Integrative Health Care for Veterans - PowerPoint Presentation

Slide1

Integrative Health Care for Veterans

War Related Illness and Injury Study Center

Washington, DCSlide2

Welcome

Acupuncture Presenter

Jeanette Akhter, MD,

MAc,Licensed AcupuncturistJeanette.Akhter@va.gov

Integrative Health Care PresenterKelly McCoy, PsyDKelly.McCoy2@va.gov

Labyrinth PresenterBrenda Jasper, MEd, PA-CNational Referral Program CoordinatorBrenda.Jasper@va.gov

Yoga Presenter

Louise

Mahoney

, MS

Louise.Mahoney2@va.govSlide3
Slide4

What is Integrative Health Care?

New and growing approach to health care delivery

Broader in focus than conventional care

Coordinated health careExplicitly combines conventional and complementary approaches

Complementary and alternative medicine (CAM): “A group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.” – NCCAM definition http://nccam.nih.gov/health/whatiscam/#definingcamSlide5

Philosophy of Integrative Health Care

Mind, body, spirit, community

Tradition and innovation

Healing extends beyond cureTailored toward patient goals

Shared responsibilitySlide6

Qualities of Integrative Health Care

Holistic, broad scope

Scientifically-rigorous

Values wisdomMotivationalPatient-centeredPrevention and treatment

InterdisciplinaryHealing environments and relationshipsCross-trained providersIncorporates mind-body skillsSlide7

Who can benefit?

Individuals managing chronic illnesses

People facing acute health and life events

Individuals who want to optimize wellnessSlide8

Integrative Health Care for VeteransSlide9

The WRIISC and Post-Deployment Health Care

War Related Illness and Injury Study Center

VA Office of Public Health and Environmental Hazards

Clinical care, research, education, risk communicationNational referral programOutpatient programs (DC, NJ, CA)

Identified need for coordinated treatment approachesSlide10

Acupuncture Satisfaction Data

2010 t

otal encounters649 individual full body890 group ear acupunctureImprovement in symptoms

(n = 103) 45% yes, completely51% yes, somewhat3% no improvement<1% too early to tell

Overall quality (n = 112)70% excellent20% very good10% good<1% poor

Would recommend to other Veterans (n = 130)99% yes<1% noSlide11

Acupuncture Satisfaction Data

N = 102

Yes, Completely

Yes, SomewhatNo

Don’t Have This ProblemBack Pain22%57%

13%7%Musculoskeletal Pain25%64%5%6%Headaches

28%47%

6%19%Upset Stomach

15%22%

26%37%

Constipation/Diarrhea

8%

16%

20%

55%

Trouble Sleeping

26%

51%

18%

5%

Energy Level

32%

53%

11%

4%

Irritability/Angry Outbursts

27%

42%

18%

13%

Concentration

18%

55%

18%

10%

Depression

16%

57%

18%

8%

Anxiety

18%

61%

18%

3%

Jumpy/Easily Startled

19%

56%

18%

7%

Disturbing Memories

18%

46%

28%

8%Slide12

iRest® Yoga

Nidra

Satisfaction Data 2010 total encounters1,318 sessions

Improvement in symptoms (n = 165)10% yes, completely85% yes, somewhat4% no improvement<1% don’t have symptoms

Overall quality (n = 184)66% excellent30% very good1% good2% poorWould recommend to other Veterans (n = 184)

100% yesSlide13

Yoga Nidra

Satisfaction Data

N = 164

Yes, CompletelyYes, Somewhat

NoDon’t Have This ProblemBack Pain8%

64%19%9%Musculoskeletal Pain8%68%11%13%

Headaches10%41%

16%33%

Upset Stomach4%

18%26%

51%

Constipation/Diarrhea

4%

19%

15%

62%

Trouble Sleeping

9%

72%

13%

6%

Energy Level

12%

72%

12%

4%

Irritability/Angry Outbursts

14%

55%

16%

14%

Concentration

10%

55%

20%

15%

Depression

12%

52%

25%

11%

Anxiety

12%

66%

17%

5%

Jumpy/Easily Startled

9%

52%

22%

17%

Disturbing Memories

13%

45%

26%

16%Slide14

Labyrinth Satisfaction Data

2010 total visits

481

How was your walk on the Freedom Labyrinth Path? (n = 227)50% excellent42% very good

