 1-hour CBT sessions and 8 weekly WBH sessions. Prior to each CBT session, the patient completed the Beck Depression Inventory-II (BDI-II). After the patient completed all intervention sessions, we re-assessed the patient’s mood and cognitive and emotional health and collected verbal feedback about their treatment experience.

Results: At baseline, the patient met the criteria for diagnosis of MDD per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and they were not receiving any form of treatment. From initial contact to the final assessment (14 weeks), the patient evidenced a 25-point reduction on the BDI-II from a score of 28 to 3, reflecting a clinically meaningful decrease from severe depressive symptoms to remission. At the final assessment, the patient no longer met the criteria for MDD.

Conclusions: For this patient, this relatively brief integrative depression treatment was both feasible and efficacious. The patient achieved depression remission in fewer than 14 weeks. These results warrant greater exploration into the potential benefits of this integrative depression treatment.

P06.19

Understanding Botanica Use in Upper Manhattan Neighborhoods: a Community Survey and Education Project A

Roxanne Ko¹, Ana Esteban², and Rebecca Leeds²

¹ New York Presbyterian/Columbia, New York, NY

² Columbia University, New York, NY

Contact: Roxanne Ko, [e-mail]

Abstract

Purpose: As the Dominican community established themselves, they brought with them Botanicas, or stores which sell a variety of dried plants, tinctures, oils and creams for medicinal use. To date, Botanica product use remains unregulated and relatively poorly documented within the medical community. The goal of this project is to quantify and qualify the current populations using Botanica products through community surveys, with a specific interest in identifying use of products that contain potentially dangerous additives and products used in place of or in conjunction with current western medications for chronic diseases. Following data collection, this project aims to create a lecture for community members and healthcare providers about Botanica products and their use. Additionally, this initial data can serve as a platform for further research or be used as a basic reference for Dominican non-traditional medicine.

Method(s): A written survey was transcribed in English and then translated into Spanish. The study will use a cross-sectional survey-based method to collect data regarding the use of Botanica remedies and products. Descriptive statistics will be used to characterize the survey participants based on identifiers requested in the survey, to characterize Botanica products being used and to quantify simultaneous use of Botanica products and standard pharmacologic medications. Linear regression models will be used to analyze relationships between participant characteristics and Botanica use as well as botanica use and occurrence of chronic conditions.

Results: This study has received 84 responses to date. 53.3% of participants do not tell their physician about Botanica product use. 20.97% use Botanica products with their standard pharmaceuticals. Greater than 25% of the participants use products that contain harmful additives. This study has also obtained information about previously undocumented Botanica products.

Conclusions: No conclusion to date, the survey will close February 2024.

P06.20LB

Traditional Chinese Medicine for Smoking Cessation: An Umbrella Review of Systematic Reviews and Meta-Analysis of Randomized Controlled Trials

Chunli Lu¹, Qian-yun Wang², Xinyan Jin³, Xue Xue⁴, Xuehan Liu³, Nicola Robinson⁵, and Jianping Liu⁶

¹ Guangdong Pharmaceutical University, Guangzhou, Guangdong, China

² Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, Beijing, China

³ Beijing University of Chinese Medicine, Beijing, Beijing, China

⁴ Hubei University of Chinese Medicine, Wuhan, Hubei, China

⁵ London South Bank University, London, Greater London, United Kingdom

⁶ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Chunli Lu, [e-mail]

Abstract

Purpose: Traditional Chinese medicine (TCM) may have special advantages in facilitating smoking cessation, but consensus on effectiveness is lacking. We aim to comprehensively review, update, and refine current evidence on TCM effectiveness and safety.

Method(s): Nine databases were searched from their inception up to February 28^th, 2023. Systematic reviews (SRs) and meta-analysis of TCM for smoking cessation were identified and retrieved. Additional databases and hand searches of RCTs from included SRs were performed for data pooling. Cochrane ROB tools and AMSTAR-2 were used to evaluate the methodological quality of RCTs and SRs. RCT data were presented as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI) using RevMan 5.4.

Results: Thirteen SRs involving 265 studies with 33081 participants were included. Among these 265 studies, 157 were duplicates (58.36%) and 52 were non-RCTs (19.62%). 88 RCTs involving 12434 participants were finally included for data synthesis. All the SRs focused on acupoint stimulation, and the majority were low or very low quality. The methodological quality of RCTs were either unclear or high risk. For continuous abstinence rate, TCM external interventions were better than placebo in 6 months to 1 year (RR=1.60, 95%CI; N=5, 533 participants). Compared with placebo, TCM external application was effective in reducing nicotine withdrawal symptoms, and the effect was gradually stable and obvious in the fourth week (MD=-4.46, 95% CI; N=1, 65 participants). Twelve RCTs reported adverse events as outcome indicators for safety evaluation, and no serious adverse events occurred.

Conclusions: At present, there are problems with repeated topic selection and overlapping. Despite the methodological limitation of the original studies, our review suggests that TCM intervention shows potential effectiveness on the continuous abstinence rate. Extending the intervention time can enhance the effect of TCM on nicotine withdrawal symptoms.

P06.21

Functional Nutrition Treatment for Autism: Analysis of Clinical Data and Outcome Assessments

Ronald Glick¹, Karl Holtzer², LuAnn Scarton³, Peyton Groves⁴, Carol Greco⁵, and Leah Northrop³

¹ Center for Integrative Medicine at UPMC Shadyside, Pittsburgh, PA

² UPMC, Pittsburgh, PA

³ Center for Integrative Medicine at UPMC, Pittsburgh, PA

⁴ University of Pittsburgh School of Medicine, Pittsburgh, PA

⁵ University of Pittsburgh, Pittsburgh, PA

Contact: Ronald Glick, [e-mail]

Abstract

Purpose: In a previous study of Autism Spectrum Disorder (ASD), a combination of a gluten, soy, and casein free diet (GF/SF/CF) and a micronutrient supplement showed significant benefit for socialization, development, and behavior. The current exploratory study evaluates functional nutrition for ASD, under the premises that:

1. Micronutrient deficiency contributes to impairment in ASD and is a potential target for treatment.

2. Individuals with ASD may react adversely to dietary milk products, gluten, and soy.

3. Given the gut-brain connection, gut dysfunction may have a deleterious effect on brain function for individuals with ASD.

Method(s): We developed a 1-year functional nutrition program for children with ASD involving: functional medicine pediatrician and nutritionist care, an elimination diet, a micronutrient supplement, and lab testing including assays of stool and nutritional status. Parents were invited to have their child participate. Outcomes included parent-report measures of social responsiveness (SRS), aberrant behavior (ABC), development (Vineland), QOL (PedsQL), and medical symptoms (MSQ). Additionally, biomedical measures assessed stool and nutrient status.

Results: The 9 patients with ASD, aged 2-15, showed improvement in scores on the SRS, ABC, and MSQ. Other measures showed slight improvement. Stool assays showed elevation of secretory IgA in 5 of 8 subjects. We include a case summary in the presentation.

Conclusions: This study found benefit on social responsiveness, aberrant behavior, and health symptoms. This small case series supports prior research showing potential benefit of the combination of a high-potency micronutrient preparation and a GF/SF/CF diet for children and adolescents with ASD. Other take-aways include:

1. Lab testing did not greatly enhance treatment.

2. Secretory IgA elevation in a majority of patients supports the premise of impaired gut function.

3. Most families found it difficult to continue with the dietary restrictions and supplement administration.

P06.22LB

Efficacy of Homoeopathic Treatment: Systematic Review of Meta-Analyses of Randomised Placebo-Controlled Homoeopathy Trials for Any Indication

Klaus von Ammon¹, Harald Hamre², and Helmut Kiene³

¹ University Witten/Herdecke, Staefa, Zurich, Switzerland

² University Witten/Herdecke, Freiburg, Baden-Wuerttemberg, Germany

³ University Witten/Herdecke, Witten, Nordrhein-Westfalen, Germany

Contact: Klaus von Ammon, [e-mail]

Abstract

Purpose: Since 1997, several meta-analyses (MAs) of placebo-controlled randomised efficacy trials of homoeopathy for any indication (PRETHAIs) have been published with different methods, results and conclusions, without a formal assessment of these MAs , to date. The main objective of this systematic review was to evaluate the efficacy of homoeopathic treatment.

Method(s): Inclusion criteria: MAs of PRETHAIs in humans; all ages, countries, settings, publication languages; and MAs published from 1 Jan. 1990 to 30 Apr. 2023. Exclusion criteria: systematic reviews without MAs; MAs restricted to age or gender groups, specific indications, or specific homoeopathic treatments; and MAs that did not assess efficacy. We searched 8 electronic databases up to 14 Dec. 2020, with an update search in 6 databases up to 30 April 2023. Primary outcome: effect estimate for all included trials in each MA and after restricting the sample to trials with high methodological quality, according to predefined criteria. The risk of bias for each MA was assessed by the ROBIS (Risk of Bias in Systematic reviews), the quality of evidence by the GRADE framework. Statistical analyses determined the proportion of MAs showing a significant positive effect of homoeopathy vs. no significant difference.

Results: Six MAs were included, covering individualised (n=2), nonindividualised (n=1) and all types of homoepathy (n=3). Effect estimates for all trials in each MA showed a significant positive effect of homoeopathy compared to placebo (5 of 5 MAs, no data in 1 MA). Sensitivity analyses with sample restriction to high-quality trials were available from 4 MAs; the effect remained significant in 3 of the MAs (2 MAs assessed ALL-HOM, 1 MA assessed I-HOM) and was no longer significant in 1 MA (which assessed NI-HOM).

Conclusions: NI-The available MAs of PRETHAIs reveal significant positive effect of homeopathy beyond placebo. This is in accordance with laboratory experiments showing partially replicable effects in vitro and in vivo.

P06.23LB

Precision-based Nutritional Therapy for Bone Health

Laura Kelly¹ and Stuart Kim²

¹ Opal Health, Topanga, CA

² Axgen, Palo Alto, CA

Contact: Laura Kelly, [e-mail]

Abstract

Purpose: Osteoporosis is a serious disease that causes bone fragility fractures and increases mortality. Bisphosphonates are the first line standard of care treatment showing average bone density increases of ∼4%. The FDA recently required a new Limitations of Use statement on all labels for these drugs citing idiopathic femur fracture and suggesting that treatment be limited to 3-5 years. Further recommendations for therapy include pharmaceuticals such as parathyroid analogues (abaloparatide) and monoclonal antibodies (denosumab), most of which contain black box warnings. For these reasons patients are asking for alternative therapeutic options. We sought to investigate the use of precision data in profiling and personalization to create treatment plans for osteoporotic patients as diagnosed by DXA scan.

Method(s): The first 4 patients to submit data were accepted for our case report. Pre-treatment data consisted of a whole genome sequence bone density test with PRS score from the Kim lab (Stanford), a nutrition test from Genova Diagnostics, and a DXA scan from the treating physician. This data was then correlated and applied to personalized nutrition protocols for each patient based on lit review on bone generation mechanisms. Patients with worse genetic scores were given the option for a basic Chinese herbal formula. 2 patients used low dose topical estrogen, 1 had 1 shot of zolendronic acid. The trial period was set at 1 year.

Results: All 4 patients reported compliance. On repeat DXA scan after 1 year all 4 patients (ages 57-76) had significant increases in bone density. Total average increases on 3 main measurements (both femur necks and spine L1-L4) were 9-15%, with single measurement increases up to 44%.

Conclusions: Precision data and nutrition far outperformed current standard-of-care, with no side effects and no limitations on treatment duration. We also note that early WGS genetic screening for fracture risk is easy and would provide early warning/allow for preventive treatment.

P06.24LB

Professionalization of Yoga in VA: Development and Implementation of VA Qualification Standards

Marlysa Sullivan¹, Juli Olson², Jessica Dillard³, and Alison Whitehead⁴

¹ Telepain Empower Veterans Program, Atlanta VA Medical Center, Atlanta, GA

² VA Central Iowa HCS, Clive, IA

³ VHA OPCC&CT, Columbia, SC

⁴ VHA, New York, NY

Contact: Marlysa Sullivan, [e-mail]

Abstract

Purpose: Yoga is covered under the Veterans medical benefits package and required to be made available if recommended by the care team. To support implementation of yoga, the Veterans Health Administration (VHA) developed yoga instructor qualification standards (QS) establishing minimum training and experience requirements to ensure high-quality and safe yoga teaching for well-being and the ability to hire a yoga instructor under their own professional class.

Method(s): A workgroup of yoga subject matter experts was led by a Human Resources Technical Advisor to complete a job analysis and develop the QS. The group met for 16 months to review publicly available information from non-VA organizations and to develop requirements and descriptions of duties and skills required for various levels of yoga instructors (e.g. entry, lead, and supervisor).

Results: VA published the QS in January 2024 with resources to support implementation. Nationally standardized functional statements outline job duties and responsibilities to ensure consistency in assignment of work and to simplify and standardize hiring. A clinic guidance document provides recommendations for coding and tracking and resources for virtual yoga. Sample notes and competency evaluation forms for supervision of yoga instructors provide support for facility level implementation. Based on identified need, guidance was also created for healthcare providers to teach yoga on a limited basis or incorporate principles of yoga in their clinical care when in scope.

Conclusions: Provision of yoga in healthcare requires considerations for teaching clinical populations. The creation of QS enables organizations to provide safe and evidence-based yoga for well-being and supports the professionalization of yoga in healthcare. The QS created and implemented in VHA can be used by other healthcare organizations to support yoga in a clinical context. The identified resources created by VHA may also be useful as yoga continues to expand in healthcare globally.

P06.25LB

The Relaxation Room Project: Creating a Restorative Space for Nursing Staff to Improve Well-being at Work

Maryclaret Ndubuisi-Obi¹ and Rozina Bhimani²

¹ University of Minnesota, Chicago, IL

² University of Minnesota, Minneapolis, MN

Contact: Maryclaret Ndubuisi-Obi, [e-mail]

Abstract

Purpose: Nurses are a critical part of the healthcare workforce in the United States. As medical technology advances and chronic illnesses continue to plague the US population, increased work demands are placed on this workforce leading to increased stress, burnout and retention difficulties. The Institute of Healthcare Improvement, the National Academy of Medicine, and the US Surgeon General have highlighted a national focus on clinician well-being to address these challenges. This quality improvement project aims to support nurse well-being by creating a restorative space through the redesign and remodel of a relaxation room guided by the Optimal Healing Environment framework.

Method(s): The project was conducted in a large urban medical center among nurses on an inpatient floor across three cardiovascular units. The project was organized into three intervention stages and self-report measures were collected to determine nurses’ awareness, utilization of the restorative space, and well-being perception.

Results: The surveys showed a 47% increase in awareness and a 55% increase in utilization of the relaxation room post-intervention. More than 50% of the staff surveyed reported a 1–4-point reduction in stress, anxiety and tiredness and a 1–4-point increase in energy. 100% of nurses reported improved well-being support post-intervention.

Conclusions: The relaxation room project makes visible the presence of institutional care, highlights the extension of the environment of care to nurses and showcases an ingenious way to support workplace well-being. This project shows that an optimized healing environment can positively impact workplace well-being by promoting a space for rest while at work.

Topic Area 07 – Culinary Medicine/Nutrition

P07.01

Cooking Up Health: Academic-Community Collaboration to Teach Nutrition Education

Anna Shannahan¹, Melinda Ring¹, and Deborah Clements²

¹ Osher Center for Integrative Medicine at Northwestern, Chicago, IL

² Feinberg School of Medicine at Northwestern, Chicago, IL

Contact: Anna Shannahan, [e-mail]

Abstract

Purpose: 1) Assess feasibility of a culinary medicine curriculum within a family medicine residency. 2) Determine impact of a culinary medicine curriculum combining academic, culinary and community components on nutrition competencies.

Method(s): 23 residents at the Northwestern Family Medicine Residency at Lake Forest were assigned asynchronous learning as videos and readings, followed by: 1) 3 weekly synchronous virtual culinary classes, led by Common Threads professional chefs, centered on plant-based recipes relevant to patient care. This was followed by a debrief and discussion of prework. 2) Residents teaching 3 weekly nutrition and healthy snack preparation classes at Round Lake Middle School, which serves 80% economically disadvantaged students and has a minority enrollment of 87%.

Results: Residents completed validated assessments and follow up surveys. There was a significant increase in confidence in nutrition counseling (p<.01), cooking skills (p<.05), and ability to prepare plant-based meals (p<.05). There was also significant increase in knowledge of plant-based diets (p<.01) and substituting animal-based proteins with plant-based protein (p < .01). 81% reported a positive or neutral impact on their knowledge due to the virtual nature of the cooking classes.

Conclusions: This pilot demonstrates feasibility and positive impact of incorporating a culinary medicine curriculum into a Family Medicine residency. It is now mandatory for all residents in the program. This curriculum can serve a need for nutrition curricula in resident training.

P07.02

The Role of Personalized Nutrition in Metabolic Health

Yulia Yusipova¹, Evgenia Cheprasova¹, Yulia Konakova¹, Anastasiya Mikhaylova¹, and Elena Stark¹

¹ European University of Longevity, Miami, FL

Contact: Yulia Yusipova, [e-mail]

Abstract

Purpose: Disruption of metabolism increases the likelihood all causes mortality. Four age-related pathologies are associated with metabolic health impairment - cardiovascular diseases, diabetes, Alzheimer's disease, and oncology. The implementation of individual postprandial glucose control methods can help identify initial or advanced stages impairments.

Method(s): Participants were randomly selected for the experiment, each consuming a standardized product, and we tracked their glucose peak in response. Subsequently, a dietary and lifestyle protocol was offered to improve glycemic flexibility. We applied a low-glycemic protocol to enhance glycemic flexibility and additionally monitored its implementation with a glucose sensor. Methods such as preloading with fiber before consuming high-carbohydrate meals, consuming water with dissolved apple cider vinegar, and mindful eating were also employed.

At the end of the two-week study, additional tests were conducted using a control product, revealing a positive trend of change in the groups.

Results: Personalized nutrition using continuous glucose monitoring has shown significant dynamics of glucose spikes before and after the protocol implementation. During the study, other correlations were identified - changes in glucose levels in relation to sleep disturbances helped patients identify causes of nocturnal hypoglycemia. We modified eating habits, helped identify reasons for increased appetite, and improved metabolic health.

This model forms the basis of a training program for managing glycemic flexibility and is currently used in conjunction with coaches to enhance clients' metabolic health.

Conclusions: The application of a personalized approach to metabolic health restoration is feasible and assists patients in making informed decisions based on sensor metrics. Patients can learn and integrate this tool into their lives. Furthermore, the use of sensors aids in providing patients with rapid feedback, which positively motivates them towards habit changes.

P07.03LB

Associations Between Dietary Factors and Ulcerative Colitis Risk: Evidence from a Mendelian Randomization Study

Zhijun Bu¹, Xue-Hui Wang¹, Xue-Feng Wang¹, Zhi-Rui Huang², Zhaolan Liu¹, and Jianping Liu³

¹ Beijing University of Chinese Medicine, Beijing, Beijing, China

² School of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, China

³ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Jianping Liu, [e-mail]

Abstract

Purpose: Previous observational studies have identified an association between dietary factors and ulcerative colitis (UC), but the causal relationship remains unexplored. This study aims to examine the causal relationship between dietary factors and UC.

Method(s): The analysis utilized data from genome-wide association studies (GWAS). Dried fruit, vegetables, processed meat, fresh fruit, and cereal intake were examined as exposure factors. UC was considered the outcome. Two-sample Mendelian randomization (TSMR) analysis was performed using methods, including inverse-variance weighted, weighted median, MR Egger, simple mode, and weighted mode.

Results: The analysis revealed a significant inverse causal relationship between dried fruit intake and UC incidence (β: -0.72, odds ratio (OR): 0.49, 95% confidence interval (CI): 0.260 to 0.914, p = 0.025). No significant association was observed between vegetable intake (β: 0.56, OR: 1.74, 95% CI: 0.561 to 5.415, p= 0.337), processed meat intake (β: 0.13, OR: 1.14, 95% CI: 0.552 to 2.339, p = 0.729), fresh fruit intake (β: -0.02, OR: 0.98, 95% CI: 0.465 to 2.054, p = 0.952), cereal intake (β: 0.18, OR: 1.20, 95% CI: 0.669 to 2.134, p = 0.547), and UC incidence. The results indicated low heterogeneity among the analyses, and the leave-one-out analysis confirmed the stability of the findings.

Conclusions: This study provides evidence of a causal relationship between dried fruit intake and a reduced risk of UC. Regular consumption of dried fruits may potentially serve as a preventive measure against UC. However, further prospective cohort studies with larger sample sizes are needed to confirm these findings.

P07.04LB

Effects of Vegetable and Fruit Juicing on Gut and Oral Microbiome Composition

Melinda Ring¹, Maria Luisa Savo Sardaro², Katherine Amato², and Veronika grote³

¹ Osher Center for Integrative Health at Northwestern University, Chicago, IL

² Northwestern University, Evanston, IL

³ Northwestern University, Chicago, IL

Contact: Melinda Ring, [e-mail]

Abstract

Purpose: Sub-optimal intake of foods like fruits and vegetables accounted for more than 50% of chronic disease-specific deaths in the U.S. in 2019. Juicing has been promoted as an easy way to consume more of these foods, and juice-only diets have also been marketed as an effective way to cleanse the digestive tract and improve health. Since juicing removes most of the insoluble fiber in fruits and vegetables, though, it may not have the same health effects as whole fruits and vegetables. For example, reductions in dietary fiber can alter the microbiota, which interacts with host metabolism, immunity, and mental health. However, knowledge of how juice affects the microbiota is limited. To begin to address this gap, we performed a dietary intervention study to examine the relationship between juice and the gut and oral microbiota.

Method(s): We analyzed stool, saliva, and internal cheek microbiomes using 16S rRNA gene amplicon sequencing in 14 participants given one of three diets: exclusive juice, juice plus food at libidum, plant-based food. The intervention lasted three days, and we collected samples at four time points: baseline, pre-intervention, immediately post-intervention, 14-days post-intervention.

Results: None of the short-term diet interventions were associated with shifts in the overall diversity or composition of the gut microbiome. However, the relative abundances of individual taxa did shift. In particular, the cheek and saliva microbiome exhibited significant differences in Streptococcaceae and Neisseriaceae, which may be associated with high sugar intake.

Conclusions: Our results suggest that short-term incorporation of processed juice into diets does not have beneficial effects on the gut or oral microbiota and may have some negative effects. They also highlight the importance of the oral microbiome as a first responder to diet modifications. We suggest that future studies use this information as a foundation for further exploring diet-microbiome-disease interplay.

Topic Area 08 – Delivery Models

P08.01

A Phenomenological Analysis of a Novel Employee Wellness Program During Covid-19

Remy Normand¹ and Karen Westervelt¹

¹ University of Vermont, Burlington, VT

Contact: Remy Normand, [e-mail]

Abstract

Purpose: In the wake of COVID-19, many university and hospital workers faced unique work conditions, bringing increased responsibilities, stress, and negative health outcomes. Specifically, frontline professionals including healthcare workers and university professors experienced demanding and hazardous work environments. With this stress comes the need for novel employee wellness programming. Research on health and wellness coaching in the workplace is limited but some studies indicate that health and wellness coaching can be effective in improving the success of employee wellness programs (EWPs). This study investigated the efficacy of an EWP implemented at the University of Vermont and University of Vermont Medical Center.

Method(s): This focus group-based study explored health coach perspectives on a novel employee wellness program. The study consisted of two focus group sessions conducted over Zoom, followed by a phenomenological analysis. The meetings were guided by facilitators using semi-structured discussion questions. The de-identified transcripts were then analyzed separately by 3 members of the research team.

Results: Four major themes emerged from the analysis. Additionally, facilitators provided useful insight for potential program modifications based on accessibility, outreach, structure, and content.

Conclusions: The data collected in this study provides information about the adaptation of the OSW model and the use of integrative health and wellness coaches as an EWP in the university and hospital setting. These results may be useful in developing wellness interventions in a broad employee population. Further research should be conducted in order to confirm these findings and develop highly effective and sustainable strategies to improve the health of university and hospital employees.

P08.02

Designing and Implementing a Pilot Pediatric Inpatient Integrative Health Consultation Program

Robin Miccio¹, Lyndsy Wasilition¹, Maria Mascarenhas¹, and Lisa Squires¹

¹ Children's Hospital of Philadelphia, Philadelphia, PA

Contact: Lyndsy Wasilition, [e-mail]

Abstract

Purpose: The Integrative Health Program was established to incorporate holistic wellness and nonpharmacological treatment options within the treatment milieu at our hospital. Having established modalities such as yoga, acupuncture, and massage in the inpatient setting, a need emerged for an overarching holistic plan of care. A consultation service pilot in Gastroenterology and Adolescent Medicine was started in October 2021.

Method(s): A holistically-trained provider and/or registered nurse responded to consultation requests, and partnered with the patient’s primary care team to develop and implement a holistic plan of care to address symptom management, stress management and wellness education. The team then provided longitudinal care during the patient’s inpatient stay. Provider encounters were billed per standard consultation practices. Holistic nurse visits were not billed. A reporting dashboard was developed to measure pilot metrics and inform the overall sustainability of this new service.

Results: 169 patients had consultations, 71% female, average age of 15 years. Common billing diagnoses were nausea with vomiting, gastroenteritis and colitis, and unspecified abdominal pain. Physician encounters ranged from 1-9 per week. 46% of the encounters were for longitudinal care with an average of 2.21 encounters per patient admission. Prevalent symptoms addressed included pain, nausea, relaxation, anxiety, depressed mood and stress. Care plans commonly included yoga, massage, aromatherapy, breathwork, acupuncture and clinical hypnosis. Per established payor contracts, an average reimbursement rate of 37% of charges was realized.

Conclusions: We successfully demonstrated the value and feasibility a pediatric inpatient IH consultation program, demonstrated by number of consultation requests, billing volume, and reimbursement rates. Preliminary results and lessons learn provided justification for expansion to additional units and integration of an advanced practice provider role.

P08.03

Developing the Role of the Holistic Nurse: From a Pediatric Academic Hospital to a Community Hospital. Bridging the Gaps of Integrative Care

Lisa Squires¹, Micah Bedrosian¹, Maria Mascarenhas¹, and Robin Miccio¹

¹ Children's Hospital of Philadelphia, Philadelphia, PA

Contact: Lisa Squires, [e-mail]

Abstract

Purpose: Integrative practitioners frequently work in outpatient settings but their presence in pediatric hospitals is limited. There is a gap in non-pharmacologic interventions for pain and anxiety management among hospital staff. Aim: Expand the role of the holistic nurse (RN) to develop education programs in addition to direct patient care. Initially conceptualized at a large academic medical center (AC), the role was adapted meet the needs of a community-based hospital (CH).

Method(s): In 2017, the RN created online educational modules (aromatherapy, breathwork and massage) for inpatient staff. As the role evolved, the RN responded to consults, collaborated with mind-body therapists, and provided direct patient care (acupressure, mindfulness, aromatherapy, breathwork, mindfulness, yoga, Reiki, and hypnosis). In 2022, with the addition of a small CH, the RN role was adapted to provide coverage in all inpatient units and emergency room (ER) and all inpatient units to support patients with anxiety, stress, painful procedures and post-operative nausea and pain. In response to a consult request (part of the adolescent medicine unit admission order set), the RN conducts individual and group patient sessions aimed at fostering self-regulation skills and comprehensive well-being tools.

Results: 985 patients were seen at AC from January 2020 to present. 737 patients at CH from December 2022 to present. Average age:13 years. Patients were seen twice during their stay. Common units served were behavioral health, adolescent medicine, oncology, GI and ER. 1000 healthcare providers have completed on-line learning modules, supplemented with in-person and live virtual classes. New employees are required to take these modules.

Conclusions: Implementation of holistic RN was successful and increased the number of patients receiving holistic services as part of routine care especially in CH. Future plans include the creation of unit-based holistic RN champions and Reiki teaching for staff and caregivers.

P08.04

Healthcare Provider Perspectives of Integrating a Comprehensive Spine Care Model in an Academic Health System: A Cross-Sectional Survey

Wren Burton¹, Stacie Salsbury², and Christine Goertz³

¹ Osher Center for Integrative Medicine at Harvard Medical School and Brigham & Women's Hospital, Boston, MA

² Palmer Center for Chiropractic Research, Davenport, IA

³ Duke, Durham, NC

Contact: Wren Burton, [e-mail]

Abstract

Purpose: Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units and the integration of first line, non-pharmacological therapies into care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant spine care (GCSC) and optimal spine care workforce requirements within an academic HCS.

Method(s): 26 spine care clinicians (55% response) completed a 25-item survey via Qualtrics on barriers and facilitators to delivering GCSC. Data analysis included descriptive statistics and content analysis.

Results: Respondents reported that guidelines were implementable within the HCS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (91.7%) agreed most patients would benefit from physical therapy or chiropractic before specialty referrals. Providers perceived spine patients expected diagnostic imaging (95.6%) and medication (82.6%) over non-pharmacological therapies. Providers agreed that receiving imaging (91.6%) and opioids (69.5%) benchmarks could be helpful but might not change orders if nudged by best practice advisories. An optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to GCSC implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery.

Conclusions: Despite general support for GCSC, significant barriers exist to implementation.

P08.05

Starting the Conversation About What Matters Most to Veterans – A Sustainable Approach to Patient Centered Care

Jennifer Rouchka

VA, Louisville, KY

Contact: Jennifer Rouchka, [e-mail]

Abstract

Purpose: Older patients often have multiple chronic conditions that affect quality of life. Whole Health focuses on eliciting patients’ values to guide treatment plans. Patient centered care (PCC) has been shown to improve access to care, decrease opioid prescriptions, improve patient outcomes, and increase patient and provider satisfaction. PCC is recommended by VA/DOD Evidence Based Practice Guidelines, but specific policies for integrating Whole Health have not been established. The purpose of this project was to adopt a patient-centered approach by starting conversations about patients’ values.

Method(s): These dialogues were started during routine primary care visits with Veterans 65 and older over the course of three Plan-Study-Do-Act (PSDA) cycles. The discussions were initiated with one of more of the following Whole Health questions (WHQs):

  What brings you joy?

  What are your hobbies and interests?

  What keeps you from the activities you enjoy?

  What is a typical day like for you?

  What are your healthcare goals?

The number of Whole Health talks initiated, influence on treatment plan, impact on clinical time, and provider satisfaction were measured.

Results: Starting the conversation about Whole Health was easy to implement, influenced the treatment plan, did not impede clinical time, and increased provider satisfaction.

Conclusions: Discussing Whole Health topics helps identify issues to address that impact each Veteran’s quality of life. Geriatric Veterans benefit from this approach since Whole Health empowers Veterans to reflect on their values and engage in their care. Increased patient rapport occurred after asking WHQs and provider satisfaction increased. Sharing this simple approach of asking values-based Whole Health questions during routine primary care visits has the potential to improved patient outcomes and reduce provider burnout.

P08.06

Multimodal Complementary Therapy as a First-Line Therapeutic Approach for Acute Cervical Disc Herniation: A Case Report

Wiebke Kohl-Heckl

Evang. Kliniken Essen-Mitte, Essen, Nordrhein-Westfalen, Germany

Contact: Wiebke Kohl-Heckl, [e-mail]

Abstract

Purpose: Around one third of every spinal disc herniation takes place in the cervical area. Guideline-based treatment is based on pain medication in acute phases and supporting therapies from subacute phase on. Multimodal concepts, especially including complementary therapeutic approaches are only recommended for manifested chronic pain syndromes.

Method(s): This case reports presents the treatment of a 37-year-old male patient with a massive cervical disc herniation C5/6 after he underwent an acute trauma on his cervical spine. The symptoms appeared as local and radiating pain from the neck to the right upper arm with 6-10 VAS (visual analog scale from 0-10, 10 maximum pain) but no motoric or sensible dysfunction. Neurosurgically, a ventral discectomy and replacement was recommended but denied by the patient. We included the patient in a 10-day stationary multimodal complementary concept with the goal of pain reduction and remodeling of the inflamed area around the herniated disc. The patient underwent educational groups in physical activation, diet, stress reduction. He joined a 7-day juice fasting by Buchinger and got single and group sessions in Iyengar Yoga by a certified Yoga teacher and physiotherapist. As well, hydro galvanic baths of the upper extremity were combined with daily hot-water neck casts and fango. We also used high-dose Vitamin C (and the local anesthesia Procaine for intravenous therapy. Additionally, Procaine was injected around vegetative ganglia and other nerval structures and was combined with electro- and NADA-acupuncture. Curcumin and Boswellia were used as herbal therapy with anti-inflammatory effects. Progressive muscle relaxation was taught by Mind-body-medicine therapeutics.

Results: After 10 days, the patient showed a pain reduction to 0, max. 1. This reduction also remained in follow up after 6 weeks, 6, 12 and 18 months.

Conclusions: Therefore, complementary multimodal approaches might be an option, not only in chronic but also acute pain conditions.

P08.07

The Multi-disciplinary Integrative Oncology Model: A Whole Health Approach to the Delivery of Integrative Care for the Pediatric Oncology Patient

Robin Miccio¹, Tonia Kulp¹, and Tracey Jubelirer¹

¹ Children's Hospital of Philadelphia, Philadelphia, PA

Contact: Tonia Kulp, [e-mail]

Abstract

Purpose: In 2017, a pilot program funded by philanthropic support was established bringing yoga therapy to the outpatient oncology clinic setting. Due to provider and patient demand, it expanded to inpatient services in 2019, including massage and acupuncture in 2020. A formal Integrative Oncology (IO) Clinic, comprising a multi-disciplinary team was established in 2019.

Method(s): Cancer patients are referred to the IO team for a formal clinical consultation led by the Medical Director or for individual therapies via an EMR order. Individual plans of care are developed according to patient needs and goals. A subset of patients are followed inpatient throughout admission, outpatient in the day hospital clinic setting, and via telehealth when appropriate. Given limited resources, therapists are available twice a week to see patients. A retrospective chart review assessed program success.

Results: 811 patients, aged 1-35 (avg. 11) were seen by the team in varying capacities across inpatient (84%) and outpatient settings. The multidisciplinary clinic served roughly 50 patients, offering comprehensive care. The program saw substantial growth from 208 patient notes in 2019 to 3090 in 2023. Services have since expanded with physician consults now available three times a month in two facilities and two outpatient clinics. Finally, patient satisfaction data collected in 2022 in 64 patient families were overwhelmingly positive with 100% of families indicating satisfaction with treatment, 98% reporting symptom improvement, and 100% expressing willingness to recommend integrative oncology care.

Conclusions: The findings demonstrate the program’s success in terms of reach and patient satisfaction. The model has evolved to provide specialized care for high-utilization patients, emphasizing coordinated support through integrative health modalities across the continuum of care.

P08.08

Why Does Virtually Delivered Whole Health Care Work for Some Veterans and Not Others?

Bella Etingen¹, Scott Coggeshall², Marissa Wirth³, Alex Kloehn², Claire Chen⁴, Gabriel Escudero³, Ibuola Kale³, Stephanie Taylor⁵, Susan Stockdale⁶, Briana Lott⁷, Timothy Hogan⁸, Barbara Bokhour², and Steven Zeliadt⁹

¹ Veterans Health Administration, Dallas, TX

² Veterans Health Administration, Seattle, WA

³ Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL

⁴ Veterans Health Administration, Denver, CO

⁵ Veterans Health Administration, Los Angeles, CA

⁶ VHA, Los Angeles, CA

⁷ Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA

⁸ Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA

⁹ VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

Contact: Bella Etingen, [e-mail]

Abstract

Purpose: The Veterans Health Administration (VHA) rapidly began offering Whole Health (WH) care virtually during COVID-19. VHA now seeks to understand how to improve this novel delivery platform (tele-WH) for WH care so it is optimally beneficial for Veterans. We assessed factors associated with perceptions of impacts of tele-WH care.

Method(s): We conducted an online, cross-sectional survey of Veterans using tele-WH services. Survey questions assessed type and format of tele-WH services used, Veteran experiences with tele-WH care and perceptions of its value, availability of technical support, and technical quality. We conducted descriptive analyses and will complete a multiple logistic regression model identifying factors associated with Veteran perceptions of impacts of tele-WH.

Results: N=421 out of 2,000 Veterans invited from 10 VHA facilities completed the survey (22% response rate). Respondents most frequently endorsed that tele-WH care helped them ‘A lot’ to: be better engaged in their health care (59%), manage their health better (50%), and achieve their personal health goals (43%). Respondents most frequently endorsed WH coaching (30%) as having helped them the most. Just under half (49%) indicated that in-person offerings were not available to them; however, 63% reported that because of tele-WH, they were able to participate in WH services they otherwise would not have been able to use. Over half (53%) reported knowing who to contact if they needed technical support. Most (79%) reported having good video and sound quality when using tele-WH. We will also report on factors associated with Veteran perceptions of impacts of tele-WH.

Conclusions: Many Veterans have received and benefitted from tele-WH care in recent years. However, in order to maximize the impacts of tele-WH care for Veterans, VHA must understand how to tailor virtually-delivered WH care. As VHA continues to adapt tele-WH care moving forward, understanding and leveraging drivers of Veteran-perceived value of tele-WH is important.

P08.09

Use of Artificial Intelligence (AI) for Traditional Medicine: Need for the Benchmarking

Saketh Ram Thrigulla

Ministry of Ayush, Government of India, New Delhi, Delhi, India

Contact: Saketh Ram Thrigulla, [e-mail]

Abstract

Purpose: Digital technologies, artificial intelligence (AI), and software as a medical device (AI-SaMD) are transforming medical practice and research, directly impacting the traditional medicine sector. While this fast-emerging sector has immense promise, it creates ethical, legal, and social challenges, such as equitable access, privacy, proper applications and users, liability, prejudice, and inclusivity.

Method(s): Extensive Review and analysis of the national, and international policies, practices and practical considerations for the use of AI in traditional medicine in the light of ethical and digital divide considerations and the need for the development of benchmarking the same.

Results: Traditional medicine and its practitioners are operational in remote areas away from urban infrastructure and face challenges with internet availability and digital literacy. The digital divide in this segment varies drastically from country to country. Less “algorithmic awareness” is a new, reinforced level of the digital divide, as it is a skill required to negotiate digital technologies successfully. Considering that the digital divide will narrow over time (defined more by generation than by age), in the case of TM, it may worsen due to some TM groups' possible non-acceptance of such technologies, considering them interfere with natural healing and holistic health practices. A pragmatic solution to solve this problem is to come up with amicable benchmarking methodologies for the use of AI in traditional medicine.

Conclusions: The paper presents the plausible areas of use of AI and benchmarking modalities for a. To provide safe and effective traditional medicine modalities for prevention and treatment, and b. Prevention of Biopiracy and sustainable use of TM resources.

P08.10LB

Started with a Human, Abandoned to a Robot

Meg Jordan

California Institute of Integral Studies, San Francisco, CA

Contact: Meg Jordan, [e-mail]

Abstract

Purpose: Behavioral and integrative health professionals are witnessing the number of AI-generated large language platforms, such as ChatGPT expand, as a few studies indicate modest changes in positive lifestyle habits. However, little to no research has been done on individuals who started with human coaching then were transferred to a Chat bot. This case study of one individual who was transferred from human to robotic dialog explores the differences in the lived experience.

Method(s): The method is an ethnographic case study of one individual who underwent two months of coaching and counseling on a digital behavioral health platform intended to turnaround a prediabetic diagnosis. It is also a first-time analysis of the psychological and emotional aftermath of someone (a “subscriber”) who sought a human therapist and coach online, then was transferred to an algorithmic “relationship” while working with the deeper issues that blocked authentic growth and development.

Results: The subject reported a reversal of four behavioral and attitudinal gains that were previously made during the four weeks of human-contact coaching/counseling sessions regarding adopting a growth mindset, and making healthier food choices and new eating habits. The ensuing weeks spent with the ChatBot were reported to result in feeling disconnected, struggling with the depersonalized nature of the coaching “dialog,” finding himself caught up in seeking more webinar-based solutions.

Conclusions: It should be noted that this case report does not assume an anti-technological stance, since the author supports automation of health care processes that resolve some of the more dire, fragmented and disconnected aspects of ailing system. Instead, it is a call to action from the perspective that simulated, artificial voices can never know what it means to be a human in need of human connection, and that the elusive quality of deep human connection is worthy of our attention, further research, and safeguarding.

P08.11LB

Developing an Integrative Prehabilitation Program for Facial Feminization Surgery: A QI Project and Model for Whole Health Integration

Anne Hall¹, Katie Hu², Justine Lee³, and Rashmi Mullur²

¹ David Geffen School of Medicine at UCLA, Los Angeles

² UCLA, Los Angeles, CA

³ UCLA Division of Plastic and Reconstructive Surgery, Los Angeles, CA

Contact: Anne Hall, [e-mail]

Abstract

Purpose: Given the high rates of mental health comorbidities among transgender and gender diverse (TGD) patients, an integrative prehabilitation program for TGD patients seeking facial feminization surgery (FFS) may further enhance their physical, mental, and emotional health and improve post-operative outcomes. Standard of care prehabilitation prepares patients for surgery by addressing physical fitness, nutrition, lifestyle behaviors, and mental health prior to surgery. Our study aims to develop and investigate whether an integrative prehabilitation program that is centered on the whole health model can improve post-op psychosocial outcomes.

Method(s): The program includes multi-media patient education on topics such as FFS, whole health, mind-body practices, self-acupressure and facial massage routines, integrative post-operative planning and care, post-op nutrition and more. The impact of the intervention will be measured by comparing the patient reported outcome measures (PROMs) for patients who participate in the integrative program to a control group that receives standard of care, which so far includes 420 patients.

Results: The PROMs include anxiety, anger, depression, global mental health, positive affect, meaning and purpose, global physical health and many more. Patient scores will be collected during the patient’s initial consultation, 3-6 months post-op and 1.0 - 1.5 years post-op. Additionally, daily PROMs for anxiety, depression, and anger will be collected 21 days post-operatively as an Ecological Momentary Assessment (EMA) and the EMA scores of the intervention group will be compared to the control group.

Conclusions: Developing and evaluating an integrative prehabilitation program for TGD patients pursuing FFS utilizing validated, quantitative PROMs may lead to new insights, not only on prehabilitation for gender-affirming surgeries, but also on effective models in which whole health education and integrative therapies can be incorporated in surgical and primary care settings.

P08.12LB

Implementing Acupuncture for Pediatric Patients Hospitalized with Sickle Cell Disease Pain Crises at a Quaternary Urban Pediatric Hospital

Rosemary Carlson¹, Robin Miccio, Erica West¹, Maria Mascarenhas², John T. Farrar², and Jasmine Umana¹

¹ Children's Hospital of Philadelphia, Philadelphia, PA

² Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA

Contact: Rosemary Carlson, [e-mail]

Abstract

Purpose: This case study describes the implementation of acupuncture in a quaternary pediatric hospital for patients with sickle cell disease (SCD) hospitalized with vaso-occlusive pain crises. We examined the delivery model of inpatient acupuncture, the utilization of acupuncture, and patient demographics.

Method(s): We performed a retrospective descriptive analysis of patients with SCD hospitalized for pain crises at the Children’s Hospital of Philadelphia (CHOP) from July 1, 2020, to January 19, 2024. We used an electronic medical record (EMR) query to identify all notes authored by an acupuncturist during hospitalizations for patients with SCD. Data elements extracted from the EMR included patient demographics, number of visits per patient, and dates of notes. We will also perform manual chart reviews to gather details from the acupuncture visits; this data will be collected in REDcap. This case study was granted IRB exemption.

Results: Since 2020, CHOP's Integrative Health Program has employed a full-time acupuncturist to service the entire hospital with a goal of offering biweekly acupuncture to all patients with SCD hospitalized with pain crises. There were 595 acupuncture visits for 179 patients in this population in this time frame. Most patients (62%) had 2-9 visits with an acupuncturist, and 89% of all patients had more than 1 acupuncture visit. Acupuncture visits increased 178% in 2023 from the year prior, after the implementation of an automatic acupuncture consult order in the EMR for patients hospitalized with SCD pain crises.

Conclusions: This data supports that acupuncture is embraced by patients with SCD and their families at CHOP. Demonstrating the successful implementation of acupuncture at CHOP builds the case for its value in comprehensive SCD pain management programming. This delivery model was successfully extended to massage and yoga in December 2023. Our results lend support to institutional efforts to offer integrative health therapies to patients with SCD experiencing pain crises.