7% fair<1% no valueWould you walk the labyrinth again? (n = 227)

99% yes<1% noDescriptions of the labyrinth: Calming, relaxing, serene, awesome, soothing, wonderful, excellent, mellow, balanced, peaceful, meditative, rejuvenating,

surprising, inspirational, therapeutic, centering, uplifting, helpful,

purposeful, anchoring, euphoric Slide15

Yoga with Movement

Chair yoga

Mat yoga (mixed gender)

Mat yoga (women only)Satisfaction data collected following completion of 12 weekly sessions of either chair or mat yoga

Would you recommend WRIISC yoga to a friend ?

(n = 11)100% yesDo you feel better after class than before? (n = 13)100 % yesWould you participate in WRIISC yoga again? (n = 12)100% yesSlide16

Yoga with Movement Feedback

“It is one thing I look forward to because for that short amount of time I have hope”

–

Operation Iraqi Freedom Veteran“Best thing in years”

– Korean War Veteran“Wonderful for body and soul” – Gulf War I Veteran

“Great class, should meet 2x per week” – Vietnam War Veteran”Slide17

Integrative Health Care Research at the WRIISC

Yoga and Mind/Body Therapies for Treatment of War Related Illness and Injuries

PI: Louise Mahoney, MS, WRIISC-CA

The Effect of Acupuncture for PTSD-Related Insomnia PI: Michelle Prisco, MSN, ANP-C, WRIISC-DCResults anticipated May-June 2012Slide18

Integrative Health Care Research at the WRIISC

Qigong for Symptom Management and Function in Veterans with Fatiguing Illnesses

PI: Anna Rusiewicz, PhD, WRIISC-NJ

Results anticipated September 2012Acupuncture to Improve the Quality of Life in Veterans with TBI and PTSDPI: Anna Rusiewicz, PhD & Thomas Findley, MD PhD, WRIISC-NJ

Results anticipated January 2012Slide19

Integrative Modalities Throughout the VHA System

Acupuncture

Aquatic bodywork

Aromatherapy

Biofeedback

Deep-breathing exercisesGuided imagery

HypnotherapyLabyrinth

Laughter yoga

Mindfulness meditation

Massage

Progressive relaxation

Tai Chi

Qigong

Reiki

Spinal manipulation

Structural integration

Tai Chi

Therapeutic touch

Yoga with movement

Yoga

NidraSlide20

VA Integrative Health

Clinic and Program

Salt Lake City, UT VAMC

AcupunctureAquatic bodyworkStress management class: guided imagery, relaxation techniques, biofeedback, qigong, awareness and reframing of thought patterns

Medical hypnosisYoga with movementHerbal/nutritional supplement/drug interaction education

MeditationQigongTobacco cessationWeight management class: nutrition, exercise, psychotherapy, hypnosis Slide21

VA Integrative Health Clinic - Research

Chronic nonmalignant pain

Longitudinal outcome research

Chronic nonspinal-related pain group vs. chronic spinal-related pain group

Nonspinal pain group: Improved depression, anxiety, bodily pain, vitality and health transitionBenefits persisted to 24 monthsSpinal-related pain group: trend toward improvement in bodily pain Smeeding, S. J. W., Bradshaw, D. H., Kumpfer, K. L., Trevithick, S. & Stoddard, G. J. (2011). Outcome evaluation of the Veterans Affairs Salt Late City Integrative Health Clinic for chronic nonmalignant pain.

The Clinical Journal of Pain, 27, 146-155. Slide22

VA Integrative Health Clinic - Research

Depression, anxiety, and posttraumatic stress disorder

Longitudinal outcome research

Group comparisons based on levels of anxiety, depression, and PTSD symptoms

Improved depression, anxiety and health-related quality of life in all groupsGreatest improvements seen in the high anxiety, high depression, and PTSD groups

Smeeding, S. J. W., Bradshaw, D. H., Kumpfer, K., Trevithick, S., & Stoddard, G. J. (2010). Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for chronic pain and stress-related depression, anxiety, and post-traumatic stress disorder. The Journal of Alternative and Complementary Medicine,16, 823-835. Slide23

AcupunctureSlide24

(acupuncture video 1)Slide25

Acupuncture is Over Three Thousand

Years Old

Acupuncture’s greatest contribution to the field medicine is its understanding of

qi –translated as life force, or energy.