P08.13LB

Integrative Medicine Growth at Indiana University and Parkview Health Consortium Member Institutions through a Data Collection Framework

Jennifer Stone¹, Niki Munk², Angela LaSalle³, Brad Tieszen³, and Tammy Sajdyk⁴

¹ Indiana University, Indianapolis, IN

² Indiana University, School of Health & Human Sciences, Indianapolis, IN

³ Parkview Health, Fort Wayne, IN

⁴ Indiana University School of Medicine, Indianapolis, IN

Contact: Jennifer Stone, [e-mail]

Abstract

Purpose: Success indicators are important to identify and measure for any new initiative or program to cultivate continued support and sustainability. Our team endeavored to design systematic methods to collect and report data on the impact of 2 Indiana Integrative Medicine programs.

Method(s): Indiana University and Parkview Health Integrative Medicine have established a data collecting framework for 6 outcome/success indicator areas: (1) Capacity building (2) Resource provision (3) Networking (4) Revenue generation (5) Education and (6) Dissemination productivity.

Results: Data collection began for IU and PHIM at their respective ACIMH membership initiation (2022 and 2019, respectively). Each institution indicates growth in all 6 outcome/success indicator areas. Specifically, IU developed a 6-member steering committee, held 10 Monthly Member meetings, populated a designated media channel with 14 10:00 minute video recorded About Me presentations from faculty. Under development is an interactive network web map that tracks the growth of IU faculty and community partners through multiple timepoints. PHIM increased total operating budget by 20% since joining ACIMH, developed a lifestyle medicine training curriculum, dietitian and music therapy programming, and a Cancer Institute Integrative Therapy program. A Medical Director of Employer Solutions position was created, and an IM regional employer clinic model was established. Of recent note is the development of a rotation for IUSM students at the PHIM Clinic that began in January 2024. The PHIM rotation meets unmet needs of both institutions, providing IUSM students with a clinical integrative medicine rotation option at PHIM, and provides the physicians at PHIM an opportunity to teach medical students.

Conclusions: Individual and collaborative growth within and between IU and PHIM in the 6 identified outcome/success indicator areas suggest the promise of continued integrative medicine reach and impact within the state of Indiana.

Topic Area 09 – Education Research

P09.01

A Bibliometric Study of Chinese Medicine and Higher Education

Xiaoran Xu¹ and Futongyu Sun¹

¹ Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Xiaoran Xu, [e-mail]

Abstract

Purpose: To conduct a literature review on Chinese medicine and higher education based on CiteSpace, introduce and analyze the current status of their research, research bottlenecks and limitations, and visualize and analyze the results. To explore the main aspects of research in TCM and higher education and the trend of hot research.

Method(s): Using “Chinese medicine and higher education” as the search term, we searched the original research literature related to Chinese medicine and higher education in China Knowledge Network (CNKI) database since its establishment, and used CiteSpace software to count the number of articles, keywords, authors and research institutions and other literature information. Higher education in terms of research objects, visual data analysis of the popular research dynamics, combined with the results of the graphical content interpreted the meaning.

Results: There are 933 selected literature about TCM and higher education, and there are 394 research institutions, mostly in the field of medical industry, and the most published article is Beijing University of Traditional Chinese Medicine; there are 602 authors; the results of keyword analysis show that high-frequency keywords bit talent training 56 times, internationalization 29 times, teaching reform 27 times, TCM education 22 times, countermeasures 18 times, and development 17 times.

Conclusions: The research direction of TCM and higher education in recent years is highlighted in the reform and development from the traditional education aspect to the internationalization path.

P09.02

Are Integrative Medicine Graduates Integrating Diet and Nutrition Into Their Practice? An Evaluation of the GW Integrative Medicine Programs

Julia Kish-Doto¹, Elise Coberly², Patrick Corr², and Leigh A. Frame³

¹ Marymount University, Arlington, VA

² The George Washington University, Washington, DC

³ George Washington School of Medicine & Health Sciences, Washington, DC

Contact: Leigh A. Frame, [e-mail]

Abstract

Purpose: The White House Challenge to End Hunger and Build Healthy Communities recently stated a national need to educate health care professionals on how to help their patients make healthy food choices. The George Washington University Integrative Medicine Programs (INTM) have a new concentration to provide nutrition training to health care professionals plus nutrition courses for all INTM learners. We evaluated how and to what extent INTM graduates implement their nutrition training after graduation and if this varies by nutrition credit hours.

Method(s): We conducted an online quantitative survey of 26 graduates of INTM to assess their practice area, frequency of nutrition counseling with patients, barriers to providing nutrition education, and level/type of provider self-care. Graduates’ statements of purpose from their applications were qualitatively analyzed to explore initial motivation to enter the field.

Results: Almost all graduates directly interact with patients (96%). More than half (56%) work in a setting that covers preventive care, and 47% counsel their patients on diet/nutrition at every visit. All graduates report self-care is very or extremely important and most feel it impacts the quality of care they provide (78%). Intellectual and physical self-care were most frequently practiced daily. Time and reimbursement were extreme barriers to discussing diet/nutrition with patients. Reasons for applying to INTM include a desire to “bridge the gap” between allopathic and complementary medicine, improve the health of local communities, and personal health experiences.

Conclusions: The importance of providing adequate nutrition training to health care professionals cannot be overstated. INTM graduates are practicing nutrition care with their patients after graduation with implications for future providers.

P09.03

Chiropractic Teaching Clinic Stakeholders’ Insights on Patient Safety: An International Qualitative Study

Michael Moore¹, Stacie Salsbury², Martha Funabashi³, and Katherine Pohlman¹

¹ Parker University, Dallas, TX

² Palmer Center for Chiropractic Research, Davenport, IA

³ Canadian Memorial Chiropractic College, Toronto, ON

Contact: Michael Moore, [e-mail]

Abstract

Purpose: To describe chiropractic teaching clinics stakeholders’ responses to queries about how to improve patient safety.

Method(s): This mixed method, cross-sectional survey was conducted with clinical stakeholders (students, faculty, and staff) at 4 international chiropractic teaching programs (n=864). After respondents completed the quantitative portion of the survey, they were asked 4 open-ended questions:

• Communication: How can communication about patient safety be improved at your institution?

• Clinical Setting: Thinking about the clinic setting, what suggestions do you have related to improving patient safety for office procedures, documentation, equipment, patient follow-ups, information exchange, or other related items?

• Education: How can the education about patient safety be improved within your clinic setting?

• Leadership: How can leaders improve patient safety in their teaching clinics?

A multidisciplinary team conducted a qualitative content analysis for each question. Then codes from each question were cross-walked to identify similar definitions and overall themes.

Results: There were 460 study respondents (53.2%), with 386 (54.5%) students, 45 (35.2%) faculty, and 29 staff (90.6%). Themes were identified within and between questions. These included: patient-centeredness, safety reporting, safety education, communication, accountability, administrative oversight, clinical workload, training gap/guidance/reassurance, emotions, documentation, patient-facing communication, patient feedback system, policy/procedure implementation, risk mitigation, physical environment, clinical practice / care standards, clinician involvement, and safety reporting.

Conclusions: Within healthcare academic settings, patient safety curricula and research are limited. Stakeholder’s attitudes need to be understood, so that strategies for improvement can be systematically developed. This study found specific themes from academic stakeholders that should be considered when designing patient safety curricula.

P09.04

Cultivating Compassion through Self Care for Nursing Students

Rebecca Nagle¹ and Lili Martin¹

¹ University of Vermont, Burlington, VT

Contact: Rebecca Nagle, [e-mail]

Abstract

Purpose: It is well documented that unmanaged stress can lead to negative outcomes for nurses and patients including increased risk for medical errors, compassion fatigue, burnout, and significantly higher rates of suicide in nurses compared to the general public. Therefore, it is imperative that nursing programs prepare their graduates to optimize wellbeing and manage stress before they enter the workforce. Clinical Question: What impact does an experience based self-compassion course to optimize nursing student mental health and wellbeing have on nursing student perceived stress and resiliency?

Method(s): The nursing course, Compassionate Care for Nurses was created to provide students with tools to optimize their mental health. The course was delivered in a hybrid format and students explored how stress affects mental health and well-being. Students participated in a variety of evidence-based, integrative health strategies that included meditation, mindfulness, reflection, yoga, tai chi, forest bathing, culinary medicine, and more. This project was deemed “not research” through the IRB. Electronic pre and posttest surveys measuring perceived stress, resiliency, and satisfaction with the course were administered at the start and end of the fall and spring semesters. Paired t- tests were used for analysis with one or two-tail significance levels (p <.05) reported.

Results: Both cohorts of students began the course with moderate stress and low resiliency levels. At the end of the fall semester, students demonstrated statistically significant decreases in stress levels (p=.037) and increased resiliency levels (p=.031). At the end of the spring semester, while not statistically significant, students demonstrated decreased stress levels, and increased resiliency levels.

Conclusions: An experiential wellness course geared towards optimizing mental health and wellbeing provides nursing students with strategies to promote resilience and prevent compassion fatigue and burnout before entering the workforce.

P09.05

Embedding Integrative Oncology (IO) Education throughout Medical Training

Alissa Huston¹, Sydney John², Elizabeth Sheen², Sue Czap², Paige Torrens², Susan Wood², Marilyn Ling³, Bryan Jan⁴, and Judy Zeeman-Golden⁵

¹ Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY

² Pluta Integrative Oncology & Wellness Center, University of Rochester Medical Center, Rochester, NY

³ Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY

⁴ Department of Medicine, Hospice and Palliative Care, Northwestern University, Chicago, IL

⁵ Retired, Pluta Integrative Oncology & Wellness Center, University of Rochester Medical Center, Rochester, NY

Contact: Alissa Huston, [e-mail]

Abstract

Purpose: Over 60% of cancer patients use a form of complementary services, yet many providers express concerns about making recommendations citing a lack of knowledge. We developed two educational experiences to bridge this knowledge gap: The IO Ambassador Program and The Immersive IO Resident Experience. Aims included: 1) to enhance knowledge on the research supporting IO based services in coordination with instruction on bedside skills and 2) to expand access to IO services at the Wilmot Cancer Institute (WCI) and it’s 12 regional sites by bringing IO based care directly to the patient.

Method(s): The IO Ambassador Program includes online education modules and training in bed-side skills in meditation, nutrition, massage and yoga by oncology certified providers. A pre/post intervention assessment was administered and the curriculum embedded in the resident experience. Residents participating in the Immersive IO Resident Experience rotated for 2 weeks in our Pluta Integrative Oncology & Wellness Center (IOWC) observing and participating in core modalities, observing consults and developing a scholarly project.

Results: The first elective was January 2021 and the IO Ambassador Program launched December 2022. At the time of submission, 2 residents have rotated and 10 out of 18 participants completed baseline demographics. Data will be presented on the curricular development process, resident reflections and updated data on participants in The IO Ambassador Program including change in knowledge. As data on program usage in our Pluta IOWC is available in our EMR, we will also track post-implementation metrics.

Conclusions: Embedding IO-focused training for providers throughout the healthcare continuum represents an important step forward in mainstreaming IO care. Training providers on the “front line” of cancer care may lead to greater empowerment for patient referrals earlier in a treatment course and the ability to bring IO based care directly to patients at regional cancer center sites.

P09.06

Employee Coaching Connection: Health and Wellness Coaching in the Workplace

Karen Westervelt¹, Alyssa Smith¹, Jurdan Mossburg¹, Sara Falxoner¹, Kyler Huffert¹, Ashley Pelkey¹, Ashlyn Woods¹, Susan Whitman¹, and Gail Rose¹

¹ University of Vermont, Burlington, VT

Contact: Karen Westervelt, [e-mail]

Abstract

Purpose: Health and Wellness Coaching (HWC) is a nascent profession with emerging evidence demonstrating effectiveness at addressing health promotion and lifestyle disease. The Employee Coaching Connection (ECC) is a novel 12-week group + individual HWC program delivered jointly by HWC students and faculty. This research explores the effects of faculty and students delivering an Employee HWC program on employee health promotion and student experience.

Method(s): Employees of a university and affiliated hospital who enrolled in ECC in the 2022-2023 academic year were invited to participate. Employee participants completed surveys at week 0, 5, 12, 18, and 24 which included Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10), Perceived Stress Scale (PSS-10), and goal attainment. Student participants completed surveys at week 0 and 12 on confidence and clinical hours obtained.

Results: Employee PROMIS-10 Global Physical Health (GPH) scores increased significantly from baseline to week 12 (p <0.05), and week 24 (p <0.05). Employee PROMIS-10 Global Mental Health (GMH) scores increased significantly from baseline to week 12 (p<0.05). Significant decreases in employee PSS-10 scores were observed from baseline to week 12 (p<.05), week 18 (p<0.05), and week 24 (p<0.05). On average, participants reported meeting 62% of their health-related goal by week 12. Students reported gaining valuable clinical experience and improved confidence in individual and group coaching skills by the end of the program.

Conclusions: The Employee Coaching Connection program supported employee wellbeing in measurable ways. Employees reported lower levels of stress and higher levels of physical and mental health at the end of this program compared to baseline. This program gave students valuable mentored practical experience. A combination of group + individual HWC delivered by students and faculty appears to be mutually beneficial for students and employees while promoting health in the workplace.

P09.07

Evaluation of a Leadership Program for Early Career Academic Integrative Physicians

Mari Ricker¹, Victoria Maizes², Patricia Lebensohn³, and Joy Weydert⁴

¹ University of Arizona, COM Tucson, AWCIM, Tucson, AZ

² University of Arizona, Tucson, AZ

³ UArizona, Tucson, AZ

⁴ UArizona, Kansas City, MO

Contact: Victoria Maizes, [e-mail]

Abstract

Purpose: The Andrew Weil Center for Integrative Medicine (AWCIM) Cultivating Leaders in Academic Integrative Medicine (ACLAIM) Program is a nine-month leadership development program designed for early career faculty teaching Integrative Medicine (IM) seeking professional development to enhance their skills in teaching, scholarship, evaluation, leadership, and community engagement. It was noted that there is a lack of professional development opportunities for early career IM leaders.

Method(s): The ACLAIM program is nine monthly 90-minute webinars, two longitudinal projects, and a two day in-person workshop, in Tucson, AZ at the end of the program. Participants committed to approximately 4 hours per month, including the 90-minute webinars, in addition to the final in-person workshop. The program was open to any academic IM early career faculty. Initially, 47 faculty from six specialties, three countries, and 15 US states, applied via online application, requiring departmental support, and a commitment to the 10 month-long program, workshop, webinars, and projects, and 30 faculty were accepted. Pre and post assessments were completed by the participants.

Results: There were 30 MD and DO faculty who committed to the year-long ALCAIM program. Of these, 21 completed all of the program requirements, five withdrew, and four partially completed the program. The pre and post assessments included a teaching portfolio, the Miller Leadership inventory, and future leadership goals, as well as a programmatic evaluation. This is an IRB approved project and we will have our assessment data in the fall of 2023 and intend to present the results along with conclusions.

Conclusions: We will review our results and feedback from the participants in the fall of 2023. It was evident in the creation of this program and the initial interest that this is an area of significant need. We hope to learn from the feedback and assessments to determine the value, sustainability, and future of the ACLAIM program leadership program.

P09.08

Health and Wellness Coaching as a Complementary Certification in Undergraduate Education: Evidence and Lessons Learned

Jeremy Sibold¹, and Karen Westervelt¹

¹ University of Vermont, Burlington, VT

Contact: Jeremy Sibold, [e-mail]

Abstract

Purpose: The purpose of this paper is to provide an evidence based rationale for HWC as a complementary area of study to non-licensure granting, undergraduate health degrees in higher education.

Method(s): A comprehensive review of the literature related to the efficacy of HWC was completed. In addition, the national program directory was mined for descriptive data for approved HWC programs.

Results: According to the NBHWC, there are currently 113 approved HWC training programs in the United States, including credit bearing (e.g., minors, concentrations, etc.) and non-credit bearing (e.g., non-degree certificates) curricula, as well as non-academic, commercial programs within the private sector. The NBHWC does not stipulate what type of institutional recognition/degree conferral is applied to HWC programs, only that the aforementioned 75 contact hours are met per the published standards. As of March 2023, 22% of the approved HWC programs in the NBHWC directory were offered for academic credit, and 19% as academic non-credit certificates. In the first four years of our academic program in Health and Wellness Coaching, over 100 students have completed the curriculum and successfully passed the NBHWC certification exam, more than double the projected enrollment.

Conclusions: Evidence from the successful implementation of a novel undergraduate program in health and wellness coaching supports health and wellness coaching as a compelling, complementary skillset for entry level graduates across a range of health settings. In establishing health and wellness coaching curricula in academic institutions, the field can offer a widely accessible mechanism for training and subsequent direct, entry level employment as a professional Health and Wellness Coach to the undergraduate population.

P09.09

Mitigating Medical Student Stress and Introducing Mind-Body Medicine with Pre-dissection Meditations

Aaron Marshall¹, and Heather Christensen¹

¹ University of Cincinnati, Cincinnati, OH

Contact: Aaron Marshall, [e-mail]

Abstract

Purpose: Cadaveric dissection is a cornerstone of undergraduate medical education. The violent reality of this hands-on learning activity brings about a variety of responses amongst students from diverse backgrounds, including emotional distress. Students’ reactions to this discomfort can be humor, desensitization, or avoidance. To mitigate distress and promote well-being, we designed a series of pre-dissection meditative practices (modeled on MSBR principles). This study assessed the feasibility and acceptability of this curricular offering, and the effects on students who attended.

Method(s): Meditations were modeled after a surgical “timeout” (in the cadaver lab, dressed in scrubs, just prior to starting the assigned dissection). The practice was an open awareness meditation: reflecting on the act of dissection, imagining the utility of the relevant anatomy during the donor’s life, acknowledging internal feelings, and offering gratitude. Surveys were conducted at the end of the semester.

Results: Attendance at the meditations ranged from 8% to 40% of the class. Post-semester survey responses were categorized into ‘never attended’ (n=30), ‘attended once’ (n=19), or ‘attended more than once’ (n=23). Of the respondents who attended (n=42), 97.6% reported at least a little reduction in stress, 71.4% reported at least a moderate reduction and 30.9% reported a lot of stress reduction. Another question with the same response choices resulted in 95.2%, 76.2% and 61.9%, feeling at least a little, at least a moderate or a lot more centered by the meditation, respectively. Among those who attended only once, 18 of 19 claimed a desire to attend more often.

Conclusions: Pre-dissection meditations can improve wellness and concomitantly introduce an experiential pedagogy in mind-body medicine. The meditative practice reduced stress in a majority of our participants. To a greater degree, the practice allowed students to feel more centered.

P09.10

Nature as Medicine & Classroom? Evaluating an Innovative, Outdoor Course for Medical & Dental Students

Mary Guerrera¹, Sierra Trudel², and Emily Winter²

¹ University of Connecticut School of Medicine, Farmington, CT

² University of Connecticut, Storrs, CT

Contact: Mary Guerrera, [e-mail]

Abstract

Purpose: There is a growing, global awareness and recognition of the important, interdependent relationships between our natural world and human health. This ancient, indigenous wisdom of ‘relationship and reciprocity’ is now being championed by several contemporary health organizations who have placed calls to action and an urgent need for collaboration and interdisciplinary research, education, and clinical work to address the increasing degradation of our planetary and human health. With more research dedicated to nature’s health impacts, health professions schools would benefit by including such training in their programs while also cultivating a comprehensive mind-body health perspective. The present program evaluation investigates a five-day outdoor course covering nature-based health techniques at a medical and dental school. This unique outdoor course combines nature, creativity, and reflection within the context of modern medicine.

Method(s): A concurrent mixed-method design using quantitative and qualitative data from 5 cohorts of students’ anonymous final course evaluations and reflection projects are evaluated.

Results: Data show students were overwhelmingly pleased with their experience during this five-day course, with feedback reinforcing the enjoyment and transformative outcomes gleaned from the class experiences. Students entered the course describing feeling stressed, overwhelmed, and overextended, and completed the course describing the acquisition of applicable skills, increased attention and mindfulness, creativity, and connection to the natural world.

Conclusions: Students described a positive course experience. Several areas of personal/professional development were described: improvements in cognitive domains, enhanced nature connection, increased mindfulness, and overall well-being. Findings have implications for medical, dental, and other health professions educational programs on how such an innovative curriculum may lean into the work of nature-based care for the whole person.

P09.11

Perceptions and Experiences of Researchers and Clinicians in Integrative Medicine With Predatory Journals and Conferences

Jennifer Stone¹, L. Susan Wieland², Jeremy Y. Ng³, Arya Nielsen, PhD⁴, and Mica Rosenow⁵

¹ Indiana University, Indianapolis, IN

² University of Maryland School of Medicine, Providence, MD

³ Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; Bosch Health Campus, Stuttgart, Germany; Centre for Journalology, Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,

⁴ Icahn School of Medicine at Mount Sinai, New York, NY

⁵ Indiana University Purdue University Indianapolis, Indianapolis, IN

Contact: Jennifer Stone, [e-mail]

Abstract

Purpose: To assess to what extent researchers and clinicians in Integrative medicine (IM) have experience with predatory journals and conferences.

Method(s): A 10-question survey was developed using definitions in published literature, approved by Indiana University IRB #17696 and deployed in newsletters and direct email to researchers and clinicians.

Results: The survey was sent to 6263 email addresses. 271 completed surveys (response rate 4.3%) were included in analysis. Most respondents held a PhD (75.4%) followed by an MD (15.8%), then MS/MSOM/DAOM (12.1%) degrees. 96 respondents provided additional comments to open-ended questions. Most respondents (87.4%) were familiar with predatory journals but fewer were familiar with predatory conferences (58.0%). When asked where they had heard of predatory journals and conferences, most reported that it was at a conference or in a journal, and not an academic course or program. Open-ended responses revealed that many learned about predatory journals and conferences informally from colleagues. 94.8% of respondents stated that they had received invitations to submit articles to journals that could be predatory, 18.0% reported they had submitted to a journal that could be predatory, and 13.1% reported they had reviewed for a journal that could be predatory. Most respondents thought it was important for researchers and clinicians to be able to identify possibly predatory journals and conferences (88.0% and 85.6% respectively).

Conclusions: IM researchers and clinicians are solicited by predatory journals and conferences but have not been formally taught about their risks. Some researchers and clinicians have unknowingly been added to editorial boards of predatory journals and have registered for predatory conferences. Predatory journals exploit unknowing authors and contribute to misinformation relating to health care. The broader impact of predatory journals/conferences on CAIM researchers should be further studied.

P09.12

Perceptions and Interest of Medical Students in Psychedelics: A Pilot Educational Initiative

Thais Salles Araujo¹, Justin Laube², and Camila Castro³

¹ UCLA, Los Angeles, CA

2UCLA, Santa Monica, CA

³ UNIFESP, Sao Paulo, Sao Paulo, Brazil

Contact: Thais Salles Araujo, [e-mail]

Abstract

Purpose: There is growing interest in the therapeutic use of psychedelics for patients with complex mental health conditions, addictions and end-of-life challenges, and it shares similar healing intentions as other integrative therapies. Yet medical professionals and trainees in the US lack training in psychedelic sciences. This pilot study aimed to explore the current state of interest and knowledge of medical students and the impact of an educational session on psychedelics on 4th-year medical students' interest in this topic.

Method(s): A pre-lecture survey assessed the baseline knowledge, perceptions and primary areas of interest of psychedelics among 27 fourth-year medical students. Two 60 min sessions (45min didactic and 15min Q&A) were conducted by an MD expert in integrative medicine and psychedelic sciences, including an illustrative case of a patient with multi-dimensional pain and existential distress. A post-lecture survey assessed their perceptions and interest in furthering their introductory knowledge in the topic.

Results: At baseline: 63% of students reported “no prior medical knowledge” of psychedelics; 18% held “neutral” and 15% held “negative” perceptions; 85% of students reported “strong interest” in psychedelic sciences. Primary areas of interest were: historical roots, therapeutic applications, and pharmacology & research. Main concerns about psychedelics included potential risks, legal status, lack of evidence and limited personal knowledge. Post session, 9% held neutral and 0% held negative perceptions; and 96% were both interested in additional psychedelic curriculum and would recommend the educational session to colleagues.

Conclusions: The pilot study showed interest amongst medical students to learn about psychedelic sciences and suggests that an hour-long educational intervention may positively impact interest and perceptions. Further studies are needed to explore with larger groups of students, of varying years.

P09.13

Physical Therapy Students’ Perceptions and Use of Complementary and Integrative Health Approaches

Carissa Wengrovius¹, Robyn Gisbert¹, Dawn Magnusson¹, and Dana Judd¹

¹ University of Colorado Anschutz Medical Campus, Aurora, CO

Contact: Carissa Wengrovius, [e-mail]

Abstract

Purpose: Healthcare students endure substantial academic and clinical stressors. While evidence supports implementation of student wellness programs that incorporate complementary and integrative health (CIH) practices, few studies have examined CIH approaches in physical therapy (PT) students. This study aimed to explore PT students’ perceptions and use of CIH approaches for the development of a student wellness program.

Method(s): A 76-question, anonymous survey was distributed to 3 PT-student cohorts at a U.S. public university. The survey consisted of four components: demographics, lifestyle behaviors, the learning environment, and CIH perceptions and utilization. This analysis is part of an ongoing mixed methods study that will also utilize focus groups to explore students' preferences for CIH curricula.

Results: Most respondents (N=84) identified as white (79.8%), female (83.3%) and under 25-years-old (52.4%). Lifestyle behaviors students felt the least confident in were stress management (M=6.53±2.16, scale=0-10) and sleep (M=6.68±2.54). Perceptions of peer and faculty relationships were strong, but their workload was overwhelming (75.3%), and they felt overstressed (49.4%). All respondents indicated rehabilitation professionals should be familiar with CIH practices, and many considered CIH practices to be somewhat (75%) or very effective (17.1%) in treating disease. Primary CIH practices being used for student self-care were regulated breathing practices (65.4%), yoga and meditation (59.3%), massage (53.8%), and natural products (49.4%). The greatest barrier for using CIH approaches was time for self-care and insufficient knowledge of clinical evidence for clinical care.

Conclusions: PT students are interested in CIH approaches for both self-care and clinical practice. Incorporating CIH approaches into a student wellness program has the potential to not only decrease current stress and burnout, but also expand student knowledge of CIH and support implementation of CIH approaches into clinical practice.

P09.14

Self-Compassion Education to Reduce Clinician Burnout

Paula Gardiner¹, Adrian Perez Aranda², Elizabeth Lin³, and Zev Schuman Olivier⁴

¹ Cambridge Health Alliance, Lexington, MA

² Instituto de Investigación Sanitaria de Aragón, Cerdanyola del Vallès, Barcelona, Spain

³ Kaiser Permanente Washington Health Research Institute, Seattle, CA

⁴ Harvard Medical School/CHA Center for Mindfulness and Compassion, Malden, MA

Contact: Paula Gardiner, [e-mail]

Abstract

Purpose: Clinician burnout has become a healthcare crisis and systems are responding by placing an increased emphasis on clinician well-being with programs to reduce burnout. We report this pilot data on a continuing medical education (CME) program called Self Compassion for HealthCare Communities (SCHC) Program.

Method(s): Physicians who are working for a large healthcare system were invited to participate in an online CME-accredited program consisting of six one-hour sessions emphasizing mindfulness and self-compassion practice strategies. This was delivered online through short didactics, discussions in break out rooms, and experientials. Demographic and baseline levels of self-compassion (Self Compassion Scale, SCS), professional quality of life scale (ProQOL), and resilience (Resilience Activation Scale, RAS). Pre-post changes were assessed using the student’s t test. The number of responders in the training intervention were calculated using the ProQOL “Burnout” subscale’s severity thresholds. The Benjamini-Hochberg test was applied to correct for multiple tests.

Results: A total of 131 physicians completed baseline assessments of which 45 (34%) completed post assessments. Among the 131 physicians who filled out baseline surveys, 83% were women, 44 % were Asian, 29 % were White. Among completers, most were females (83%), and more than 40 years old (80%). Pre-and-post comparisons among completers, showed that in the domains of self-compassion, there was an increase in self-kindness (p < .001); common humanity (p < .001); and mindfulness (p < .001) and a reduction of over-identification (p < .001); isolation (p < .001); and self-judgment (p < .001). There were decreases in burnout, secondary trauma, as well as an increase in job satisfaction. After applying the multiple test correction, these pre-post effects remained statistically significant

Conclusions: We found that it is feasible to offer Self-Compassion training to physicians. Among those who completed the program, significant improvement in the domains of self-compassion and less burnout was reported.

P09.15

Understanding Student Integrative Medicine Attitude, Use, and Interest to Guide Interprofessional Opportunities

Mica Rosenow¹ and Niki Munk²

¹ Indiana University Purdue University Indianapolis, Indianapolis, IN

² Indiana University, School of Health & Human Sciences, Indianapolis, IN

Contact: Mica Rosenow, [e-mail]

Abstract

Purpose: Patients in the United States access complementary care available in Integrative Medicine (IM) programs and communities across the country. Future healthcare provider attitudes about and experiences with modalities that patients utilize for self-initiated care or through prescribed treatment plans are important to support Whole Health outcomes. Interprofessional education opportunities in academic programs without dedicated IM programs can help facilitate understanding and awareness of current research and changing complementary care in allopathic medical settings. A cross-sectional study was completed to 1) identify graduate student attitudes toward IM modalities and 2) determine interests for future interprofessional education opportunities.

Method(s): An online survey was distributed by REDCap link and QR code through school or teacher email communications and presentations across Indiana University’s Medical, Nursing and Health and Human Sciences schools. Students completed the Integrative Medicine Attitude Questionnaire and reported previous use and future interests. SPSS was used to analyze survey results.

Results: Participants (n=34, 25.7 ± 5.04 yrs.) identified very positive attitudes toward holism (48.3 ± 5.8) and provider introspection and therapeutic relationships (50.1 ± 5.1) with less favorable attitudes toward modality effectiveness (30.5 ± 6.3). Half of participants had used one or more integrative modalities with 22% interested to learn more about multiple modalities. Prayer/Meditation and Yoga were most previously used with highest interests in Yoga, Traditional Chinese Medicine and Acupuncture, Biofeedback, and Herbal/Vitamin treatments.

Conclusions: Students in professional healthcare programs without a formal IM program value provider introspection and the therapeutic relationship. Less favorable attitudes toward the effectiveness of IM modalities emphasize the need for and encouragement of interprofessional education opportunities provided to prepare future medical providers.

P09.16LB

Enhancing Proficiency: Educational Standards for Qualified Health Professionals in Therapeutic Yoga Foundations

Heidi Crocker¹, Christiane Brems², and Geno Carvalho²

¹ International Association of Yoga Therapists, Huntington Beach, CA

² Stanford Medicine Department of Psychiatry and Behavioral Health, Stanford, CA

Contact: Heidi Crocker, [e-mail]

Abstract

Purpose: This study introduces a pioneering pilot program that significantly advances the professional evolution of yoga therapy in Western healthcare. The program aims to equip QHPs with the essential understanding and skills to integrate yoga into their scope of practice, fostering a whole-health approach to patient care. As QHPs personally experience the positive impact of yoga within their professional domains, there is a heightened likelihood of them advocating for the inclusion of yoga therapists within interprofessional healthcare teams.

Method(s): IAYT initiated a groundbreaking pilot study in collaboration with YogaX Advanced Yoga Teacher Training at Stanford Psychiatry, targeting a specialized 300-hour therapeutic yoga program tailored for Qualified Healthcare Professionals (QHPs). The comprehensive YogaX training program is centered around seamlessly integrating holistic yoga therapeutics into healthcare, with the primary goal of equipping QHPS to skillfully incorporate yoga practices into their established healthcare methodologies.

Results: In response to the unique demands of this initiative, IAYT meticulously developed accreditation standards, educational competencies, and a rigorous accreditation process. This framework not only ensures the quality of therapeutic education at the 300-hour level but also establishes a distinctive recognition for healthcare providers who successfully complete this transformative training program. This marks a significant stride in formalizing and elevating the standards of therapeutic yoga education in healthcare.

Conclusions: The growing desire among healthcare providers to enhance patient care through personalized assessment, goal setting, and non-pharmaceutical interventions underscores the need for a comprehensive guiding framework. The formulation of educational standards designed specifically for QHPs serves as a beacon, guiding healthcare providers toward a more informed and adept utilization of yoga therapy principles in their practices.

P09.17LB

Integrated Clinical Care Competencies for Doctor of Chiropractic Degree Programs: A Modified Delphi Consensus Process

Zachary Cupler¹, Clinton Daniels², Jason Napuli³, Robert Walsh⁴, Anna-Marie Ziegler³, Kevin Meyer⁵, Matthew Knieper³, Sheryl Walters⁶, Stacie Salsbury⁷, Robert Trager⁸, Jordan Gliedt⁹, Morgan Young¹⁰, Kris Anderson¹¹, Eric Kirk¹², Scott Mooring¹³, Patrick Battaglia¹⁴, David Paris¹⁵, Amanda Brown¹⁶, Justin Goehl¹⁷, and Cheryl Hawn¹⁸

¹ Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, PA

² Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, WA

³ VA St. Louis Health Care System, St. Louis, MO

⁴ VA Palo Alto Health Care System, Palo Alto, CA

⁵ VA Puget Sound Health Care System, Tacoma, WA

⁶ Logan University, Chesterfield, MO

⁷ Palmer Center for Chiropractic Research, Davenport, IA

⁸ Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

⁹ Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI

¹⁰ Washington State Labor and Industry, Olympia, WA

¹¹ Spectra Community Health Center, Grand Forks, ND

¹² Advocate Aurora Health Care, West Bend, WI

¹³ Northwestern University Health Sciences, Bloomington, Bloomington, MN

¹⁴ Care St. Louis Health, St. Louis, MO

¹⁵ VA Northern California Health Care, Redding, CA

¹⁶ Henry Ford Health, Detroit, MI

¹⁷ Dartmouth Health, Lebanon, NH

¹⁸ Texas Chiropractic College, Pasadena, TX

Contact: Zachary Cupler, [e-mail]

Abstract

Purpose: There has been rapid growth of chiropractors pursuing career opportunities in both public/private hospitals and integrated care settings. Doctor of Chiropractic degree programs (DCPs) have historically prepared DCP students for private practice while chiropractic post-graduate clinical training residencies and fellowships have attempted to fill the necessary gaps for integrated care competency development. The purpose of this study was to develop integrated care core competencies for DCPs to guide the advancement of clinical chiropractic education.

Method(s): A systematic literature review identified 1718 citations, with 23 articles meeting eligibility criteria. Domains and seed statements were generated from this literature, piloted at a conference workshop, and evaluated via a modified Delphi consensus process. Of 44 invited, 36 content experts participated as panelists. Public comment period yielded 20 comments, none resulting in substantive changes to the competencies.

Results: After two modified Delphi rounds, consensus was reached on all of the competency statements. The final competencies were categorized into 4 domains, 11 subdomains, and 78 competency statements. Collaboration competencies highlighted Roles and Responsibilities; Cooperation, Respect, and Engagement; and Self-Reflection. Clinical Excellence competencies emphasized Patient Safety, Clinical Acumen, Professional Literacy, and Ethics. Communication competencies stressed Interprofessional and Interpersonal formats. Systems Administration competencies featured Digital Health and Organizational Responsibility and Safety.

Conclusions: We identified 78 core competencies appropriate for preparing DCP students and early career chiropractors for clinical practice in integrated healthcare settings. DCPs may consider these competencies for curricular design and reform to strengthen DCP graduates for integrated practice setting advanced training and employment.

P09.18LB

Teaching Cancer CALM: Culinary and Lifestyle Medicine (CALM) Education for Cancer Risk Reduction (CRR)

Stephanie Harris¹, Hope Barkoukis¹, Ryanne Lachman¹, Lindsay Malone¹, Alec Dodson², David Bebee¹, Laura Fernandez¹, and Elaine Borawski¹

¹ Case Western Reserve University School of Medicine, Cleveland, OH

² Case Western Reserve University School of Medicine, Pacific Palisades, CA

Contact: Stephanie Harris, [e-mail]

Abstract

Purpose: Culinary medicine (CM) promotes health and supports disease management; so it is critical to increase competency in CM. This longitudinal prospective cohort study aims to evaluate the impact of a cancer-prevention specific CM curriculum on medical students’ (i) cancer risk reduction (CRR) knowledge, (ii) personal health behaviors and cooking skills, and (iii) intentions to incorporate CRR assessment and counseling as part of future practice.

Method(s): 2^nd year medical students enrolled in the Wellness and Preventive Care Pathway participated in eight, 3-hour CRR focused CM education sessions. Guided by the Health Behavior Theory and Theory of Planned Behavior models, the study examines the impact of curriculum on standardized measures of general nutrition/cancer knowledge; attitudes/beliefs and self-efficacy around diet/lifestyle modifications to prevent cancer; and personal/professional intentions of integrating CRR strategies. Baseline survey was completed in 09/2023; post-test will be done in 03/2024.

Results: 86 students completed the baseline survey; 31 Wellness Pathway (100% of those enrolled) and 55 non-pathway students (controls). At baseline, the 2 groups did not differ statistically by gender, race or age. Both groups scored low on the comprehensive nutrition and CRR knowledge test (I=2.91 vs C=3.19 correct out of 15). The control group was more confident in their ability to apply CRR strategies with future patients ( $\overline{\mathrm{X}}$ =3.01 vs. $\overline{\mathrm{X}}$ = 2.94 p=.06) and reported higher cooking skills ( $\overline{\mathrm{X}}$ = 5.26 vs. $\overline{\mathrm{X}}$ = 4.82 p=.07). The two groups did not differ on their beliefs about the role of nutrition in medical practice or their intention to implement CRR strategies. Comparison of change at end of curriculum will be reported.

Conclusions: This study is one of the first to incorporate and evaluate CRR-specific CALM competencies into medical education. If curriculum is successful, it is applicable to numerous disease states and is an innovative approach to teach nutrition competencies.

P09.19LB

Utilizing Integrative Medicine to Enhance Chronic Pain Management in a Family Medicine Residency

Erica Veazey¹ and Elise Blaseg²

¹ Utah Healthcare Institute, Salt Lake City, UT

² Utah Healthcare Institute/ St. Mark's Family Medicine Residency, Salt Lake City, UT

Contact: Erica Veazey, [e-mail]

Abstract

Purpose: This project aimed to develop and implement an integrative medicine handout listing treatments and local resources for chronic pain management in a Family Medicine Residency. The goal was to improve residents' knowledge and utilization of integrative approaches to enhance patient care.

Method(s): A comprehensive handout was created, detailing various integrative treatments for chronic pain, including acupuncture, mind-body techniques, yoga, and massage therapy. Local resources offering these services were also included. The handout was presented at a Noon Conference and integrated into the Electronic Medical Record (EMR). A survey was conducted among residents at the St. Mark's Family Medicine Residency Program to evaluate the impact of the handout.

Results: Survey results indicated a positive impact of the handout on residents' approach to chronic pain management. Following the presentation, residents reported a 3x increased likelihood of utilizing integrative medicine techniques in their practice. Residents reported using the handout in 85% of appointments for chronic pain. Additionally, 100% of residents found the handout to be helpful in the clinical care of patients with chronic pain and expressed interest in further education on integrative medicine.

Conclusions: The integrative medicine handout successfully improved residents' awareness and utilization of integrative approaches to chronic pain management. By providing comprehensive information and local resources, the handout facilitated the integration of integrative medicine into the residency program's patient care. The positive feedback and interest from residents highlight the importance of incorporating integrative medicine education into medical training programs. This project demonstrates the potential for enhancing patient care through the integration of evidence-based integrative medicine practices in primary care residency settings.

Topic Area 10 – Expressive Therapies

P10.01

Effectiveness of Art Therapy Interventions for Treating Pain and Anxiety in Adolescents in the Emergency Department

Susanne Bifano¹ and Daniel Tsze²

¹ NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY

² Columbia University Vagelos College of Physicians and Surgeons, New York, NY

Contact: Susanne Bifano, [e-mail]

Abstract

Purpose: To determine the effectiveness of art therapy in reducing pain and anxiety in adolescents with painful conditions being treated in the emergency department (ED).

Method(s): Prospective observational pilot study of patients 12-18 years old presenting to an ED with a painful condition. Pain intensity was measured using the Verbal Numerical Rating Scale (scored 0-10); a decrease of ≥20% was clinically significant. Anxiety was measured using the State-Trait Anxiety Inventory (scored 20-80: 20-40=zero-low anxiety; 41-60=moderate anxiety; 61-80=high anxiety); a change from higher to lower category was clinically significant. Outcomes were measured at baseline, immediately after and 1-hour after art therapy completion. A standardized interview was conducted immediately after art therapy completion.

Results: We enrolled 50 patients. Fifty and 21 patients were assessed immediately after and 1-hour after art therapy completion, respectively. Mean duration of art therapy was 34.7 minutes. Mean baseline pain was 6.2 and decreased by 23.2% (95% CI 14.9-31.5) and 28.6% (95% CI 9.2-48), immediately after and 1-hour after art therapy completion, respectively. Mean baseline anxiety was 48 (moderate) and decreased to 38 (low) and 43 (moderate) at the same time points, respectively. Forty-eight patients (96%) reported feelings of relaxation, decreased pain intensity, and/or empowerment (e.g., “Very relaxing”; “I didn’t feel as much pain”; “Really showed my emotions”; “A way to explain to doctors what I’m feeling and what parts hurt”).

Conclusions: Art therapy was associated with clinically significant decreases and qualitative improvements in pain and anxiety in adolescents with painful conditions being treated in the ED.

P10.02

Heightened Connections to Community, Culture, Spirituality, and Emotions through Bharatanatyam: A Qualitative Study of Experienced Dancers

Varsha Ganesh¹, Timothy Chen², Arin Budhiraja³, Bruriah Horowitz², Christina Sauer², and David Victorson⁴

¹ New York University, New York, NY

² Northwestern University Feinberg School of Medicine, Chicago, IL

³ Northwestern University, Los Angeles, CA

⁴ Northwestern University, Evanston, IL

Contact: Varsha Ganesh, [e-mail]

Abstract

Purpose: While some evidence suggests psychosocial and physical health benefits of Bharatanatyam (e.g., Indian Classical Dance), no study has explored the lived experiences of Bharatanatyam dancers themselves and the value they place on this practice for their own well-being. Using a qualitative methodology, the purpose of this study is to explore Bharatanatyam dancers’ perceptions of this practice and its impact on their lives.

Method(s): Bharatanatyam dancers with at least 10 years of experience participated in a 60-minute recorded Zoom interview about their experience, history, and relationship with Bharatanatyam, with a focus on how it may have impacted their well-being. Using a Grounded Theory approach, research team members engaged in open coding to create an initial codebook from the first transcript, and then took an interrater reliability test (Kappa >.70) before coding subsequent transcripts. Group-based axial coding was used to create higher-order categories and themes from the original codes. Saturation was documented.

Results: In total, 15 Bharatanatyam dancers were interviewed, resulting in 206 unique codes. Saturation was met for 82% of the codes. Axial coding yielded 27 higher-order categories, and five overarching themes: 1) “Foundations of Bharatanatyam”, which highlighted important aspects of the practice 2) “Heightened Connections” across emotional, spiritual, community, and cultural areas, 3) “Improvements in Mind/Body/Spirit” highlighting increased emotional, physical, cognitive, and energetic wellbeing, 4) “Motivations and Challenges for the Practice” such as perceived benefits and practice barriers, and 5) “Processes of Practice” highlighting the dynamic and stylistic nature of the artform.

Conclusions: This study offers evidence that Bharatanatyam plays a role in a dancer's well-being through heightened connection and improvement in physical and mental health; knowledge which can help transform its role from a mere artform to a creative healthcare modality.

P10.03

The Efficacy of Integrating a Music-Based Intervention in MOUD Community Treatment Clinics: Protocol for a Feasibility Trial

Caitlin Krater¹, Debra Burns², Shelby Schuller-Hsu¹, Adam Hirsh¹, and Eric Garland³

¹ Indiana University Indianapolis, Indianapolis, IN

² Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, IN

³ University of Utah, Salt Lake City, UT

Contact: Caitlin Krater, [e-mail]

Abstract

Purpose: Addiction is a disease of reward dysregulation, and while efficacious treatments exist, few methods restore the regulation of the reward system negatively affected by substance abuse. Music-based interventions are safe, non-addictive solutions that can potentially reverse the maladaptive neuroplastic changes resulting from substance abuse. Music therapy as an add-on treatment is beneficial in reducing craving and increasing motivation for treatment while in detoxification units. However, there is scant literature describing the use of music-based interventions in outpatient settings. The aim of this study is to examine the feasibility of integrating a music-based intervention (MBI) into an outpatient treatment program; the efficacy of an MBI on drug use and other important outcomes; and potential mechanisms that will assist in optimizing and integrating MBIs in substance abuse treatment.