Qi helps us maintain health. It provides the power for:GrowthDevelopmentMovementMaintaining body temperatureProtection against illnessOverall regulationSlide26

When our

Qi

is

balanced, our capacity to both heal disease and prevent future

illness is maximized. Our health is

influenced by the quality, quantity and balance of our Qi.

Symptoms of illness, whether mental, emotional or physical, are an indication of an imbalance of

Qi.

Qi

is Our Life ForceSlide27

Qi Imbalance

Qi

depletion, obstruction, disorganization

Causes of imbalanceInjury Illness Environmental exposurePoor quality nourishmentLack of physical exerciseSlide28

Rest and digest

Daytime, summer

Nighttime, winter

Awake and alert

YANG/Sympathetic Arousal

YIN/Parasympathetic Restoration

Inhale

Exhale

Balance is a constantly changing state. It exists in a dynamic and fluid interplay between our more substantial, dense

yin

aspect, and our more insubstantial, active

yang aspect.

Qi

Moves with a Rhythm, Inside a BoundarySlide29

Acupuncture heals below cognition

It helps people feel more embodied, more present, more self aware

12 main pathways – connected end to end like garden hoses

Acupuncture Helps Restore BalanceSlide30
Slide31

How Does Acupuncture Work?

Local effect

Mechanical stimulation of connective tissue

Adenosine releaseIncrease local blood flow“Gate” mechanismSlide32

How does Acupuncture Work?

Increases release and binding of endogenous

opioids

Basal forebrainLimbic systemBrainstemfMRI studiesPositron emission tomography studiesSlide33
Slide34
Slide35

Goals of Acupuncture

Unique - focused on individual Veteran’s needs

Physical

MentalEmotionalSpiritualSlide36

Method

Ask

Listen

ObservePalpateChoose specific pointsObserve resultsSlide37

Washington, DC WRIISC Acupuncture Options

Full body, individual series of treatments

Unique design for the individual’s presentationSlide38

DC Acupuncture Options

Group Ear Acupuncture

Five points on each ear

Balance of sympathetic/parasympathetic nervous systems as well as emotional balanceCan be used for detoxificationOften affects sleep patternsMultiple venues at DC WRIISCSlide39
Slide40

Acupuncture Interest at WRIISC-DC

Year 2010

649 full body acupuncture treatments

145 Gulf War Veteran treatments890 ear acupuncture treatments103 Gulf War Veteran treatmentsSlide41

Acupuncture and Integrative Health Care

Acupuncture can help:

Improve focus and attention, supporting psychotherapy clients to integrate and embody insights

Bring energy to physical injuries, supporting the work of physical therapists

Mitigate side effects of necessary medications

Help some reduce medications – for sleep or pain for exampleSlide42

Acupuncture helps

the mind find a place to rest,

the body release trauma's imprint and

the spirit come back home – safe and sound.

Acupuncture Helps Veterans Get All The Way Home - Safe and SoundSlide43

Berman, B. M.,

Langevin

, H. M., Witt, C. M.,

Dubner, R. (2010). Acupuncture for chronic low back pain

. New England Journal of Medicine, 363, 454-461. http://www.ncbi.nlm.nih.gov/pubmed/20818865

Birch, S., Hesselinm, J. K., Jonkman, F. A., &

Hekker, T. A. (2004). Clinical Research on Acupuncture: Part I. What have Reviews of the Efficacy and Safety of Acupuncture told us so far?

The Journal of Alternative and Complementary Medicine, 10.http://www.ncbi.nlm.nih.gov/pubmed?term=birch%202004%20clinical%20research%20on%20acupuncture%20part%201

Blitzer, L., Atchison-

Nevel

, D., & Kenny, M. (2004). Using acupuncture to treat

major depressive disorder:

a pilot investigation. Clinical Acupuncture and Oriental Medicine, 4, 144-147.