Method(s): 60 adults enrolled in a State Opioid Treatment Program and receiving medications for opioid use disorder (MOUD) will be randomly assigned to receive music therapy or treatment as usual (TAU). The music therapy delivery schedule mirrors TAU in timing and dose (1 hour group session per week for 8 weeks). Measures of proximal and distal outcomes will be obtained for both groups at baseline (T1), intervention completion (T2), and 3 months follow-up.

Results: Music's influence on mediating processes, such as self-regulation, self-transcendence, reward, craving, and affect will be investigated. Results will provide new insights into feasibility and mechanisms of a theoretically coherent music intervention targeting substance abuse.

Conclusions: This study explores the feasibility of integrating a music-based intervention into a community opioid treatment clinic and collect preliminary data on potential mechanisms that may explain the benefits of music-based interventions in outpatient addictions treatment. This is the first time a music-based intervention has been developed based on current theories of addiction.

P10.04

The Use of Preferred Music to Improve the Sleep Quality of a High School Athlete Post-Concussion

Deborah Layman¹, Rebekah Smith², and Christopher Tangen³

¹ Cleveland State University, Cleveland, OH

² Cleveland State University; University Hospitals of Cleveland, Cleveland, OH

³ University Hospitals of Cleveland, Cleveland, OH

Contact: Deborah Layman, [e-mail]

Abstract

Purpose: The purpose of this study was to examine the use of preferred music in addressing the self-reported sleep quality, pain, and mood of a high school athlete post-concussion.

Method(s): Participant was an 18-year-old athlete with a concussion history resulting in severe headaches, difficulty sleeping, and negative mood.   In this single-subject, quasi-experimental study, 11 individual weekly music therapy sessions were conducted via HIPAA-compliant Zoom. The first 4 sessions focused on determining participant’s musical preferences. Then, an Apple Music playlist was created, containing preferred, instrumental hip-hop music ranging from 49-118 beats per minute, based on participant’s preferences, self-reported arousal level, and specific musical elements. Musical selections were sequenced utilizing iso-principle, with highest bpm music first and then gradually to lowest bpm. The participant used the playlist each night at bedtime. During the remaining 7 music therapy sessions, the student music therapist taught specific music relaxation techniques for use with the playlist.

The Brief Pain Inventory (Short Form) and the Pittsburgh Sleep Quality Index were administered pre- and post-intervention to assess self-reported pain and sleep quality. Self-reported pain and mood were recorded before and after each session using 7-point Likert scales. Sleep quality (using a 5-point Likert scale) was self-reported each morning.

Results: PSQI scores decreased from 10 pre-intervention to 5 post-intervention. Self-reported sleep quality increased from less than 3 to almost 5, indicating the participant felt more rested. Overall perception of pain also decreased from 4 pre-intervention to 1 post-intervention; pain interference decreased from 2.5 to 0. Self-reported mood increased throughout intervention, stabilizing by Session 8 at 6 out of 7.

Conclusions: Results indicate that using a preferred-music prescribed playlist, paired with music & relaxation techniques, may improve sleep quality, pain, and mood.

P10.05LB

The Making of “Thrive! Healthy People – Healthy Planet”: An Evidence-informed Health Center-based Art Exhibition

Sara Warber¹, Leonie Schulz², Diana K.B. Hoover³, Elaine Sims¹, Nia Heard-Garris⁴, and Katherine N. Irvine²

¹ University of Michigan, Ann Arbor, MI

² James Hutton Institute, Aberdeen, Aberdeen City, United Kingdom

³ University of Wisconsin-Stevens Point, Stevens Point, WI

⁴ Feinberg School of Medicine at Northwestern University; Division of Academic General Pediatrics and Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center at the Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL

Contact: Sara Warber, [e-mail]

Abstract

Purpose: Whole person health relies on the health of our surroundings and on the health of the planet, which is threatened by environmental degradation. Divisive politics and science literacy gaps impede our capacity for unified action. Art can reach viewers on an emotional level, allowing them to reflect, alter their perspectives, and change their behaviors. Art placed in hospitals and health centers can connect with people of all backgrounds at a time when health is their primary focus. We describe the making of an evidence-informed art exhibition, “Thrive! Healthy People – Healthy Planet,” designed for display in hospitals and health-centers.

Method(s): In 2019, an interdisciplinary group of artists, writers, hospital arts specialists, social scientists, and physicians collaborated to explore the nexus of art, health, and environment. The group adopted an emergent inquiry approach grounded in qualitative research methods and best practices in interdisciplinary research and evaluation.

Results: Initial exploration of environmental artists’ work uncovered a lack of imagery depicting health. Popular environmental art focused on raising the alarm about environmental catastrophe, but few examples created a vision of a vibrant planet including healthy people. The group then co-created a series of statements based on nine essentials for health: air, water, food, shelter, energy, biodiversity, community, safety, and purpose. The statements formed the basis of a call for photographic art. Following interdisciplinary jurying and curation, the “Thrive!” exhibition was showcased at a major health center during the summer of 2023. Limited viewer evaluation suggested that several goals of the exhibition were realized.

Conclusions: Insight from the inaugural exhibition will inform a tool kit for other institutions seeking to host the exhibition. An evidence-informed planetary health exhibition has the potential to shift attitudes and behaviors and could be a catalyst for important dialogues within whole person healthcare.

Topic Area 11 – Group Medical Visits

P11.01

Facilitators and Barriers of Integrative Group Health Visits

Prasad Vinjamury¹, Jacqueline Yu¹, Chloe Lee¹, and Jennifer Noborikawa¹

¹ Southern California University of Health Science, Whittier, CA

Contact: Prasad Vinjamury, [e-mail]

Abstract

Purpose: The Integrative Group Health Visit (IGHV) pilot program for chronic pain patients was implemented with the objective to incorporate the positive aspects of group medical visits specifically on concepts from integrative health. The purpose is to describe the lessons learned and barriers faced during the development and implementation of the IGHV program.

Method(s): The IGHV program was developed by a group of clinicians, staff, and students at a University Health Center located in California. Ten weekly sessions were offered. These were followed by group discussions led by a moderator. At the end of these sessions, participants completed qualitative surveys to offer an insight on the facilitators and barriers to participation in the IGHV.

Results: Eighteen patients registered for this pilot program and on average 6 patients attended a session. The average number of sessions attended by each participant is 5. Most attendees perceived that the physical activity and mindfulness activities in the beginning were very useful to focus on the present moment and feel more engaged. The top three facilitators for participation were the affordability (no cost), session topics and the time when the virtual sessions were presented. Interestingly, the top three barriers for participation were also the length of the program (10 weeks), the day, time and length of the presentations, and the virtual group format. The barriers explain the limited attendance. Overall, the participants rated the program as informative, supportive, engaging and empowering and wanted to attend similar programs if offered in the future.

Conclusions: IGHV were perceived as useful and empowering by chronic pain patients from diverse backgrounds. The effectiveness of IGHV could be improved by addressing the barriers such as simplifying the registration process, facilitating technology education, and changing the duration and number of sessions and having a dedicated staff member to coordinate these sessions with the help of clinical students.

P11.02

Provider Experience with Integrative Medical Group Visits at Safety-Net Healthcare Settings

Mary Jackson¹, Katherine Lenger¹, Alexandra Naranjo², and Isabel Roth³

¹ The University of North Carolina at Chapel Hill, Raleigh, NC

² The University of North Carolina at Chapel Hill, Asheville, NC

³ University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC

Contact: Mary Jackson, [e-mail]

Abstract

Purpose: Healthcare providers across the country are experiencing increased rates of burnout resulting in emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. Current literature suggests that changes at the individual, work cluster, organizational, and national levels can improve provider wellbeing and decrease burnout. Integrative Medical Group Visits (IMGV) are a modification to the work cluster level. However, there is a lack of understanding of provider experience with IMGV delivery and what benefits and drawbacks providers observe.

Method(s): Interviews were conducted via Zoom and telephone with 21 clinicians, administrators, and staff from safety-net healthcare settings throughout the country who have implemented IMGVs for patients with chronic pain. In addition to questions related to implementation, the team asked questions about provider experience, well-being, and satisfaction with the IMGV model. Interviews were recorded, transcribed, and coded using thematic content analysis by a team of trained qualitative researchers.

Results: The authors identified themes which positively contributed to greater provider well-being during IMGV: collaboration with an interprofessional team, provision of quality healthcare, a horizontal power dynamic between providers and patients, and innate benefits of a group structure. An additional fifth theme includes adoption and implementation determinants of IMGV at safety-net healthcare settings.

Conclusions: The current study was the first to use interviews from providers and staff who have implemented IMGV to assess their experience and understand the effect on provider well-being. Despite limitations, these findings suggest that the themes identified warrant further investigation into IMGVs as a model to promote provider well-being and mitigate aspects of burnout including depersonalization and decreased sense of self-efficacy.

P11.03

Testing the Feasibility of Online Narrative Healing Circles to Improve Social Connections: A Shared Medical Appointment (SMA) Pilot

Michelle Loy¹ and Anne-Marie Audet²

¹ Integrative Health/Weill Cornell Medical/NYP Hospital, New York, NY

² New York Presbyterian, New York, NY

Contact: Michelle Loy, [e-mail]

Abstract

Purpose: Social connection is a public health priority given the national epidemic of loneliness. Emerging research suggests a relationship between social connection and person-reported quality of life, health status, and mortality risk reduction. Innovative health delivery models such as Shared Medical Appointments (SMA) are associated with improved clinical outcomes for acute and chronic diseases. The aim of this pilot was to assess the feasibility of virtual Narrative Healing Circles (NHC), a new form of SMA among mixed-diagnosis urban population.

Method(s): Recruitment included referrals, flyers, hospital website etc. Two physicians (integrative medicine and chaplaincy specialists), both trained in narrative medicine, co-led a series of 4 or 8 bi-weekly one-hour long virtual NHC SMAs. Sessions included centering meditation, topic introduction, short writing exercise initiated with a written, musical, or visual prompt, followed by time of sharing/listening. Optional electronic pre/post participant surveys emailed at enrollment (7-questions, response rate 29%) and after 4-8 NHC SMA sessions (12-questions, RR 34%).

Results: 18 months of virtual SMAs attended by 62 unique participants, 266 total visits. Average age: 57 years (27-84) Gender: 85% F 15% M Ethnicity: 73% White,16% African American, 6% Asian, 5% Hispanic. 1/2 lived in underserved areas. Payor mix: 40% Medicare 60% Commercial insurance. Mean attendance per session: 6 (1-13). Range of sessions attended: 1-28. Top symptoms reported in the pre-survey: anxiety/depression (67%) pain (55%). After 4-8 sessions, participants reported improvements in anxiety/fear (43%), depression/hopelessness (33%), irritability (33%), loneliness (33%). Positive changes reported: restarting yoga/meditation practice, greater focus on humor-awe, journaling, mindfulness, stress-management. 94% reported goals met, 95% would recommend series. Two clinicians’ leaders reported increased empathy and work satisfaction.

Conclusions: NHC SMA is feasible, improves agency/wellbeing.

P11.04

Shared Medical Appointment Program with Self-Monitoring for Lifestyle Modifications to Improve Blood Pressure

Irina Todorov¹, Eno-obong Udoh¹, and Sonal Patil²

¹ Cleveland Clinic, Cleveland, OH

² MethroHealth, Cleveland, OH

Contact: Irina Todorov, [e-mail]

Abstract

Purpose: Lifestyle modifications are recommended for all hypertensive patients. Group education visits with peer support can be an effective and sustainable way to support lifestyle modifications. We conducted a pre-post study of shared medical appointments (SMA) for lifestyle modifications and coping skills to improve hypertension control in patients with uncontrolled hypertension.

Method(s): A single group pre-and post-intervention study of hypertensive patients with uncontrolled hypertension based on clinic blood pressure (BP) of systolic BP>130 or diastolic BP >80 mm Hg. Any interested patient with uncontrolled hypertension desiring lifestyle modifications but no medication changes were enrolled. Patients were trained to use home BP machines and offered enrollment in 6-week SMAs or weekly emails with educational materials with free mindfulness app use for 6 weeks. SMA sessions were facilitated by a medical provider and mind-body therapists. We compared pre-post changes in BP using paired t-tests.

Results: Thirty-two patients enrolled in the study; (Mean age 56 years, 72.7% women, 42.4% Black) and 54.5% opted to enroll in the SMAs. Self-monitoring was not completed by one Black male, one White male, and one White female. SMA attendance was <50% in two White and one Black participant, 7 were males, one binary gender and the rest were female participants. Results of the unadjusted pre- to post-paired-t test indicated that there is a significant improvement in systolic BP from mean SBP of 144.3 (SD 12.5) to post-intervention SBP 132.7 (SD 12.5) with p < 0.001. Results of unadjusted pre- to post-paired-t test of participants (n=16) attending SMA showed a significant improvement in systolic BP from mean SBP of 144.7 (SD 12.8) to post-intervention SBP 129.4 (SD 6.7) with p < 0.001; however, for participants who only received educational materials, there was no significant improvement in Systolic BP (p=0.1).

Conclusions: Participating in SMA may improve systolic BP whereas weekly printed education may not improve systolic BP when both groups engage in self-monitoring.

P11.05LB

Ketamine-Assisted Group Therapy for Mental Health Promotion

Selma Holden¹ and Olivia Esteireiro²

¹ University of New England, Biddeford, ME

² University of New England, Portland, ME

Contact: Selma Holden, [e-mail]

Abstract

Purpose: Ketamine is an emerging pharmaceutical option for depression and is also utilized in psychedelic-assisted psychotherapy to address anxiety, post-traumatic stress and other mental health conditions. Practitioners of ketamine-assisted therapy (KAT) combine medically supervised ketamine administration with interactive therapeutic sessions. The high cost of individual sessions is not routinely covered by insurance, requiring creative solutions to increase access. By combining the group medical visit model with KAT, treatment costs are lowered and additional benefits may arise. This pragmatic pilot study aims to explore the feasibility and effectiveness of group KAT for addressing symptoms of depression, anxiety and post-traumatic stress.

Method(s): Five cohorts of five patients underwent a six-week program that included three group KAT sessions, via oral or intramuscular routes. Medicine sessions were followed by group integrations and occasional home-therapy programs. All cohort activities were supported by a physician and therapist team. Symptoms were measured at baseline after program completion using the PHQ9, GAD7, PCL7, and the 26-point Self-Compassion Scale.

Results: Follow-up results were available from 18 of the 23 patients who completed the program. Non-parametric comparisons of baseline to post-treatment measures demonstrate significant decreases in PHQ9 (p=.001), GAD7 (p=.006), and PCL7 (p<.0001) scores, but not Self-Compassion. The average cost different between individual and group therapy was $1,850.

Conclusions: Offering psychedelic therapy in a group format is feasible and less expensive. Preliminary results show possible effectiveness for group KAT to address symptoms associated with anxiety, depression, and post-traumatic stress. Longitudinal follow-ups are needed to explore the durability of symptom relief and qualitative interviews will hopefully uncover other possible themes besides a potential change in self-compassion.

Topic Area 12 – Health Equity and Health Disparities

P12.01

A Touch of Compassion: A Qualitative Study with Support Workers

Lorraine Horton¹ and Rachael Shaw²

¹ Birmingham Community Healthcare NHS Foundation Trust, Birmingham, West Midlands, United Kingdom

² Aston University, UK, Birmingham, West Midlands, United Kingdom

Contact: Lorraine horton, [e-mail]

Abstract

Purpose:

• Many learning-disabled people do not communicate verbally

• Touch is rarely explored as the primary communication medium contributing to exclusion from connection with others

• Support Workers “constantly” use touch in their care role and it is mostly task related

• There is very little research on the significance of touch and its communicative function in the lives of learning-disabled people.

This study sought to understand:

• The kinds of touch used in daily care

• Support Workers awareness of the potential to communicate and connect through touch - to have a 'touch conversation'

• Whether they considered touch to be a medium through which to demonstrate compassion.

Method(s):

1. Individual semi-structured interviews with 16 voluntary participant support workers from residential and day-care services

2. Recorded and transcribed interviews

3. Inductive thematic analysis

4. Themes generated:

• Uses of touch

• Communication through touch

• Relationship building through touch

• Organizational support

Results: Touch is complex and multidimensional. The relationship between care receivers and supporters exists in the context of the “constant” touch required. Touch is essential in intimate care. Interviews afforded supporters a unique opportunity to reflect upon their touch, realizing their potential to communicate through touch with “intellectual kindness”, thus impacting positively on the care relationship. None of the care organizations involved held explicit policies or specific training on touch. Supporters received little support in their use of touch and its complex communicative function.

Conclusions: Further research is required to fully understand the significance of touch, particularly interactive touch, in the lives of learning-disabled people when communication is otherwise difficult. National guidance and training will enable supporters and care receivers to confidently use touch as a reciprocal communicating medium and sense of human connection.

P12.02

Advancing DEI in an Integrative Health Sciences University - A DEI Task Force endeavor

Preetideep Singh¹ and Roshalda Williams¹

¹ Southern California University of Health Sciences, Whittier, CA

Contact: Preetideep Singh, [e-mail]

Abstract

Purpose: The world is brimming with diverse challenges in health and healthcare education due to widespread health inequities. DEI in healthcare education is an important tool to dismantle social and structural determinants of health, which enables us to create a just system of healthcare to achieve Whole Health. Southern California University of Health Sciences (SCU) is an integrative health sciences university where a cross-cultural blend of healthcare disciplines presents a unique set of challenges and opportunities to advance DEI.

Method(s): A President’s task force was created to document the university’s commitment to DEI. The task force was comprised of a group of “diverse” individuals. The group was tasked to operate under certain guidelines to recommend a university-wide policy statement on DEI and provide recommendations for goals or objectives to fulfill elements of the statement. The group created a strategic plan with assistance from an external agency to implement DEI efforts across the university. Data was gathered and analyzed from various departments across the university.

Results: Evidence indicates DEI commitment in values, Great Colleges survey results, and celebration of inclusivity through awards. Leadership commitment to diversity is evidenced by 42% of board members being women and 33 % being ethnic minorities. 49.7% of staff is ethnically diverse, student population of over 50% females are some examples of demographics at SCU. DEI is embedded in SCU’s curriculum to include ULOs and PLOs, coursework & delivery, faculty development initiatives, co-curricular and cultural programming, workshops, student services, and marketing initiatives. SCU community is dedicated in serving underserved populations and committed to developing external collaborations with a focus on DEI.

Conclusions: The evidence gathered indicates a strong and continued commitment to DEI at SCU in order to advance Whole Health training of healthcare professionals.

P12.03

Application of a Food as Medicine Framework to Nutrition-Focused Programing

Kyle Mausteller¹, Fernanda Cuadro¹, Ashley Visco², Terrah Keck-Kester², Susan Veldheer³, Lilly Su⁴, Laurie Crawford¹, and Paula Moodie¹

¹ Penn State College of Medicine, Hershey, PA

² Penn State Health, Hershey, PA

³ Penn State Cancer Institute, Hershey, PA

⁴ Stanford Medicine Children's Health, Palo Alto, CA

Contact: Kyle Mausteller, [e-mail]

Abstract

Purpose: Food insecurity is associated with poor health outcomes and affects 1.8 million Pennsylvanians. Community Health Needs Assessments (CHNAs) completed by healthcare organizations (HOs) often identify food insecurity as a challenge. Currently, activities to address social needs identified in clinical settings and community-based programs are conducted separately, leading to siloed activities. HOs are in a unique position to create integrated Food as Medicine (FAM) solutions for their patients. This report outlines an evidence-informed process for organization of the FAM programs supported by a central Pennsylvanian HO.

Method(s): The current FAM programs supported by the HO were identified. Interviews were conducted with clinicians, CHNA committee members, and others to compile a list of FAM activities. The FAM framework suggested by Mozaffarian was adapted to organize the programs by type and define what is the Penn State Food as Medicine Program.

Results: We identified 81 FAM sites, including 12 different program types that represent 4 of 5 intervention categories. Most programs fell within the population-level community food programs (67%, 8 programs, 48 sites) category including: community gardens (14/48, 29%), food pantry wellness programs (12/48, 25%), and school-based garden programs (7/48, 15%). FAM programs were identified in additional categories, including medical tailored grocery packages (8%,1 program, 11 sites), produce prescription programs (17%, 2 programs, 3 sites), and government nutrition security programs (SNAP Ed, 8%, 1 program, 9 sites).

Conclusions: This report represents a first step of one HO to systematically organize its Food as Medicine programing that is guided by evidence. This organization can springboard our FAM program at Penn State, allow us to better identify gaps, and determine strategies to address them.

P12.04

From Skepticism to Advocacy: A Mindfulness Mobile App for Patients with Sickle Cell Disease as a Means of Addressing Health Equity

Yulia Mulugeta¹, Jacqueline Caputo¹, Marcus Williams¹, Maryanna Klatt², Janet Childerhose³, Anvitha Gogineni¹, and Andrew Schamess¹

¹ The Ohio State University, Columbus, OH

² Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

³ The Ohio State University College of Medicine, Columbus, OH

Contact: Yulia Mulugeta, [e-mail]

Abstract

Purpose: Within populations experiencing sickle cell disease (SCD), pain is the most reported complaint. As patients age, this pain becomes chronic due to the increasing frequency of Vaso-occlusive crises resulting in diminished quality of life, increased health service utilization, and increased reliance on opioid for pain management. The purpose of our study is to design and implement a mindfulness-based mobile app to address health equity and health disparities as a supplemental tool to help build resiliency for adults with SCD.

Method(s): Using a design-thinking, patient-centered methodology, input from patients with SCD (n=11) and caregivers (n=3) was used to design program structure and content for a mobile app.  Additional patients (n=5) completed beta test of the app-based mindfulness training over the course of 12 weeks while providing concurrent feedback about their app experience. Upon completion, patient testimonials were recorded and participants’ thoughts on mindfulness, personal experiences of living with SCD, racial disparities in treatment delivery, and overall feedback on content and structure of the mobile app were collected and qualitatively analyzed.

Results: Beta testers reported that although there may have been initial skepticism regarding the mindfulness-based app intervention, their perspective changed significantly through the 12-week mindfulness training course. After the course, patients emphasized positive effects of the program including racial concordance, accessibility/adaptability of the practices to daily life, minimization of pain experience, and a shift in perspective which brought a greater sense of autonomy over their disease experience.

Conclusions: Results suggest that a mindfulness intervention delivered via a mobile app is an equitable/accessible approach for patients with SCD. A clinical trial with 45 SCD patients beginning Autumn 2023 will assess impact on pain perception, loneliness, and emergency department utilization.

P12.05

Health and Illness Beliefs and Practices Among Pakistani Immigrants in Norway: An Application of The Health Traditions Model

Saliha Khalid¹, Agnete Egilsdatter Kristoffersen¹, Trine Stub¹, Samera Azeem Qureshi², Christine Råheim Borge³, and Lise-Merete Alpers⁴

¹ UiT The Arctic University of Norway, Tromsø, Troms og Finnmark, Norway

² National Institute of Public Health, Oslo, Oslo, Norway

³ Lovisenberg Diaconal Hospital, Oslo, Oslo, Norway

⁴ VID specialized university, Oslo, Oslo, Norway

Contact: Saliha Khalid, [e-mail]

Abstract

Purpose: Pakistani immigrants are one of the largest non-Western ethnic minority groups in Norway. They report different health complaints and poorer health as compared to ethnic Norwegians. The difference between the Western biomedical model of health and illness and their traditional Asian models can lead to varied conceptions of health and illness among immigrants, Norwegian society, and healthcare providers. This study aims to understand the health and illness beliefs and practices of first and second-generation Pakistani immigrants in Norway.

Method(s): In-depth semi-structured interviews were conducted with 24 Pakistani immigrants living in Oslo, the capital of Norway. Participants were recruited via a hospital in Oslo using purposive and snowball sampling. Interviews were conducted in Urdu or English upon the interviewee’s choice and varied from 30 - 90 minutes. All the interviews were recorded, transcribed, translated into English, and analyzed via NVivo using the thematic analysis method of Braun and Clarke. Rachel Spector’s Health Traditions model of cultural competence was used as a theoretical basis to understand the beliefs and traditions of health.

Results: Health appeared as a multi-factorial entity with roots in culture, religion, ethnicity, and environment. Some summarized health as the absence of any illness, but most of them explained it as a balance of body, mind, and soul. The model presents the interrelated phenomena of mental, physical, and spiritual health with personal health protection, maintenance, and restoration methods used by migrants, as illustrated in the attached table. Illness beliefs were associated with religious knowledge and various superstitions.

Conclusions: This study can help healthcare providers in Norway to understand the Pakistanis' health traditions and beliefs, leading to better communication. Shared decision-making considering immigrants' health practices can pave the way to whole-person healthcare and improve health equity outcomes for immigrants.

P12.06

Promoting Resource Caravans Across the Perinatal Period to Mitigate Socioeconomic Disadvantage: The Role of Psychological Capital

Charlotte Farewell

University of Colorado Anschutz Medical Campus, Aurora, CO

Contact: Charlotte Farewell, [e-mail]

Abstract

Purpose: The purpose of this study was to investigate psychosocial resource caravans across the perinatal period that may mitigate perinatal mental health disparities among low-resourced individuals.

Method(s): Pregnant individuals experiencing socioeconomic disadvantage are currently being recruited (n=300) and mixed-methods data are being collected at four timepoints across the prenatal and postpartum periods. We are investigating point-estimates of psychosocial resources at all four timepoints followed by latent growth modeling to explore trajectories and associations with mental health outcomes. All analyses are being conducted with Mplus Version 8.

Results: The final logistic regression model predicting prenatal depression risk was statistically significant, X2 (7, N = 266) = 30.11, p < .01. Higher levels of optimism were associated with lower odds of experiencing prenatal depression compared to lower levels of optimism (OR=.82, 95% CI). Individuals with more social support also had lower odds of experiencing depression compared to individuals with less social support (OR=.98, 95% CI). The final logistic regression model predicting anxiety risk was statistically significant, X2 (7, N = 266) = 17.14, p = .02). Higher levels of optimism were associated with lower odds of experiencing anxiety compared to lower levels of optimism (OR=.89, 95% CI).

Conclusions: These preliminary findings have significant implications for the development of strengths-based interventions to promote perinatal well-being. Mindfulness and optimism are psychological constructs that have been shown to be strongly correlated and collectively associated with mental health; therefore, evidence-based mindfulness interventions that integrate positive psychology strategies focusing on the cultivation of psychosocial resources may help to mitigate the risk for experiencing perinatal mood disorders and promote the intergenerational transmission of resilience.

P12.07

Structural Pathways to Providing Financially-Accessible Naturopathic Care in the United States

Nadine Ijaz¹, and Heather Carrie²

¹ Carleton University, Ottawa, ON

² Heather Carrie Research Associates, Vashon Island, WA

Contact: Nadine Ijaz, [e-mail]

Abstract

Purpose: The care of licensed naturopathic doctors (NDs) in the United States may be paid for directly by the patient, reimbursed by private insurance and/or under state Medicaid plans for eligible low-income populations. With a focus on the six states with Medicaid coverage for ND services (AZ, CT, NM, OR, VT, WA), this study aims to characterize the structural pathways used to create more financially accessible naturopathic care.

Method(s): Using descriptive content analysis, two types of data were engaged with reference to the study aims: grey literature (e.g., government websites, organizational reports) and interviews with naturopathic leaders (n=18).

Results: Structural pathways for financially accessible ND care are evident both in public and private sector contexts. Public contexts include federally qualified health centers and Indian Health Services; private contexts include multi-practitioner and solo clinics. Key mechanisms facilitating financial accessibility include primary care provider status, Medicaid reimbursement, salaried employment models, community fundraising, and formal recognition of ND clinics as patient-centered medical homes (PCMH). Some structural pathways are more evident in some states, owing to local contextual factors and the dedicated efforts of key ND leaders; e.g., in Oregon and Washington State, salaried NDs serve as primary care providers in multiple FQHCs, whereas in Vermont, NDs offer care in several private clinics with PCMH recognition. Naturopathic leaders emphasized strong advances made in recent decades, through relationship-building advocacy work and underpinned by patient demand. Key barriers included discrimination experienced by NDs within conventional health systems.

Conclusions: Licensed NDs have been innovating important pathways for more financially accessible care. NDs seeking to expand accessibility in their states may benefit from lessons learned across the studied contexts, while accounting for unique local factors.

P12.08

The Role of CIH Schools in Serving Underserved Communities

Nipher Malika¹, Margaret Whitley¹, Patricia M Herman², Ian Coulter¹, Michele Maiers³, and Margaret Chesney⁴

¹ RAND Corporation, Santa Monica, CA

² RAND Corporation, Sonoma, CA

³ Northwestern Health Sciences University, Bloomington, MN

⁴ UCSF, San Francisco, CA

Contact: Michele Maiers, [e-mail]

Abstract

Purpose: In the U.S., people who use complementary and integrative health (CIH) provider-based services are predominantly those who have more education and income and who identify as non-Hispanic White. Despite evidence that use of CIH positively impacts physical health, mental health and provides greater benefit for marginalized racial/ethnic groups compared to non-Hispanic Whites, CIH is still underutilized among marginalized racial/ethnic populations. CIH schools are uniquely positioned to play a pioneering and proactive role in community outreach and service, making them the prime catalyst for transforming the landscape of CIH utilization among underserved and under-resourced communities.

Method(s): The RAND Center for Collaborative Research in Complementary and Integrative Health is a collaboration between the RAND Corporation and 13 North American institutions training CIH practitioners. These institutions have longstanding partnerships with local organizations to offer CIH care to marginalized communities. Interviews with these institutions were conducted to gather information on their service history, partners, offered services and community demographics.

Results: Results will provide an aggregate summary of the community-based partnerships and services the CIH institutions provide. Key findings include community engagement, targeted initiatives/partnerships, continued collaborations, and the impact on CIH student education.

Conclusions: This presentation will underscore the critical role played by CIH schools in increasing access to care for underserved communities. Their commitment to community engagement, culturally competent care, and patient-centered approaches has made strides in reducing disparities and promoting wellness. Continued collaboration between CIH schools and underserved communities is vital for creating a healthier, more inclusive future.

P12.09

Utilizing Geographic Information Systems to Improve Food Access in a Central Pennsylvania Health System

Courtney Landis¹, Kyle Mausteller¹, Lilly Su¹, Ashley Visco², Laurie Crawford¹, Paula Moodie¹, Susan Veldheer¹, and Terrah Keck-Kester²

¹ Penn State College of Medicine, Hershey, PA

² Penn State Health, Hershey, PA

Contact: Courtney Landis, [e-mail]

Abstract

Purpose: Food insecurity negatively impacts health. To assess food security, tools such as Geographic Information Systems (GIS) allow researchers to identify factors influencing the availability of healthy food. In this research study, we aim to explore the geographic limitations pediatric patients and their families at Penn State Health (PSH) experience when attempting to access programming. We will use GIS to create a map which provides further insight regarding gaps in PSH’s food access resources to inform the creation of new food access programs.

Method(s): Using EIM, charts were compiled of patients, birth-18 years of age, with a well child check at Penn State Academic Pediatric sites in 2021. These charts were assessed for food insecurity on social needs screening. A list of patients who received food boxes from 2017-2021 was also obtained. Families who identified as food insecure and families who received a food box were surveyed. Addresses were mapped against current PSH food access locations.

Results: Of 4257 charts, 158/4257 (3.7%) patients identified as food insecure on social needs screening or received a food box, and 31/158 (19.6%) patients completed the survey, 24/31 (77.4%) of which reported continued food insecurity. Utilizing GIS, locations of patients and current PSH food access points were mapped. Using these maps, we identified multiple gaps in our current programming.

Conclusions: The creation of a PSH-specific food mapping project has allowed us to better understand where to focus food access resource efforts. This is an example of how health care systems can utilize GIS to better understand gaps in community outreach programming.

P12.10LB

Acupuncture Research in a Federally Qualified Health Center (FQHC) – Lessons in Infrastructure

Raymond Teets¹, Arya Nielsen², Lynn DeBar³, Morgan Justice⁴, Donna Mah⁵, Hyowoun Jyung⁶, and Matthew Beyrouty⁶

¹ Icahn School of Medicine at Mount Sinai / Institute for Family Health, New York, NY

² Icahn School of Medicine at Mount Sinai, New York, NY

³ Kaiser Permanente Center for Health Research, Portland, OR

⁴ Kaiser Permanente Washington Health Research Institute, Seattle, WA

⁵ Pacific College of Health and Science, New York, NY

⁶ Institute for Family Health, New York, NY

Contact: Raymond Teets, [e-mail]

Abstract

Purpose: Roughly 1/3 of US older adults experience chronic low back pain (cLBP) along with greater prevalence of comorbidities and polypharmacy, complicating common cLBP treatments. Understanding treatment effectiveness among racially, ethnically, and economically diverse older adults may help inform equitable treatment approaches for cLBP. The BackInAction (BIA) study addresses a critical evidence gap on the effectiveness and safety of acupuncture treatment for Medicare-eligible older adults. This multi-site study, includes the Institute for Family Health a New York City based FQHC serving a diverse population.

Method(s): This randomized controlled pragmatic trial enrolled 800 adults ≥ 65 years old with cLBP (IFH n = 123). Study treatments compared usual care plus standard acupuncture; vs enhanced acupuncture; vs usual medical care alone. Study outcomes were assessed at least quarterly over one year (primary outcome at 6 months). To enhance diversity, database build accounted for Spanish-speaking participants, and research coordinators spoke Spanish. Research recruitment and referrals were routed through participants’ trusted providers and medical ‘home’, rather than direct outreach. Acupuncture was administered in the participants’ home institution. Scheduling and session record were managed through the electronic medical record. Research coordinators and acupuncturists were in routine communication, via weekly surveys.

Results: IFH providers (n=139) created 576 referrals, with participant demographics reflecting success in recruitment of underserved, with 86% participants covered by Medicaid or Medicare; 38% identifying as ‘Black’; 37% identifying as ‘Hispanic or Latino’; and 29% identifying Spanish as their primary language. The no show rate was roughly 10%.

Conclusions: Successful recruiting and retaining a diverse participant group offers lessons for acupuncture research in the underserved milieu.

P12.11LB

Adapting Self-Acupressure for Symptom Relief in Black and Latina Breast Cancer Survivors (BCS): A Feasibility Study

Amrita Bonthu¹, Yu-Chen Liu², Lourdes Inbar-Albo¹, Katarina Aubuchon¹, Dingyue Yang¹, Ella Lowry¹, Angela Perez Villalobos¹, Juei Fang (Christine) Chang³, Jacqueline Chen¹, Stacey Dai1, Kristi Graves¹, Judy Huei-yu Wang¹, and Carla Arieta⁴

¹ Georgetown University, Washington DC, DC

² Georgetown, Washington DC, DC

³ Georgetown University, Washington DC, FL

⁴ EFFECTIVE INTEGRATIVE HEALTHCARE TEAM, Washington DC, DC

Contact: Amrita Bonthu, [e-mail]

Abstract

Purpose: Black and Latina breast cancer survivors (BCS) have disparate outcomes in physical functioning and symptom burden compared to non-Hispanic White BCS. Self-acupressure, a low-cost, low-intensity approach from Traditional Chinese Medicine, uses fingers to apply pressure to specific acupoints that stimulate neural pathways to boost energy (qi) and reduce sleep disturbance, anxiety, and pain. In this study, we adapted an existing acupressure education video to meet the specific needs of Black and Latina BCS.

Method(s): Phase I adapted the existing intervention; we conducted usability testing with 6 Black and 6 Latina BCS. We then conducted a pilot randomized control trial (RCT; Phase II) of the video with 40 BCS (83% of recruitment goal to date; 55% Black, 45% Latina; stages 0-IV). BCS were randomly assigned 2:1 to an 8-week self-acupressure arm (n=28) vs. standard education (n=12). Intervention BCS completed a process evaluation of the acupressure video and 8-week daily logs (track acupressure practice). We assessed feasibility (retention rate), acceptability (BCS feedback on video), and fidelity (adherence to protocol).

Results: In Phase I, Black and Latina BCS provided positive feedback about the video for its clarity and visual appeal. The video was finalized after increasing representation of Black and Latina women, adding a Spanish translation, and providing patient testimonials. In Phase II, results from preliminary analyses indicated high feasibility (82.5% retention; 33/40 remained in study), acceptability (100%; the 18/28 who completed process evaluation reported positive feedback), and fidelity (71.4% daily adherence to acupressure ≥ 75% of time). There were no adverse events.

Conclusions: Our ongoing pilot RCT demonstrates positive outcomes for adapting a self-acupressure intervention video for Black and Latina BCS. Further analysis will be conducted following the completion of Phase II to assess the effect of the intervention on improving physical and psychological symptoms and functioning.

P12.12LB

Addressing the Mental Health Needs of Pregnant and Postpartum Members in the Chinese Community

Kandace Fung¹, Ka-Kit Hui², and Weijun Zhang³

¹ Charles R. Drew University of Medicine and Science; UCLA David Geffen School of Medicine; UCLA Integrative Medicine Collaborative, Los Angeles, CA

² UCLA Department of Medicine, Center for East-West Medicine, Los Angeles, CA

³ UCLA, Los Angeles, CA

Contact: Kandace Fung, [e-mail]

Abstract

Purpose: Despite significant mental health needs during pregnancy and postpartum, Asian Americans often underutilize mental health services. In the Chinese community, the gap between need and access is further amplified by cultural stigma and a lack of mental health interventions. This project aims to develop a culturally relevant, non-drug mental health service pilot program tailored to these needs.

Method(s): This project employs a multi-phase approach, including a preliminary literature review, a needs assessment involving in-depth interviews with local stakeholders, and an online course learning evidence-based non-drug therapies and community engagement approaches. We will identify a non-drug therapy with cultural and local fits and then collaborate with community-based providers to pilot the non-drug mental health service, incorporating group-based interventions, educational presentations, and tools to address somatic symptoms associated with postpartum depression. The pilot program will be implemented at the Chinatown Service Center, with pre- and post-participation questionnaires assessing mental health literacy and service satisfaction.

Results: Our literature review revealed the importance of tailoring the service to the community's collectivistic values, fostering social support and community building through group sessions. The needs assessment will help identify key themes and inform service development. To engage participants and disseminate the piloted non-drug mental health services, we plan to host community health activities and patient education workshops focusing on auricular acupressure to address symptoms such as insomnia.

Conclusions: The multi-phase approach demonstrates the pragmatic process of implementing a culturally appropriate non-drug mental health service for pregnant and postpartum Chinese community members in San Gabriel Valley. The results of this pilot program will facilitate the implementation of a large-scale mental health service in the Chinese community.

P12.13LB

Improving Racial and Ethnical Diversity in Clinical Trials

Hyowoun Jyung¹, Eve Walter², Mirta Milanes², and Raymond Teets³

¹ Institute for Family Health, New York, NY

² Alliance Chicago, Chicago, IL

³ Icahn School of Medicine at Mount Sinai / Institute for Family Health, New York, NY

Contact: Hyowoun Jyung, [e-mail]

Abstract

Purpose: Less than 1/3 of clinical trials recruit their target sample size within the predicted time frame. Ethnic minority, lower socioeconomic status, and lower educated groups are underrepresented in research. This diversity and inclusion study ran ancillary to an NIH funded pragmatic, multi-site acupuncture randomized controlled trial, BackinAction (BIA) study. It focused on a single site, the only FQHC in the trial. Objectives were to enhance diversity and inclusion in the recruitment of patients; assess and reduce patient opt-out rates; and understand diversity and inclusion in an Integrative Medicine clinical trial.

Method(s): We convened a patient and caregiver Diversity, Recruitment, and Retention Advisory Board to guide our research and intervention. The Recruitment and Retention Specialist trained in cultural competency served as a contact person to provide support when patients missed acupuncture appointments and conducted interviews to understand barriers to participating.

Results: Most eligible patients were non-White and on public insurance. Black patients were significantly less likely to agree to participate than non-Black patients. There was a higher rate of risk to LTFU among Hispanic patients. There was a higher rate of risk to LTFU among female patients compared to males. The main barriers to clinical trial for “opt-out” include negative attitude and limited experience with clinical trials and integrative medicine. Among the three groups, opt-outs had the most negative attitudes on clinical trials and least experience with integrative medicine. The main reasons for missing or rescheduling appointments included conflicts with doctor’s appointments, illness, worse pain, and ambivalence on acupuncture efficacy.

Conclusions: This study provides better understanding of the underrepresented population’s barriers to participating in clinical trials and potential strategies to improve recruitment and retention using Advisory Board and Recruitment and Retention Specialist.

P12.14LB

Let’s Cut Fruit! A Culturally Rooted and Participatory Public Art Based Behavioral Intervention for Cultivating Asian American Mental Health Dialogue

Anika Ullah¹, and Weijun Zhang²

¹ UCLA David Geffen School of Medicine, UCLA Health Center for East-West Medicine, Los Angeles, CA

² UCLA, Los Angeles, CA

Contact: Anika Ullah, [e-mail]

Abstract

Purpose: Asian Americans have the lowest rate of mental health care utilization across all racial-ethnic minority groups. This study explores a novel, culturally rooted intervention, “Let’s Cut Fruit! Conversations for Collective Care,” designed to initiate Asian American mental health dialogue in Chinatown, Los Angeles through implementing evidence-based modalities of community and family therapy care.

Method(s): Employing community based participatory research and the social ecological model, this project applies a multi-phase approach, including a preliminary literature review, a needs assessment involving in-depth interviews with local stakeholders, and an online course learning evidence-based non-drug therapies and community engagement approaches.

Results: “Let’s Cut Fruit!” builds upon Asian cultural norms of parents offering their children cut fruit as a silent form of apology after familial conflict and affinity to healing in outdoor public spaces to augment existing cultural strategies of care for addressing AAPI mental health stigma and inequities. Participants will be able to bring a family member to one of several creatively designed fruit stands that will be dispersed across public parks in Chinatown, Los Angeles. Participants will cut fruit together while engaging in intergenerational healing activities with reflection cards to facilitate discussion of stigmatized mental health topics, education on TCM/somatic manifestations of mental illness, and foster interpersonal connection through practicing evidence-based modalities of family therapy.

Conclusions: This project aims to foster intergenerational mental health dialogue through arts-based intervention. The literal and metaphorical “cutting of fruit” represents taking the next step in reconciliation efforts to open up and engage in critical conversations of care while offering a playful, culturally-rooted, and non-confrontational means of initiating mental health support in Asian-American communities.

P12.15LB

Understanding the Perceived Effects of Yoga on Incarcerated Men

Chanda Williams

University of California, San Francisco, Oakland, CA

Contact: Chanda Williams, [e-mail]

Abstract

Purpose: This study explored the perceived effects of yoga on incarcerated men's physical, mental, and emotional well-being. Yoga is an integrative healthcare practice that is effective in treating the effects of trauma while improving overall well-being. With roughly 1.8 million people incarcerated, the United States is home to the largest number of incarcerated people worldwide. Prior studies have shown that between 62-87% of incarcerated adult males have experienced trauma exposure at some point in their lifetime before incarceration.

Method(s): Examine the perceived effects of yoga on the physical, mental, and emotional well-being of incarcerated men. Semi-structured interviews with formerly incarcerated men who participated in a trauma-informed, mindfulness-based yoga program during their incarceration. Eligible participants are at least 18 years of age at the time of consent, can read and write in English, and are willing and able to provide consent for this study.

Results: Eight men enrolled in the study and were interviewed via Zoom. Two participants identified as Black or African American, two were Hispanic, and four were White. The average length of incarceration was 23 years, and the participants were released a little less than three years ago. The findings of this study shed light on the potential benefits of yoga in correctional settings. It illustrates the positive changes experienced by incarcerated men, such as improved self-control, reduced aggression, and increased self-esteem. Moreover, the participants expressed a deeper understanding of mindfulness and the capacity to cope with stressors both within and beyond prison walls.

Conclusions: This formative research provides valuable insights into the therapeutic effects of yoga as an integrative healthcare modality beneficial for reducing the effects of trauma in carceral settings. Participation in the program can lead to durable benefits years after release, including an increased sense of agency and self-regulation.