Chen HY, Shi Y, Ng CS, Chan SM, Yung KK, Zhang QL. Auricular acupuncture treatment for

insomnia

: A systematic review. J

Altern

Complement Med 2007; 13(6): 669-76.

http://www.ncbi.nlm.nih.gov/pubmed/17718650

Duncan A,

Liechty

JM, Miller C,

Chinoy

G,

Ricardi

, R. Employee use and perceived benefit of a CAM

wellness clinic

at a major military hospital: Evaluation of a pilot program. J

Altern

Complement Med. In Press.

Eich

, H.,

Agelink

, M.W., Lehmann, E.,

Lemmer

, W., &

Klieser

, E. (2000). Acupuncture in patients with

minor depressive episodes and generalized anxiety disorders

: Results of an experimental study.

Fortsch

Neurol

Psychiatrie

, 68, 137-144.

http://www.ncbi.nlm.nih.gov/pubmed?term=eich%202000%20acupuncture%20in%20patients%20with%20minor%20depression

Acupuncture Research – Selected BibliographySlide44

Goertz CM, Niemtzow R, Burns SM, Fritts MJ, Crawford CC, Jonas WB. Auricular acupuncture in the treatment of

acute pain syndromes:

A pilot study. Mil Med 2006; 171(10): 1010-4.

http://www.ncbi.nlm.nih.gov/pubmed/17076456

Haker, E., Egekvist, H., & Bjerring, P. (2000). Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. J Auton.Nerv.Syst., 79, 52-59.http://www.ncbi.nlm.nih.gov/pubmed?term=2000%20haker%20effect%20of%20acupuncture%20on%20healthy%20subjects

Hicks J, Hicks A, Mole P. Five element constitutional acupuncture. Edinburough: Elsevier, 2004.http://www.worldcat.org/title/five-element-constitutional-acupuncture/oclc/56011386&referer=brief_results

Hollifield, M., Sinclair-Lian, N., Warner, T. D., & Hammerschlag, R. (2007). Acupuncture for

Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial. J Nerv.Ment.Dis., 195, 504-513.

http://www.ncbi.nlm.nih.gov/pubmed?term=hollifield%20acupuncture%20for%20posttraumatic%20stress

Hui, K. K., Liu, J., Makris, N., Gollub, R. L., Chen, A. J., Moore, C. I. et al. (2000). Acupuncture modulates the

limbic system and subcortical gray structures

of the human brain: evidence from fMRI studies in normal subjects. Hum.Brain Mapp., 9, 13-25.

http://www.ncbi.nlm.nih.gov/pubmed/10643726

Acupuncture Research – Selected Bibliography (continued)Slide45

Kaptchuck

TJ.

The web that has no weaver: Understanding Chinese medicine,

2 ed. N.Y.: McGraw-Hill, 2000.Kim KB,

Sok SR. Auricular acupuncture for insomnia: Duration and effects in Korean older adults. J

Gerontol Nurs 2007; 33(8): 23-8; quiz 30-1.http://www.ncbi.nlm.nih.gov/pubmed/17718375Leo, R. J. &

Ligot, J. S., Jr. (2007). A systematic review of randomized controlled trials of acupuncture in the treatment of

depression. J Affect.Disord

., 97, 13-22. http://www.ncbi.nlm.nih.gov/pubmed?term=leo%202007%20acupuncture%20in%20the%20treatment%20of%20depression

Napadow

, V.,

Makris

, N., Liu, J.,

Kettner

, N. W.,

Kwong

, K. K., &

Hui

, K. K. (2005). Effects of

electroacupuncture

versus manual acupuncture

on the human brain as measured by

fMRI

.

Hum.Brain

Mapp

., 24, 193-205.

http://www.ncbi.nlm.nih.gov/pubmed?term=2005%20electroacupuncture%20versus%20manual%20acupuncture

Pilkington K, Kirkwood G,

Rampes

H, Cummings M, Richardson J. Acupuncture for

anxiety and anxiety disorders-

-a systematic literature review.