Topic Area 13 – Health Outcomes

P13.01

A Qualitative Exploration of the Impacts of Participating in Community-Based Arts and Humanities Programming on Veteran Health and Well-being

Makayla Dones¹, Adena Cohen-Bearak¹, Anna Barker², Justeen Hyde³, Barbara Bokhour⁴, and Ekaterina Anderson²

¹ Center for Healthcare Organization and Implementation Research, Bedford, MA

² Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA

³ Veterans Health Administration, Bedford, MA

⁴ Veterans Health Administration, Seattle, WA

Contact: Makayla Dones, [e-mail]

Abstract

Purpose: For over a decade, the U.S. Veterans Health Administration (VHA) has been implementing a Whole Health (WH) system of care that seeks to promote health and well-being in line with what matters most to the Veteran. VHA has been offering VA-based art therapies to facilitate self-reflection and expression. As part of its WH transformation, VHA is expanding these therapies beyond VA Medical Centers to WH and Arts programs that are community-based and/or community-involved. We sought to understand the impact of community WH and Arts programming on Veterans’ health, life, and well-being.

Method(s): As part of a mixed-methods evaluation, we conducted semi-structured interviews with 9 Veterans from 5 VA sites who participated in a range of WH and Arts offerings (visual arts, music, writing) between 2019 and 2023. We used qualitative content analysis to generate themes that describe Veterans’ perceptions of the impact of WH & Arts programs.

Results: All interviewees mentioned improvements in their well-being and health. Many gained meaningful insights into and developed mechanisms for coping with their mental health conditions (depression, PSTD, OCD, suicidal ideation). Veterans discussed using art as a refuge from physical pain and difficult life circumstances. Participation in arts programming also fostered social connectedness, a sense of belonging, and community reintegration. Finally, displaying their work offered Veterans opportunities for recognition and for developing a new identity as an artist. Veterans strongly encouraged their peers to pursue community-based arts to experience its healing effects.

Conclusions: By participating in WH and Arts programming, Veterans obtained a diverse range of health and well-being benefits. The use of arts and humanities to enhance patients’ well-being – as therapeutic modalities and well-being programs – holds great promise within the VHA and beyond. Other systems may consider creating/expanding community-involved arts and humanities programs for their patients.

P13.02

Assessment of the Vitamin D3 Levels in Tear and Blood of College Students Practicing Indoor and Outdoor Physical Activities

Renato Leca

Universidade Federal de Sao Paulo, SantoAndre, Sao Paulo, Brazil

Contact: Renato Leca, [e-mail]

Abstract

Purpose: The aim of this study is to compare the vitamin D3 levels in tear and blood between indoor and outdoor college students partitioning regular physical activities.

Method(s): 36 college students practicing regular physical activities , from different sports, were separated into two groups: one with indoor athletic activities and the other outdoor athletic activities. The indoor group self-reported less than three hours of sun exposure per week. The outdoor group self-reported more than seven hours of sun exposure er week.

All the athletes were in excellent health condition.

Vitamin D3 levels in blood and tear were evaluated in all participants of this study. The tear was collected by placing Schirmer stripes in the lower conjunctival sac fundus of the right eye and collected after 5 minutes. Both tear and blood passed the electrochemiluminecence method for evaluation of vitamin D3 levels. For this study we measured the metabolite 25 (OH) vitamin D3.

Results: 36 college students, 27 women and 9 men, aged 19 to 27 years, averaging 21.75 years, all healthy, were evaluated; 20 students were part of the indoor activity group and 16 were from the outdoor group.

The plasma vitamin D3 level of the indoor group was 25.01 ng/ml, whereas the plasma vitamin D3 level of the outdoor group was 35.55 ng / ml (p <0,05). However, in all 36 participants of this study, the levels of vitamin D3 in the tear were higher than 100 ng / ml (the maximum detection limit of the system used), well above the plasma levels in the two groups of participants (p <0.0001).

Conclusions: In this study, it was observed that tear levels of vitamin D3 were much higher than plasma levels, both in internal and external physical activities (p< 0.0001). We also found that there was a significant difference (p<0.05) between plasma vitamin D3 levels between the indoor and outdoor activity groups, with higher levels observed in the outdoor group. This difference was not observed in tear levels between the two groups.

P13.03

Comparing Mindfulness Interventions: Do Targeted Interventions Improve Mindfulness and Health?

Kathryn Jackson¹, Carol Greco², and David Victorson³

¹ Northwestern University, Chicago, IL

² University of Pittsburgh, Pittsburgh, PA

³ Northwestern University, Evanston, IL

Contact: Kathryn Jackson, [e-mail]

Abstract

Purpose: To examine the effect of different types, lengths, and delivery approaches of mindfulness-based interventions (MBIs) on outcomes of mindfulness and health improvement

Method(s): Participants were recruited nationwide from live, teacher-led, group-based MBI courses. Participants completed new PROMIS mindfulness measures (global, allowance, insight, openheartedness, presence, boundlessness) and PROMIS measures of physical function, anxiety, depression, fatigue, sleep disturbance, social role participation, and cognitive function at baseline (BL), post-intervention (Post) and 8-week follow up (FU). Change in mindfulness and health, and differences by type (MBSR vs. Other), delivery (online vs. in person), length (6 vs. 8+ week), and attendance were assessed with mixed effects linear regression models.

Results: 300 participants enrolled and 89% completed both FUs. The sample was majority female (81%), white (84%), educated (88% college+), and average 45 years old. 48% practiced meditation at BL. 87% of MBIs were MBSR; others focused on self-compassion, cognitive therapy, and anxiety reduction. 95% were 8+ weeks. 88% were online. Across all MBIs, all mindfulness measures increased from BL to Post and remained higher through FU; this change did not differ by any MBI group. Increases were greater from BL to Post for those with higher attendance for all measures except boundlessness, and the increase was sustained through FU for global, insight and presence. Participants had decreased anxiety, depression, fatigue, and pain, and increased social participation from BL to Post, sustained through FU, and better sleep and cognitive function from BL to Post. Participants enrolled in non-MBSR and 6-week class decreased more in anxiety and depression compared to MBSR and 8+ week groups.

Conclusions: MBIs are effective at increasing mindfulness and improving health, regardless of delivery method. MBIs tailored to specific health conditions may increase benefit on target symptoms.

P13.04

Connecting with What Matters Most to Veterans: Impacts on Diabetes and Hypertension Management

Jennifer Rouchka¹, and Gina Foltz²

¹ VA, Louisville, KY

² OPCC&CT, Slippery Rock

Contact: Jennifer Rouchka, [e-mail]

Abstract

Purpose: Veterans Health Administration (VHA) is undergoing a cultural transformation from a “find it, fix it” transactional medical model to a more holistic, patient-centered, and valued-based care approach. The purpose of this observational study is to explore the clinical impact of connecting Veterans’ values and healthcare goals with treatment recommendations. Research shows that patient engagement can improve lifestyle factors (smoking, alcohol consumption, exercise, and diet) and medication adherence which lead to better outcomes. Provider engagement has also been linked to better patient outcomes. The Electronic Quality Measurement Portal (eQM) data is a resource-neutral and accessible way to pull observational data to measure the clinical effect of the Whole Health approach on diabetes and hypertension management.

Method(s): Comparative panel data was pulled from the Electronic Quality Measurement (eQM) Portal, a quality management portal used in Primary Care evaluation and performance measurement consideration. Data points were framed around timeline when provider engaged in the Whole Health approach with Veterans, beginning in November 2021. Data Source: eQM Portal (va.gov)

Results: There is a trend towards improved hypertension and diabetes management in the provider's panel since November 2021 when the Whole Health approach was adopted.

Conclusions: eQM Data is an accessible and effective tool to evaluate the impact of the Whole Health approach. Preliminary observational data suggests connecting with what matters most to Veterans, empowering and equipping them in their healthcare plan, has a positive impact on diabetes and hypertension management. The data reflects the positive outcomes of increased provider and patient engagement through a patient centered, values-based care approach.

P13.05

Consideration of Identity Acceptance and Engaged Living in Whole-Person Type 2 Diabetes Management and Emotional Functioning

Valery Bodziony

Vanderbilt's Osher Center for Integrative Health, Nashville, TN

Contact: Valery Bodziony, [e-mail]

Abstract

Purpose: Research suggests illness identity acceptance (IA), defined as the extent to which illness is positively integrated into sense of self, is associated with aspects of Type 2 Diabetes (T2D) functioning essential to adjustment and management. Engaged living (EL), a core process underlying psychological flexibility defined as acting in line with values, may be associated with positive illness management, though research within T2D is limited. This study explored how IA and EL jointly influence T2D emotional distress and diet self-management.

Method(s): Participants (N = 217, M _age = 54.94, 50.4% Male, 87.9% White) with T2D completed a validated online survey. Data was analyzed using hierarchical multiple regressions.

Results: Results showed IA, EL, and the interaction contributed to 27.8% of variance in T2D distress (F (7,209) = 11.51, p <.001, R ² = .278). Within this model, depression and EL were associated with T2D distress. In the next model, IA, EL, and the interaction contributed to 14.3% of variance in diet behavior (F(7, 209) = 4.97, p < .001, R ² = .140). In this model, EL and the interaction were associated with diet behavior. The interaction contributed to 7.2% more variance in diet behavior (R ² Δ = .072, p < .001) beyond IA and EL.

Conclusions: This study showed IA and EL, when considered individually and in tandem, are important in coping with T2D distress and engaging in positive diet self-management. Engaging in valued behaviors may reduce distress associated with managing T2D and buffer the potential influence of depressive symptoms. Those who accept and ingrate T2D into their identity may be more likely to engage in valued behaviors, and diet specifically may be influenced by the relationship between IA and EL. Using acceptance- and values-based interventions in whole-person T2D care may promote IA and EL to facilitate adjustment and management.

P13.06

Effects of Self-Versus Provider guided Virtual CIH Therapies on Patient-Reported Outcomes Among Veterans with Chronic Musculoskeletal Pain

Taona Haderlein¹, Steven Zeliadt², Alex Kloehn², Briana Lott³, A. Rani Elwy⁴, Claudia Der-Martirosian⁵, Joy Toyama⁵, Adam Resnick⁶, and Stephanie Taylor⁷

¹ Veterans Health Administration, Los Angeles

² VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

³ Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA

⁴ Center for Healthcare Organization and Implementation Research, Bedford, MA

⁵ Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA

⁶ West Los Angeles VA Medical Center, Los Angeles, CA

⁷ Veterans Health Administration, Los Angeles, CA

Contact: Stephanie Taylor, [e-mail]

Abstract

Purpose: Complementary and integrative health (CIH) therapies are key to VA’s Whole Health approach to pain care. During the COVID-19 pandemic, the VA rapidly expanded virtual CIH therapy provision. However, few have examined the effectiveness of virtual CIH therapies. As such, we assessed patient-reported outcomes associated with various CIH delivery formats.

Method(s): The sample comprised 1,091 veterans with chronic musculoskeletal pain identified in the EHR as newly initiating CIH therapies who completed the CIH Experience Survey between 3/23/2021–8/31/2022. Using multivariate models with self-guided virtual (apps or videos) delivery as the reference group, we compared patient reported outcomes associated with the use of any yoga, Tai Chi/Qigong, or meditation delivered via 1) virtually by providers, 2) in-person, 3) a combination of in person + virtual therapies, or 4) a combination of virtual, self-guided + virtual, provider-guided therapies. We examined patient-reported pain, fatigue, mental health, and general well-being up to 8 weeks after starting a CIH therapy. Model covariates included past-4-week use of yoga, Tai Chi/Qigong, and meditation; therapy use consistency; and demographics.

Results: Across all three therapies, 38% reported improvement in pain, 23% in fatigue, 41% in mental health and 41% in general well-being. Compared to veterans using only self-guided virtual delivery, veterans using only provider-guided virtual CIH delivery were less likely to report improvement in pain (OR: 0.5, 95% CI 0.4–0.8) and veterans using only in-person CIH delivery were more likely to report improvement in general well-being (OR: 1.7, 95% CI 1.0–2.6). No other significant differences were found.

Conclusions: Although VA devoted significant resources to provider-guided virtual care during COVID-19, it appears important to also support self-guided virtual CIH therapies and traditional in-person delivery.

P13.07

Gut, Brain, and Pain: Disorders of Gut-Brain Interaction are Associated with Low Back Pain in People with Symptomatic Lumbar Spinal Stenosis

Ayumi Saito¹, Alyson Littman¹, Young-Chang Arai², Amy Cizik³, Janna L. Friedly⁴, Adam Goode⁵, Patrick J. Heagerty⁶, Maggie Horn⁷, Jeffrey G. Jarvik⁸, Sandra Johnston¹, Johanna W Lampe⁹, Eric Meier¹⁰, Stephen J. Mooney⁹, Monica Smersh¹, Pradeep Suri¹¹, Prasad Vinjamury¹², and Sean D. Rundell¹¹

¹ University of Washington, Seattle, WA

² Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Aichi, Japan

³ Population Health Sciences, The University of Utah, Salt Lake City, UT

⁴ Rehabilitation Medicine, University of Washington, Seattle, WA

⁵ Clinical Research and Epidemiology, Department of Orthopedic Surgery / Duke University, Durham, NC

⁶ Department of Biostatistics / University of Washington, Seattle, WA

⁷ Duke University School of Medicine, Durham, NC

⁸ Departments of Radiology, Neuroradiology, Health Services and Neurological Surgery/ University of Washington, Seattle, WA

⁹ Department of Epidemiology, University of Washington, Seattle, WA

¹⁰ Department of Biostatistics, University of Washington, Seattle, WA

¹¹ Department of Rehabilitation Medicine / University of Washington, Seattle, WA

¹² Southern California University of Health Science, Whittier, CA

Contact: Ayumi Saito, [e-mail]

Abstract

Purpose: Recent research suggests the gut-brain axis is associated with chronic pain. This study aimed to determine if a history of Disorders of Gut-Brain Interaction (DGBI) is associated with pain and pain-related dysfunction in persons with symptomatic lumbar spinal stenosis (LSS).

Method(s): We used baseline data from a prospective study of 271 adults ≥ 50 years with symptomatic LSS for cross-sectional analysis. The exposure was self-report of ever having been diagnosed with Irritable Bowel Syndrome (IBS), Functional Dyspepsia (FD), abdominal distention (bloating), Gastroesophageal Reflux Disease (GERD), chronic constipation (CC), and/or Inflammatory Bowel Disease (IBD). Outcomes were pain interference and physical function by PROMIS T-scores and an 11-point Numeric Rating Scale (NRS) of back or leg and buttocks pain intensity. Linear regression models adjusted for age and sex were used to compare the mean scores of the outcomes in those with and without any history of DGBI/IBD.

Results: Of the 277 participants (mean age: 66.5 y),137 had a history of DGBI/IBD. IBS:17%; FD: 1%; bloating:11%; GERD: 31%; CC:11%; IBD:6%. PROMIS Pain Interference T-scores were significantly higher in those with bloating (3.3 pts higher; 95% CI:0.4, 6.1), GERD (2.7; 0.8, 4.5), and CC (3.9;1.4, 6.6) history compared to those with no history of DGBI/IBD. PROMIS Physical Function T-scores were significantly lower in those with IBS (-1.2; -3.3, -0.1), bloating (-2.4; -4.7, -0.1), GERD (-2.2; -3.8, -0.6), and CC (- 4.3; -6.6, -1.9) history compared to no history. Both leg pain (1.1; 0.1, 2.1) and back pain (1.3; 0.3, 2.3) intensities were significantly higher for a CC history compared to no history.

Conclusions: Participants with GERD or bloating history had greater pain-related dysfunction without greater pain intensity compared to those with no DGBI/IBD history. Those with CC history had worse pain and pain-related dysfunction. People with symptomatic LSS with DGBI history may be more susceptible to pain-related difficulties.

P13.08

Potential Physiologic Biomarker of Enhanced Patient-Clinician Interactions in Patients with Gastroesophageal Reflux Disease

Michelle Dossett¹, Machelle Wilson¹, Ted Kaptchuk², and John Denninger³

¹ University of California, Davis, Sacramento, CA

² Beth Israel Deaconess Medical Center, Boston, MA

³ Massachusetts General Hospital, Boston, MA

Contact: Michelle Dossett, [e-mail]

Abstract

Purpose: We previously demonstrated enhanced non-specific therapeutic effects of an integrative medicine consultation vs. a standard primary care visit in patients with gastroesophageal reflux disease (GERD). In this pilot trial, we tested the therapeutic effect of the consultation in the absence of a treatment and examined potential physiologic biomarkers of a therapeutic interaction.

Method(s): 24 individuals with GERD were randomized to either an empathic primary care visit (n=8) or an integrative medicine visit (n=16) with one of 4 different physicians. Participants completed questionnaires regarding GERD symptom severity at baseline and 2 weeks later. Skin conductance response and heart rate were recorded in both the patient and the physician during the visit. We used analysis of variance controlling for baseline GERD symptoms or Pearson correlation for analyses.

Results: Individuals who received the integrative medicine visit had a non-significant improvement in their GERD symptoms compared to those who received the standard primary care visit (p = 0.14). There was no significant relationship between correlation in patient and physician skin conductance response during the visit and improvement in patients’ GERD symptoms (p = 0.80). However, there was a significant relationship between change in patients’ skin conductance response from the beginning to the end of the study visit and their subsequent improvement in GERD symptoms (b = 0.77, p = 0.03). Change in patient heart rate variability (RMSSD) was not associated with change in GERD symptoms (p = 0.56).

Conclusions: Receipt of a treatment may be necessary to enhance the therapeutic effect of the patient-clinician interaction. Patients who experience greater relaxation during the course of a medical visit may be more likely to experience subsequent improvement in symptoms. Further research is needed to validate these findings.

P13.09

Symptoms of Depression are Strongly Associated with Early to Medium-term Functional Limitations after Total Joint Replacement for Knee Osteoarthritis

George Sayegh¹, and Prakash Jayakumar¹

¹ Department of Surgery and Perioperative Care, Dell Medical School - The University of Texas at Austin, Austin, TX

Contact: George Sayegh, [e-mail]

Abstract

Purpose: There is mounting evidence that symptoms of depression are more strongly correlated with symptom intensity and magnitude of capability than objective pathophysiology. Screening tools such as the short 2-item Patient Health Questionnaire (PHQ-2) might help facilitate the detection of symptoms of depression, and a better understanding of the correlation between PHQ-2 and outcomes following total knee arthroplasty (TKA) may encourage surgeons in proactively identifying and addressing mental health prior to surgery. The primary objective of this study was to assess the association between preoperative symptoms of depression (PHQ-2) and magnitude of capability at 6 weeks and 6 months after TKA.

Method(s): We performed a prospective cohort study across 3 orthopedic clinics and recruited 151 TKA patients, of whom 114 (76%) completed follow-up. Patients completed demographics, pre-operative PHQ-2 depression screening questionnaire, and the KOOS JR at 6-weeks and 6-months postoperatively. The mean (SD) age was 65 years (9.4), 56% was female, and 57% identified as white. Negative binomial regression models were used to seek factors associated with KOOS JR at 6 weeks and 6 months, accounting for potential confounders.

Results: In bivariate analysis, being from Latino/Hispanic race (RC=3.0, 95%CI=0.15 to 5.9, p=0.039), and baseline PHQ-2 score (RC=1.6, 95%CI=1.1 to 2.1, p<0.001) were associated with KOOSJR at 6-weeks. Only baseline PHQ-2 (RC=2.0, 95%CI=1.6 to 2.3, p<0.001) was associated with KOOSJR at 6-months.

Conclusions: The prevalence of symptoms of depression and their negative impact on magnitude of capability should direct orthopedic surgeons toward strategies to identify and manage mental health concerns in patients with knee OA considering TKA. Screening for symptoms of depression using the PHQ-2 can help anticipate a patient’s level of distress from worry, despair, and negative mood, triggering a call to action for surgeons to help patients access emotional support and behavioral therapies.

P13.10

Understanding Associations between Aspects of Diabetes-Specific Biopsychosocial Functioning and Diabetes Stigma to Inform Whole-Person Care

Valery Bodziony

Vanderbilt's Osher Center for Integrative Health, Nashville, TN

Contact: Valery Bodziony, [e-mail]

Abstract

Purpose: Type 2 Diabetes (T2D) is demanding in terms of adjusting to and managing the disease, including coping with diabetes stigma (DS). Research suggests people with T2D may experience feeling judged, blamed, and treated differently, and may internalize DS into their sense of self, leading to increased risk of negative physical and mental health outcomes. Psychological factors, such as cognitive defusion and engaged living (EL), may buffer the effects of DS through promotion of adaptive T2D-related thoughts and valued behaviors. It is necessary to understand associations between biopsychosocial functioning and DS to inform whole-person T2D care.

Method(s): Participants were 217 adults with T2D (M_age = 54.94, 50.4% Male, 87.9% White). Data was collected via online survey using validated measures, and analyzed using hierarchical regression.

Results: Gender (r = .160, p < .001), comorbidities (r = .300, p < .001), diabetes distress (r = .633, p < .001), exercise behavior (r = -.144, p < .001), CF (r = .600, p < .001) and EL (r = -.365, p < .001) were significantly associated with DS. Results showed health comorbidities (β = 2.23, p = .002), diabetes distress (β =1.25, p = .001), and CF (β = .439, p = .001) significantly contributed to 47.3% of variance in DS (F = 23.35, p = .001, R ² = .473). Adding CF and EL to the model significantly contributed to 3.9% more variance in DS than gender, diabetes duration, comorbidities, diabetes distress, and self-management behaviors alone.

Conclusions: Consideration of biopsychosocial factors in tandem is necessary to understand the experience of DS and to provide whole-person care. People with high CF may believe stigmatizing labels are true and integrate beliefs into their sense of self, leading to behavior that isn't valued or helpful in management of T2D. Acceptance-based treatments may improve psychosocial functioning and coping with DS, and may limit risk of negative health outcomes. Education is needed to increase awareness of DS and the impact on T2D-functioning.

P13.11

VA Whole Health: Veteran Pain Perception and Health-Related Quality of Life

Sharyl Frensemeier

Cincinnati VA Medical Center, Cincinnati, OH

Contact: Sharyl Frensemeier, [e-mail]

Abstract

Purpose: Up to 66% of Veterans experience chronic pain within any three-month period (Donahue et al., 2020). Research suggests that chronic pain treatment including psychological constructs, particularly an emphasis on acceptance of one’s pain combined with values-based committed action, can lead to increased quality of life (QOL) and decreased pain perceptions (Baranoff et al., 2016; McCracken & Velleman, 2010). The Veterans Health Administration has recently adopted the Whole Health System of Care, which emphasizes patient autonomy, values-based committed action, and health behavior group attendance.

Method(s): This is a retrospective chart review of 63 Veterans with chronic pain who engaged in Whole Health programing at the Cincinnati VA Medical Center between May 2018 and December 2020. Self-report measures were completed during orientation and at 6 months: which were re-administered six months later: the Patient-Reported Outcomes Measurement Information System (PROMIS) Global 10, Life Engagement Test (LET), Defense and Veterans Pain Rating Scale (DVPRS) and the Pain, Enjoyment, and General Activity (PEG) Scale.

Results: Wellness group attendance ranged from 0-50 (M = 15.59, SD = 14.08), though few Veterans with chronic pain chose to attend pain-specific groups offered within the program. No significant improvements in Veterans’ pain perception) or pain interference occurred between orientation and follow-up. While Veterans did not report significant changes in physical health (PROMIS), their PROMIS10 mental health scores improved significantly between orientation (M = 40.00, SD = 9.49) and follow-up (M = 42.23, SD = 9.70), t(60) = -2.52, p = .02.

Conclusions: Veterans’ mental health QOL improved after six months of Whole Health programming.

P13.12

Validation of an Internet-Based Parkinson Severity Assessment Tool

Devon J. Fox¹, Caleb Weaver², Joshua Farahnik³, Sarah Park⁴, and Laurie Mischley¹

¹ Bastyr University, Seattle, WA

² University of Washington, Seattle, WA

³ Bastyr University Research Institute, Seattle, WA

⁴ Harvard Medical School, Boston, MA

Contact: Sarah Park, [e-mail]

Abstract

Purpose: An enhanced understanding of Parkinson’s disease (PD) in recent years has led to the revelation that the motor symptoms by which we’ve been defining and describing PD are late-stage, downstream consequences of a degenerative process decades in the making. The objective outcome measures traditionally used in clinic and PD research rely heavily on motor symptoms and have been shown to lack sensitivity early in the disease. The Patient-Reported Outcomes in PD (PRO-PD) scale is an entirely subjective, patient-centered tool designed to be useful to patients, providers, and researchers as a remote patient monitoring system. The goal was to create a continuous outcome measure that does not require a clinic visit, is sensitive early in the disease, does not fluctuate throughout the day, captures severity of both motor and non-motor symptoms, and correlates with quality of life (QoL) and existing measures of severity.

Method(s): Two datasets were used with a total of 13,349 participants with PRO-PD scores. Data quality, feasibility, Cronbach’s alpha, and confirmatory factor analysis was conducted. Longitudinal analysis to determine change over time was completed. Response to change was evaluated by initiation of levodopa.

Results: The PRO-PD scale shows acceptable validity with a 95.1% completion rate, non-significant floor and ceiling effects, acceptable skew and kurtosis, Cronbach’s alpha of >0.75 for the total scale and subscales with acceptable unidimentionality (r between 0.37 and 0.84). Confirmatory factor analysis (CFI = 0.841, Tucker Lewis Index = 0.829, RMSEA = 0.088) shows room for improvement for factors. Responsiveness has been shown by mean change per year in PRO-PD score of 38 (±14) and significant improvement in PRO-PD score with initiation of dopamine replacement therapy.

Conclusions: These analyses suggest the PRO-PD is a feasible and valid tool for remote patient monitoring in PD.

P13.13

Veterans' Views of a Mindfulness Program for Pain

Roni Evans¹, Mallory Mahaffey², Lee Cross², Alexander Haley¹, and Diana Burgess²

¹ University of Minnesota, Minneapolis, MN

² Minneapolis VA Health Care System, Minneapolis, MN

Contact: Roni Evans, [e-mail]

Abstract

Purpose: Understanding participants' views about interventions is critical for research translation.

Method(s): Our team conducted a three-group, randomized pragmatic trial, Learning to Apply Mindfulness to Pain (LAMP) testing a telehealth mindfulness based intervention (MBI) for Veterans with pain. We administered open-ended questions to a sub-sample of 142 Veterans about their views of the MBI, to assess the extent it met their capability, opportunity and motivational needs (based on the underlying theoretical model of behavior change which informed MBI development). A rapid qualitative assessment was performed by two team members using a codebook based on the theoretical model.

Results: Overall, the majority mentioned the MBI enhanced their capabilities, particularly their psychological and physical skills, with the most mentioning they learned ways to apply mindfulness for pain management. Participants also shared they gained useful knowledge, and ways to regulate their pain management behaviors. A sizable number mentioned the MBI provided important opportunities and resources, with the social influence provided by the MBI facilitators most commonly cited. A smaller number noted the group support was also helpful. The majority of respondents shared the program was motivating, providing positive reinforcement that mindfulness could affect their pain. Large numbers shared the program influenced their beliefs about their own capabilities and the consequences of practicing mindfulness for pain; for some, it influenced their optimism. A smaller number shared they had negative perspectives of the MBI’s influence on their beliefs.

Conclusions: Overall, these results confirm that at least in part (and from the Veteran participant perspective), the MBI achieved its goals in meeting important capability, opportunity and motivational domains required for facilitating engagement in positive pain management behaviors. Areas for improvement and optimization were also identified.

P13.14LB

Myofascial Contributions to Movement-Evoked Pain in Knee Osteoarthritis and Massage Treatment Considerations for Improved Health Outcomes

Alisa Johnson¹, Dorothea Atkins², and Staja Booker¹

¹ University of Florida, Gainesville, FL

² Holos Touch LLC, Audubon, NJ

Contact: Alisa Johnson, [e-mail]

Abstract

Purpose: Knee osteoarthritis (KOA) is a leading cause of chronic musculoskeletal pain and disability worldwide. It is well-accepted that KOA pain is heterogeneous and driven by multiple biopsychosocial factors. A substantial percentage of KOA patients report significant pain during movement (movement-evoked pain), which is a substantial barrier to engaging in physical activity. While MEP has been associated with greater clinical pain, increased central and peripheral pain sensitivity, and worse physical function, emerging evidence suggests pathological shifts in myofascial tissues may be important; yet, these factors and potential treatments are understudied in relation to MEP in KOA. The aim of the present study was to determine associations between myofascial components and MEP in persons with KOA.

Method(s): Forty adults aged ≥50 years with symptomatic KOA were assessed for myofascial pain using standard criteria in the lateral, medial, posterior, and anterior leg. MEP was assessed during exercise, walking, balance, and chair stand tasks. Demographic variables (age, sex) and body mass index (BMI) were included as covariates.

Results: While the distribution of myofascial pain varied in the sample, the total number of active myofascial sites (Mdn=5, IQR=7) were statistically associated with MEP during exercise (rho=0.46, p=0.006), and walking (rho=0.36, p=0.029), but not balance or chair stand tasks. One-way analyses of covariance showed differential associations between MEP and myofascial pain with active myofascial pain in the medial (p’s=0.006-0.048), lateral (p’s=0.001-0.016), and posterior (p=0.041) thigh associated with MEP.

Conclusions: These findings indicate myofascial factors may underly MEP and be critical treatment targets for personalized pain therapies and studies are needed to determine the efficacy of interventions targeting myofascial components, such as massage therapy, for reducing MEP and optimizing health outcomes in chronic musculoskeletal pain conditions.

Topic Area 14 – Health Services Research

P14.01

A Randomized, Parallel-Group, Double-Blind Trial to Evaluate the Efficiency of Medical Painting Therapy in Patients with Essential Tremor

Monica Elisabeth Winnubst¹, Carolina Candeias da Silva², Graziele Costa Santos¹, Henrique Ballalai Ferraz¹, and Vanderci Borges¹

¹ UNIFESP - Federal University of São Paulo, São Paulo, Sao Paulo, Brazil

² Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil

Contact: Monica Elisabeth Winnubst, [e-mail]

Abstract

Purpose: Essential Tremor (ET) is a common movement disorder. Beta-blockers and anticonvulsants are the treatment prescribed to control the signs. This trial aims to evaluate the efficiency of Medical Painting Therapy (MPT) as a complementary treatment to ET and its effectiveness in quality-of-life domains, anxiety, and depression symptoms.

Method(s): This clinical trial is a prospective, interventional longitudinal with parallel groups. Thirty-six patients were randomized into the art intervention group GETA and the art aleatory group GDA (control group). Patients of both groups underwent 16 therapy sessions. Double-blind evaluations were performed four times by neurologists specializing in movement disorders to assess tremor signs using the Fahn-Tolosa-Marín scale. The World Health Organization Quality of Life-Brief scale was used to evaluate the quality-of-life domains, and the Beck Anxiety and Depression Inventories to assess those diseases. GETA patients participated in MPT based on light, color, and darkness principles of complementary integrative therapy from anthroposophical medicine.

Results: The research took 50 months long. Of the 36 eligible patients, 16 from the GETA, and 8 from GDA completed the entire protocol. When comparing the first- and second-time evaluation groups, the GETA group showed statistical significance in diminishing the ET signs (p= 0.006). The quality of life, anxiety, and depression signs obtained improvement with statistical significance. The light and darkness artistic works from GETA showed a strong influence of the working of the light. Carmine was the main curative color chosen. The GETA participants testified they began to guide their life with more autonomy.

Conclusions: MPT showed effectiveness with statical significance in diminishing ET, anxiety, and depression signs improving quality of life, and contributing to the ET patient developing salutogenesis.

P14.02

Adverse Events (AE) Following Joint Manipulation and Mobilization: An International e-Delphi Study and Focus Groups to Define and Classify these AEs

Martha Funabashi¹, Lindsay M Gorrell², Katherine Pohlman³, Andrea Bergna⁴, and Nicola R Heneghan⁵

¹ Canadian Memorial Chiropractic College, Toronto, ON

² Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist, Zurich, Zurich, Switzerland

³ Parker University, Dallas, TX

⁴ SOMA Srl, Milano, Milano, Italy

⁵ University of Birmingham, Hugh Town, Isle of Wight, United Kingdom

Contact: Martha Funabashi, [e-mail]

Abstract

Purpose: To establish a standardized adverse event (AE) definition and severity classification for AEs following spinal and peripheral joint manipulation (MAN) and mobilization (MOB) for adults with musculoskeletal conditions.

Method(s): This sequential mixed-methods study included an electronic Delphi process (e-Delphi) followed by virtual focus groups with international and multidisciplinary MAN and MOB practitioners, educators and researchers, patients, medical doctors, regulators and medico-legal representatives. Three rounds of the e-Delphi were performed with round 1 (R1) having open-ended questions on participants’ working definition and severity classification of AE. Round 2 rated level of agreement for the statements generated from R1 and a previous scoping review of the literature. Round 3 re-rated level of agreement with statements not achieving consensus in R2. E-Delphi data were analyzed descriptively to evaluate the a priori defined consensus. To further explore e-Delphi findings, focus groups were conducted and were analyzed using a theoretical thematic analysis.

Results: Response rates were: R1, 85% (n=183), R2, 77% (n=163), and R3, 73% (n=153). Consensus was reached for the severity categories of mild, moderate, severe and catastrophic AE, as well as 2 domains (i.e., symptom intensity and impact on patients) to differentiate between severity categories. Consensus was not reached for an AE definition. Focus group sought clarity with acceptability, as well as inclusion of and differences between certain terms for the severity classification categories.

Conclusions: The here-established severity classification facilitates and streamlines inter-professional and international dialogue regarding the reporting of AE following MAN and MOB in clinical practice and research. The lack of consensus on a standardized definition for AE demonstrates the complexity of this topic. Findings may contribute to advancing patient safety knowledge across professions.

P14.03

Can a Whole Health Approach Be Identified in Clinical Documentation? Lessons Learned From Primary Care and Mental Health Clinical Notes

Rendelle Bolton¹, Kelly Dvorin¹, Juliet Wu¹, Makayla Dones², Zenith Rai¹, Barbara Bokhour³, Marla Clayman¹, and Bella Etingen⁴

¹ VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, MA

² Center for Healthcare Organization and Implementation Research, Bedford, MA

³ Veterans Health Administration, Seattle, WA

⁴ Veterans Health Administration, Dallas, TX

Contact: Bella Etingen, [e-mail]

Abstract

Purpose: Person-centered conversations with patients to identify what matters most, understand life context, and connect them to complementary and integrative health (CIH) and well-being services are key aspects of VA’s Whole Health (WH) approach. Documenting these conversations can facilitate coordination around patients’ preferences and goals, but there is no standard approach to documenting WH. As VA integrates WH into primary care (PC) and mental health (MH) settings, we developed a chart review tool to assess the presence of WH documentation in clinical encounter notes.

Method(s): We coded 469 free-text clinical encounter notes from routine visits written by 20 early adopting PC and 12 MH clinicians. For each note, we captured the extent (none, minimal, extensive) to which six elements of WH were documented (patient voice, context, co-produced treatment plans, what matters most, connection to WH-aligned services, or CIH delivery). We compared ratings across clinicians and qualitatively identified variation in clinicians’ documentation approach.

Results: Elements of WH were not extensively documented. Person-centered elements (voice, context, and co-produced treatment plans) were captured more frequently than “what matters most” or CIH/well-being service connection or delivery (Table 1). MH clinicians located in PC clinics documented WH more often than other providers. Qualitatively, notes seldom captured the essence of the patient as a person, and current WH goals or plans were infrequent. Templated content, copy-and-paste practices, appointment type, and contextual factors contributed to variation in documentation.

Conclusions: While some elements of a WH approach were identifiable in clinical encounter notes, extensive WH documentation was rare even among early adopters. In the context of a WH system transformation, there is a need to develop and incentivize feasible, meaningful, person-centered documentation to support coordination around what matters most to patients.

P14.04

Chiropractic Clinical Registries: A Scoping Review

Kent Stuber¹, Katherine Pohlman¹, Michele Maiers², Joel Carmichael³, and Amy Fergson¹

¹ Parker University, Dallas, TX

² Northwestern Health Sciences University, Bloomington, MN

³ University of Colorado Anschutz Medical Campus, Lone Tree, CO

Contact: Kent Stuber, [e-mail]

Abstract

Purpose: Clinical data registries can be important for studying healthcare in a “real-world” environment. This scoping review aimed to map the literature related to chiropractic clinical registries.

Method(s): Our registered research protocol followed the JBI Evidence Synthesis Manual Guidelines and the PRISMA scoping review extension. We used a broad, peer-reviewed search strategy without study design or level of evidence restrictions, except excluding editorials and letters to the editor. A research librarian searched MEDLINE, CINAHL, Index to Chiropractic Literature (ICL), Alt Healthwatch, and SPORTDiscus. Two reviewers’ pilot-tested data extraction on 5 random abstracts. The same reviewers conducted independent title and abstract screening, followed by full-text review and then data extraction. A third reviewer refereed as needed. We synthesized results according to study populations, location, and registry type.

Results: We screened 296 titles and abstracts from a June 2023 literature search. We included 3 studies from the 15 full-text studies assessed for eligibility. All 3 studies were published since 2014, with 2 conducted in North America and 1 in Europe. Two studies reported chiropractic utilization data from non-chiropractic-specific registries. The remaining study reported pilot data from an online data collection system for a chiropractic practice-based research network. Two studies required specific health conditions for inclusion in their analysis.

Conclusions: Our scoping review highlights the limited corpus of evidence on chiropractic clinical outcomes registries and the need for further exploration and investment in chiropractic clinical registries. Establishing an efficient and productive chiropractic clinical outcomes registry offers substantial potential to produce a wide range of data that could facilitate growth in chiropractic evidence-based practice, health policy, education, and research.

P14.05

CIH Providers and the Public Health Response to the COVID-19 Pandemic

Margaret Whitley¹, Patricia M Herman², Ian Coulter¹, and Raheleh Khorsan³

¹ RAND Corporation, Santa Monica, CA

² RAND Corporation, Sonoma, CA

³ Southern California University of Health Sciences, Whittier, CA

Contact: Margaret Whitley, [e-mail]

Abstract

Purpose: During peak periods of the COVID-19 pandemic, many complementary and integrative health (CIH) providers saw their clinical practice reduced substantially. Simultaneously, many public health and medical practitioners were overwhelmed with providing emergency care and implementing preventive measures. CIH providers were an underutilized asset in this fight. We sought to learn how they can be effectively integrated into future public health emergency responses.

Method(s): We convened an expert panel of ten CIH and public health practitioners and researchers. We provided the panelists a review of the news media and scientific literature about tasks facing the public health workforce during a pandemic and how CIH practitioners could contribute. We facilitated a daylong online panel discussion about these topics. Conversations were transcribed, and we identified key themes.

Results: Essential tasks in the early response to the COVID-19 pandemic included testing, contact tracing, and education about prevention. Despite their clinical skills and resources, few CIH providers were involved. Panelists stated that it was not that CIH providers lacked skills to do needed tasks. Rather, there was a lack of public health awareness among CIH providers, insufficient linkages between CIH and public health, and policy and financial challenges.

Conclusions: For CIH practitioners to be more involved in responding to public health crises, changes are needed: (1) mutual awareness— recognition among CIH providers that they can fulfill a key role in a public health response, and recognition among public health planners of this potential; (2) training—increasing education opportunities in public health for CIH providers; (3) connections— stronger links between CIH and public health professional organizations; (4) financial support for CIH providers contending with underlying economic challenges; and (5) formalizing public health within the scope of practice of the CIH professions.

P14.06

Consumer Sexualized Behavior in Massage Therapy: A Netnographic Study

Mica Rosenow¹, Tina Brown², and Niki Munk²

¹ Indiana University Purdue University Indianapolis, Indianapolis, IN

² Indiana University, School of Health & Human Sciences, Indianapolis, IN

Contact: Mica Rosenow, [e-mail]

Abstract

Purpose: Consumer sexualized behavior (CSB) in the massage therapy treatment room is widely discussed within and outside the massage therapy industry. Efforts to decrease sex slavery, the #Metoo Movement, and the media reports for high profile sexual coercion and consent cases can increase historic victimization reports. A netnographic study was conducted in professional massage therapy communities to investigate CSB in practice across time to identify 1) how CSB experiences were reported to colleagues, 2) what CSBs were experienced, and 3) CSB effect on care access, quality, and cost.

Method(s): Nine online communities consented to data collection of original and reply posts with CSB as part of business practices from 2012 to June 2023. Posts were coded for report frequency and sexualized behavior type by date in Excel. NVIVO was used to identify themes related to experience effects on care access, quality, and cost.

Results: 1,482 reports (306 original posts) were collected where multiple CSB incidents (35%) and potential legitimate requests (20%) were reported. Reports included CSB that met verbal, non-verbal, and physical sexual harassment definitions with higher rates during the Trump campaign (2016), Epstein arrest/death (2019), and Watson case and Georgia shooting (2021). A high rate of explicit sexual solicitation (43.7%) included consumer provided documentation by text and photo (35.9%). Emergent themes of the effects on care include reduced access and quality by excluding men from services and ending careers prematurely.

Conclusions: Sexualized behaviors are commonly reported by massage therapists within online professional communities. Increased reporting rates were evident during highly publicized sexual harassment and exploitation events. The high number and impact of graphic, disturbing, and illegal CSB reports within massage therapy social media support communities highlights the need for CSB reduction to protect treatment access and quality.

P14.07

Descriptive Characteristics of Medicare Beneficiaries Utilizing Spinal Manipulative Therapy vs. Prescription Drug Therapy For Neck Pain

Alexis Hannah¹, and Brian Anderson²

¹ Palmer College of Chiropractic, Port Orange, FL

² Palmer College Of Chiropractic, Davenport, IA

Contact: Brian Anderson, [e-mail]

Abstract

Purpose: Neck pain (NP) is a significant source of disability often requiring long-term management, including prescription drug therapy (PDT) or spinal manipulative therapy (SMT). Comparing the value of these treatments among Medicare beneficiaries is necessary, forming the focus of a grant-funded project involving faculty and student researchers at two institutions. Here we report characteristics of Medicare beneficiaries utilizing PDT vs SMT for management of NP.

Method(s): Medicare claims were analyzed from 2018-2021 for beneficiaries with a new episode of NP beginning in 2019. Subjects were continuously enrolled in Medicare Parts A, B, and D and between 65-99 years without a history of cancer, skilled nursing facility stays or hospice care. Treatment cohorts were restricted to either SMT or PDT during and after their index visit in 2019, requiring > 2 treatment visits within 90 days. Sociodemographic characteristics and health status among cohorts were reported.

Results: The SMT and PDT cohorts included 34,730 and 251,739 subjects, respectively. Sociodemographic characteristics of the SMT (vs PDT) cohort included older age (73.3 vs 73.0), higher prevalence of male sex (37% vs 31%) and white race (93% vs 87%) who were less likely to receive Part D income subsidy (5% vs 16%) or be dual eligible for Medicare & Medicaid (3% vs 11%). The SMT (vs PDT) cohort also had a significantly lower prevalence of chronic conditions and more subjects with a Charleson Comorbidity Index score of 0 (81% vs 76%). All comparisons were significant at p<0.05.

Conclusions: Our cohorts displayed little racial diversity and a female to male ratio near 2:1. Low-income benefits were more likely in the PDT cohort, who were also generally less healthy. The authors will subsequently evaluate adverse events, care escalation, and payer/patient costs among treatment cohorts, using propensity scoring to balance characteristics and health status. Results will help identify safe and efficient NP management among Medicare beneficiaries.

P14.08

Does Use of Acupuncture Combined With Movement Therapies Reduce Imaging Costs?

Stephen Frochen¹, Stephanie Taylor², Scott Coggeshall³, Claire Chen⁴, and Steven Zeliadt⁵

¹ US Department of Veterans Affairs, Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles Healthcare System, Los Angeles, CA

² Veterans Health Administration, Los Angeles, CA

³ Veterans Health Administration, Seattle, WA

⁴ Veterans Health Administration, Denver, CO

⁵ VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

Contact: Stephen Frochen, [e-mail]

Abstract

Purpose: Complementary and integrative health therapies are recommended for management of chronic musculoskeletal pain as an alternative to the medicalization of chronic pain. We evaluated how VA’s expanded availability of acupuncture, yoga, Tai Chi, and Qigong has impacted imaging costs for Veterans with chronic pain.

Method(s): Of the 2,873,610 VA users we identified with chronic musculoskeletal pain between 2018-2022, 5,039 began using acupuncture with one of three movement therapies (yoga, Tai Chi, and Qigong), 210,737 began using acupuncture without these movement therapies, comprising two treatment groups. Using propensity score matching, we matched Veterans in each treatment group to a conventional care control group to examine differences in total imaging costs during a 6-month follow-up period.

Results: Before matching, the two Veteran patient treatment groups differed from each other and from Veterans with chronic musculoskeletal pain overall. Prior year use of specialty pain care, mental health care, and physical therapy was higher for Veterans using acupuncture without movement therapies compared to the general Veteran patient population with chronic pain, and was highest for Veterans using acupuncture with movement therapies. After partial matching, findings suggest that acupuncture use with or without movement therapies did not reduce downstream imaging costs during the following 6 months.

Conclusions: Veteran patients with chronic musculoskeletal pain who used acupuncture with or without movement therapies differed from the overall Veteran patient population with chronic pain. Although we hypothesized that acupuncture might reduce the medicalization of pain care, operationalized as decreased imaging costs, our results suggest patients turning to acupuncture also have high use of other pain-related services. Non-randomized observational studies of acupuncture may not be feasible without careful understanding of the trajectories leading patients to acupuncture.

P14.09

Effect of Yoga on Spine Mobility and Quality of Life in Patients With Spondyloarthritis

Harriet Morf¹, Vanessa Bundle¹, Anna-Maria Liphardt¹, Birte Coppers¹, Claudia Bouzas¹, Sebastian Rudolf¹, Paloma Palm von Alten Blaskowitz¹, Johannes Knitza², Maria Gabriela Raimondo¹, Hanna Labinsky³, Lukas Hatscher⁴, Andreas Wirsching¹, Daniela Bohr¹, Elizabeth Araujo¹, Alina Ramming¹, Andreas Ramming¹, and Georg Schett¹

¹ University Hospital Erlangen, Erlangen, Bayern, Germany

² Digitales Institut Marburg, Marburg, Hessen, Germany

³ University Hospital Würzburg, Würzburg, Bayern, Germany

⁴ Charite Berlin, Berlin, Bayern, Germany

Contact: Harriet Morf, [e-mail]

Abstract

Purpose: Ankylosing spondylitis (AS) is an inflammatory autoimmune disease that can lead to spinal deformities. Complementary to the treatment with anti-inflammatory medication, daily physical therapy, especially a combination of stretching and strengthening exercises, is recommended. Yoga is known to improve flexibility and strength. Previous research has shown positive effects of regular Yoga exercises on sleep, quality of life and disease activity. Our aim was to investigate the impact of an 8-week Yoga intervention on spine mobility and on physical and psychological aspects of patients with AS.

Method(s): 22 AS (ASAS diagnostic criteria) patients participated in an online 8-week yoga class (60 minutes/ week, (DRKS00025215)). All patients were well-medicated. Patient mobility was assessed by BASMI, disease related functional impairment by BASFI, disease activity by BASDAI, physical activity related health competence by PAHCO, pain-related anxiety by TSK and health related quality of life by short form (SF)-36 before (Visit 1) and after the 8-week Yoga intervention (Visit 2). Statistical analysis was performed using SPSS (SPSS Inc., Chicago, Illinois, USA). All results are reported as means +/- standard deviation (SD).

Results: 22 participants (female = 17 (77.3%) / male = 5 (22.7%); age: 43.41 years +/- 14.181) were included in this preliminary analysis. Patient mobility measured by BASMI improved in response to the Yoga intervention (Visit 1: 1.88 +/- 1.23; Visit 2: 1.60 +/- 1.01; p=0.032). PAHCO improved in the aspect of control competency (Visit 1: 5.87 +/- 2.51; Visit 2: 6.82 +/- 2.07; p=0.022) and SF-36 in the psychological component (Visit 1: 43.04 +/- 12.28; Visit 49.60 +/- 12.04; p=0.002). TSK was reduced after the Yoga intervention (Visit 1: 34.77 +/- 7.10; Visit 32.36 +/- 6.10; p=0.011).

Conclusions: We conclude that an 8-week yoga intervention can improve spinal mobility and health competency as well as reduce fear of movement in well treated and Yoga naïve AS patients.

P14.10

Group Health & Wellness Coaching: Development and Validation of the Required Competencies

Ruth Q. Wolever¹, Timothy R. Cline², Jocelyn M. Weiss³, Suzie Carmack⁴, Cindy Schultz⁵, Michael Arloski⁶, and Karen Lawson⁷

¹ Osher Center at Vanderbilt, Nashville, TN

² Dr. Tim Cline, LLC, Pittsburgh, PA

³ Guidehouse, Raleigh, NC

⁴ Maryland University of Integrative Health, Laurel, MD

⁵ Schultz Consulting, LLC, Eagan, MN

⁶ Real Balance Global Wellness, Ft. Collins, CO

⁷ IHWC Productions, Bloomington, MN

Contact: Ruth Q. Wolever, [e-mail]

Abstract

Purpose: As the popularity and demonstrated effectiveness of Health and Wellness Coaching (HWC) continue to grow to address chronic disease prevalence worldwide, delivery of this approach in a group format is gaining traction, particularly in healthcare. Nonetheless, very little empirical work exists on group coaching and no published competencies currently exist for Group Health and Wellness Coaching (GHWC).

Method(s): We used a well-established two-phase (Development and Judgment) process to create and validate GHWC competencies with strong content validity.

Results: Seven highly qualified Subject Matter Experts systematically developed and proposed the GHWC competencies, which were then validated by 78 National Board Certified Health and Wellness Coaches (NBC-HWCs) currently practicing GHWC who rated the importance and use frequency of each one. The validation study led to 72 competencies which are organized into the structure and process of GHWC.

Conclusions: GHWC requires not only coaching skills, but significant group facilitation skills to guide the group process to best support members in maximizing health and well-being through self-directed behavioral change. As the presence of HWC continues to grow, it is imperative that GHWC skill standards be accepted and implemented for the safety of the public, the effectiveness of the intervention, and the value analysis of the field. Such standards will guide curriculum development, allow for a more robust research agenda, and give practical guidance for health and wellness coaches to responsibly run groups. High quality standards for GHWC are particularly needed in health care, where a Level III Current Procedural Terminology (CPT®) code for GHWC has been approved since 2019 and reimbursement of such has been proposed by the Centers for Medicare and Medicaid for 2024.

P14.11

Identifying Patient and Clinician-Centered Strategies To Improve Access to Integrative Care for Primary Care Patients With Chronic Pain

Wu-Hsun Tom Yang¹, Sebastian Tong², Ashley Johnson³, Karissa Tu⁴, and Marshall Brooks⁵

¹ University of Washington Osher Center for Integrative Health, Seattle, WA

² University of Washington School of Medicine, Seattle, WA

³ University of Washington Department of Family Medicine, Seattle, WA

⁴ University of Washington School of Medicine, Bozeman, MT

⁵ Virginia Commonwealth University Department of Family Medicine & Population Health, Richmond, VA

Contact: Wu-Hsun Tom Yang, [e-mail]

Abstract

Purpose: One in five Americans live with chronic pain, which leads to reduced functioning, negative effects on health outcomes, and increased health care utilization. While many integrative medicine approaches to chronic pain are evidence-based, many patients, especially those in rural communities and those living in poverty, do not have access to these modalities. The study hopes to identify challenges to incorporating integrative treatments for chronic pain in primary setting and to identify perceived needs of primary care physicians and patients in improving care for patients with chronic pain.

Method(s): Semi-structured interviews (45 minutes to an hour) with primary care clinicians who treats patients with chronic pain. Interviews were recorded, transcribed, and analyzed by themes.

Setting or Dataset: primary care practices within the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region with high proportions of racial/ethnic minorities and/or in rural communities.

Populations Studied: 15 primary care clinicians who work with patients with chronic pain.

Outcome Measures: Clinicians were asked about perceptions of chronic pain, systems within clinical and community settings to care for patients, and challenges and facilitators to caring for patients with chronic pain using non-pharmacologic therapies.

Results: Themes that emerged from interviews included limited access and knowledge about integrative services available in the clinic and/or in the community. Clinicians remark that treating chronic pain is challenging due to the multifactorial factors causing it and the limited ability of patients to access integrative services due to finance, insurance, transportation, etc. Clinicians often associated chronic pain with chronic opioid use.

Conclusions: Primary care often lacks resources to access non-pharmacologic treatments for patient’s chronic pain. Future work is needed to explore models of implementing integrative care for chronic pain into primary care.

P14.12

Implementing Paper-Based Patient-Reported Outcome Collection Within Outpatient Integrative Health and Medicine

Roshini Srinivasan¹, Samuel N. Rodgers-Melnick², Rachael L. Rivard³, Christine Kaiser², David Vincent², Francoise Adan⁴, and Jeffery Dusek⁵

¹ University Hospitals Connor Whole Health, Durham, NC

² University Hospitals Connor Whole Health, Cleveland, OH

³ HealthPartners Institute, Minneapolis, MN

⁴ University Hospitals Health System, Cleveland, OH

⁵ University of California - Irvine, Irvine, CA

Contact: Roshini Srinivasan, [e-mail]

Abstract

Purpose: Little is known about the feasibility of routine, paper-based patient-reported outcome (PRO) collection in outpatient integrative health and medicine (IHM). The present study sought to investigate the feasibility of pre- and post-encounter PRO collection and to characterize factors associated with successful collection.

Method(s): We conducted a retrospective review of 27,464 outpatient IHM encounters including 9520 chiropractic, 8237 acupuncture, 5847 massage, 2345 IHM consultation, and 1515 osteopathic manipulation treatment encounters at 4 whole health clinics offering IHM over 17 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. We used logistic regression analysis to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs.

Results: Patients (N=5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Figures 1a and 1b depict the adjusted odds ratios (aOR) for each regression. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors: covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint; covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters.

Conclusions: Implementing a paper-based immediate PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs is challenging. Future endeavors should seek to leverage the electronic health record and patient portals to optimize PRO collection.

P14.13

Massage Therapist Support in Social Media Communities for Consumer Sexualized Behavior

Tina Brown¹, Mica Rosenow², and Niki Munk¹

¹ Indiana University, School of Health & Human Sciences, Indianapolis, IN

² Indiana University Purdue University Indianapolis, Indianapolis, IN

Contact: Tina Brown, [e-mail]

Abstract

Purpose: Consumer sexualized behavior (CSB) negatively impacts the health and well-being of professionals across career disciplines, including integrative health clinicians. While many clinicians practice within a physically present community environment, massage therapists do not, prompting the need for alternative support communities such as those developed through social media. Social media has grown as an alternative form of reporting sexual misconduct since the rise of #MeToo and may strengthen missing support connections for massage professionals when faced with CSB. A netnographic study sought to: 1) describe CSB reporting within massage therapy social media communities and 2) evaluate community support sentiment when sexualized behaviors are expressed.

Method(s): Original and recall reply posts describing CSB (search terms: “sex”, “sexual”, and “happy ending”) and related reactions between January 2012–June 2023 were extracted from 5 private and 4 public Facebook groups. Sentiment analysis with NVivo was conducted.

Results: Reported CSBs from 1,482 extracted posts included incidents of groping, assault, stalking, solicitation, exposure, masturbation, and ejaculation within the work environment. Sentiment analysis of replies (n=15,219), original (n=306), and recall (n=1,176) posts revealed a 65% negative sentiment across all posts (1,648 positive, 2,636 mixed, 4,117 neutral, 8,300 negative) compared to an overall 77.9% positive sentiment in reactions (9,360 likes; 1099 loves; 1053 cares; 1,122 haha; 2,499 wow; 848 sad; 1,701 angry).

Conclusions: Analysis of social media posts and reactions expands understanding of support among massage therapists. Given the misaligned official reporting rates of CSB within massage therapy practice and incident frequency suggested by this study, massage therapists seemingly rely on a supportive community for themselves within social media. The benefit of this community is unclear given the mostly negative replies within these communities, such as victim-blaming.

P14.14

Teaching Yoga for Wellness Groups via Video-Based Telehealth: Perspectives from Veterans Health Administration Yoga Teachers

Molly Delzio¹, Francesca Nicosia², Tony Pomales³, and Mary K. Good³

¹ SFVA, San Francisco, CA

² University of California San Francisco / San Francisco VA Healthcare System, Oakland, CA

³ Veterans Rural Health Resource Center-Iowa City, Center for Access & Delivery Research and Evaluation, Iowa City VAHCS, Iowa City, IA

Contact: Francesca Nicosia, [e-mail]

Abstract

Purpose: Online yoga has increased in recent years, but little is known about synchronous, video-based telehealth yoga within healthcare settings. This study examined the perspectives of Veterans Health Administration (VA) yoga teachers regarding a VA Office of Rural Health-funded TeleYoga Program intended to expand access to yoga for rural and underserved Veterans.

Method(s): Qualitative, interview-based study among yoga teachers from 7 VA TeleYoga Program sites. Interviews focused on teaching experience, program implementation, and delivery. Interviews were conducted and recorded over Teams; transcripts were thematically analyzed.

Results: 13 yoga teachers with a range of clinical and yoga backgrounds completed interviews (e.g., recreation therapy, physical therapy, wellness coach, dietician, social worker; RYT 200-hour to Certified Yoga Therapist). Four key factors were identified for delivery of telehealth yoga within healthcare settings: (1) equipment; (2) physical space; (3) accessibility; and (4) administrative support. First, equipment required for effective tele-yoga groups included: large monitor, wireless microphone headset, high resolution webcam, adequate lighting, secure videoconferencing platform, reliable internet connectivity, and yoga props for Veterans with complex health conditions. Second, adequate physical space is still necessary to deliver yoga via telehealth. In the absence of a dedicated fitness room, clinical or office space needs to be adapted. Third, given that classes are heterogenous, it is highly recommended that teachers acquire training to make online yoga safe, accessible, inclusive (e.g., trauma-informed principles, adaptive yoga), and adaptable to patient needs in real time. Finally, effective delivery required adequate support personnel (e.g., scheduling, IT support) and a simple, efficient process for onboarding patients.

Conclusions: VA TeleYoga teachers hold unique expertise and contribute valuable information to facilitate expansion of yoga within healthcare settings.

P14.15

The Use of Acupuncture Therapy Among a Commercially-Insured Cohort with Low Back Pain During the COVID-19 Pandemic

Molly Candon¹, Jeffery Dusek², and Arya Nielsen,³

¹ University of Pennsylvania, Philadelphia, PA

² University of California - Irvine, Irvine, CA

³ Icahn School of Medicine at Mount Sinai, New York, NY

Contact: Molly Candon, [e-mail]

Abstract

Purpose: Acupuncture therapy is an evidence-based, cost-effective treatment for acute and chronic pain. Unlike other types of pain care, particularly pharmacologic treatments, acupuncture therapy cannot be delivered via telehealth. Thus, COVID-19 restrictions may have had a disproportionate impact on those individuals who engaged in acupuncture therapy prior to the pandemic.

Method(s): In this NCCIH-funded study, we track a cohort of commercially-insured Americans who used acupuncture therapy for low back pain (LBP) in 2019 to understand how COVID-19 affected their pain care in 2020 and 2021. Our primary data source is Optum insurance claims. Our study sample includes individuals with a diagnosis of LBP in 2019, at least one claim for acupuncture therapy in 2019, and who were continuously enrolled in Optum between 2019 and 2021. Our primary analysis measures the cohort’s use of acupuncture therapy, pharmacologic treatments (e.g., opioids), and nonpharmacologic treatments (e.g., physical therapy) during the pandemic.

Results: In 2019, there were 16,407 individuals who had LBP, engaged in acupuncture therapy, and were continuously enrolled. We found that only 38.5% of 2019 acupuncture users had an acupuncture claim in 2020; the share dropped to 26.3% in 2021. While treatment modalities that occur predominately in-person also reduced (e.g., 73.9% of 2019 acupuncture users also used physical therapy in 2019, which fell to 48.4% in 2020 and 41.9% in 2021), the reduction was smaller compared to acupuncture therapy. Pharmacologic treatments were more stable (e.g., among 2019 acupuncture users, 23.3% filled an opioid in 2019 and 18.0% filled an opioid in 2021). Of note, antidepressant use among 2019 acupuncture users increased, from 20.7% in 2019 to 22.2% in 2021.

Conclusions: These findings suggest that COVID-19 affected pain care among individuals who engaged in acupuncture therapy for LBP prior to the pandemic, and that, after the pandemic, acupuncture therapy reduced more than other types of pain care.

P14.16

Understanding Perceptions of Massage Therapy for Pain Among Primary Care Providers in the Veterans Health Administration

Sarah Shue¹, Anne Griffin², Niki Munk³, and Stephanie Taylor⁴

¹ Roudebush VA Medical Center, Indianapolis, IN

² VA Greater Los Angeles Health Care, Los Angeles, CA

³ Indiana University, School of Health & Human Sciences, Indianapolis, IN

⁴ Veterans Health Administration, Los Angeles, CA

Contact: Sarah Shue, [e-mail]

Abstract

Purpose: Primary care providers (PCPs) are typically the first healthcare provider that patients engage with when seeking care for their pain. However, anecdotal evidence suggests many PCPs are unaware of the evidence supporting the effectiveness of massage therapy (MT) for pain and do not discuss it as a pain management option. To address this issue, we conducted a quality improvement project to elicit PCPs’ perceptions of MT for pain and determine how best to inform PCPs that MT is an evidence-based practice for pain.

Method(s): We conducted brief qualitative interviews with 33 PCPs in 7 Veteran Administration (VA) medical facilities from March to September 2023 to 1) understand their perceptions of MT for pain and 2) elicit recommendations for educational materials to support MT referral practices. VA facilities were geographically diverse and had a range of MT referral volumes. We used a rapid approach to analyze the data.

Results: PCPs overwhelming felt the scientific evidence for MT for pain was lacking. However, they considered MT beneficial, low harm, and easily integrated with other therapies based on their own clinical experience and/or anecdotal evidence from patients. PCPs also reported not understanding what MT involved and being unable to properly set patient expectations about MT. Despite that, PCPs shared they had unwillingly become “gatekeepers” for MT, which created frustration due to MT accessibility issues and/or unclear local approval processes. To better inform MT discussions and referrals, PCPs want a one-page handout with links to scientific evidence, a bulleted overview of what patients can expect from MT, and local guidance on placing MT referrals.

Conclusions: Although VA PCPs generally supported MT for pain, they lacked knowledge of MT and experienced barriers to placing MT referrals. To facilitate effective patient discussions and the MT referral process, PCPs want brief educational materials that include scientific evidence and information about MT to guide patient expectations.

P14.17

Use of Complementary Medicine by US Healthcare Professionals During the Pandemic: A Nationally Representative Survey

Mirela-Ioana Bilc¹, and Holger Cramer²

¹ University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

² University of Tübingen, Stuttgart, Baden-Wuerttemberg, Germany

Contact: Mirela-Ioana Bilc, [e-mail]

Abstract

Purpose: There is extensive research investigating healthcare workers’ attitudes, knowledge and professional use of complementary medicine (CM) across medical professions and settings. However, less is known about health professionals’ use of CM for their own health, both overall and regarding specific modalities. This is particularly informative in the context of the COVID-19 pandemic which has led to an unpreceded burden on healthcare workers. Accordingly, using data from the 2022 National Health Interview Survey (NHIS), we examined the use of various CM modalities among healthcare professionals.

Method(s): The NHIS is an annual nationally representative survey of the US civilian non-institutionalized adult population (n=27,651). We used hierarchical logistic regression with relative weights to predict use of different CM modalities among healthcare and non-healthcare professionals in the past 12 months, while accounting for potential confounders associated with CM use.

Results: Results of the regression analyses indicated that healthcare workers were more likely than non-healthcare workers to use CM in general (53.9% vs. 36.8%, OR=1.39, 95% CI , p≤ .001) and specifically more likely to visit massage therapists (18.5% vs. 10.5%, OR=1.31, 95% CI , p≤ .001 ) and use mind-body medicine including meditation, guided imagery, progressive relaxation and yoga (40.6% vs. 25.9%, OR=1.32, 95% CI , p≤ .001). No significant effects were observed for the remaining CM modalities (chiropractor, p= .462; acupuncturist, p= .092; naturopath, p= .157; art and/or music therapist, p= .306).

Conclusions: Our findings indicate that US healthcare workers were significantly more likely to use CM than the general population. This confirms results from a previous nationally representative sample (2007 NHIS) and shows a stable trend among healthcare workers. Future research is needed to investigate factors which might influence how personal use of CM is translated into professional use and vice-versa.

P14.18

Utilizing the Social Ecological Model to Identify Workplace Well-Being Risks and Future Directions

Jacqueline Caputo¹, Riley Summers¹, Timothy Rethorn¹, Angela Emerson², Catherine Quatman-Yates³, and Maryanna Klatt⁴

¹ The Ohio State University, Columbus, OH

² Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, OH

³ School of Health and Rehabilitation Sciences, Division of Physical Therapy, The Ohio State University, Columbus, OH

⁴ Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

Contact: Jacqueline Caputo, [e-mail]

Abstract

Purpose: The social ecological model (SEM) details the interaction of the individual, their community, other people, organizations, community factors, and public policy that synergistically influence health. The SEM can be effective in identifying potential barriers to cultivating a healthy work culture. This study investigated Ohio Hospital Association’s (OHA) current and desired wellness programming via a wellness programming survey evaluation. Ohio State University (OSU) partnered with the OHA, which supports over 200 hospitals across the state of Ohio, for an in-depth analysis of members current resources and directions for future steps to address employee resiliency.

Method(s): The survey evaluating current assets and needs of OHA members was sent out by OHA administration to all member employees. Those interested in filling out the survey had two weeks from the initial email date to answer the survey. Quantitative and qualitative data were analyzed and sorted into the categories of the SEM for further investigation regarding the factors influencing well-being at each institution.

Results: Of the participants who responded to the survey (n=75), 84% stated their hospital had well-being programs and 16% reported either no wellness programming or they were unsure of resources available. When asked about institutional resources present, only 49.3% reported yes, while the other half reported “No” or “Unsure”(n=73). The qualitative data highlighted that the employee resources currently available were clustered in the individual, community, and organizational levels. However, programs requested by respondents were more likely to be represented in the interpersonal and policy levels of the SEM.

Conclusions: The SEM provided insight into where opportunities lie for OHA to implement well-being resources for its members. These results highlighted how making small changes at each level of the SEM can create a larger cultural shift towards whole health for OHA member employees.

P14.19

Whole Health Research: Perspectives From CIH Educational Institutions

Michele Maiers¹, Margaret Whitley², Ian Coulter², Margaret Chesney³, Nipher Malika², and Patricia M Herman⁴

¹ Northwestern Health Sciences University, Bloomington, MN

² RAND Corporation, Santa Monica, CA

³ UCSF, San Francisco, CA

⁴ RAND Corporation, Sonoma, CA

Contact: Michele Maiers, [e-mail]

Abstract

Purpose: Whole health (WH) and whole person health (WPH) are emerging and related areas of healthcare traditionally considered integral to complementary and integrative health (CIH). Research methodology and priorities need to be shaped as these concepts continue to evolve. Using the term WPH for both, we surveyed members of the RAND REACH Center to understand CIH academic institutions’ perspectives on WPH research.

Method(s): An online survey was distributed to the Center’s Research Advisory Board members, representing research interests of CIH academic institutions. Four open-ended items assessed perceptions about WPH: key elements of WPH; aspects of CIH patient care that align with WPH; needed methods to conduct WPH research in CIH; and priority research topics for WPH in CIH. Content analysis of narrative responses was conducted by one investigator (MM) and validity checked by a second (MW).

Results: Among member institutions, 11/13 responded. Key elements of WPH were commonly cited as aligned with CIH: person-centered care, the bio-psycho-social-spiritual model of health and wellbeing, individualized care, and an emphasis on interconnected, multicomponent systems. Social determinants of health and community/planetary health were also noted. Methodological considerations for innovations in WPH research were wide-ranging: measurement of holistic patient-centered outcomes; individualized, pragmatic interventions studied at point-of-care and delivered within care pathways; mixed-methods studies; and high quality CIH practice-based research networks.

Priority WPH research topics included the integration of CIH into the healthcare system; chronic diseases like pain, addiction, depression, osteoarthritis and metabolic syndrome; and chronic disease prevention.

Conclusions: Views from the CIH academic community may influence WHP research as this field matures. Many core elements of WPH are represented within CIH; this places CIH researchers and practitioners at the leading edge of a new movement in healthcare.

P14.20

Assessing the Landscape of Integrative Oncology at US Comprehensive Cancer Centers (CCCs)

Shabeer Siddiqui¹, Yuming Shi², Elyssa Kim¹, Jessica Cheng¹, Jamie Fertal¹, Barbara Greenwell¹, Sarah Ku¹, Frank Munoz¹, Anne Reb¹, Christy Roames¹, Seyma Saritoprak¹, Amy Truong¹, Edyssa Uy¹, and Richard Lee¹

¹ City of Hope, Irvine, CA

² University of Pittsburgh Medical Center, Pittsburgh, PA

Contact: Richard Lee, [e-mail]

Abstract

Purpose: Interest in integrative oncology (IO) has been growing among patients and its availability has expanded within comprehensive cancer centers (CCCs). This study assesses the landscape of IO programs in cancer centers across the U.S.

Method(s): A cross-sectional survey of CCCs regarding IO programs was conducted in 2023. Participants were asked to describe the importance of IO within their cancer center, what programs and services are available to patients, and how these programs and services are operated.

Results: We sent out 94 survey invitations and received 58 completed surveys, a response rate of 62%. Three-quarters (74%) of completed surveys came from NCI-designated cancer centers and academic cancer centers. Over half of respondents (57%) rated IO services to be important (or very important) at their cancer center with 53% of respondents stating that their cancer center has a formal IO clinical program. Respondents stated that their IO program has been in existence for ≥10 years (40%), 5-9 years (26%), and 0-4 years (34%). Among the surveyed cancer centers, the IO program is available to both adult and pediatric populations (33%) while 49% of cancer centers have availability for adults only. The responders reported that the IO program is available to patients with active cancer (91%), patients in survivorship off-treatment (81%), and healthy patients without a history of cancer (22%). The IO services were offered in an outpatient clinic on main campus (76%), outpatient clinic in community sites (29%), or inpatient setting (40%). The most common oncology specific services reported were nutrition (51%), exercise counseling (42%), mind body medicine (38%), and acupuncture (33%).

Conclusions: Despite increasing patient interest and established benefits of integrative therapies, only half of CCCs reported having a formal IO program. More research is needed to understand the gap between patient interest, the growing evidence base, and the lack of programs.

P14.21LB

Phenotypes of Early Low Back Pain Health Service Use by Veterans Receiving Veterans Health Administration Care

Brian Coleman¹, Phillip Ma², Anthony Lisi³, Joseph Goulet⁴, and Qing Zeng²

¹ Yale School of Medicine & VA Connecticut, New Haven, CT

² George Washington University, Washington, DC, DC

³ Yale University, New Haven, CT, 4VA Connecticut, West Haven, CT

Contact: Brian Coleman, [e-mail]

Abstract

Purpose: The Veterans Health Administration (VHA) Stepped Care Model for Pain Management (SCM-PM) promotes stepwise management of Veterans with low back pain (LBP). We aimed to identify health service use phenotypes for LBP following initiation of VHA care for LBP.

Method(s): We included patients with LBP-related diagnoses in a primary care visit from 10/1/2015-9/30/2020 and at least 2 subsequent LBP care visits. We excluded patients with any opioid prescription in the 180 days prior to and those who died within 2 years of index. Age was the only demographic included. Binary flags for health service use within 3 months after index were included for primary care (PC), emergency/urgent care, physical therapy (PT), chiropractic care, pain clinics, physical medicine & rehabilitation (PM&R), complementary & integrative health, mental health, orthopedics, neurosurgery, ancillary services, and all other clinic services. Unsupervised machine learning using k-means clustering with 10 clusters was used to define health service use phenotypes.

Results: There were 86,703 Veterans who met the inclusion criteria, with an average age of 46 years. Health service use phenotypes identified were: 1) PT only (n=11,991; mean age=31.8 yrs.); 2) PT only (n=9,662; 57.8 yrs.); 3) PC only (n=8,452; 32.1 yrs.); 4) PC only (n=7,799; 57.7 yrs.); 5) PC + PT + ancillary services (n=7,778; 76.8 yrs.); 6) ancillary services only (n=5,038; 51.5 yrs.); 7) ancillary services + any other service (n=13,348; 28.7 yrs.); 8) PM&R only (n=4,200; 34.6 yrs.); 9) PM&R + any other service (n=9,019; 59.6 yrs.); and 10) any other service, without PC, PT, nor PM%R (n=9,416; 43.4 yrs.).

Conclusions: We identified health service use patterns for Veterans with LBP generally consistent with the SCM-PM. Age was associated with health service use patterns. The most common phenotypes included use of PC and PT, alone or in combination. Future work will evaluate the sequencing of health service use and the effect of other demographic features over a longer follow up period.

P14.22LB

A Remote-Delivered Self-management Programs for Osteoarthritis Patients: A Qualitative Study

Juliet Insinga¹, Elise Coash¹, Amanda Chin¹, Lance Laird², and Chenchen Wang¹

¹ Center for Integrative Medicine at Tufts at Tufts Medical Center, Tufts University School of Medicine., Boston, MA

² Boston University, Boston, MA

Contact: Chenchen Wang, [e-mail]

Abstract

Purpose: The American College of Rheumatology Guideline strongly recommends self-efficacy and self-management programs for osteoarthritis (OA). Our aim is to explore the feasibility and perceived benefits of a remote Wellness Education program specifically designed for old adults with OA.

Method(s): Two remote randomized controlled trials were conducted, where participants meeting ACR criteria for OA were randomly assigned to either a Mind-body or Wellness Education group. Over a 12-week period, participants in a Wellness Education group attended biweekly remote sessions on Zoom, which included didactic lessons on OA-related topics, physical and psychological health and supervised stretching. Semi-structured interviews and focus groups were conducted via Zoom to gather participant feedback. Focus group and interview questions were based on key themes including general satisfaction, education, remote experience, perceived benefits, and the impact of COVID-19.

Results: Eighteen participants completed interviews (13 in the focus group and four in the semi-structured process). Mean participant age was 67.2 +/- 8, with 54% females, 10% Hispanic or Latino, 22% Black or African American, and 10% from other races. All interviewees expressed general satisfaction with the intervention and consensus suggested remote delivery wellness education was an acceptable adaptation for this program. They reported significant benefits, including improved understanding of OA, improved dietary choices, increased confidence in symptom management, stress reduction, enhanced social interaction, and relatedness to other OA patients. These findings highlight the importance of education and self-management strategies in OA care and the positive outcomes associated with this remote intervention.

Conclusions: This study underscores the significance of integrating remotely delivered programs as an approach for promoting self-management in patients with OA, addressing challenges associated with limited healthcare access in aging populations.

P14.23LB

A Model of Understanding Barriers and Facilitators to Non-Pharmacological Pain Modalities: Patients, Clinicians, and Administrators Perspectives

Tegan Reeves¹, Jeffery Dusek², Richard Printon³, Mia Vang⁴, Sophie Kurschner⁴, and Arti Prasad⁵

¹ Sensei Inc, Palm Springs, CA

² University of California - Irvine, Irvine, CA

³ Hennepin Group, Minneapolis, MN

⁴ Hennepin, Minneapolis, MN

⁵ Hennepin HealthCare, Minneapolis, MN

Contact: Jeffery Dusek, [e-mail]

Abstract

Purpose: The current work uses quality in-depth inquiry to build a model of understanding perceptions of barriers and facilitators of use of non-pharmacological pain modalities (NPM) across patients, clinicians and administrators.

Method(s): Semi-structured -interviews were conducted with regionally representative recruitment in six stakeholder groups: chronic pain patients (CPP, n=15), complementary and integrative health providers (CIH, n=12), clinicians (primary/specialty care providers, nurse practitioners, n=8), healthcare administrators (n=6), and health insurance representatives (n=7), and health insurance representatives (n=7).Grounded, iterative, coding was used to identify major themes within and across groups. Thematic mapping was then used to model perceptions of barriers and facilitators.

Results: A model of barriers and facilitators is presented with four main spectrum-categories: Financial, Logistical, Relational, and Experiential. Stakeholder major themes within an ecological model showed that perceptions moved from the inner-most an emphasis on Financial and Experiential by patients; to Financial, Logistical, and Relational by providers; to Relational and Experiential by administrators; to the outer-most emphasis on Relational by insurance representatives.

Conclusions: An ecological and spectrum-based view of NPM is necessary to develop meaningful and effective interventions and assessments.

P14.24LB

Effects of A Multidisciplinary Rehabilitation Team Based Approach with Exercise, Nutrition, Psychotherapy and Chinese Medicine in Cancer Survivors

Yanhong Gu¹, Tianzhu Qiu, Yiqian Liu, and Ting Wang

¹ Department of Oncology/The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

Contact: Yanhong Gu, [e-mail]

Abstract

Purpose: Less than 10% of individuals with cancer-related impairments receive rehabilitation services and such services are hardly available in China. To overcome the limitations of current physical therapy-based cancer rehabilitation, we conducted a multidisciplinary rehabilitation team based on exercise, nutrition intervention, psychotherapy and traditional Chinese medicine to service cancer survivors.

Method(s): Evaluation was done by specially trained rehabilitation specialists of multidisciplinary rehabilitation team before and after receiving rehabilitation services. Evaluation included cardiorespiratory fitness, body composition, dietary survey, anxiety status, depressive status, quality of life and functional disorders. Individualized interventions including exercise prescription, nutritional prescription, psychological quality and traditional Chinese medicine according to the results of evaluation were performed by kinesiologist, nutritionist, psychologist and Chinese medicine practitioner respectively.

Results: A total of 8 individuals received nutritional assessment after intervention. Appetite increased in 50% cases according to CASQ (P=0.022). Based on PG-SGA, 75% patients had severe malnutrition at baseline, which decreased to 25% after intervention (P=0.034). Seven individuals received psychological assessment. The patients' fatigue scores decreased from 13.3 before intervention to 7.6 after intervention, but the difference did not reach statistical significance according to BFI. Five patients underwent CPET assessment cardiopulmonary function improved significantly at peak load (84.8W vs 97.4W, P=0.049) and oxygen uptake efficiency slop (72.6 vs 82.6, P=0.043). Due to the short follow-up time, no evaluation of traditional Chinese medicine has been done.

Conclusions: A multidisciplinary rehabilitation services based on exercise, nutrition, psychotherapy and Chinese medicine in cancer survivors has potential benefits in terms of improved nutritional status and cardiorespiratory function.

Topic Area 15: Implementation Science

P15.01

Champions of Whole Health: The Growth of Employee Whole Health in Veterans Health Administration

Tamara Schult¹, Kavitha Reddy², and Danielle Lutz³

¹ Veterans Health Administration, Hastings, MN

² Veterans Health Administration, St. Louis, MO

³ Veterans Health Administration, Finger Lakes, NY

Contact: Tamara Schult, [e-mail]

Abstract

Purpose: Veterans Health Administration (VA) is undergoing a large-scale transformation to change the way healthcare is delivered. The long-term goal is to transform the organization to deliver a Whole Health System (WHS) of care that focuses on a Veteran’s life mission, aspiration and purpose and then provides care to optimize that. Ongoing implementation suggests it is important to give VA employees the experience of WH to inform their awareness and desire to share this model with their Veteran patients, and to support their overall health and well-being. The application of the well-being aspects of the WHS to VA employees is Employee Whole Health (EWH).

Method(s): The national strategy for implementation has three focus areas: (1) ensuring strong collaborations across the enterprise and integration of WH into existing initiatives; (2) providing education and experiences to employees to improve their work-life integration; and (3) evaluating the influence of EWH on well-being and organizational metrics. Efforts have been ongoing to increase the number of EWH coordinators at local VA medical centers with dedicated time in the role and to track service provision by coordinators.

Results: Data from 2021 indicated 34 medical centers had an EWH coordinator with >= 50% time dedicated to the role, while 10 had some, but less time. The remaining 95 had no coordinator. As of Aug 2023, 94 had a >= 50% EWH coordinator; 9 had some dedicated time; and 36 had no coordinator. In 2022, a new tracking system to document EWH was implemented. In Aug 2022, 36 medical centers were inputting data; by Aug 2023, this number was 116. The number of unique EWH offerings increased from 772 to 13,078 with employee touches increasing from 12,200 to 317,106 over that same timeframe.

Conclusions: Tremendous growth in the number of local EWH coordinators and service provision has occurred. EWH coordinators at VA medical centers are champions of WH driving transformation efforts in service of Veteran patients and their VA colleagues.

P15.02

Feasibility of ParkerNavigate: Nutrition – Motivational Interviewing, Telehealth Nutrition Program at a Chiropractic Teaching Clinic

Zak Monier¹, Kathryn Hartlieb¹, Tammy Fogarty¹, and Katherine Pohlman¹

¹ Parker University, Dallas, TX

Contact: Zak Monier, [e-mail]

Abstract

Purpose: Assess the feasibility of conducting a 12-week motivational interviewing (MI) informed, telehealth-based nutrition program for overweight spinal pain patients seeking care at a chiropractic teaching clinic.

Method(s): Recruitment occurred between Nov2022-Apr2023 with these criteria: English speaking, age 18-65, BMI >25 kg/m², spinal pain >30 days/previous year, current numerical pain rating scale (NRS)>3, and mobile phone/email access. Questionnaires and body composition measurements occurred at baseline and week 12. Participants received weekly nutrition informative texts and 4 MI-informed phone calls occurred in month 1 and 2 in month 2 and 3. Exit interviews were scheduled upon study completion. Feasibility aspects include: implementation via screening capacity, demand via phone call compliance, retention and follow-up rates, and acceptability via exit interviews.

Results: Implementation – Of the 826 potential participants, 270 were screened (32.7%) with 4 enrolled (1.5%). Exclusions reasons: eligibility criteria (n=211), no interest (n=35), withdrew (n=20). Demand – Participants completed an average of 43.8% of required telehealth calls (n=32). Scheduling conflicts/availability (n=11) and participant non-response (n=7) were the reasons for missed calls. Two participants (50.0%) completed the final visit and 1 completed the exit interview (25.0%). Acceptability – From the 1 participant, length of the program was felt to be sufficient, nutritional content beneficial, and no issues receiving content/completing calls.

Conclusions: A well-developed, MI informed nutrition program for overweight and obese spinal pain patients could provide great value by promoting healthy behavior change and decrease pain. However, this study found screening and retention challenges that impacted feasibility of such a program in a chiropractic teaching clinic. Information from this study should be considered as programs are developed.

P15.03

Mindfulness Targeted to Sustaining the Mental Health of First Responders: For Firefighters vs Police the Etiology of Stress Impacts Implementation

Maryanna Klatt¹, Marcus Williams², Jacqueline Caputo², Beth Steinberg³, Yulia Mulugeta², Mindy Gabriel⁴, and Catherine Quatman-Yates⁵

¹ Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

² The Ohio State University, Columbus, OH

³ Ohio State University Center for Integrative Health, College of Medicine, Department of Family and Community Medicine, Columbus, OH

⁴ Columbus State Community College, Columbus, OH

⁵ School of Health and Rehabilitation Sciences, Division of Physical Therapy, The Ohio State University, Columbus, OH

Contact: Maryanna Klatt, [e-mail]

Abstract

Purpose: Community first responders (FRs), comprised of Firefighters/EMTs (FFs) and Police (PO) are vulnerable to high levels of chronic and recurrent workplace stressors. They also experience high levels of depression, burnout, suicidal ideation, and suicide. These can ultimately impact the quality and safety of frontline community care delivery and could potentially cause detrimental short-and long-term mental health consequences for these FRs. The intended research study was to adapt Mindfulness in Motion (MIM), an 8-week evidence-based mindfulness curriculum that bolsters stress resilience, to specifically cater to the needs of FRs.

Method(s): Semi-structured interviews were conducted with FRs to gain insight into the work environment and stressors.

Results: Qualitative interviews (n=21, 10 police officers, 11 firefighters/EMS) revealed that despite a seemingly similar work environment, police officers and firefighters/EMS had significantly different sources of stress. PO stress was focused on a sense of voyeurism, while FF stress came from the amount of time spent with the same people in the firehouse and having to rely upon other FFs for their own safety. Implementation science also revealed that across both groups of FRs having someone that is familiar to, and understands, their unique daily workflow would be best to facilitate MIM programming. Potential FFs and POs were identified to fulfill the role of MIM facilitator and were included in filming for the video content on the mobile app for mindfulness practice delivery. From the interviews, it was also evident that including a directory of additional wellness resources (specific to the FR group) was desired.

Conclusions: To properly address differences in stress etiology, it was necessary to create and implement two separate tracks in the MIM program-one for FFs and one for POs. Having input from the FRs about their specific work environment/stressors has been critical in sculpting mindfulness programming that addresses specific occupational stress.

P15.04

Society for Integrative Oncology Anxiety and Depression Clinical Practice Guidelines – Process and Update

Suzie Zick¹, Heather Greenlee², Lynda Balneaves³, Nofisat Ismalia⁴, Debu Tripathy⁵, Jodi MacLeod⁶, Richard Lee⁷, Santosh Rao⁸, Julia Rowland⁹, and Linda Carlson¹⁰

¹ University of Michigan, Ann Abor, MI

² University of Washington, Seattle, WA

³ University of Manitoba, Winnipeg, MB

⁴ American Society of Clinical Oncology, Philadelphia, PA

⁵ MD Anderson Cancer Centre, Houston, TX

⁶ Society for Integrative Oncology, Pepper Pike, OH

⁷ Cherng Family Center for Integrative Oncology, Irvine, CA

⁸ University Hospitals Case Medical Center, Pepper Pike, OH

⁹ Smith Center for Healing and The Arts, District of Columbia, DC

¹⁰ University of Calgary, Canmore, AB

Contact: Suzie Zick, [e-mail]

Abstract

Purpose: A priority of the Society for Integrative Oncology (SIO) is to develop disseminable and actionable clinical practice guidelines on the evidence-based use of integrative medicine in oncology settings. Here we describe this process and our recent published guideline on integrative approaches to anxiety and depression management.

Method(s): In 2019, a grant from the Samueli Foundation was awarded to SIO to develop oncology-focused clinical practice guidelines. SIO has developed a collaboration with the American Society of Clinical Oncology (ASCO) to extend the input and reach of these guidelines. To date, SIO and ASCO have partnered in developing three joint guidelines on the management of pain, anxiety/depression, and sleep in people with cancer. The guidelines follow the ASCO guideline development processes and are based upon data from and quality of randomized, controlled clinical trials. SIO and ASCO have assembled diverse panelist representation across professions, geography, institution type, race, gender, and career stage.

Results: The status as of September 2023 is: In September 2022 the guideline on integrative medicine for pain management in oncology was published and the guideline on integrative oncology care of anxiety and depression in cancer was published in August 2023, both in the Journal of Clinical Oncology. The sleep quality in cancer care guideline co-chairs have been identified as have the next clinical guideline topic, to update the integrative therapies in breast cancer treatment guideline published in 2017. In this session we will review the guideline development process and share the specific recommendations from the anxiety and depression guideline. Knowledge translation products for the anxiety and depression guideline will also be shared.

Conclusions: Developing and disseminating evidence-based clinical practice guidelines for integrative medicine modalities has the potential to improve uptake and implementation, and thus, the impact of these approaches across many settings.

P15.05

The Pivot From In-Person to Online Mindfulness: Lessons Learned From a Clinical Trial of a Group-Based Intervention for Low Back Pain

Holly Thomas¹, Suzanne Lawrence¹, Graham Dore¹, Tra Nguyen², Maria Gabriela Castro³, Jessica Barnhill³, Kathleen McTigue¹, Carol Greco¹, and Natalia Morone⁴

¹ University of Pittsburgh, Pittsburgh, PA

² Boston Medical Center, Boston, MA

³ University of North Carolina, Chapel Hill, NC

⁴ Boston University/Boston Medical Center, Boston, MA

Contact: Holly Thomas, [e-mail]

Abstract

Purpose: Traditionally, group mindfulness interventions have been delivered in-person. Virtual platforms may improve access for people with lack of transportation, complicated schedules or limited mobility. Due to COVID-19, a multisite pragmatic clinical trial, OPTIMUM, shifted from in-person to virtual format. OPTIMUM randomized 451 primary care patients with chronic low back pain, many from underserved groups, to mindfulness-based medical group visits or usual primary care. Here we describe the in-person to online pivot, including implementation barriers and solutions.

Method(s): To maximize success of the remote intervention, staff from three sites met bi-weekly prior to and throughout study recruitment. Site-specific weekly meetings also identified potential barriers and solutions.  We piloted the virtual intervention at all sites and conducted participant exit interviews to tailor our approaches. Qualitative interviews and feedback from staff, mindfulness providers, and the study’s Community Advisory Board were used to monitor and improve processes.

Results: Barriers and solutions are summarized in the table. We addressed technological challenges by offering devices and tech training and by providing in-session tech support. Solutions for interpersonal challenges focused on ensuring that participants could have similar engagement and interpersonal connections as with in-person formats. Privacy issues were addressed during consent and at the first intervention session.

Conclusions: Barriers to virtual group delivery can be overcome, even among populations that are typically under-represented in behavioral clinical trials. Early planning and allocation of financial and staff resources towards appropriate solutions is essential. Pilot work can identify barriers prior to intervention finalization. Virtual formats are a powerful tool for bringing effective mindfulness interventions to people in need, but attention to barriers is necessary to avoid exacerbating existing health disparities.

P15.06LB

An Implementation Research of Integrated Traditional Chinese Medicine in a Smoking Cessation Clinic: A Randomized Controlled Trial

Chunli Lu¹, Xiaoying Chen², xuehan Liu², Qian-yun Wang³, Xingru Pan², Xue Xue⁴, Nicola Robinson⁵, Lirong Liang⁶, and Jianping Liu⁷

¹ Guangdong Pharmaceutical University, Guangzhou, Guangdong, China

² Beijing University of Chinese Medicine, Beijing, Beijing, China

³ Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, Beijing, China

⁴ Hubei University of Chinese Medicine, Wuhan, Hubei, China

⁵ London South Bank University, London, Greater London, United Kingdom

⁶ Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Beijing, Beijing, China

⁷ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Chunli Lu, [e-mail]

Abstract

Purpose: This randomized controlled trial aims to evaluate the facilitative role of integrating Traditional Chinese medicine (TCM) intervention into conventional treatment in real-world smoking cessation clinics, while assessing its implementation effects.

Method(s): A mixed method (quantitative and qualitative), parallel randomized controlled design with a TypeⅠeffectiveness-implementation hybrid approach was conducted in a smoking cessation clinic in China. A total of 62 participants were enrolled and randomly assigned to receive either Varenicline alone or Varenicline plus TCM tea bag for four weeks. Implementation outcome included the adherence rate, while healthy outcomes include abstinence rate, level of tobacco dependence (FTND), nicotine withdrawal symptoms (MNWS) and fire-related TCM symptoms, and the safety outcomes. (Trial registration number: ISRCTN16358150).

Results: The results of healthy outcomes in terms of abstinence rate, level of FTND, MNWS and fire-related TCM symptoms showed no statistically significant differences between the two groups. However, the experimental group showed a more favorable trend in integrated TCM intervention compared to the control group regarding FTND, MNWS and TCM symptoms. Compared with the conventional intervention in clinic, integrated TCM intervention can enhance the adherence rate. No serious adverse events were reported during the trial.

Conclusions: The implementation of integrative TCM interventions in smoking cessation clinic settings has demonstrated promote the quality and efficacy of smoking cessation services.

P15.07LB

Factors Affecting Implementation of Whole Person Pain Care in the VHA: Rapid-cycle Evaluation using Consolidated Framework for Implementation Research

John Finnell¹, April Casselman², and Paul Nabity³

¹ Central Texas Veterans Health Care System, Austin, TX

² Veterans Health Administration, Arlington, TX

³ UTHealth San Antonio, San Antonio, TX

Contact: John Finnell, [e-mail]

Abstract

Purpose: The prevalence of chronic pain is 31.5% in Veterans compared to 20.1% in non-Veteran civilians. Veterans are also at high risk for polymorbid chronic pain. The CARA Act (2016) and current pain guidelines support the implementation and delivery of an interdisciplinary team-based, biopsychosocial, stepped-care model to pain management, which will be referred to here as Whole Person Pain Care (WPPC). The purpose of this study is to conduct a rapid-cycle analysis of interview data from key stakeholders to identify specific determinants of the implementation of the WPPC model across VHA.

Method(s): A single trained individual conducted semi-structured interviews over five domains of the Consolidated Framework for Implementation Research 2.0 (CFIR) constructs: 1) Innovation; 2) Outer Setting; 3) Inner Setting; 4) Individuals; and 5) Implementation Process. Office of the IRB, UT Health San Antonio determined that the project (20230681NRR) does not require IRB approval because it is not regulated research. Two raters coded the interview summaries based on the CFIR constructs. Inter-rater reliability was assessed, and differences were resolved through consensus.

Results: The sample included semi-structured interviews of national-level leaders, high-level leaders, mid-level leaders, and implementation team members from seven VHA medical centers. The study completed 60% (n=33) of target N=55 semi-structured interviews and concurrent rapid analysis coding at the time of this submission.

Conclusions: Analyses identified common positive and negative implementation determinants, comparing both site and leadership level data, respectively, to establish convergence and divergence of CFIR constructs. A strength is the rapid qualitative analysis uses a prospective implementation science strategy to evaluate the adoption of the WPPC approach and provide rapid feedback and response. A limitation is that the implementation study evaluated seven VHA sites, and the results may not be generalizable to other VHA sites.

P15.08LB

Music Therapy Integration and Deployment: An Implementation Science Approach to a Large Healthcare System

Seneca Block

University Hospitals Connor Whole Health, Cleveland, OH

Contact: Seneca Block, [e-mail]

Abstract

Purpose: From a whole health perspective, music therapy (MT) programming is a viable, non-invasive, and clinically effective treatment for patients coping with issues related to hospitalization. Additionally, MT may be utilized to support employee wellbeing through staff-based initiatives. Specifically, MT often utilizes music for relaxation, active music making, and songwriting for both patient and staff care. The following will outline the growth of a medical based team of 12 board certified music therapists (MT-BC) within a large midwestern hospital system through an integrative health (IH) approach. The development of the program will be presented via timelines of implementation, funding, direct patient care, staff initiatives, and the implementation of an academic training program for MT students. Further insights into program directorship and learning moments throughout the implementation of a medically based MT program will be shared.

Method(s): Music therapy program integration took place within a large midwestern comprehensive health system with 22 hospitals, more than 50 health centers and outpatient facilities, and over 200 physician offices located throughout 16 counties. The system’s flagship location is additionally an academic medical center with a local medical school affiliation and residency programs. The main campus also includes a children’s hospital, women’s hospital, and comprehensive cancer center.

Results: As MT services continue to serve as a nonpharmacological approach within the medical treatment culture (Misra et al., 2017), an emphasis on effective holistic treatment approaches has been observed in recent years to meet demands for treatments that avoid the potentially harmful side effects of medications.

Conclusions: This MT program consists of a group of providers poised to deliver best-care practices that span beyond patient and staff populations, while serving the surrounding community.

P15.09LB

The Behavioral Mechanisms of Integrated Traditional Chinese Medicine in Smoking Cessation: An Interview Nested in a Randomized Controlled Trial

Chunli Lu¹, Xingru Pan², Nicola Robinson³, Lirong Liang⁴, and Jianping Liu⁵

¹ Guangdong Pharmaceutical University, Guangzhou, Guangdong, China

² Beijing University of Chinese Medicine, Beijing, Beijing, China

³ London South Bank University, London, Greater London, United Kingdom

⁴ Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Beijing, Beijing, China

⁵ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Chunli Lu, [e-mail]

Abstract

Purpose: Low proportion of follow-up visits and the challenges in sustaining smoking cessation behavior are critical aspects in clinical practice. Integrated Traditional Chinese Medicine (TCM) interventions have demonstrated potential effectiveness for smoking cessation and promoting healthy behavioral patterns. This study aimed to evaluate the behavioral mechanisms of integrated TCM treatment package for smoking cessation.

Method(s): Interview were conducted in a randomized controlled trial. The data were analyzed by policy category of Behavior Change Wheel and Theoretical Domains Framework using Framework-Thematic analysis method.

Results: A total of 19 interviewees underwent a four-week treatment with TCM tea, while 24 participants received conventional smoking cessation treatment only. Regarding the development of “smoking cessation behavior”, some patients in the experimental group substituted their habit of smoking with drinking TCM tea due to their increased acceptance of TCM tea, thereby facilitating smoking cessation. In contrast, patients in the control group had certain expectations regarding the potential effectiveness of using TCM tea to promote smoking cessation behavior. Compared with the standard diagnostic and treatment approach, integrated TCM outpatient services resulted in a higher proportion of follow-up visits.

Conclusions: As an innovative approach in smoking cessation clinics, Traditional Chinese Medicine (TCM) has the potential to enhance adherence to smoking cessation programs and facilitate abstinence by establishing a TCM-style behavior.

Topic Area 16 – Lifestyle Medicine

P16.01

Effect of Virtual Heartfulness Meditation and Yoga Program on Mental Wellbeing Among the General US Population

Kunal Desai¹, Jayaram Thimmapuram², Nicolai Veronique³, and T.S. Sreekumar⁴

¹ Wright State University, Dayton, OH

² Wellspan York Hospital, York, PA, York, PA

³ Director of Heartfulness Yoga Academy, Hyderabad, Telangana, India

⁴ Vivekananda Yoga University (VaYU), USA., Norwalk, CA

Contact: Kunal Desai, [e-mail]

Abstract

Purpose: Mental health is of utmost importance, encompassing an individual's emotional, psychological, and social wellbeing and influences physical health. The study investigated the effects of a virtual yoga and Heartfulness meditation program on anxiety, loneliness, and Satisfaction with life among participants from the general population in the United States.

Method(s): We recruited 61 participants to receive a 6-week virtually conducted yoga exercises and Heartfulness meditation program in a prospective pre-post single-arm intervention study in February-March 2022. Participants with a history of meditation practice (≥ 100 hours of meditation) were excluded from the study. Eight live virtual education sessions with a practical demonstration of yoga exercise and guided meditation, were conducted. Generalized anxiety disorder-7 scale (GAD-7), UCLA loneliness scale, and Satisfaction with life scale (SWLS) scores were collected at baseline and the end of the study period. Of the 61 participants, 39 (64%) completed a 6-week program.

Results: There was a decrease in mean GAD-7 scores between week 0 (6.92 ± 0.61) and week 6 (3.32 ± 0.59) and a decrease in mean loneliness score between week 0 (43.78 ± 1.82) and week 6 (36.34 ± 1.80) for all subjects (p < 0.0001). There was an improvement in SWLS scores between week 0 (23.82 ± 0.97) and week 6 (26.77 ± 0.97) for all subjects (p < 0.0001). For each additional meditation and yoga exercise session practiced each week, on average, there was an additional 0.21-point increase in SWLS score from pre- to post-program.

Conclusions: A significant reduction in generalized anxiety and loneliness scores was noted at the end of a virtual Heartfulness meditation combined with a yoga exercises program. Regular practice of yoga and meditation was associated with increased life satisfaction scores. The effectiveness of the integrative mind-body programs such as Heartfulness meditation and yoga on holistic wellbeing need to be explored in large, controlled studies in the future.

P16.02

Holistic Lifestyle Medicine for Reversal and Remission of Type 2 Diabetes: Insights from an Indian Population Study

Pramod Tripathi¹, Nidhi Kadam¹, Thejas Kathrikolly¹, Diptika Tiwari¹, Anagha Vyawahare Vyawahare¹, and Baby Sharma¹

¹ Freedom from Diabetes Research Foundation, Pune, Maharashtra, India

Contact: Pramod Tripathi, [e-mail]

Abstract

Purpose: To assess the effectiveness of a one-year online holistic lifestyle intervention in T2D reversal and remission in an Indian population.

Method(s): Patients with T2D (>18 years; n=1910), enrolled in a one-year program at Freedom from Diabetes Clinic, Pune, India, from April-December 2021 were included in this study. The intervention comprised of four components: Diet- a plant-based diet tailored to patients’ BMI, including juice, water, and intermittent fasting; Exercise- Individualized with a focus on muscle activation, strengthening, and improving flexibility through a variety of yoga and conventional exercises; Stress Management- psychological intervention with therapeutic approaches like CBT, REBT, NLP, Clinical Hypnotherapy, concepts of ikigai, and Pranic Healing; Medical Management- planned online consultations. The intervention emphasized on indigenous food and spiritual healing practices rooted in Indian philosophy. Baseline and one-year follow-up assessments included anthropometric and biochemical parameters. Remission was defined as maintaining HbA1c <6.5% for a minimum of 3 months without glucose-lowering medicines.

Results: The mean age of the population was 52±10.5 years. Post-intervention, a significant weight reduction (median decrease:7 kg, p<0.05) was observed. T2D reversal was observed with a median reduction in HbA1c (1.1%), fasting insulin (3.6 uU/ml) and HOMA-IR (1.3) (p<0.05). Remission was achieved in 30% of patients along with improvement in hypertension (reduction to <140/90) and dyslipidemia (total cholesterol <200 mg/dl) (p<0.05). Weight loss >5 kgs was associated with higher remission (41% vs. 25%) and HbA1c <6.5% (52% vs. 39%) (p < 0.05). Endline HOMA-IR (<2.5), shorter disease duration (<6 years) and drug-naïve status predicted remission.

Conclusions: This study highlights T2D reversal and remission achievements, especially with >5 kg weight loss. It identifies key predictors of remission and underscores the potential benefits of Lifestyle Medicine in comprehensive T2D management.

P16.03

Impact of a One-Year Lifestyle Intervention Program on Metabolic Health: Analysis in an Obese Indian Population

Pramod Tripathi¹, Anagha Vyawahare Vyawahare¹, Nidhi Kadam¹, Thejas Kathrikolly¹, Diptika Tiwari¹, Baby Sharma¹, and Malhar Ganla¹

¹ Freedom from Diabetes Research Foundation, Pune, Maharashtra, India

Contact: Pramod Tripathi, [e-mail]

Abstract

Purpose: The study aimed to assess the effectiveness of a one-year lifestyle intervention program in improving metabolic health with a focus on weight loss, insulin resistance, and dyslipidemia in obese Indian population.

Method(s): Data on anthropometric, biochemical, and medical history were collected on 540 obese participants (age >18 years, BMI>30kg/m2) who underwent an online one-year lifestyle intervention program in Pune city India. The intervention comprised of four components: Diet- a plant-based diet tailored to patients’ BMI, including juice, water, and intermittent fasting; Exercise- Individualized with a focus on muscle activation, strengthening, and improving flexibility through a variety of yoga and conventional exercises; Stress Management- psychological intervention with therapeutic approaches like CBT, REBT, NLP, Clinical Hypnotherapy, and Pranic Healing; and regular physician consultations.

Results: The mean age of the participants was 46±11.1 years, with an average BMI of 35±4kg/m²; 67% were females. At baseline: 31%, 29%, 48%, and 67% showed hypertension, dyslipidemia, high HbA1c (prediabetic range), and insulin resistance (HOMA-IR>2.5). Post-intervention, significant improvements were observed in weight, BMI, HOMA-IR, and lipid parameters (p<0.05). Further, 31% shifted to the overweight BMI category (25-30 kg/m²). Of the 155 participants with prediabetes (HbA1c 5.7 to 6.5%), 39% shifted to the non-diabetes range (HbA1c<5.7).

Conclusions: In conclusion, the one-year lifestyle intervention program led to significant improvements in metabolic health markers, including weight, BMI, insulin resistance, and dyslipidemia, in obese Indian individuals, with a notable transition of participants with prediabetes to normal glycemic profile, highlighting the promising potential of this holistic approach for addressing metabolic health issues in this population.

P16.04

Impact of Heartfulness Meditation Compared to Gratitude Science Practices on Mental Wellbeing in Healthcare Professionals: Randomized Trial

Kunal Desai¹, Patricia O’Malley², and Emily Van Culin²

¹ Wright State University, Dayton, OH

² Premier Health Network, Dayton, OH

Contact: Kunal Desai, [e-mail]

Abstract

Purpose: To investigate whether heartfulness meditation practice, compared to gratitude practice, leads to measurable changes in mental wellbeing among healthcare providers across the US.

Method(s): The participants were randomly assigned to one of the following 6-week interventions: the trainer-guided virtual heartfulness meditation program or the podcast-based self-guided gratitude practice group. The Professional Quality of Life Scale-5 (ProQOL-5) to determine risk for Compassion Satisfaction (CS) and Burnout (BO) and secondary traumatic stress (STS) as well as the Utrecht Work Engagement Scale (UWES) to assess Vigor or resilience and work satisfaction were collected at baseline and the end of the study period. Qualitative questions regarding the experience of learning and practicing were also offered at the end of 6 weeks.

Results: Most of the participants were nurses (50%), followed by allied healthcare professionals (37%) and physicians (13%) (N=83). There was a general trend towards increases in CS in the heartfulness group compared to the gratitude group. However, this was not statistically significant. Strong evidence suggests there was a significant improvement in BO for the heartfulness group between Week 0 and Week 6 (p = 0.002) as well as STS (p=0.0004) and Vigor (p=0.0392). Qualitative data analysis revealed that the subjects in the heartfulness arm reported improved sleep and decreased reactivity to stress. Subjects in the gratitude arm reported improved mood and favorable results using gratitude practices at home with family members.

Conclusions: In our study, Heartfulness meditation practice was associated with a significant improvement in Burnout and Vigor at work, with a trend towards compassion satisfaction after 6 weeks compared with Gratitude practices. Qualitative analysis indicates the benefits of both Heartfulness and Gratitude practices. Further randomized trials with a larger sample size are needed to explore these science-based practices for wellbeing of the healthcare workers.

P16.05

Impact of Integrating Wellbeing and Self-Care Healing Practices for Women at High Risk for Breast and Gynecologic Cancers on Daily Wellness Practices

Heather Macdonald¹, and Anusha Wijeyakumar²

¹ Hoag, Irvine, CA

² Hoag Hospital, Newport Beach, CA

Contact: Heather Macdonald, [e-mail]

Abstract

Purpose: The Hoag Breast and Ovarian Cancer Prevention Program provides cancer surveillance and prevention to women at high risk for inherited breast and gynecologic cancers. Our program serves both previvors and cancer survivors. As diet, exercise and mindfulness practices may reduce cancer incidence and recurrence by up to 30%, our program integrates self-care and a mixture of eastern and western wellness practices into standard medical care as healing practices for prevention, treatment and recovery from cancer. Our healthcare team reflects the principles of diversity, equity, inclusion and belonging in team composition, team culture and interactions with each other and with patients. After 5 years of implementation, we sought to measure impact of these interventions on patient practices.

Method(s): Our multidisciplinary team of genetic counselor, breast surgeon, gynecologic oncologist, women’s health nurse practitioner, nurse navigator, social worker, dietician, activity coach, mindfulness coach and psychologist/sex therapist provide integrated approach to standard medical care and wellness. Patients receive individual consultations with wellness providers and set individual goals prioritizing regular wellness and self-care. Between 2020 and 2022, we surveyed newly enrolled program participants regarding changes in daily habits after implementing recommended wellness practices.

Results: Of 125 new program participants, 51 (40%) responded to a phone survey. 38% responded they had made daily ongoing changes to diet, activity or mindfulness practices.

Conclusions: Integration of wellness and standard medicine can meet the unique needs of these “previvor” patients and improve wellness habits. Integration of eastern wellness practices and western medical care focuses on physical, mental and psycho-social health. DEIB is prioritized in program and team development, patient and team member interactions and provision of health care.

P16.06

Teaching CALM: Culinary and Lifestyle Medicine for Health Care Professionals

Lindsay Malone¹, Stephanie Harris¹, and Hope Barkoukis¹

¹ Case Western Reserve University School of Medicine, Cleveland, OH

Contact: Lindsay Malone, [e-mail]

Abstract

Purpose: The physician of tomorrow should be prepared to address lifestyle factors that both prevent and contribute to the development of chronic disease. This longitudinal, prospective cohort study will assess self-reported confidence in Lifestyle (LM) competencies, quality of life (QOL), health behaviors and cooking attitudes/skills of medical students enrolled in the JJM Mandel Wellness and Preventative Care Pathway, compared to those not enrolled.

Method(s): Medical students enrolled in the Pathway are expected to spend 1-3 hrs./wk. engaged in Pathway activities that address each domain of wellness, including physical activity, nutrition and culinary medicine, and emotional, social and mental health and wellness. These activities include hands-on culinary workshops and seminars related to the Pathway domains. The program has a 75% attendance requirement. Data will be collected using a pre-test/post-test survey. Validated tools used in the survey include the Liner Analog Self-Assessment of Quality of Life, Mediterranean Diet Assessment Tool, Fruit and Vegetable Behavior checklist, Cooking Attitude Subscale and Cooking and Food Skills Measure. Data will be collected at baseline, at the beginning of each medical school year, and just before graduation to assess the impact of the program.

Results: Data is currently being collected and will be available at the time of the conference for discussion. Our findings will include self-reported confidence in LM competencies, QOL, emotional wellness, current health behaviors, dietary intake and eating habits, cooking attitudes and skills.

Conclusions: Incorporating CALM-based curriculum into medical education is an innovative mechanism for teaching key LM-based competencies for HCP. We anticipate an increase in self-reported confidence in the LM competencies as well as positive changes in medical students’ quality of life, current health behaviors and cooking attitudes and skills as compared to those not enrolled in the pathway.

P16.07

Proposed EMR Templates Modifications to Improve Smoking Cessation & Physical Activity Outcomes

Aasia Syed

Metrohealth Medical Center Cleveland Ohio, Cleveland, OH

Contact: Aasia Syed, [e-mail]

Abstract

Purpose: To encourage patients towards their tobacco smoking cessation and increasing physical activity goals by using EMR template as a tool to address, record and retrieve patient specific information and progress towards their individually set goals during follow up visits in behavioral health outpatient clinic setting.

Method(s): This study was designed for outpatient Psychiatry clinic.  It included 38 patients followed for approximately one year. Questions related to smoking cessation and physical activity were added in electronic medical records templates for initial and follow up visits. Type of treatment which helped each patient towards tobacco smoking cessation and duration of time from initial visit until they quit smoking was also recorded. Vernaciline, Nicotine Patches and Bupropion were used. Motivational Interviewing techniques were used. Patients who achieved quitting smoking were added to a certain list.

Patients chose their desired physical activity and start date and frequency and duration of physical activity/ activities of their choice. Patients who achieved their goals of desired physical activity level were added in a certain list.

PHQ 9 scores were recorded on every follow up visit for all patients. BMI was recorded for all patients.

Hgb A1c was followed every three months for diabetic patients.

Results: Most patients showed significant improvement in their mood after quitting smoking and/or increasing physical activity. Most patients maintained their nonsmoker status and maintained their physical activity.

Conclusions: Modified EMR template proved to be a significantly effective tool to help provider to remember to address and follow up on smoking cessation and physical activity progress during each session. Patients responded positively, when their goals and progress from previous session were shared with them. In many patients Hgb A1c and BMI improved significantly. PHQ 9 scores also improved significantly.

P16.08

Rapid Convergence of Gut Microbiome and Enrichment of Beneficial Microbes During Arhatic Yoga Practices in a Retreat Environment

Jason Yuan¹, Glenn Mendoza², Marianne Chung³, and Sanjay Swarup⁴

¹ Pranic Healing Research Institute, Jersey City, NJ

² Pranic Healing Research Institute, Paramus, NJ

³ Pranic Healing Research Institute, Atlanta, GA

⁴ Pranic Healing Research Institute, National University of Singapore, Queenstown, Singapore

Contact: Glenn Mendoza, [e-mail]

Abstract

Purpose: The human microbiome plays a vital role in human health, mediated by the gut–brain axis, with a large diversity of functions and physiological benefits. The dynamics and mechanisms of microbiome interactions with advanced meditations are not well understood and documented. Arhatic Yoga is a spiritual technology practiced by thousands worldwide based on advanced meditations of different yoga traditions. The study investigates the short-term modulations of the microbiome during Arhatic Yoga practices.

Method(s): A single-arm pilot clinical trial was conducted in a controlled environment with a vegetarian diet and similar lifestyles during a 10-day retreat with twenty-four (24) Arhatic Yoga practitioners in upstate New York. We collected saliva (16) and fecal (24) samples at day 1, day 3-5, and day 7-9. 16S next-generation amplicon sequencing of oral and gut microbiome was performed. Multivariate statistical analyses were performed including PERMANOVA and functional predictions (PICRUSt). The study was IRB-approved.

Results: The gut microbiome was more diverse (beta diversity) than oral microbiome. In contrast, oral microbiome profile showed a significant (p<0.05) difference in the species richness and evenness (alpha diversity) at the end of the study. Non-metric multidimensional scaling (NMDS) confirmed the shift in the gut microbiome profile of the practitioners within a short time of 3 days, which was further supported by PERMANOVA analysis (p<0.05). Health benefiting microbes known to improve the gastrointestinal and gut-barrier functions, immune modulation, and oral-gut axis were enriched. Gut microbiomes of all yoga practitioners converged to similar profiles by the end of the study.

Conclusions: This study demonstrates that advanced meditations and Arhatic Yoga practices rapidly enrich the health-benefiting microbes. Consortia of such microbes may be tested for potential benefits in alleviating symptoms of circulatory, gastrointestinal, inflammatory, and psychological disorders.

P16.09

Information About the Gut Microbiome’s Connection to Health and Disease Can Impact Mindset: An Education-Based Intervention

Sasha Narain¹, Ben Knudsen², Karen Schlumpf¹, Brad Moore¹, and Leigh A. Frame¹

¹ George Washington University School of Medicine and Health Sciences, Washington, DC

² George Washington University, Washington, DC

Contact: Leigh A. Frame, [e-mail]

Abstract

Purpose: The gut microbiome is a dynamic ecosystem of microorganisms with many functions. Healthy lifestyle behaviors positively correlate with a diverse gut microbiome and optimal function. As a relatively new field, patients may not be aware of its involvement in health. We measured patients’ mindsets about health practices, dietary intake, and physical activity before and after learning about the role of the gut microbiome in health outcomes.

Method(s): General Internal Medicine Clinic patients were recruited to complete a baseline survey focused on evaluating gut microbiome knowledge, behavior mindset (4-point Likert scale), dietary intake, and physical activity. Immediately after, they viewed a video and handout describing how a plant-based diet, physical activity, stress management, etc. enhance the gut microbiome and health outcomes. A follow-up survey was sent one month later to assess change from baseline.

Results: Baseline and final surveys were completed by 119 and 60 patients respectively. Two questions reached statistical significance. The number of people who chose Strongly Agree for “Exercise influences the types of bacteria present in the digestive system” increased from 7 (12%) to 23 (39%), p = 0.004. While those who chose Strongly Disagree for “An inactive lifestyle promotes the growth of healthy types of digestive system bacteria” increased from 12 (20%) to 24 (41%), p = 0.035. There was no change in physical activity or the median number of servings consumed of fruit (2), beans (1), whole grains (2), or processed snacks (1).

Conclusions: We observed a greater change in patients’ mindset than behavior. Large lifestyle changes are challenging to adopt and require a deep commitment for maintenance–this is a process. Our results indicate that patients may now be more aware of how lifestyle choices affect health outcomes and, thus, may be more ready for change–the important first step in the behavioral change process.

P16.10

Effect of Yoga Use on the Health-Related Quality of Life among New Zealand Yoga Users Diagnosed with Long-term Health Conditions: A Longitudinal Study

Sridhar Maddela¹, Stephen Buetow¹, Ruth Teh¹, and Fiona Moir¹

¹ University of Auckland, Auckland, Auckland, New Zealand

Contact: Sridhar Maddela, [e-mail]

Abstract

Purpose: With its holistic practices, yoga has become popular in Western countries, particularly for maintaining health and managing chronic non-communicable diseases, thus improving the overall quality of life. We aimed to understand how yoga use impacts health-related quality of life (HRQoL) among yoga users (YUs) diagnosed with long-term health conditions in New Zealand (NZ) over nine months.

Method(s): A standard WHOQOL-BREF survey was utilized to evaluate the HRQoL of 151 YUs diagnosed with long-term health conditions in four domains: physical, psychological, social relationships, and environmental. The data was collected at four time points: baseline, three months, six months, and nine months. The study employed descriptive statistics to examine HRQoL scores. Correlation analyses assessed associations between domain scores, health satisfaction, and overall HRQoL scores in response to yoga use. A mixed effects model for repeated measures (MMRM) investigated the effect of time on the HRQoL scores.

Results: The data were collected between October 2021 and July 2022. The completed questionnaires were returned by 63, 42, 37, and 35 YUs at respective time points. Between the baseline and final follow-up, the mean total HRQoL score increased (p<0.001). The MMRM revealed a main effect of time on the physical (estimate = 2.4, SD = 0.1, p <0.05) and psychological domains (estimate = 2.1, SD = 0.1, p <0.05), indicating their consistent improvement over nine months.

Conclusions: Long-term yoga use has been found to benefit overall HRQoL among YUs diagnosed with long-term health conditions, particularly in their physical and psychological HRQoL domains. The study findings could inform health professionals regarding yoga use in NZ.

P16.11LB

A Comprehensive Lifestyle Program (CLP) Improves Anthropometric, Fitness, and Dietary Measures and Multiple PROs in Women with Breast Cancer (BCa)

Lorenzo Cohen¹, Banu Arun¹, Taylor Austin-Isbell², Gildy Babiera¹, Karen Basen-Engquist¹, Cindy Carmack¹, Alejandro Chaoul³, Aimee Christie⁴, Robin Haddad¹, Cheuk Hong Leung¹, Yisheng Li¹, Smitha Mallaiah⁵, Raghuram Natarathna⁶, Jewel Ochoa¹, Patricia Parker⁷, George Perkins¹, Catherine Powers-James⁴, Anil Sood¹, Veronica Vallone¹, Richard Wagner⁵, Peiying Yang¹, and Sai-ching Yeung¹

¹ The University of Texas MD Anderson Cancer Center, Houston, TX

² Chattanooga OBGYN Group, PLLC, Chattanooga, TN

³ The Jung Center, Houston, TX

⁴ UT MD Anderson Cancer Center, Houston, TX

⁵ The University of Texas M D Anderson Cancer Center, Houston, TX

⁶ Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India

⁷ Memorial Sloan Kettering Cancer Center, Scarsdale, NY

Contact: Lorenzo Cohen, [e-mail]

Abstract

Purpose: We examined a CLP for women with BCa to counter the harms of excess weight, unhealthy diet, low levels of physical activity, and chronic stress.

Method(s): Women with stage II/III BCa undergoing XRT were randomized to CLP or usual care (UC). Women in CLP had two sessions a week each of diet, exercise, and yoga counseling (YC) and one session a week of behavioral counseling for 6 weeks, followed by weekly behavioral counseling for 6 months. Data were collected at baseline and 3, 6, and 12 months. Measures included body composition from DEXA (percent body fat (BF), visceral adipose tissue (VAT), and fat mass (FM)), waist circumference, fitness testing, fiber consumption, and multiple PROs. Outcomes from 6-months are reported.

Results: 100 women were randomized to CLP (50) or UC (50); mean age 51; 22% Black and 11% Hispanic. Adherence to the intensive 6-week portion of the intervention was high with 85% only missing 3 sessions or less out of 42 sessions. Change in body composition revealed significant reductions in CLP vs. UC: BF: -1.1 vs. +1.6, p<0.001; VAT: -3.5 vs. +13.2, p=0.035; FM: -0.5 vs. +0.9, p=0.002; waist: -1.9 vs. +1.4, p<0.001. Fitness testing revealed significant improvements in CLP vs. UC for upper and lower body strength, VO2 Max (3.5 vs. 1.4, p=0.034), and Godin (38.4 vs. 11.4, p=0.038). Dietary recalls revealed increased fiber consumption in CLP vs. UC (+4.4 vs. -2.8, p<0.001). There were statistically and clinically significant improvements in QOL scores for the CLP group and little or no changes for UC. There were also significant group differences for mindfulness, mindful eating, and social support that increased in CLP and decreased in the UC group. Qualitative data from exit interviews will also be presented with themes that were consistent across participants, in particular the importance of mindfulness and the YC component.

Conclusions: CLP resulted in improvements in body composition, fitness, fiber consumption, and multiple PROs.

P16.12LB

Balance and Gait Quality Changes in Veterans Following at Least 1-Year in a Companion Dog Whole Health Intervention

Matthew Funke¹, Jamie Giffuni², Julie Rekant², Odessa Addison², and Heidi Ortmeyer³

¹ Department of Veterans Affairs/VA Maryland Health Care System, Baltimore, MD

² Department of Veterans Affairs/GRECC, Baltimore, MD

³ University of Maryland/Baltimore, Baltimore, MD

Contact: Matthew Funke, [e-mail]

Abstract

Purpose: The primary aim of this study was to evaluate changes in balance and gait performance in Veterans participating in a whole health companion dog adoption program following 1 year of participation. A secondary aim was to evaluate the influence of time the Veteran and their dog spent being physically active together on observed balance and gait changes.

Method(s): Fourteen Veterans (10 male, 4 female; 61.8 ± 11.9 years old) completed a functional assessment (Four-square step test and 30 second chair stand) and a Six Minute Walk Test (6MW) (N=13) at baseline and following a companion dog program lasting at least 12 months. Active and Sedentary time was captured with proximity-sensor-enabled activity monitors worn by the Veteran and dog for an average of four 24-hr periods over 7 days. Active percentage was calculated as the amount of time the Veteran and dog were both physically active as a percentage of their overall time in close proximity to one another and is an objective measure for the time the Veteran spent walking their dog.

Results: Veterans demonstrated significant improvements on the Four Square Step Test (mean (95% CI) change: -2.67 (-4.08, -1.26) s), 30 second chair stand (4.07 (1.80, 6.34) reps), and 6MW distance (51.64 (25.30, 77.99) ft). Average stride time (-0.06 (-0.10, -0.02) s), stance time (-0.05 (-0.08, -0.01) s), and swing time (-0.01 (-0.02, -0.00) s) during the 6MW decreased at one year compared to baseline. Active percentage was positively correlated with change in 6MW distance (Spearman’s rho = 0.565, p=0.035). Sedentary percentage was inversely correlated with change in 6MW distance (Spearman’s rho=-0.635, p=0.015).

Conclusions: Veterans participating in a companion dog whole health program show improvements in balance and gait performance after at least one year. Spending more time being physically active together (walking their dog more often or for longer bouts during the day) may be a mechanism through which improved functional endurance is achieved.

P16.13LB

Effect of Yoga Nidra Intervention on Blood Pressure and Heart Rate Variability among Hypertensive Subjects: A Single-arm Intervention Trial

Navdeep Ahuja¹, Monika Pathania¹, Latika Mohan¹, Sunita Mittal¹, Praag Bhardwaj¹, and Minakshi Dhar¹

¹ All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttaranchal, India

Contact: Navdeep Ahuja, [e-mail]

Abstract

Purpose: Hypertension has a very high prevalence across the globe and contributes significantly to cardiovascular morbidity and mortality. Lifestyle modifications, including yoga, meditation, and relaxation techniques, have emerged as promising adjuncts to pharmacotherapy. There is a data need to identify and establish the effects and mechanisms of these techniques for management of Hypertension. This study explores the acute effects of Yoga Nidra (YN), on blood pressure (BP) in essential hypertension and the potential mechanisms of the effect of YN on blood pressure, in the form of changes in Heart Rate Variability (HRV) components.

Method(s): A total of 32 hypertensive individuals (mean age: 43±0.54 years) were enrolled in the Lifestyle Disease Clinic. Patients were provided regular consultation and pharmacotherapy. BP and HRV were assessed before and after a single 16-minute YN session. HRV parameters included time and frequency domain measures. Statistical analysis included linear regression to study the relationship of components of HRV with that of the changes in blood pressure.

Results: Following YN intervention, there was a significant reduction in both systolic (SBP) and diastolic (DBP) BP (p<0.001). HRV analysis revealed significant increases. Regression analysis showed changes in SBP can be explained significantly by some of the HRV parameters as coefficients.

Conclusions: A single session of YN reduced the systolic and diastolic blood pressure and increased HRV parameters. Regression analyses showed that the reduction in blood pressure can be explained by an increase in HRV parameters. Thus, this study demonstrates the positive effect of YN as an intervention for essential hypertension and also the potential mechanisms in the form of changes in the ANS which can be explained by neurovisceral integration models. The study contributes significantly to the concept of positive health which could be utilized by a large percentage of the global population. Clinical Trial Number: CTRI/2023/01/048719.

P16.14LB

Fasting and Autophagy: Cellular Mechanisms for Health and Longevity – A Systematic Review

Basant El-Fetouh Katamesh¹, Rylea Ranum², Mary Whipple³, Ahmed Mazen Amin⁴, Ahmed A. Ibrahim⁵, Abdul Rhman Hassan⁶, Sara Bonnes¹, Ivana Croghan¹, Sanjeev Nanda¹, Ryan Hurt¹, Jithinraj Edakkanambeth Varayil¹, Leorey Saligan⁷, and Ann Vincent¹

¹ Mayo Clinic, Rochester, MN

² University of Houston, Texas, TX

³ University of Minnesota, Minnesota, MN

⁴ Faculty of Medicine, Mansoura University, Mansoura, Egypt., Mansoura, Ad Daqahllyah, Egypt

⁵ Menoufia University, Menoufia, Al Minuflyah, Egypt

⁶ Wayne State University, Detroit, MI

⁷ NIH, Bethesda, MD

Contact: Ann Vincent, [e-mail]

Abstract

Purpose: Fasting is reported to improve physiological health partially through its effects through autophagy; a process breakdown and removal of old cellular material performed by cellular lysosomes. There is a knowledge gap regarding the mechanisms and biomarkers responsible for autophagy. Our objective was to identify markers of autophagy reported in clinical studies where fasting or time restricted feeding was an intervention.

Method(s): A systematic review was conducted across multiple databases including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. We included randomized, non-randomized experimental studies, cohort, and case series that included reported autophagy-related proteins and genes. Fasting was defined as refraining from food for at least 12 hours. Using Covidence, abstracts and full texts were screened, and data were extracted by two independent reviewers. Conflicts were resolved through group discussion. The AHRQ questionnaire was used to assess risk of bias.

Results: A total of 5 papers met the inclusion criteria. Several markers of autophagy that were influenced by fasting were identified (Table 1). Among the identified biomarkers, SIRT1 an autophagy enzyme and ATG autophagy genes were the most represented, reported in 3/5 and 2/5 of the studies.

Conclusions: The result of our systematic review suggests that fasting interventions modify markers of autophagy. SIRT1 is a known modulator of multiple steps of autophagy including initiation, elongation, maturation, and degeneration. Likewise, ATG autophagy genes influence mechanisms including induction, nucleation, phagophore formation, elongation, and autophagosome formation. These results provide a compelling rationale for well-designed clinical trials exploring the impact of fasting on a boarder spectrum of autophagy markers.

P16.15LB

Takeaways and Utilization Strategies from an Online Lifestyle Medicine Course Among Healthcare Professionals

Jessica Jurcak¹, Tracy Segall¹, Dani Zborovsky², Samuel N. Rodgers-Melnick¹, and Francoise Adan¹

¹ University Hospitals Connor Whole Health, Cleveland, OH

² University of Illinois Chicago, Chicago, IL

Contact: Jessica Jurcak, [e-mail]

Abstract

Purpose: To understand (1) key takeaways from an American College of Lifestyle Medicine (ACLM) course; and (2) how healthcare professionals (HCPs) planned to utilize the information.

Method(s): A free online ACLM course was offered to all employees within a large health system. The course provided information about lifestyle medicine and food as medicine. Over the course of 1 year, HCPs were encouraged to share feedback, and they received points from the system’s wellness program. After completing the course, HCPs completed a survey providing their role, work location, and answers to three questions: (1) Please share your most important takeaway; (2) How will the information impact your personal well-being and/or professional care? and (3) Anything else to share about the experience. A thematic analysis of the questions was completed along with descriptive statistics of respondents’ work location, department, and role.

Results: Of the 381 ACLM participants, 316 (82.9%) provided survey responses. Respondents included nurses (33.9%), other allied health professions (20.9%), advanced practice providers (11.7%), physicians (11.1%), pharmacy professionals (4.1%), and non-clinical HCPs (3.5%). Respondents primarily worked in clinical departments (77.5%) including community medical centers (35.4%), an academic medical center (31.3%), and community health centers (13.3%). Two of the most common themes about important takeaways were (1) the importance of lifestyle to prevent and treat chronic disease, and (2) the strong indication that lifestyle matters. Key themes about impact on personal well-being and professional care included motivation and strategies for improving nutrition intake as well as feeling empowered to recommend small changes and plant-based diets to patients. Respondents also expressed general enjoyment of the course.

Conclusions: This analysis provides insight into how an ACLM course can be utilized within the context of personal and professional healthcare.

P16.16LB

Mindful Eco-Wellness: Behavioral Steps Toward Personal and Planetary Health

Bruce Barrett¹, Sarah Walters¹, Cathy Middlecamp², Kevin Riordan³, and Simon Goldberg³

¹ Dept Family Medicine and Community Health, University of Wisconsin - Madison, Madison, WI

² University of Wisconsin - Madison, Madison, WI

³ Counselling Psychology, University of Wisconsin - Madison, Madison, WI

Contact: Bruce Barrett, [e-mail]

Abstract

Purpose: To a significant extent, both the climate catastrophe and the epidemics of obesity and diabetes are driven by the same human behaviors - fossil fueled transportation and over-consumption of carbon-intensive foods. Emerging research suggests that mindfulness-based practices might be effective in supporting behaviors that reduce carbon footprint while also supporting mental and physical health. An intervention able to harness the transformative power of mindfulness to effectively support health-giving pro-environmental “eco-wellness” behaviors could yield many positive impacts.

Method(s): At UW-Madison, we developed Mindful Eco-Wellness: Steps Toward Healthier Living. Loosely based on the Mindfulness-Based Stress Reduction course, our curriculum teaches mindfulness practices in tandem with sustainability principles. The multi-week curriculum for Mindful Eco-Wellness follows the themes of Air, Water, Food, Energy, Transportation, Consumption, Nature Experience, and Ethics. Pedagogical lessons on energy, ecological sustainability, and the ethics of planetary health are intertwined with mindfulness practices, nature experience, and metta (loving-kindness) meditation.

Results: The Mindful Eco-Wellness curriculum has been pilot tested in two community-based settings (n=16 and n=15) and in four Group Medical Visit (GMV) courses with class sizes ranging from 6 to 10 medical patients. In both settings, results from qualitative interviews and pre- and post- testing using validated questionnaires suggest improvements in self-reported health and pro-environmental behaviors.

Conclusions: We urgently need effective interventions to help people to improve choices, behaviors, and habits that benefit both individual and planetary health. The Mindful Eco-Wellness course represents one such potential pathway towards achieving this balance, bridging the gap between mindfulness, environmental sustainability, and individual health with both feasibility and potentially effectiveness. However, rigorous evaluation is needed.

P16.17LB

Associations Between Mindfulness App Engagement and Improvement in PROs Over Time in a Cardiac Rehab Sample: The Role of Baseline Anxiety

Christina Sauer¹, Bruriah Horowitz¹, Kim L. Feingold², Rita Szymanski¹, DerShung Yang³, Niina Haas³, Yashoswini Chakraborty⁴, Timothy Chen¹, Varsha Ganesh⁵, Arin Budhiraja⁶, and David Victorson⁴

¹ Northwestern University Feinberg School of Medicine, Chicago, IL

² Northwestern University, Chicago, IL

³ BrightOutcome, Buffalo Grove, IL

⁴ Northwestern University, Evanston, IL

⁵ New York University, New York, NY

⁶ Northwestern University, Los Angeles, CA

Contact: Christina Sauer, [e-mail]

Abstract

Purpose: To examine relations between mindfulness app engagement and changes in PROs of HRQOL in a sample of cardiac rehab patients.

Method(s): PROs were completed at baseline, 9 weeks & 13 weeks. The Wakeful app use period was 9 weeks. Change scores were calculated for PROs between baseline and posttests. App use metrics defined engagement. The sample was divided into groups reflecting subclinical and clinical anxiety at baseline. Bivariate correlations were used. All associations reported were statistically significant (p<.05).

Results: 34 participants completed PROs. Subclinical anxiety participants (n=17) showed a positive association between listening to podcasts and posttraumatic growth (PTG) at 9 and 13 weeks (r’s=.62 and .51) but saw inverse associations between using in-class A/V materials and cardiac anxiety at 9 and 13 weeks (r’s= -.43 and -.48) and cumulative minutes and logins to the app with mindfulness at 13 weeks (r= -.53 and -.66). Clinical anxiety participants (n=13) demonstrated inverse associations between listening to podcasts and anxiety at 9 weeks (r= -.62); between independent practice and cardiac anxiety at 9 weeks (r=-.62); and between cumulative logins and depression at 9 and 13 weeks (r=-.79). Positive associations were seen between listening to podcasts and self-compassion at 9 weeks (r= .86 ) and social support at 13 weeks (r= .70); between independent practice and social support (r= .65) and PTG (r=.82) at 9 weeks, and with self-compassion (r = .67) and mindfulness (r = .63) at 13 weeks; between in-class A/V minutes and cumulative minutes using the app and PTG (r’s=.68 & .67) and mindfulness (r=.70 & .69) at 9 weeks, and PTG at 13 weeks (r=.65); between consecutive days of practice and social support (r= .75) and PTG (r = .69) at 9 weeks; and between cumulative logins and PTG (r=.71) and gratitude (r=.69) at 13 weeks.

Conclusions: App engagement is associated with improvements in PROs, especially in those with elevated baseline anxiety.

Topic Area 17 – Practice-Based Research

P17.01

Effect of Yoga on Psychological Well-Being in Patients With Spondyloarthritis

Harriet Morf¹, Sebastian Rudolf¹, Anna-Maria Liphardt¹, Birte Coppers¹, Claudia Bouzas¹, Vanessa Bundle¹, Paloma Palm von Alten Blaskowitz¹, Johannes Knitza², Maria Gabriela Raimondo¹, Hanna Labinsky³, Lukas Hatscher⁴, Andreas Wirsching¹, Daniela Bohr¹, Elizabeth Araujo¹, Alina Ramming¹, Andreas Ramming¹, and Georg Schett¹

¹ University Hospital Erlangen, Erlangen, Bayern, Germany

² Digitales Institut Marburg, Marburg, Hessen, Germany

³ University Hospital Würzburg, Würzburg, Bayern, Germany

⁴ Charite Berlin, Berlin, Bayern, Germany

Contact: Harriet Morf, [e-mail]

Abstract

Purpose: Background: Ankylosing spondylitis (AS) is an inflammatory autoimmune disease that can lead to spinal deformities. Complementary to the treatment with anti-inflammatory medication, physical therapy is known to improve patient well-being and to maintain the mobility of AS patients. Yoga is known to improve flexibility and core strength and previous research has shown positive effects of regular Yoga exercises on quality of life and disease activity. Thus, the aim of this study is to investigate the effect of a 12-week Yoga intervention on psychological well-being in patients with AS.

Method(s): AS (ASAS diagnostic criteria) patients participated in an online 12-week yoga class (60 minutes/ week, (DRKS00030719)). Patient perceived disease activity was assessed by patients’ global assessment, pain by PAIN-Detect, disease function by BASFI, disease activity by BASDAI and physical and psychological function by short form (SF)-36 before (Visit 1) and after the 12-week Yoga intervention (Visit 2).

Results: 22 participants (female = 16 (72.7%) / male = 6 (27.3%); age: 40.5 years +/- 11.10) were included in this preliminary analysis. Patient global assessment in relation to disease activity decreased in response to the Yoga intervention (Visit 1: 5.15 +/- 2.64; Visit 2: 3.47 +/- 2.44; p=0.017). SF-36 improved in the physical sum score (Visit 1: 40.06 +/- 10.12; Visit 2: 43.34 +/- 8.75; p=0.038). There was a significant association between objective disease function measured by BASFI and physical sum score from the SF-36 (r= -0.811; p < 0.00). Higher subjective illness perception showed significantly worse scores in BASFI (r= 0.603; p=0.006) and BASDAI (r=0.710; p=0.001). In male participants an improvement in pain was observed in response to the Yoga class (Visit 1: 9.50 +/- 8.34; Visit 2: 7.83 +/- 7.36; p=0.042).

Conclusions: We conclude that a 12-week yoga intervention can improve patient perceived disease activity and physical well-being in AS patients.

P17.02

Complementary Therapies for Aged: Evidence Map

Lissandra Zanovelo Fogaça¹, Mariana Cabral Schveitzer², Marlene Rocha³, Caio Portella⁴, Ricardo Ghelman⁵, Carmem Veronica Mendes Abdala⁶, and Luiz Ramos¹

¹ Escola Paulista De Medicina ‐ Universidade Federal De Sao Paulo, São Paulo, Brazil

² UNIFESP and CABSIN, São Paulo, Brazil

³ Universidade Metodista de São Paulo, Registro, Sao Paulo, Brazil

⁴ Brazilian Academic Consortium for Integrative Health, Sao Paulo, Brazil

⁵ CABSIN, Sao Paulo, Brazil

⁶ BIREME/OPAS/WHO, Sao Paulo, Brazil

Contact: Ricardo Ghelman, [e-mail]

Abstract

Purpose: People around the world are living longer. Aging and longevity present complex sociocultural, psychological, bioenergetic, medical, and environmental aspects. Traditional, Complementary, and Integrative Medicine (TCIM) can treat diverse health conditions to improve health and wellness. Evidence Maps (EM) demonstrates quality assessment, interventions' effects, and health outcomes.

Method(s): We used the 3iE Evidence Gap Map methodology. To guide the search on seven databases we used (P) aged, (I) TCIM, (C) no comparator, and (O) health-related. The AMSTAR 2 was applied.

Results: Based on 803 TCIM interventions this EM included 54 systematic reviews related to the aged (Tai Chi, Tai Chi Chuan, Qi Gong, Traditional Chinese Exercises, Acupuncture, Meditation, and Yoga). The quality assessment was 27 high, 10 moderate, 17 low, and critically low. Outcome effects were classified as 105 as positive, 30 as potential positive, 12 as no effect, and 4 as inconclusive. The positive effects of Tai Chi, Tai Chi Chuan, and Traditional Chinese Exercises were related to being balanced, risk of falls, postural control, cognitive performance, memory, physical function, muscle strength, exercise capacity, Parkinson's, visuospatial capacity, quality of life, and mobility. The positive effects of Yoga, Meditation, and Qi Gong were mainly related to mental health outcomes such as depression, anxiety, cognitive performance, and stress as well and Acupuncture were related to sleep quality, insomnia, gastrointestinal disorder, sequels of stroke, and Alzheimer's.

Conclusions: Gaps that justify more research were related to the heterogeneity of participants, time, frequency, and duration of interventions. This EM indicates more than 100 positive and promising aged health outcomes. EM methodology provides valuable information for patients, health practitioners, and policymakers to promote evidence-based complementary therapies for the Aged.

P17.04

Supporting the Whole Health of Managers and Their Perceptions Around Well-being

Charles Gray¹, Danielle Parrilla², and Tamara Schult³

¹ Department of Veterans Affairs, Chillicothe, OH

² Veterans Health Administration, Bedford, MA

³ Veterans Health Administration, Hastings, MN

Contact: Tamara Schult, [e-mail]

Abstract

Purpose: A VA Medical Center was selected in order to evaluate the perceptions of managers around their own well-being and the support they are able to provide to their employees to engage in self-care. To do this, a brief script of questions was developed to discuss with the participants.

Method(s): Ten managers participated in these interviews with notes being taken. Due to psychological safety concerns, the interviews were not recorded, however, detailed notes around their responses, expressions, and general feelings were captured. Responses were transcribed in writing and coded for emerging themes and patterns.

Results: From the information collected, it's evident that in healthcare, workload poses a significant barrier for both managers and staff in engaging in well-being activities. Furthermore, it has become clearer that managers view their primary responsibility as enabling their staff to excel, and shielding them from certain factors within the organization that contribute to burnout. However, a common issue is that managers often lack proper training for their role. The training they do undergo is typically based on their own choices and initiative.

Conclusions: The study at a VA Medical Center examined manager perceptions of well-being support for employees. Workload emerged as a significant barrier, and while managers prioritize empowering staff and mitigating burnout factors, their training often relies on self-initiative.

P17.05

Surgery: A Surprising Environment Offering a Patient Introduction Opportunity Regarding the Transformative Value of Integrative Medicine

Maryanna Klatt¹, Jacqueline Caputo², Jane Ginther³, Yulia Mulugeta², Anne-Marie Duchemin⁴, Lisa Coleman⁵, Brianna Michel⁶, and Laura Pheiffer⁷

¹ Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

² The Ohio State University, Columbus, OH

³ The Ohio State University Wexner Medical Center, Columbus, OH

⁴ Stress, Trauma and Resilience Program, Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, OH

⁵ Ohio State University Wexner Medical Center, Columbus, OH

⁶ Ohio State University, Columbus, OH

⁷ The Ohio State University Medical Center, Columbus, OH

Contact: Maryanna Klatt, [e-mail]

Abstract

Purpose: Pre-operative anxiety significantly affects patient experience and recovery outcomes, and presents an opportunity to explore evidenced-based, non-pharmaceutical approaches to reduce this anxiety. The surgical suite is an underexplored environment in which to expose patients to the value of integrative strategies that can improve outcomes and reduce healthcare costs. A pre-recorded mindfulness meditation and recorded silence were used as an innovative non-pharmaceutical intervention to alleviate pre-operative anxiety.

Method(s): Five surgical patients consented to sharing their surgical sources of anxiety through semi-structured interviews to inform the content of the pre-recorded meditation. Utilizing a randomized controlled design, patients were assigned recorded silence or a guided meditation informed by patient interviews. Both conditions were delivered via an iPad with sound-proof headphones lasting 10 minutes. Patients completed self-report questionnaires on anxiety, emotional distress (pre/post) via the same iPad, and then rated perceived helpfulness of the intervention.

Results: 90 patients consented in the study with 44 receiving the guided meditation and 46 receiving silence. Both conditions showed significant decreases in patient emotional distress pre/post intervention (p=0.00001) and in self-reported anxiety (p=0.00001), but the guided meditation condition produced significantly larger decreases in emotional distress (p=0.0049), and significantly larger decreases in anxiety (p=0.00001) as compared to the silence group. Patient-rated intervention helpfulness was significantly greater in the meditation group (p=0.00001) as compared to the silence intervention.

Conclusions: Non-pharmacological means of addressing patient pre-operative anxiety should be explored as a pragmatic addition to pre-operative offerings to lessen patient anxiety before surgery. Additionally, the peri-operative environment may be effective for introducing patients to the value of an integrative health strategies.

P17.06

What are the Statistical Groupings of Biopsychosocial Factors Associated with Level of Capability and Pain Intensity in Patients with Hip Pain?

George Sayegh¹, and Prakash Jayakumar¹

¹ Department of Surgery and Perioperative Care, Dell Medical School - The University of Texas at Austin, AUSTIN, TX

Contact: George Sayegh, [e-mail]

Abstract

Purpose: Musculoskeletal health is a complex interplay of pathophysiology, mental health, and social factors. Mindset significantly influences comfort and capability in musculoskeletal conditions, often more than objective pathophysiology. We aimed to understand how these factors impact patients with hip conditions (osteoarthritis and avascular necrosis).

Method(s): A total of 138 English- and Spanish-speaking adults seeking care for chronic hip pain (mean age 61 ±12 years, 62% female, 67% white) were enrolled and 117 (85%) completed surveys for mental health (symptoms of anxiety and depression), social health (Accountable Health Communities Health Related Social Needs survey), level of hip capability (Hip disfunction and Osteoarthritis Outcomes Score for Joint Replacement), and pain intensity (numeric pain rating scale) at baseline.

Results: In our baseline assessment, we found three groups: A (minimal OA severity and psychosocial distress, 75%), B (moderate OA severity with overall psychosocial distress and severe depression symptoms; 11%), and C (severe OA severity with psychosocial distress; 14%). At baseline, group B (RC=-13, p=0.02), group C (RC=-10, p=0.04), and being disabled (RC=-20, p<0.001) were associated with lower hip capability. Increased pain intensity was linked to group C (RC=2.1, p<0.001) and incomes below $150,000 (RC=1.5-1.7, p<0.042). After three months, combined groups B/C (RC=-28, p<0.01) versus group A, being disabled (RC=-20, p=0.045) versus employed, and income $15,000-$49,999 (RC=-25, p=0.016) were linked to lower hip capability. Combined groups B/C (RC=2.9, p<0.01) and being disabled (RC=2.9, p=0.021) were tied to increased pain intensity at three months.

Conclusions: Statistical groupings involving higher levels of distress are associated with lower levels of capability and pain intensity at baseline and over time despite conservative treatment. Our findings support the need to redesign models of musculoskeletal care to offer a more personalized integrative whole-person approach.

P17.07

Whole Person Care for the Parent-Infant Dyad: A Community Midwifery Model

Jessica M. Harrison¹, Ariana Thompson-Lastad², Tanya Khemet Taiwo³, Chanda Williams⁴, Mounika Parimi⁵, Briana Wilborn⁶, and Maria Chao⁷

¹ Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

² UCSF, Berkeley, CA

³ UC-Davis, Davis, CA

⁴ University of California, San Francisco, Oakland, CA

⁵ UC Berkeley, Berkeley, CA

⁶ Briana Wilborn, Midwife, San Francisco, CA

⁷ Osher Center for Integrative Health, UCSF, San Francisco, CA

Contact: Jessica M. Harrison, [e-mail]

Abstract

Purpose: Postpartum health is in crisis in the US, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends five postpartum home visits during the sex weeks after childbirth, yet standard postpartum care in the US is generally one clinic visit six weeks after birth. We present community midwifery in the US as a whole person postpartum care model concordant with WHO guidelines, describing this model of care and its potential to improve postpartum health for birthing people and their babies. We highlight systemic barriers to expanding access to community midwifery care.

Method(s): We conducted semi-structured interviews with 34 community midwives providing out-of-hospital care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis.

Results: Twenty-four midwives were Licensed Midwives and ten were Certified Nurse-Midwives. Fourteen midwives identified as people of color. Most spoke multiple languages. We describe five key elements of community midwifery postpartum care: 1) multiple visits for the parent-infant dyad; 2) continuity of personalized care; 3) relationship-centered care; 4) prenatal preparation for postpartum; 5) focus on postpartum rest. This whole health approach typically includes 5-8 visits including home visits over 6 weeks postpartum. Though midwives generally sought reimbursement from private insurance companies, they often were out of network providers and received limited reimbursement. All participants said they would like to serve people insured through Medicaid but most described insurmountable barriers (e.g., expensive malpractice insurance requirements; “offensively low” reimbursement) to doing so.

Conclusions: The community midwifery model of postpartum care is a whole person approach to caring for the parent-infant dyad and has the potential to address rising pregnancy-related morbidity and mortality in the US if structural barriers are addressed.

Topic Area 18 – Research Methodology

P18.01

Characteristics of Bibliometric Analyses of the Complementary, Alternative, and Integrative Medicine Literature: A Scoping Review

Jeremy Y. Ng¹, Aimun Qadeer Shah², Henry Liu³, Sarah Ali², Hamas Tariq², Rayhane Rebaine⁴, Tenzin Chimi Yehshopa⁵, Nima Karimi⁵, Mujeedat Lekuti⁵, Mabel Koo⁵, L. Susan Wieland⁶, and David Moher⁷

¹ Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; Bosch Health Campus, Stuttgart, Germany; Centre for Journalology, Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, Ottawa, ON

² Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada, Hamilton, ON

³ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Ottawa, ON

⁴ Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON

⁵ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON

⁶ University of Maryland School of Medicine, Providence, MD

⁷ Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, Ottawa, ON

Contact: Jeremy Y. Ng, [e-mail]

Abstract

Purpose: There is a growing body of literature on complementary, alternative, and integrative medicine (CAIM). Bibliometric analysis studies (that use statistical techniques to understand publication trends) have increasingly been used to analyze the CAIM field. The objective of this scoping review was to investigate the quantity and characteristics of bibliometric analyses conducted about CAIM-related literature.

Method(s): Using the Joanna Briggs Institute (JBI) methodological framework, the following databases were systematically searched: MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Scopus, and Web of Science. Eligible articles included English-language bibliometric analyses about CAIM therapies. Both the database search and eligibility were informed by an operational definition of CAIM therapies. Screening and data extraction were conducted in duplicate.

Results: 286 included bibliometric analyses were published between 1995 and 2023, with the majority (74.8%; n=214) published in the last 5 years. Studies were published across 38 countries, with China representing 50.0% (n=143) of the first authors of articles, followed by India (4.9%, n=14). CAIM therapies were labeled using National Cancer Institute (NCI) categories, including whole medical systems (n=100), biologically-based practices (n=89), mind-body therapies (n=29), and manipulative-body therapies (n=17). Some articles discussed CAIM generally (n=26) or were categorized as other (n=25). No studies focused on energy healing (e.g., Reiki) (n=0). All studies (n=286) used performance analysis metrics, while 79.7% (n=228) used science mapping methods. Web of Science (62.6%, n=179) was the most commonly used database to conduct bibliometric analyses, followed by Scopus (21.0%, n=60) and PubMed (13.6%, n=39).

Conclusions: The global diversity and range of CAIM therapies across bibliometric analyses underscore the field’s evolving nature. Future research should explore underrepresented areas and continue monitoring the impact of CAIM research.

P18.02

Common Language Effect Sizes for Communicating Research Findings in Integrative Medicine – Re-Analysis of a Meta-Analysis on Yoga for Low Back Pain

Dennis Anheyer¹, Holger Cramer², and Thomas Ostermann³

¹ Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

² University of Tübingen, Stuttgart, Baden-Wuerttemberg, Germany

³ Department for Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany, Witten, Nordrhein-Westfalen, Germany

Contact: Dennis Anheyer, [e-mail]

Abstract

Purpose: Common language effect sizes (CLES) are a statistical measure used to quantify the practical significance or real-world relevance of a research finding. By using CLES, researchers can bridge the gap between statistical significance and practical relevance, making their findings more accessible and meaningful to a broader audience, ultimately facilitating evidence-based decision-making. This study is a re-analysis of a meta-analysis on yoga for treating low-back pain. The aim of this study was to re-express existing results into CLES and to investigate their reliability in meta-analysis.

Method(s): We converted existing effect sizes of 14 included randomized controlled trials into CLES. Then, meta-analyses were performed with the CLES of each included study. The pooled CLES were compared with the pooled estimates of the initial meta-analysis which were also converted into CLES.

Results: Analysis revealed a delta between re-expressed pooled meta-analysis estimate and pooled CLES of 2.01% (equals a delta in Cohen’s d of 0.08). This delta decreased by the number of studies included in meta-analysis. Fewer studies in meta-analysis led to a higher delta. The delta was also influenced by studies size. If studies with smaller sample size were removed from meta-analysis the delta decreased.

Conclusions: CLES are useful to make research more understandable for non-experts. However, there are still some statistical challenges to overcome to improve the reliability of CLES in meta-analyses.

P18.03

Outdoor Physical Activity as a Confounder for Vitamin D Status: Findings from a Scoping Review

Patrick Corr¹, Alia Badawi², Stephanie Vu², and Leigh A. Frame²

¹ George Washington University, Washington, DC

² George Washington School of Medicine & Health Sciences, Washington, DC

Contact: Alia Badawi, [e-mail]

Abstract

Purpose: Correlations between vitamin D (VitD) and health and disease are plentiful. However, findings are not always clear with VitD supplementation studies. We hypothesize that these observed relationships may be confounded by physical activity (PA), especially outdoors. The aim of this scoping review is to assess the evidence for PA as a confounder of VitD status.

Method(s): We used Arksey and O’Malley’s five-stage approach to conducting scoping reviews and aligned our design with the PRISMA-P guidelines. We conducted systematic searches in CINAHL, Cochrane Library, PubMed, Scopus, and SportDISCUS from inception to November 10, 2022 and reviewed the results via Covidence. Peer-reviewed studies in English related to VitD photoproduction and PA were included.

Results: We included 154 total articles after removal of duplicate and irrelevant results (N=2270). The majority of manuscripts (n=124) were published between 2011 and 2023 with cross-sectional designs (n=97). The evidence base continues to affirm the relationship between sun exposure and VitD status and the positive impact of sufficient VitD status on athletic performance and physical function; however, the role of PA in this relationship remains unclear.

Conclusions: Research included in this scoping review provides conflicting information regarding the relationship between VitD status, sun exposure, and PA. There is a body of literature that suggests PA alone (i.e., without sun exposure) does not improve 25(OH)D concentrations; however, this is challenged by research that identifies lower rates of VitD deficiency among athletes regardless of sun exposure. At present, the science suggests that the relationship between VitD status and PA seems largely a function of sun exposure with little research considering the potential confounding between the health benefits of PA and the health benefits of VitD. Much work needs to be done and large-scale studies need to be completed to help identify and quantify any confounding between VitD and PA.

P18.04

Semantic Web Demonstration of Medicinal Plants and Traditional Chinese Medicine From the Perspective of Integrated Medicine

Chenhao He

Beijing University of Chinese Medicine, Beijing, China

Contact: Chenhao He, [e-mail]

Abstract

Purpose: Traditional Chinese medicine ( TCM ) plays an important role in the epidemic of new coronavirus pneumonia. However, the information of traditional Chinese medicine is complex and the lack of resource description framework leads to the inability to apply artificial intelligence technology to support new drug research and development. This article envisages the use of information technology to improve the field of traditional Chinese medicine, the combination of Chinese and Western medicine, highlighting the concept of integrated medicine.

Method(s): The standard database was established for data integration and analysis. Protégé 5.5 beta 3.0 and later versions were used to integrate traditional Chinese medicine information into the semantic network based on extensible markup language (XML). Jena was used as a reasoning tool to reason and save the ontology in the semantic network of traditional Chinese medicine, and the ontology library of traditional Chinese medicine was formed. Lucene was used to establish the index of the ontology library of traditional Chinese medicine, and the retrieval was carried out. A new drug research and development platform for medicinal plants was built to display and output the results.

Results: Through popular technologies such as artificial intelligence, the implicit semantics of the nature and taste of traditional Chinese medicine are analyzed intelligently, so as to provide a new path for clinical scientific understanding of visceral manifestation theory, discovering new drug clues related to disease and syndrome and diagnosis and treatment, expounding traditional Chinese medicine theory, and improving medical model combined with Western medicine integration.

Conclusions: To discover new knowledge through the semantic web of traditional Chinese medicine, accelerate the progress of new drug development, improve the level of clinical diagnosis and treatment, and guide clinicians to use drugs rationally.

P18.05

The Missing Piece of the Puzzle: Putting Ayurveda as a Whole System of Medicine into an Integrative Medicine Fellowship

Sankari Wegman¹, Charles Elder², and Arti Prasad³

¹ Maharishi University of Management, Fairfield, IA

² Kaiser Permanente Center for Health Research, Portland, OR

³ Hennepin HealthCare, Minneapolis, MN

Contact: Sankari Wegman, [e-mail]

Abstract

Purpose: Ayurveda, the traditional medicine of India, has been under-represented in integrative medicine (IM) training and practice. Maharishi International University’s (MIU) novel IM fellowship aimed to integrate Ayurveda, “the science of life,” with conventional IM, to provide clinicians with an additional paradigm in health promotion and disease management, to understand the origin of self-care practices, and to advance the Consciousness-Based Education model practiced at MIU.

Method(s): The curriculum satisfies the American Board of Integrative Medicine (ABOIM) domains. The core ayurvedic concepts from MIU’s well-established Masters in Maharishi AyurVeda and Integrative Medicine (MAVIM) and the University of Arizona's Foundational Fellowship Curriculum (FFC) were blended to create learning objectives that aligned with IM Fellowship core competencies. Curriculum mapping ensured all 23 courses reflected overall educational goals. A two-year online program (1183 hours) was developed, with year one focusing on foundational principles of IM and Ayurveda and year two on integrative approaches for each organ system. Didactic hours from FFC and MAVIM (∼480 each), live clinical training (126 hours), and research, including capstone (100 hours), were accounted. CANVAS (MIU’s learning management system) allowed for interface with educational material, live clinical webinars, discussion forums, assessments, and course evaluations.

Results: The Fellowship received master’s degree program status from MIU’s Academic Council and provisional approval from ABOIM. Fifteen Fellows enrolled into the inaugural 2023 class. This fellowship is an innovative model of inter-academic partnership and collaboration with other universities.

Conclusions: Developing this fellowship has proven feasible and successful, promising to enhance the medical knowledge of practicing physicians. This may be the first Fellowship in the world to honor a whole system of medicine by giving it an equal footing in an integrative medicine fellowship.

P18.06

Using AI in Qualitative Data Analysis for Integrative Medicine Research: A Comparison of Human and AI-Derived Codes from a Bharatanatyam Study

Arin Budhiraja¹, Varsha Ganesh², Timothy Chen³, Yashoswini Chakraborty⁴, Bruriah Horowitz³, Christina Sauer³, and David Victorson⁴

¹ Northwestern University, Los Angeles, CA

² New York University, New York, NY

³ Northwestern University Feinberg School of Medicine, Chicago, IL

⁴ Northwestern University, Evanston, IL

Contact: Arin Budhiraja, [e-mail]

Abstract

Purpose: Given increasing use of qualitative methods in integrative medicine (IM) research, combined with the rapid evolution of AI technologies, this study explores the role of using publicly available AI as a rapid aid in qualitative analysis by comparing human and AI-derived codes from an IRB-approved Bharatanatyam interview study.

Method(s): Human coders from our research team created an initial codebook using a deidentified transcript from a 60-minute interview with an experienced Bharatanatyam teacher. Four example codes from this codebook were presented to Microsoft’s Bing AI along with the full transcript with instructions to openly code it, using the same Grounded Theory guidelines. Both AI and human coders then coded a second transcript, however this time, they applied existing codes from the initial codebook and created new ones when needed. Finally, human coders and AI independently performed axial coding (e.g., binning codes to higher order categories) on the complete list of codes from both transcripts. At each step, human and AI-derived codes were compared for agreement.

Results: Human coders and AI created the same code 87% of the time (40/46 codes). Human coders created four unique codes (9%) that AI didn't, while AI created 2 unique codes (4%) that human coders didn't. From the 40 overlapping codes, AI created six higher-order categories (axial coding), while humans created 15 categories. AI categories tended to be more general compared with human-derived codes. While category names varied greatly between AI and human coders, both consistently binned the same code clusters to respective categories 80% of the time.

Conclusions: This study demonstrates initial feasibility of using AI to assist qualitative coding efforts, primarily in the open coding phase. It seems that publicly available AI models aren’t yet capable of replicating axial coding with the same specificity as human coders. Nevertheless, there is promise for using AI in the initial phase of qualitative analysis for IM research.

P18.07LB

Whole Person Approaches to the Study of Chronic Pain: Age and Sex Among People With and Without Chronic Overlapping Pain Conditions in OPTIMUM

Jessica Barnhill¹, Jose Baez², Paula Gardiner³, Carol Greco⁴, Keturah Faurot⁵, Susan Gaylord⁵, Elondra Harris⁵, Suzanne Lawrence⁴, Vanessa Miller⁵, Isabel Roth⁶, Karim Sariahmed⁷, Holly Thomas⁴, Janice Weinberg⁸, and Natalia Morone⁹

¹ University of North Carolina, Chapel Hill, NC

² Boston Medical Center, Boston, MA

³ Cambridge Health Alliance, Lexington, MA

⁴ University of Pittsburgh, Pittsburgh, PA

⁵ University of North Carolina at Chapel Hill, Chapel Hill, NC

⁶ University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC

⁷ Boston Medical College, Boston, MA

⁸ Boston University, Boston, MA

⁹ Boston University/Boston Medical Center, Boston, MA

Contact: Jessica Barnhill, [e-mail]

Abstract

Purpose: Research on chronic lower back pain (cLBP) shows a high prevalence of other pain conditions. However, investigation into chronic overlapping pain conditions using validated criteria is lacking. Researchers at the University of Michigan developed the Chronic Overlapping Pain Conditions Screener (COPCS) to assess the presence of ten chronic conditions with one tool. To compare participants with or without COPC, we used the COPCS in OPTIMUM, a pragmatic randomized trial of mindfulness for cLBP.

Method(s): The COPCS includes a body map linked to questions to assess the presence/absence of ten currently symptomatic chronic pain conditions. We electronically distributed the screener to participants who had been enrolled in the OPTIMUM trial for at least two months. Descriptive statistics and logistic regression were performed to compare the association between the prevalence of one or more COPCs by self-reported sex assigned at birth and age at enrollment.

Results: There were 126 people (44.8%) with at least one COPC (not including cLBP). Seventy percent (n=196) were female. The mean age was 52 years (SD=15.3). Ninety-six out of 196 females (50%) and 29 out of 84 males (34.5%) had at least one COPC (not including cLBP). Among those with at least one COPC, 77% were female compared to 65% female in the group without COPCs. Among people with at least one COPC, the mean age was 49.5 years (SD=15.0), compared to 54.0 (SD=15.2) in those without a COPC. People with at least one COPC were more likely to be younger, evidenced by a mean age difference of 4.5 years (95% CI 0.9, 8.1). People under age 50 had 1.8 times the odds of having at least one COPC (95% CI 1.1, 2.9) compared to people aged 50 and older.

Conclusions: Aside from chronic lower back pain, people who had at least one COPC were more likely to be female and more likely to be younger than people who did not have co-occurring pain condition.

P18.08

A Randomized, Double-Blind, Placebo-Controlled Trial Assessing Melatonin-Free Supplements for Sleep

Jessica Saleska¹, Antonija Kolobaric², Susan Hewlings³, Corey Bryant³, Chris Colwell⁴, Chris D'Adamo⁵, Bernard Rosner⁶, Jeff Chen³, and Emily Pauli³

¹ Radicle Science, Woodland Hills, CA

² University of Pittsburgh, Pittsburgh, PA

³ Radicle Science, Encinitas, CA

⁴ University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA

⁵ University of Maryland, Baltimore, MD

⁶ Harvard University, Boston, MA

Contact: Antonija Kolobaric, [e-mail]

A bstract

Purpose: Inadequate sleep increases the risk for health complications and has become a global health concern. Sleep is multidimensional and complex; sedative hypnotic drugs are commonly used, but not always tolerated. New treatments are needed and multi-ingredient agents, targeting different systems, may be a potential solution. This study assessed the effects of two multi-ingredient supplements on sleep relative to placebo.

Method(s): Adults (N=620) with a primary health concern for better sleep were randomly assigned to receive 1 of 3 study products (Sleep A, Sleep B or placebo) for 4 weeks. Both active products contained federally legal hemp-derived cannabinoids, botanical oils, GABA and L-theanine. Sleep disturbance (primary outcome) was assessed at baseline and weekly using NIH’s Patient-Reported Outcomes Measurement Information System (PROMIS™) Sleep Disturbance SF 8A survey. Other health outcomes (anxiety, stress, pain, and well-being) were assessed using validated measures at baseline and weekly. A linear mixed-effects regression model was used to assess the change in each health outcome score between each activeproduct group and the placebo.

Results: There was a significant difference in sleep disturbance, anxiety, stress, and well-being between Sleep A and placebo. There was no significant difference in any health parameter between Sleep B and placebo. Side effects were mild or moderate. There were no significant differences in the frequency of side effects between the study groups.

Conclusions: A botanical blend containing a low concentration of THC improved sleep disturbance, anxiety, stress, and well-being in healthy individuals that reported better sleep as a primary health concern.

Author Index

A

Abtahi, Amir: P05.16

Adan, Francoise: OA05.04, OA10.04, OA12.03, OA15.03, P14.12, P16.15LB

Addison, Odessa: P16.12LB

Adler, Shelley: P05.29

Agarwal, Radhika: P06.15

Ahuja, Navdeep: P16.13LB

Ahuja, Sanjay: P04.09

Ai, David: OA06.01

Al-Dabbas, Mahmoud A.: P03.14LB

Alford, Dan: OA07.02

Ali, Sarah: P18.01

Allen, Kelli: OA01.04

Almeida Cezario Santos, Lais Renata: P05.10

Almquist, Zachary: OA04.04

Alpers, Lise-Merete: P12.05

Altner, Nils: OA10.05

Amato, Katherine: P07.04LB

Ambrosano, Gláucia: P05.10

Amri, Hakima: P05.30

Amy, Richard: P06.03

An, Xuedong: P03.06LB

Anand, Kanwaljeet: P05.44LB

Anderson, Belinda: OA13.01

Anderson, Brian: OA04.04, OA05.02, P14.07

Anderson, Ekaterina: OA12.02, P13.01

Anderson, Kris: P09.17LB

Andrews-Marney, Elana R.: P03.14LB

Anglo, Claudine: P05.18, P06.18

Anheyer, Dennis: OA10.05, P03.03, P18.02

Anheyer, Melanie: P03.03

Arai, Young-Chang: P13.07

Araujo, Elizabeth: P14.09, P17.01

Arce, Nick: P05.36LB

Archer, Kristin: P05.16

Arewasikporn, Anne: P02.11

Arieta, Carla: P12.11LB

Arloski, Michael: P14.10

Arnold, L Eugene: P01.07LB, P06.10

Arun, Banu: P16.11LB

Ashraf, Umair: P06.16

Ast, Hayleigh: P01.07LB

Atkins, Dorothea: P13.14LB

Atlas, Steven: OA07.02

Aubuchon, Katarina: P12.11LB

Aucoin, Monique: OA08.02

Audet, Anne-Marie: P11.03

Austin, Robin: OA17.03

Austin-Isbell, Taylor: P16.11LB

Avins, Andy L.: OA03.02

B

Babiera, Gildy: P16.11LB

Badawi, Alia: P18.03

Baez, Jose: OA13.02, P18.07LB

Bai, Chen: P01.05LB, P01.08LB

Bai, Juan: P03.13LB

Bailey, Aiko: P02.10

Bair, Matthew J: OA14.01

Bakhshaie, Jafar: P05.03

Balneaves, Lynda: P15.04

Bangerter, Ann: OA01.04, P05.08

Barker, Anna: OA12.02, P13.01

Barkoukis, Hope: P09.18LB, P16.06

Barnett, Tyler: OA05.04

Barnhill, Jessica: P15.05, P18.07LB

Barrett, Bruce: P16.16LB

Barria, Javier: OA09.05

Bartolovich, Mandy: P04.09

Barton, Bruce: OA03.01

Barz, Dominik: P06.04

Basen-Engquist, Karen: P16.11LB

Bastian, Lori: OA05.03, P04.10

Batson, Trevor: P01.03

Battaglia, Patrick: P09.17LB

Bauer, Brent: P04.07, P06.08, P06.09

Bean, Jonathan: OA07.02

Bebee, David: P09.18LB

Bedrosian, Micah: P08.03

Bell, Debra: OA06.03

Bender, Kimberly: OA02.03

Benitez, Alain: P04.03

Bensoussan, Alan: P03.14LB

Bentley, Tanya: P05.36LB

Benyamini, Yael: P05.23, P05.26

Berghöfer, Anne: OA14.02

Bergna, Andrea: P14.02

Berman, Rachel: P05.36LB

Bertenthal, Daniel: OA13.03

Beyrouty, Matthew: P12.10LB

Bhardwaj, Praag: OA10.03, P05.42LB, P05.45, P16.13LB

Bhimani, Rozina: P06.25LB

Bhullar, Davinder: OA16.01

Bianculli, Emma: OA02.02

Bifano, Susanne: P10.01

Bilc, Mirela-Ioana: OA10.05, OA11.01, P05.20, P14.17

Birling, Yoann: P03.02

Biswas, Mayurika: OA16.02

Blakeney, Erin: OA07.03

Blaseg, Elise: P09.19LB

Blitz, Jill: P05.37LB

Block, Seneca: P15.08LB

Block, Shannon: P05.16

Blume, Rachel: P02.10

Bodziony, Valery: P13.05, P13.10

Boehmer, Jana: P06.17

Bohr, Daniela: P14.09, P17.01

Bokhour, Barbara: OA07.01, OA12.02, P08.08, P13.01, P14.03

Bolton, Rendelle: OA07.01, P14.03

Bonnes, Sara: P16.14LB

Bonthu, Amrita: P12.11LB

Booij, Sanne: OA12.01, OA16.03

Booker, Staja: P13.14LB

Boomgaarden, Margaret: OA18.04

Borawski, Elaine: P09.18LB

Borge, Christine Råheim: P12.05

Borges, Vanderci: P14.01

Borjigin, Jimo: P05.09

Bottari, Diana: OA17.01

Bouwens, Sophia G.: P02.02

Bouzas, Claudia: P14.09, P17.01

Bradley, Ryan: OA05.02

Brandt, Cynthia: OA04.03, OA05.03, P04.10

Branson, Mariah: OA01.04, P05.08

Bransteter, Irina: P05.06

Brault, Jeffrey: P04.07

Bravatti, Michelle: OA17.02

Breedlove, London: OA06.03

Brems, Christiane: P09.16LB

Bretz, Slate: OA10.02

Brewer, Julie: OA01.03

Bringmann, Holger C.: OA14.02

Brintz, Carrie: P05.16

Bronfort, Gert: OA01.02, OA01.04, OA11.03, P05.25

Brooks, Marshall: P14.11

Brown, Amanda: P09.17LB

Brown, Kirk: OA01.01

Brown, Richard: P04.14LB

Brown, Tina: P14.06, P14.13

Brown-Johnson, Stephanie: P06.15

Bruehl, Stephen: P05.16

Brunnhuber, Stefan: OA14.02

Bruton, Alisha: P01.07LB

Bryant, Corey: P18.08

Bu, Zhijun: P07.03LB

Bublitz, Sara: P04.07

Buchholz, Analena: P05.20

Budhiraja, Arin: P02.13, P10.02, P16.17LB, P18.06

Buetow, Stephen: P16.10

Bultmann, Ute: OA16.03

Bundle, Vanessa: P14.09, P17.01

Burdick, Ryan: OA03.04

Burgess, Diana: OA01.04, P05.08, P13.13

Burns, Debra: P10.03

Burns, John: OA01.03, OA17.01

Burton, Wren: P04.12LB, P06.05, P08.04

Bussières, André: OA07.02

C

Cabral Schveitzer, Mariana: P05.33, P17.02

Calva, Jason: P04.07

Calvert, Collin: OA01.04, P05.08

Candon, Molly: OA03.03, P14.15

Cappelletti, Monica: OA14.04

Caputo, Jacqueline: OA10.02, P12.04, P14.18, P15.03, P17.05

Carey, Michael: P05.15

Carlson, Linda: P15.04

Carlson, Rosemary: P08.12LB

Carmack, Cindy: P16.11LB

Carmack, Suzie: P14.10

Carmichael, Joel: P14.04

Carnahan, Ryan: OA14.03, P04.01

Carrie, Heather: P12.07

Carter, Lily: P05.09

Carvalho, Geno: P09.16LB

Cascio, Michelle: P05.19

Casselberry, Regina: P04.04, P04.05

Casselman, April: P15.07LB

Casteel, Carri: OA14.03, P04.01

Castro, Camila: P09.12

Castro, Maria Gabriela: P15.05

Cave, Adele: P03.14LB

Chakraborty, Yashoswini: P02.13, P16.17LB, P18.06

Chang, Chia-Wei: P03.16LB

Chang, Dennis: P03.14LB

Chang, Eva: OA17.01

Chang, Juei Fang (Christine): P12.11LB

Chao, Maria: OA07.04, OA08.04, P17.07

Chaoul, Alejandro: P16.11LB

Chen, Claire: OA07.01, P08.08, P14.08

Chen, Jacqueline: P12.11LB

Chen, Jeff: P18.08

Chen, Steven: OA17.04

Chen, Su: P01.05LB, P01.08LB

Chen, Timothy: P02.13, P10.02, P16.17LB, P18.06

Chen, Xiaoying: P02.15LB, P15.06LB

Chen, Zhesheng: P01.06LB

Cheng, Jessica: OA15.02, P14.20

Cheprasova, Evgenia: P07.02

Cherkin, Dan: P02.10

Chesney, Margaret: OA02.02, P12.08, P14.19

Childerhose, Janet: P12.04

Chin, Amanda: P14.22LB

Chiu, Christine: P03.14LB

Chiu, Dorothy: OA17.04

Cho, Seung-Hun: P03.09LB, P03.15LB

Chon, Tony: P04.07

Choo, Queenie Hui-En: P06.02

Chowdhary, Anoushka: P05.18, P06.18

Chrenka, Ella A.: P02.02

Chrischilles, Elizabeth: OA14.03, P04.01

Christensen, Heather: P09.09

Christie, Aimee: P16.11LB

Christofides, Katerina: P03.14LB

Chung, Marianne: OA18.03, P05.27, P16.08

Chung Schreiber, Kerri W.: P02.02

Church, Dawson: P05.23

Cidral-Filho, Francisco: P01.01, P01.02, P06.03

Cizik, Amy: P05.04, P13.07

Clarke, Patricia StandTal: P06.01

Clayman, Marla: P14.03

Clements, Deborah: P07.01

Cline, Timothy R.: P14.10

Coash, Elise: OA17.02, P14.22LB

Coberly, Elise: P09.02

Coggeshall, Scott: OA07.01, OA11.04, P08.08, P14.08

Cohen, Ezra: OA07.02

Cohen, Lorenzo: OA15.04, P16.11LB

Cohen-Bearak, Adena: P13.01

Cole, Jill: P04.13LB

Cole, Steve: OA01.01

Coleman, Brian: OA04.03, OA05.03, P04.10, P04.14LB, P14.21LB

Coleman, Lisa: P17.05

Colgan, Dana Dharmakaya: OA07.03, P05.11, P05.12

Colwell, Chris: P18.08

Connors, Erin: P05.16

Conway, Nancy: OA17.01

Cook, Andrea: OA03.02

Cook, Benjamin: OA09.05

Cook-Cottone, Catherine: OA09.01

Cooley, Katherine: P05.36LB

Cooley, Kieran: OA08.02

Coppers, Birte: P14.09, P17.01

Corcoran, Kelsey: OA04.03, OA07.02, P04.10

Coronado, Rogelio: P05.16

Corr, Patrick: P09.02, P18.03

Cortellazzi, Karine Laura: P05.10

Cortessis, Victoria: P05.14

Cotton, Sian: P02.06

Coulter, Ian: OA02.02, P12.08, P14.05, P14.19

Coyne, Christopher J.: OA03.01

Cramer, Holger: OA09.04, OA10.05, OA11.01, P03.03, P05.20, P14.17, P18.02

Craven, Melissa: OA07.04

Crawford, Laurie: P12.03, P12.09

Creswell, David: OA01.01

Crocker, Heidi: P09.16LB

Croghan, Ivana: P06.08, P06.09, P16.14LB

Cross, Lee: OA01.04, P05.08, P13.13

Crowley, Kerri: P05.22

Cuadro, Fernanda: P12.03

Cuccaro, Paula: OA02.03

Cui, Jing: P03.10LB, P06.06LB

Cupler, Zachary: P04.04, P04.05, P09.17LB

Cusimano, Andrew: OA15.04

Czap, Sue: P09.05

D

D’Adamo, Chris: P18.08

da Silva, Carolina Candeias: P14.01

Daggy, Joanne K: OA14.01

Dai, Stacey: P12.11LB

Daniels, Clinton: P04.02, P09.17LB

Dawoud, Adina: P05.37LB

De Blasio, Frances M.: P03.14LB

de Castro Meneghim, Marcelo: P05.10

DeBar, Lynn: OA03.02, P12.10LB

Deliorman Orhan, Didem: P03.04

Delzio, Molly: OA04.01, P14.14

Deng, Xiaolin: OA18.01

Denninger, John: P13.08

Der-Martirosian, Claudia: P13.06

Desai, Kunal: P16.01, P16.04

Desai, Neha: P04.09

Devan, Kansagara: P05.39LB

Dewsbury, Lauren S.: P03.14LB

Dhar, Minakshi: P16.13LB

Dhruva, Anand: OA06.04

Diaz, Rosalie: P02.08

Dignan, Katherine: OA16.01

Dillard, Jessica: P06.24LB

Dillman, Olivia: P02.06

Divan, Mina Kumari: P05.19

Do, Alexander: P04.07

Dobos, Gustav: OA08.01, OA10.05

Dodds, Nathan: OA09.03

Dodson, Alec: P09.18LB

Dones, Makayla: P13.01, P14.03

Donskey, Curtis J.: OA16.01

Dore, Graham: P05.01, P15.05

Dossett, Michelle: P13.08

Dourlain, Jordan: P04.03

Du, Tianhui: P01.10LB

Duchemin, Anne-Marie: P17.05

Dunne, Eugene: P05.15

Dupont-Versteegden, Esther E.: P04.13LB

Dusek, Jeffery: OA02.01, OA03.01, OA03.03, OA05.04, OA08.03, OA10.04, OA11.02, OA12.03, P02.03, P02.14LB, P04.02, P04.04, P04.05, P04.09, P05.06, P05.19, P14.12, P14.15, P14.23LB

Dutcher, Janine: OA01.01

Dvorin, Kelly: P14.03

Dyer, Natalie L: OA03.01, P02.14LB

Dykstal, Charles: OA02.04

D’Andrea-Penna, Gina: P05.36LB

E

Edakkanambeth Varayil, Jithinraj: P16.14LB

Edwards, Amy: OA11.02

El Melik, Razan: P06.08, P06.09

El-Fetouh Katamesh, Basant: P06.08, P06.09, P16.14LB

Elder, Charles: P18.05

Elhadidy, Nandie: OA13.02

Elwy, A. Rani: P13.06

Embrey, Misty: P06.16

Emerson, Angela: OA10.02, P14.18

Emmert-Aronson, Ben: OA17.04

Eng, Carolyn: OA03.02

Eren, Gökçen: P03.04

Escudero, Gabriel: P08.08

Esteban, Ana: P06.19

Esteireiro, Olivia: P11.05LB

Estey, Esther: OA09.01

Etingen, Bella: OA07.01, OA12.02, P08.08, P14.03

Evans, Jennifer: P04.03

Evans, Roni: OA01.02, OA01.04, OA07.02, OA11.03, OA17.03, P05.08, P05.25, P13.13

Evans, Samantha: OA18.04

F

Fagan, Naomi L.: P03.14LB

Fahey, Paul: P03.02

Falxoner, Sara: P09.06

Farahnik, Joshua: P13.12

Farewell, Charlotte: P12.06

Farrar, John T.: P08.12LB

Farrell, Marny T.: P02.02

Farris, Yulia: P01.07LB

Faryar, Kiran A.: OA03.01

Faurot, Keturah: OA13.02, P18.07LB

Feinberg, Termeh: OA13.03, OA13.04

Feingold, Kim L.: P02.01, P16.17LB

Fendrich, Michael: OA17.01

Fergson, Amy: P14.04

Ferguson, John: OA01.04, P05.08

Fernandez, Laura: P09.18LB

Ferraz, Henrique Ballalai: P14.01

Fertal, Jamie: OA15.02, P14.20

Finch, Dezon: OA04.03

Finnell, John: P15.07LB

Fix, Gemmae: OA12.02

Fleming, Kate: P04.07

Flusberg, Yael: P06.16

Flyckt, Rebecca: P02.03

Fogarty, Jack S.: P03.14LB

Fogarty, Tammy: P15.02

Foltz, Gina: P13.04

Foote, Trevor: OA14.01

Fox, Devon J.: OA18.04, P13.12

Frame, Leigh: P09.02, P16.09, P18.03

Fredericksen, A. Kiera: OA09.05

French, Megan: OA16.01

Frensemeier, Sharyl: P13.11

Friedly, Janna: P05.04, P13.07

Friedman, Jessica: OA01.04, P05.08

Frochen, Stephen: P14.08

Funabashi, Martha: P09.03, P14.02

Fung, Kandace: P12.12LB

Funke, Conner: P02.06

Funke, Matthew: P16.12LB

G

Gabriel, Mindy: P15.03

Gallagher Seaman, Mary: P06.17

Ganesh, Varsha: P02.13, P10.02, P16.17LB, P18.06

Ganla, Malhar: P16.03

Garcia Drago, Victoria: OA08.04

Gardiner, Paula: OA13.02

Gardiner, Paula: OA09.05, P09.14, P18.07LB

Garhyan, Jaishree: P03.12LB

Garland, Eric: P10.03

Garner, Mikayla K: OA14.01

Garnsey, Camille: P05.32, P05.41LB

Gaskins, Devyn: OA10.01, P05.28

Gaylord, Susan: OA13.02, P18.07LB

Ghelman, Ricardo: P05.33, P17.02

Giffuni, Jamie: P16.12LB

Ginther, Jane: P17.05

Gisbert, Robyn: P09.13

Glick, Ronald: P06.21

Glickstein, Barbara: OA13.01

Gliedt, Jordan: P04.02, P09.17LB

Gnall, Katherine: P05.32, P05.41LB

Goehl, Justin: P09.17LB

Goertz, Christine: OA14.03, P04.01, P08.04

Gogineni, Anvitha: P12.04

Goldberg, Simon: P16.16LB

Goldman, Veronica: P05.29

Golubic, Mladen: P02.06

Good, Mary K : OA04.01, P14.14

Goode, Adam: P05.04, P13.07

Goodman, Hannah: OA09.05

Gorrell, Lindsay M: P14.02

Goulet, Joseph: OA05.03, P14.21LB

Graves, Kristi: P12.11LB

Gray, Charles: P06.12, P17.04

Gray, Nora: P01.09LB

Greco, Carol: OA01.01, OA09.03, P05.01, P05.25, P06.21, P13.03, P15.05, P18.07LB

Greenberg, Jonathan: OA01.03, P05.03

Greene, Dola: P06.14

Greenlee, Heather: P15.04

Greenwell, Barbara: OA15.02, P14.20

Griffin, Anne: P14.16

Groessl, Erik: OA12.04

Grote, Veronika: P07.04LB

Groves, Peyton: P06.21

Grzenda, Adrienne: OA14.04

Gu, Xiaohong: P01.05LB, P01.08LB

Gu, Yanhong: P14.24LB

Gubitosi-Klug, Rose: P05.06

Guerrera, Mary: P09.10

Guo, Lei: P05.34LB

Guo, Ning: OA10.01, P05.07

Guo, Shuwen: P01.10LB

Gupta, Rishabh: P05.16

Guyker, Wendy: OA09.01

H

Haas, Niina: P16.17LB

Haddad, Robin: P16.11LB

Haddow, Susan (Sue): OA08.03

Haderlein, Taona: P13.06

Hagan, Joshua: OA10.02

Hagel Campbell, Emily: OA01.04, P05.08

Haley, Alexander: OA01.02, OA01.04, OA17.03, P05.08, P13.13

Hall, Anne: P08.11LB

Haller, Heidemarie: OA08.01, OA14.02

Hammer, Matthew: P01.07LB

Hamre, Harald: P06.22LB

Hanna, Isabelle: OA07.02

Hannah, Alexis: P14.07

Hansen, Annika: OA07.04, OA08.04

Hansen, Kathryn: OA07.03

Hanson, Leah R.: P02.02

Hanson, Linda: OA01.02, OA11.03, OA17.03, P05.25

Harris, Elondra: P18.07LB

Harris, Richard: P02.04, P02.11, P05.09

Harris, Stephanie: P09.18LB, P16.06

Harrison, Jessica M.: P17.07

Harte, Steven: P02.04

Hartlieb, Kathryn: P15.02

Hartogensis, Wendy: OA07.04, P05.18, P05.29, P06.18

Hasegawa, Yuto: OA18.02

Hassan, Abdul Rhman: P16.14LB

Hatscher, Lukas: P14.09, P17.01

Hatsu, Irene E.: P01.07LB, P06.10

Hattom, Lena C.: P03.14LB

Hausdorff, Jeffrey M.: P06.05

Hawn, Cheryl: P09.17LB

He, Chenhao: P18.04

He, Mengyang: P01.11LB

Heagerty, Patrick J.: P05.04, P13.07

Heard-Garris, Nia: P10.05

Hecht, Rick: P05.18, P05.29, P06.18

Heil, Maureen: P05.22

Heiman, Isaac: P05.30

Heneghan, Nicola R: P14.02

Hennessy, Sierra: P05.08

Heo, IN: P04.11LB

Herman, Patricia M: OA02.02, OA03.04, P04.06, P12.08, P14.05, P14.19

Herrmann, Amanda A.: P02.02

Hewlings, Susan: P18.08

Hill, Jacob: P05.02, P05.07

Hirsh, Adam: P10.03

Ho, Chin Ee: P06.02

Hoenders, Rogier: OA12.01, OA16.03, P03.02

Hogan, Timothy: OA12.02, P08.08

Hohenberg, Mark: P03.14LB

Holden, Selma: P11.05LB

Holtzer, Karl: P06.21

Hooker, Julia: OA01.03

Hoover, Diana K.B.: P10.05

Horn, Maggie: P05.04, P13.07

Horowitz, Bruriah: OA02.04, OA09.03, P02.13, P10.02, P16.17LB, P18.06

Horton, Lorraine: P12.01

Horton, Teresa: OA02.04

Hosahalli Vasanna, Smitha: P04.09

Hostetler, Dan: OA02.04

Houwink, Elisa: P06.08, P06.09

Hu, Bo: OA10.01

Hu, Katie: P08.11LB

Hu, Xiao-yang (Mio): P03.08LB

Huang, Jinchang: P01.06LB, P01.10LB, P01.11LB

Huang, Linda: P06.08, P06.09

Huang, Meixiang: OA18.02

Huang, Zhi-Rui: P07.03LB

Huels, Emma: P05.09

Huffert, Kyler: P09.06

Hughes, Robert: OA03.01

Hui, Ka-Kit: P12.12LB

Huizar, Kaitlyn: OA18.02

Hünninghaus, Kristin: OA08.01

Hurt, Ryan: P16.14LB

Huston, Alissa: P09.05

Hwang, Eui-Hyoung: P04.11LB

Hwang, Man-Suk: P04.11LB

Hyde, Justeen: OA12.02, P13.01

I

Ibrahim, Ahmed: P16.14LB

Ijaz, Nadine: P12.07

Inbar-Albo, Lourdes: P12.11LB

Insinga, Juliet: P14.22LB

Irvine, Katherine N.: P10.05

Isaac, Jade: OA06.02

Ismalia, Nofisat: P15.04

Isralowitz, Richard: OA06.02

J

Jackson, Jhia: OA07.04

Jackson, Kathryn: OA09.03, P13.03

Jackson, Mary: P11.02

Jackson, Steven D.: P02.02

Jafar, Deyyan: P03.14LB

Jain, Divya: P05.46

Jammes, Chloé: P05.30

Jan, Bryan: P09.05

Jarvik, Jeffrey: P05.04, P13.07

Javed, Danish: P01.01, P01.02

Jayakumar, Prakash: P13.09, P17.06

Jeitler, Michael: OA14.02

Jensen, Mark: P04.07

Jiang, Honglin: P01.06LB

Jiang, Johnson: P02.12, P05.05

Jiang, Lin: P01.08LB

Jillian, Rigert: OA15.04

Jin, Xinyan: P02.15LB, P03.05, P06.20LB, P03.13

John, Sydney: P09.05

Johnson, Alisa: P13.14LB

Johnson, Ashley: P14.11

Johnston, Sandra: P05.04, P13.07

Johnstone, Jeni: P01.07LB, P06.10

Jones, Jennifer: OA02.03

Jordan, Meg: P08.10LB

Joswiak, Jessica: OA16.01

Jubelirer, Tracey: P08.07

Judd, Dana: P09.13

Jurcak, Jessica: OA10.04, P16.15LB

Justice, Catherine: OA08.03

Justice, Mary: P06.13

Justice, Morgan: OA03.02, P12.10LB

Jyung, Hyowoun: P12.10LB, P12.13LB

K

Kadam, Nidhi: OA16.02, P16.02, P16.03

Kaiser, Christine: P02.03, P14.12

Kaitz, Jenesse: OA12.02

Kale, Ibuola: P08.08

Kalllenberg, Gene: OA03.01

Kamiya, Atsushi: OA18.02

Kanchibotla, Divya: P03.12LB

Kang, Xiaomin: P03.11LB

Kannan, Vivek: OA09.04

Kaplan, Joshua: P05.39LB

Kaptchuk, Ted: P13.08

Karamacoska, Diana: P03.14LB

Karasz, Alison: OA03.01

Karimi, Nima: P18.01

Karstens, Lisa: P01.07LB

Kasom, Danna: OA05.01

Kathrikolly, Thejas: OA16.02, P16.02, P16.03

Keck-Kester, Terrah: P12.03, P12.09

Kekic, Adrijana: P06.08, P06.09

Kelly, Laura: P06.23LB

Kennedy, Douglas: OA01.02, OA17.03

Khalid, Saliha: P12.05

Khemet Taiwo, Tanya: P17.07

Khorsan, Raheleh: P14.05

Kiefer, Patricia: P02.08, P06.07

Kiene, Helmut: P06.22LB

Kim, Elyssa: OA15.02, P14.20

Kim, Ryung: OA03.01

Kim, Stuart: P06.23LB

Kim, Sung Tae: P02.03

Kim, Yunna: P03.15LB

Kim, Yunna: P03.09LB

Kiran, Usha: P05.46

Kirk, Eric: P09.17LB

Kish-Doto, Julia: P09.02

Kisicki, Abby: OA02.04

Klatt, Maryanna: OA10.02, P06.13, P12.04, P14.18, P15.03, P17.05

Klee, Dan: P05.11

Kloehn, Alex: OA07.01, P08.08, P13.06

Knieper, Matthew: P09.17LB

Knitza, Johannes: P14.09, P17.01

Knudsen, Ben: P16.09

Ko, Roxanne: P06.19

Koffler, Karen: OA06.04

Kogan, Mikhail: OA06.02, P06.16

Kohl-Heckl, Wiebke: P08.06

Kok, Zirui: P06.02

Kolobaric, Antonija: P18.08

Konakova, Yulia: P07.02

Koo, Mabel: P18.01

Kowalski, Matthew: P04.12LB, P06.05

Koziol, Michael: P02.02

Kraft, Colleen: P05.08

Krater, Caitlin: P10.03

Krause, Beatrix: OA14.04

Kristoffersen, Agnete Egilsdatter: P12.05

Ku, Sarah: OA15.02, P14.20

Kulkarni, Pournima: OA16.02

Kulp, Tonia: P05.22, P08.07

Kurschner, Sophie: P14.23LB

Kwon, Do Young: P03.09LB, P03.15LB

L

Labak, Collin: P04.02

Labinsky, Hanna: P14.09, P17.01

LaChance, Laura: OA08.02

Lachman, Ryanne: P09.18LB

Ladawn Ricks-Oddie, Joni: P05.21

LaFaille, Michelle: P05.36LB

Laird, Lance: OA07.02, OA17.02, P14.22LB

Lampe, Johanna: P05.04, P13.07

Landis, Courtney: P12.09

LaRowe, Lisa: P05.03

LaSalle, Angela: P08.13LB

Laube, Justin: P09.12

Lauche, Romy: P05.20

Lavin, Paola: P05.10

Lavretsky, Helen: OA14.04, OA17.02

Lawrence, Suzanne: OA13.02, P05.01, P15.05, P18.07LB

Laws, Brian V: OA14.01

Lawson, Karen: P14.10

Layman, Deborah: P10.04

Lazarov, Aneta: P05.23, P05.26

Lebensohn, Patricia: P09.07

Leca, Renato: P13.02

Lechuga, Claudia: P02.14LB

Lee, Caitlin: P02.12, P05.05

Lee, Chiyoung: OA16.04

Lee, Chloe: P11.01

Lee, Junsoo: P01.03

Lee, Justine: P08.11LB

Lee, Richard: OA15.02, P14.20, P15.04

Lee, Yeon-Woo: P04.11LB

Leeds, Rebecca: P06.19

Leininger, Brent: OA01.02, OA17.03, P05.25

Lekuti, Mujeedat: P18.01

Lenger, Katherine: P11.02

Leonard, Lori: OA16.01

Leung, Brenda: P01.07LB, P06.10

Leung, Cheuk Hong: P16.11LB

Leyde, Sarah: P05.12

Li, Jia-Xuan: P03.13LB

Li, Keying: P03.13LB

Li, Qianqian: P01.08LB

Li, Wenna: P01.06LB, P01.11LB

Li, Yannan: OA18.02

Li, Yisheng: P16.11LB

Li, Zhiqiang: P02.16LB

Lian, Fengmei: P03.06LB, P03.11LB

Lian, Yanyan: P01.06LB

Liang, Lirong: P15.06LB, P15.09LB

Lim, Chai K.: P03.14LB

Lin, Elizabeth: P09.14

Lin, Shin: P02.12, P05.05

Lin, Wan-Yi: P03.16LB

Lindsay, Emily: OA01.01

Ling, Marilyn: P09.05

Liphardt, Anna-Maria: P14.09, P17.01

Lipton, Richard: P05.02, P05.07

Lisi, Anthony: OA04.03, OA05.03, OA07.02, P04.10, P04.12LB, P14.21LB

Littman, Alyson: P05.04, P13.07

Liu, Henry: P18.01

Liu, Hui: P01.05LB, P01.08LB

Liu, Jianping: P02.15LB, P03.05, P03.08LB, P03.10LB, P03.13LB, P06.06LB, P06.20LB, P07.03LB, P15.06LB, P15.09LB

Liu, Jianxun: P03.14LB

Liu, Qiang: P03.13LB

Liu, Tiegang: P01.05LB, P01.08LB

Liu, Xuehan: P03.05, P03.13LB, P06.20LB, P15.06LB

Liu, Yiqian: P14.24LB

Liu, Yu-Chen: P12.11LB

Liu, Zeyu: P01.06LB

Liu, Zhaolan: P07.03LB

Loew, Brenda: P02.10

Loewenthal, Julia: P04.12LB

Long, Cynthia: OA14.03, P04.01, P06.05

Lopez, Gabriel: OA15.04

Lott, Briana: OA05.01, P08.08, P13.06

Love, Thomas: OA02.01, OA05.04

Lovejoy, Travis: P05.39LB

Lowry, Christopher: P05.18, P06.18

Lowry, Ella: P12.11LB

Loy, Michelle: P05.17, P11.03

Lu, Chuan: P03.16LB

Lu, Chunli: P03.05, P06.20LB, P15.06LB, P15.09LB, P03.13LB

Lu, Rebecca: P02.03

Luff, Amanda: OA17.01

Luo, Gang: OA11.04

Lupesko-Persky, Osnat: P05.18, P06.18

Luther, Stephen: OA04.03

Lutz, Danielle: P15.01

Ly, Melinda: P02.12, P05.05

Lyons, Paul: P05.13

M

Ma, Phillip: P14.21LB

Macdonald, Heather: P05.21, P16.05

MacLeod, Jodi: P15.04

Maddela, Sridhar: P16.10

Magnusson, Dawn: P09.13

Mah, Donna: P12.10LB

Mahaffey, Mallory: OA01.04, P05.08, P13.13

Maiers, Michele: OA02.02, OA03.04, P12.08, P14.04, P14.19

Maizes, Victoria: P09.07

Majd, Iman: OA06.04, P02.10

Maker-Clark, Geeta: OA06.01

Malhotra, Varun: P01.01, P01.02

Malika, Nipher: OA02.02, P12.08, P14.19

Mallaiah, Smitha: OA15.04, P16.11LB

Mallory, Molly: P04.07

Malone, Lindsay: P09.18LB, P16.06

Manor, Brad: P06.05

Marshall, Aaron: P09.09

Marsland, Anna: OA01.01

Martin, Lili: P09.04

Mascarenhas, Maria: P04.03, P05.22, P08.02, P08.03

Mascarenhas, Maria: P08.12LB

Mason, Ashley: P05.18, P06.18

Matey, Eric: P06.08, P06.09

Matthias, Marianne: OA01.04, OA14.01, P05.08

Mausteller, Kyle: P12.03, P12.09

Mazen Amin, Ahmed: P16.14LB

McAlindon, Timothy: OA17.02

McClellan, Leah: OA02.04

McClure, Ryan: P01.07LB

McDermott, Katherine: OA01.03

McFarland, Chris: OA11.03

McGarness, Amy: OA17.03

Mcgillis, Megan: P05.01

McGowan, Michael: OA05.01

McGuigan, Paul: P05.06

McKee, M. Diane: OA03.01, P02.14LB

McTigue, Kathleen: P15.05

McVoy, Molly: P05.06, P05.19

Medich, Melissa: OA05.01

Mehling, Wolf: P05.29

Mehta, Darshan: OA06.04

Meier, Eric: P05.04, P13.07

Meis, Laura: OA01.04, P05.08

Memon, Mushtaq: OA18.01

Mendes Abdala, Carmem Veronica: P05.33, P17.02

Mendoza, Glenn: OA18.03, P05.27, P16.08

Merrigan, Justin: OA10.02

Merrill, Joseph: OA09.02, P05.12

Metri, Najwa-Joelle: P03.14LB

Meyer, Kevin: P09.17LB

Miccio, Robin: P04.03, P08.02, P08.03, P08.07, P08.12LB

Michalsen, Andreas: OA14.02

Michel, Brianna: P17.05

Middlecamp, Cathy: P16.16LB

Mikhaylova, Anastasiya: P07.02

Milanes, Mirta: P12.13LB

Miller, David: OA11.02, P04.09, P05.06, P05.19

Miller, Vanessa: P18.07LB

Minen, Mia: P05.02, P05.07

Minichiello, Vincent: OA06.04

Mischley, Laurie: OA18.04, P13.12

Mishra, Anusha: P01.09LB

Mitchell, Aimee: P06.13

Mitchell, Christina: P05.15

Mittal, Sunita: P16.13LB

Mittman, Brian: OA17.02

Modlesky, Christopher: P01.03

Moffat, Kelly: OA18.04

Mohan, Latika: P16.13LB

Moher, David: P18.01

Mohr, David: P06.17

Moir, Fiona: P16.10

Monier, Zak: P15.02

Montejano Vallej, Rebeca: OA08.01

Moodie, Paula: P12.03, P12.09

Moomaw, Allison: P05.22

Moonaz, Steffany: P05.37LB

Mooney, Stephen: P05.04, P13.07

Moore, Brad: P16.09

Moore, Liliana: OA13.03, OA13.04

Moore, Michael: P09.03

Mooring, Scott: P09.17LB

Moran, Patty: P05.18, P06.18

Morf, Harriet: P14.09, P17.01

Mori, DeAnna: OA04.02

Morone, Natalia: OA09.03, OA13.02, P05.01, P15.05, P18.07LB

Moskowitz, Judith: P02.01

Mossburg, Jurdan: P09.06

Motta, Jacquelyne: P01.04

Mroz, Daniel: P06.04

Mullur, Rashmi: P08.11LB

Mullur, Rashmi: OA04.01

Mulugeta, Yulia: OA10.02, P12.04, P15.03, P17.05

Munk, Niki: OA14.01, P04.08, P08.13LB, P09.15, P14.06, P14.13, P14.16

Munoz, Frank: OA15.02, P14.20

Muñoz Alba, Mariana: OA18.01

Murphy, Anne: P02.11

N

Nabity, Paul: P15.07LB

Nagle, Rebecca: P09.04

Nanda, Sanjeev: P16.14LB

Napuli, Jason: P09.17LB

Narain, Sasha: P16.09

Naranjo, Alexandra: P11.02

Narayanan, Santhosshi: OA15.04

Natarathna, Raghuram: P16.11LB

Nausheen, Fauzia: P05.13

Ndubuisi-Obi, Maryclaret: P06.25LB

Neudecker, Mandy: P05.19

Newman, Ronnie: P05.44LB

Ng, Han Seong: P06.02

Ng, Jeremy Y.: OA09.04, P09.11, P18.01

Nguyen, Tra: OA13.02, P15.05

Nichols, Matthew: OA05.04

Nicosia, Francesca: OA04.01, P14.14

Nielsen, Arya: OA03.01, OA03.02, OA03.03, P02.14LB, P09.11, P12.10LB, P14.15

Nielson, Jessica: P06.14

Niles, Barbara: OA04.02

Ning, Jing: P02.05

Noborikawa, Jennifer: P11.01

Norby-Adams, Lydia: P01.07LB

Normand, Remy: P08.01

Northrop, Leah: P06.21

O

O'Brien, Andrew: P02.04

O'Donnell, Roisin: P05.16

O’Malley, Patricia: P16.04

O'Neil, Maya: P05.39LB

Obayashi, Mizuho: OA18.02

Ochoa, Jewel: P16.11LB

Oken, Barry: P05.11

Olson, Anne D.: P04.13LB

Olson, Juli: P06.24LB

Olson, Stacy: P06.12

Orr, Morgan: OA10.02

Ortmeyer, Heidi: P16.12LB

Ostermann, Thomas: P03.03, P18.02

Owusu-Ansah, Amma: P04.09

Oxenham, D. Vincent: P03.14LB

Ozdinc, Baris: OA18.04

Özgencil, Fikriye: P03.04

Özüpek, Burçin: P03.04

P

Pallerla, Harini: P02.06

Palm von Alten Blaskowitz, Paloma: P14.09, P17.01

Palmer, Julia: OA09.02

Pan, Xingru: P15.06LB, P15.09LB

Pandya, Leena: P05.18, P06.18

Parimi, Mounika: P17.07

Paris, David: P09.17LB

Park, Crystal: P05.32, P05.41LB

Park, Sarah: OA18.04, P13.12

Park, Sun-Young: P04.11LB

Parka, Woohee: P03.15LB

Parker, Patricia: P16.11LB

Parrilla, Danielle: P17.04

Parry, Gareth: OA09.05

Patel, Darshana: P02.08

Pathak, Namyata: P03.01

Pathak, Tanusha: P01.01

Pathania, Monika: OA10.03, P05.42LB, P05.45, P16.13LB

Patil, Sonal: P11.04

Patrick, Rhonda: P05.18, P06.18

Pauli, Emily: P18.08

Pearce, Michelle: P05.16

Pelkey, Ashley: P09.06

Peng, Meredith: P05.31

Pereira, Cora: OA17.02

Perez, Jaime: P04.04, P04.05, P04.12LB

Perez Aranda, Adrian: P09.14

Perez Villalobos, Angela: P12.11LB

Perkins, George: P16.11LB

Pham, Eileen: P02.12, P05.05

Pheiffer, Laura: P17.05

Pieper, Amy: OA16.03

Pike, Kenneth: OA09.02

Pike, Martin: P01.09LB

Pilkonis, Paul: OA09.03

Plonka, Maik: OA08.01

Pohlman, Katherine: P04.14LB, P09.03, P14.02, P14.04, P15.02

Pollmann, Nina: P05.20

Polser-Crabtree, Geneva: P05.16

Polusny, Melissa: OA01.04

Pomales, Tony: OA04.01, P14.14

Portella, Caio: P05.33, P17.02

Possobon, Rosana: P05.10

Powers-James, Catherine: P16.11LB

Prasad, Arti: OA08.03, P14.23LB, P18.05

Prathikanti, Sudha: OA07.04

Pressman, Alice R.: OA03.02

Price, Cynthia: OA07.03, OA09.02, P05.11, P05.12, P05.24

Priest, Amanda: P05.16

Printon, Richard: P14.23LB

Pucka, Andrew: P02.04

Purcell, Natalie: OA13.03, OA13.04

Q

Qi, Xuewei: P01.06LB

Qin, Lixin: P02.02

Qin, Xueying: P01.08LB

Qiu, Tianzhu: P14.24LB

Qiu, Yuqin: P01.06LB

Quatman-Yates, Catherine: OA10.02, P14.18, P15.03

Qureshi, Samera Azeem: P12.05

R

Rai, Zenith: P14.03

Raimondo, Maria Gabriela: P14.09, P17.01

Raison, Charles: P05.18, P06.18

Rakic, Marina: P05.36LB

Raman, Vatsav: P03.12LB

Ramming, Alina: P14.09, P17.01

Ramming, Andreas: P14.09, P17.01

Ramondetta, Lois: OA15.04

Ramos, Luiz: P17.02

Ramrakhyani, Somya: P05.43LB

Ramsundarsingh, Susan: P05.44LB

Rana, Anish: P04.03

Ranum, Rylea: P16.14LB

Rao, Santosh: OA15.03, P15.04

Ratajec, Holly: P03.14LB

Rathbun, Mathew: OA18.01

Reb, Anne: OA15.02, P14.20

Rebaine, Rayhane: P18.01

Redden, Susan: OA02.04

Reddy, Bill: P02.09

Reddy, Kavitha: P06.17, P15.01

Reed, David: OA07.01, OA12.02

Reed, Ellaina: OA17.02

Reeder, Annie Kate: P05.02, P05.07

Reeves, Tegan: OA08.03, P14.23LB

Reichert, Elizabeth: P05.44LB

Reichman, Rocky: OA17.02

Rej, Soham: P05.10

Rekant, Julie: P16.12LB

Resnick, Adam: P13.06

Rethorn, Timothy: P14.18

Rhoten, Bethany: P05.16

Ricker, Mari: P09.07

Ring, Melinda: OA06.01, OA06.04, P02.01, P07.01, P07.04LB

Riordan, Kevin: P16.16LB

Rist, Pamela: P06.05

Ritter, Vadan: OA07.04

Rivard, Rachael: OA12.03, P04.09, P14.12

Roames, Christy: OA15.02, P14.20

Roberts, Stefanie: P05.18, P06.18

Robinette, Lisa M.: P01.07LB, P06.10

Robinson, Nicola: P06.20LB, P15.06LB, P15.09LB

Robison, Jeanene: OA15.01

Rocha, Marlene: P17.02

Rodgers-Melnick, Samuel: OA02.01, OA05.04, OA10.04, OA11.02, OA12.03, OA15.03, P02.03, P04.09, P14.12, P16.15LB

Rodriguez, Monique: P05.12

Rodriguez, Ruth: P05.01

Roff, Chelsea: OA09.01

Ron, Nakari: OA07.04, OA08.04

Rosansky, Joseph: OA09.05

Rosas, Lisa G.: OA17.04

Rose, Gail: P09.06

Roseen, Eric: OA07.02, OA17.02

Rosenow, Mica: P09.11, P09.15, P14.06, P14.13

Rosner, Bernard: P18.08

Rosoff-verbit, Zoe: P04.03

Roth, Isabel: P05.01, P11.02, P18.07LB

Rouchka, Jennifer: P08.05, P13.04

Rovnaghi, Cynthia R: P05.44LB

Rowland, Julia: P15.04

Roy, Nikita: P03.14LB

Rubinstein, Sidney: P04.14LB

Rudin, Robert: P04.06

Rudolf, Sebastian: P14.09, P17.01

Rundell, Sean: P05.04, P13.07

Ruth, Avaion: P05.14

Rutledge, Thomas: OA12.04

Ruvalcaba, Denise: OA07.04, OA08.04, OA17.04

S

Saito, Ayumi: P05.04, P13.07

Sajatovic, Martha: P05.06

Sajdyk, Tammy: P08.13LB

Sakamoto, Shinji: OA18.02

Saleska, Jessica: P18.08

Saligan, Leorey: P16.14LB

Salles Araujo, Thais: P09.12

Salsbury, Stacie: P04.14LB, P08.04, P09.03, P09.17LB

Sanogo, Fatimata: P05.14

Santa Maria, Diane: OA02.03

Santos, Graziele Costa: P14.01

Saper, Robert: OA07.02, OA10.01, OA17.02

Sariahmed, Karim: P18.07LB

Saritoprak, Seyma: OA15.02, P14.20

Sauer, Christina: OA09.03, P02.13, P10.02, P16.17LB, P18.06

Savo Sardaro, Maria Luisa: P07.04LB

Sayegh, George: P13.09, P17.06

Scarton, LuAnn: P06.21

Schamess, Andrew: P12.04

Scharf, Jodi: P05.02

Schett, Georg: P14.09, P17.01

Schlumpf, Karen: P16.09

Schneider, Michael: OA11.03, P05.25

Schoenfeld, Naomi: OA07.04, OA08.04

Schuh, Michael: P06.08, P06.09

Schuller-Hsu, Shelby: P10.03

Schult, Tamara: P06.12, P06.17, P15.01, P17.04

Schultz, Cindy: P14.10

Schulz, Craig: OA01.02, OA17.03, P05.25

Schulz, Leonie: P10.05

Schuman Olivier, Zev: OA09.05, P09.14

Schwarz, Jacob: P05.16

Seal, Karen: OA13.03, OA13.04

Segall, Tracy: OA03.01, OA10.04, OA11.02, P05.06, P16.15LB

Sen, Ilyda: OA10.02

Seng, Elizabeth: P05.02, P05.07

Serpa, Greg: OA01.04, P05.08

Sethi, Dilasha: P05.42LB, P05.45

Shafto, Katherine: OA08.03

Shah, Aimun Qadeer: P18.01

Shallcross, Amanda: P05.02, P05.07, P05.28

Shannahan, Anna: OA06.04, P07.01

Shannon, Zacariah: OA14.03, P04.01

Sharma, Baby: OA16.02, P16.02, P16.03

Shaw, Rachael: P12.01

Sheen, Elizabeth: P09.05

Sheikh, Shazia: P05.13

Shen, Sa: P05.44LB

Sherman, Megan: P05.24

Sherman, Samantha J.: P02.02

Shi, Yuming: P14.20

Shiau, Deng-Shan: OA18.01

Shidlo, Noa: P05.26

Shin, Byung-Cheul: P04.11LB

Shin, Marlena: OA05.01

Shin, Yeongjae: P04.11LB

Shipton, Danielle G.: P03.14LB

Shue, Sarah: P14.16

Sibinga, Erica: OA02.03

Sibold, Jeremy: P09.08

Siddarth, Prabha: OA14.04

Siddiqui, Shabeer: OA15.02, P14.20

Silliman Cohen, Tiffany: P04.03

Sims, Elaine: P10.05

SINGH, PREETIDEEP: P12.02

Singla, Abhinav: P06.08, P06.09

Siwik, Chelsea: P05.18, P06.18

Slaven, James E: OA14.01

Slusher, Barbara: OA18.02

Smalheer, Alecia: P02.08

Smersh, Monica: P05.04, P13.07

Smith, Alyssa: P09.06

Smith, Bridget: OA12.02

Smith, Jennifer: OA04.04

Smith, Jennifer: P02.08

Smith, Rebekah: P10.04

Soderlind, Jennifer: P04.07

Şöhretoğlu, Didem: P03.04

Soldaini, Antonella: OA07.04

Somers, Tamara: OA01.03

Somohano, Vanessa: P05.39LB

Song, Sunah: OA05.04

Sood, Anil: P16.11LB

Šoral, Michal: P03.04

Soumyanath, Amala: P01.09LB

Sprimont, Preston: P05.36LB

Squires, Lisa: P05.22, P08.02, P08.03

Sreekumar, T.S.: P16.01

Srikanth, Priya: P01.07LB, P06.10

Srinivasan, Roshini: OA12.03, P04.04, P04.05, P05.06

Srinivasan, Roshini: OA10.04, P02.03, P05.19, P14.12

Stark, Elena: P07.02

Steen, Jeremy P.: OA09.04

Stein, Bradley: OA03.04

Steinberg, Beth: OA10.02, P06.13, P15.03

Steiner-Lim, Genevieve: P03.14LB

Stephens, Byron: P05.16

Stockdale, Susan: P06.17, P08.08

Stolaruk, Shannon: P02.12, P05.05

Stone, Jennifer: P08.13LB, P09.11

Stone, Katie: OA03.02

Storrow, Alan: OA03.01

Strigo, Irina: P05.29

Strong, Luci: P06.15

Stub, Trine: P12.05

Stuber, Kent: P14.04

Su, Lilly: P12.09

Su, Lilly: P12.03

Subramanian, Saumya: P03.12LB

Sullivan, Marlysa: P06.24LB

Summers, Riley: OA10.02, P14.18

SUN, Futongyu: P09.01

Sun, Wenjie: P03.06LB

Sun, yuting: P03.11LB

Surdam, Jessica: OA03.01, OA10.04, P05.06

Suri, Pradeep: P05.04, P13.07

Svitak, Aleta L.: P02.02

Swain, Michael: P04.14LB

Swann, Jonathan: P01.07LB

Swarup, Sanjay: P16.08

Swedlow, Pam: OA07.04, OA08.04

Syed, Aasia: P16.07

Szymanski, Rita: P16.17LB

T

Taber, Benjamin: P06.16

Taíra, Anderson: P05.10

Tan, Huangying: P02.15LB

Tangen, Christopher: P10.04

Tankha, Hallie: OA10.01, P05.28

Tansey, Ellie K.: P02.02

Tariq, Hamas: P18.01

Tatham, Lisa: P05.17

Taylor, Brent: OA01.04, P05.08

Taylor, Stephanie: OA01.04, OA05.01, OA11.04, P05.08, P08.08, P13.06, P14.08, P14.16

Taylor-Swanson, Lisa: OA13.01, P02.11

Teets, Raymond: OA03.02, P12.10LB, P12.13LB

Teh, Ruth: P16.10

Temple, Leslie Mendoza: OA06.02

Teo, Pei Si: P06.02

Tester, June: OA17.04

Tharwat Deraz, Nada: OA11.02

Thimmapuram, Jayaram: P16.01

Thomas, Holly: OA13.02, P05.01, P15.05, P18.07LB

Thompson, Cheryl: P02.08

Thompson-Lastad, Ariana: OA07.04, OA08.04, OA17.04, P17.07

Thrigulla, Saketh Ram: P08.09

Tieszen, Brad: P08.13LB

Tiwari, Diptika: OA16.02, P16.02, P16.03

Todorov, Irina: P11.04

Tong, Sebastian: P14.11

Torrens, Paige: P09.05

Toyama, Joy: OA11.04, P13.06

Trager, Robert: OA02.01, OA05.04, P04.02, P04.04, P04.05, P04.12LB, P09.17LB

Tran, Anthony: P02.12, P05.05

Tran, Vesna: OA18.02

Treadway, Anna: OA09.02

Treasure, Michelle: P02.08

Trichy, Nithya: P02.06

Trinquart, Ludovic: OA17.02

Tripathi, Pramod: OA16.02, P16.02, P16.03

Tripathy, Debu: P15.04

Troung, Anthony: P02.12, P05.05

Trudel, Sierra: P09.10

Truong, Amy: OA15.02, P14.20

Tsze, Daniel: P10.01

Tu, Karissa: P14.11

Turchin, Candice: OA07.04

U

Udoh, Eno-obong: P11.04

Ullah, Anika: P12.14LB

Umana, Jasmine: P08.12LB

Uy, Edyssa: OA15.02, P14.20

V

Vago, David: OA03.01

Vaidya, Ashok: P03.01

Vaidya, Rama: P03.01

Vaishampayan, Shailendra: P06.11

Vallone, Veronica: P16.11LB

Van Culin, Emily: P16.04

Van Iseghem, Theresa: P05.34LB

Vang, Mia: P14.23LB

Varjabedian, David: P03.14LB

Vasudev, Mithila: P05.42LB, P05.45

Veazey, Erica: P09.19LB

Vedelli, Jordan Kupono Holck: P05.44LB

Veldheer, Susan: P12.03

Veldheer, Susan: P12.09

Verma, Vivek: P05.46

Veronique, Nicolai: P16.01

Victorson, David: OA02.04, OA09.03, P02.13, P10.02, P13.03, P16.17LB, P18.06

Vincent, Ann: P06.08, P06.09, P16.14LB

Vincent, David: P14.12

Vining, Robert: OA04.04, P04.06, P06.05

Vinjamury, Prasad: P05.04, P11.01, P13.07

Visco, Ashley: P12.03, P12.09

Visser, Ellen: OA12.01

Visvanathan, Meena: P06.15

Visvanathan, Pallavi: P05.02, P05.07

Volsky, David: OA18.02

von Ammon, Klaus: P06.22LB

Vorderstrasse, Allison: OA16.04

Vranceanu, Ana-Maria: OA01.03, P05.03

Vu, Stephanie: P18.03

Vyawahare, Anagha Vyawahare: OA16.02, P16.02, P16.03

W

Waarsenburg, Elkana: OA16.03

Wagner, Richard: OA15.04, P16.11LB

Wakode, Santosh: P01.01, P01.02

Wallace, Robert: OA14.03, P04.01

Walsh, Dana: OA18.04

Walsh, Elizabeth: OA06.04

Walsh, Robert: P09.17LB

Walter, Eve: P12.13LB

Walter, Tina: OA15.01

Walters, Sarah: P16.16LB

Walters, Sheryl: P09.17LB

Wan, Yuxiang: P01.06LB, P01.11LB

Wang, Chenchen: OA04.02, OA17.02, P14.22LB

Wang, David: P02.07

Wang, David: P02.04

Wang, Hui: P01.06LB, P01.10LB, P01.11LB

Wang, Jiale: P03.05

Wang, Judy Huei-yu: P12.11LB

Wang, Qian-yun: P06.20LB, P15.06LB

Wang, Ting: P14.24LB

Wang, Xiaoqin: P03.13LB

Wang, Xingmei: P04.03

Wang, Xue-Feng: P07.03LB

Wang, Xue-Hui: P07.03LB

Wang, Yang: P01.08LB

Wang, Ying: P02.04

Warber, Sara: P10.05

Wasilition, Lyndsy: P08.02

Watanabe, Richard: P05.14

Wayne, Peter: P04.12LB, P06.05

Weaver, Caleb: P13.12

Wegman, Sankari: P18.05

Weigensberg, Marc: P05.14

Weinberg, Janice: P05.01, P18.07LB

Weiss, Anna: OA02.04

Weiss, Jocelyn M.: P14.10

Weiss, Roger: OA09.05

Wellman, Robert: OA03.02

Wells, Rebecca: P05.02, P05.07

Wengrovius, Carissa: P09.13

Wennik, Jesse: OA07.04, OA08.04

West, Erica: P08.12LB

Wester, Christianne: OA16.03

Westervelt, Karen: P08.01, P09.06, P09.08

Wexler, Ryan: OA17.02

Weydert, Joy: P09.07

Whipple, Mary: P16.14LB

Whitaker, Sarah: P05.16

Whitehead, Alison: P06.24LB

Whitley, Margaret: OA02.02, P12.08, P14.05, P14.19

Whitman, Susan: P09.06

Wieland, L. Susan: P09.11, P18.01

Wijeyakumar, Anusha: P05.21, P16.05

Wilborn, Briana: P17.07

Willcox, Merlin: P03.08LB

Williams, Chanda: P12.15LB, P17.07

Williams, David: P02.11

Williams, Marcus: OA10.02, P12.04, P15.03

Williams, Maya: OA07.02

Williams, Roshalda: P12.02

Wilson, Machelle: P13.08

Wineberg, Christine: OA06.03

Winnubst, Monica Elisabeth: P14.01

Winter, Emily: P09.10

Wirsching, Andreas: P14.09, P17.01

Wirth, Marissa: P08.08

Wolever, Ruth Q.: OA16.04, P14.10

Wolf, Ayla A.: P02.02

Wolfe-Modupe, Folashade: OA07.04

Wong, Danveshka: OA04.04

Wood, Susan: P09.05

Woodruff, Nicole: OA13.04

Woods, Ashlyn: P09.06

Wright, Aidan: OA01.01

Wright, Jessica: P06.08, P06.09

Wu, Amy: P05.19

Wu, Julia: OA07.04, OA08.04

Wu, Juliet: P14.03

Wu, Larry: P02.07

X

Xiao, Lan: OA17.04

Xie, Huisheng: OA18.01

Xiong, Feiyi: OA18.02

Xu, Chen: OA18.01

Xu, Gang: P05.09

Xu, Xiaoran: P09.01

Xue, Xue: P03.13LB, P06.20LB, P15.06LB

Y

Yadav, Siddhant: P06.08, P06.09

Yam, Scott: P06.04

Yang, DerShung: P16.17LB

Yang, Dingyue: P12.11LB

Yang, Donghua: P01.06LB

Yang, Haolin: P01.10LB, P01.11LB

Yang, Juan: P04.07

Yang, Nan: P03.10LB, P06.06LB

Yang, Peiying: P16.11LB

Yang, Qing: OA16.04

Yang, Wu-Hsun Tom: P14.11

Yang, Yong: P06.02

Ye, Xinglan: P03.13LB

Yeh, Gloria: P05.15

Yeh, Yuan-Chieh: P03.16LB

Yehshopa, Tenzin Chimi: P18.01

Yeung, Sai-ching: P16.11LB

Young, Morgan: P09.17LB

Yu, Jacqueline: P11.01

Yu, Wingyu: P03.02

Yuan, Jason: OA18.03, P05.27, P16.08

Yuan, Jun: P03.13LB

Yusipova, Yulia: P07.02

Z

Zabel, Samantha: P04.08

Zaccari, Belle: P05.39LB

Zaidi, Abdullah: OA09.04

Zanovelo Fogaça, Lissandra: P05.33, P17.02

Zappa, Melissa: OA13.01

Zawaydeh, Jordan: P05.43LB

Zborovsky, Dani: P16.15LB

Zeeman-Golden, Judy: P09.05

Zeliadt, Steven: OA05.01, OA07.01, OA11.04, OA12.02, P08.08, P13.06, P14.08

Zeng, Qing: P14.21LB

Zhang, Bingrui: P03.13LB

Zhang, Chunguang: P01.06LB

Zhang, Jianliang: OA18.01

Zhang, Weijun: OA17.02, P12.12LB, P12.14LB

Zhang, Xiao-wei: P03.08LB

Zhang, Xiaowen: P03.08LB

Zhang, Xiaoyi: OA11.04

Zhao, Fangfang: P03.13LB

Zhao, Jiayao: P01.05LB

Zhao, Wei: P01.06LB

Zhao, Xiwen: P04.10

Zhao, Yan: P06.02

Zhu, Jingru: P01.08LB

Zhu, Xiaolei: OA18.02

Zick, Suzie: P15.04

Ziegler, Anna-Marie: P09.17LB

Zimmerman, Benjamin: P01.09LB

Zolotov, Yuval: OA06.02

Zou, Kaixuan: OA18.01

Zou, Xinrong: P03.13LB

Zuckerman, Scott: P05.16