Acupunct

Med 2007; 25(1-2): 1-10.

http://www.ncbi.nlm.nih.gov/pubmed?term=2007%20pilkington%20acupuncture%20for%20anxiety

Acupuncture Research – Selected Bibliography (continued)Slide46

Plank S,

Goodard

J. The effectiveness of acupuncture for

chronic daily headache: An outcomes study. Mil Med 2009; 174(12): 1276-81.http://www.ncbi.nlm.nih.gov/pubmed/20055068

Sjoling M, Rolleri

M, Englund E. Auricular acupuncture versus sham acupuncture in the treatment of women who have insomnia. J Altern Complement Med 2008; 14(1): 39-46.http://www.ncbi.nlm.nih.gov/pubmed?term=2008%20sjoling%20acupuncture%20in%20women%20who%20have%20insomnia

Spence, D. W.,

Kayumov

, L., Chen, A., Lowe, A., Jain, U., Katzman, M. A. et al. (2004). Acupuncture increases

nocturnal melatonin secretion

and reduces

insomnia and anxiety:

a preliminary report. J Neuropsychiatry

Clin

Neurosci

., 16, 19-28.

http://www.ncbi.nlm.nih.gov/pubmed?term=2004%20spence%20acupuncture

Spira

A. Acupuncture: A useful tool for health care in an

operational medicine

environment. Mil Med 2008; 173(7): 629-34.

http://www.ncbi.nlm.nih.gov/pubmed?term=2008%20spira%20acupuncture

Van

Tulder

, M. W.,

Furlan

, A. D., &

Gagnier

, J. J. (2005). Complementary and alternative therapies for

low back pain

.

Best.Pract.Res

Clin

Rheumatol

., 19, 639-654.

http://www.ncbi.nlm.nih.gov/pubmed/15949781

Acupuncture Research – Selected Bibliography (continued)Slide47

(acupuncture video 2)Slide48

Yoga NidraSlide49

(yoga

nidra

video 1)Slide50

(yoga

nidra

video 2)Slide51

LabyrinthSlide52

(labyrinth video)Slide53

Labyrinth – Brief History

> 4,000 year history

Found in many cultures and religious traditions

Now used in health care facilities, schools, and houses of worship worldwide

Labyrinth from the Atlantic Bronze Age, Galicia (Spain)

Labyrinth carving at a temple in Halebid, India, circa 2500 BCSlide54

Labyrinth - Research

Walking meditation is shown to reduce anxiety and elicit a 'relaxation response’ associated with:

lower blood pressure and breathing rates

reduced incidents of chronic pain and insomniaAlso associated with many of the benefits seen in sitting meditation and yoga

Benson, H., "The relaxation response: therapeutic effect," Science. 1997 Dec 5;278(5344):1694-5. PMID: 9411784 Slide55

Labyrinths at VA

Veterans, staff, and volunteers can walk a labyrinth at:

Albany VAMC

Canandaigua VAMCSeattle VAMCMemphis VAMC

Washington, DC VAMCSlide56

Labyrinth Resources

Labyrinth Society

http://www.labyrinthsociety.org/

Worldwide Labyrinth Locatorhttp://labyrinthlocator.com/Slide57

Labyrinth - Practice

Not like a maze: no dead ends

Pace is up to you

Opportunity to slow down, relax, relieve stress, reflect, meditate

9/11 Memorial Labyrinth at Boston CollegeSlide58

Reasons for Walking the Labyrinth

To relax

To express intent

For physical healingAs a pilgrimageTo meditateTo ask a questionFor emotional healingTo ease griefFor inspirationTo pray

For ceremony or ritualJust for fun!Slide59

Benefits of Walking the Labyrinth

Decreases stress

Helps reconnect physical, emotional, and spiritual wellbeing

Provides opportunity for personal spaceOffers strength and hopeSlide60

Stages of Walking the Labyrinth

Releasing

Receiving

Renewal

Chartres Cathedral labyrinth in Nature’s First Pattern by Gilchrist, 1996http://www.charlesgilchrist.com/SGEO/Gal902.htmlSlide61

Preparation for Walking

Wait until there is enough room for you

Remove shoes or cover them

Quiet your mouth and body to promote a peaceful ambianceBreathe deeply, center yourself, and put other things out of your mindIf you wish, invoke the presence of a higher force for guidancePause at the entrance to bow or in some way acknowledge the labyrinthSlide62

Walking the Labyrinth

Walk at your own pace

There may be two-way traffic, cooperate

It is okay to pass others or be passedBring awareness to your experience, your body, your thoughts, and your feelingsPause in the center if you wish to meditate thereReturn by the same path you entered or, if you choose, walk directly outUpon exiting, turn and again acknowledge the labyrinthSlide63

After Leaving the Labyrinth

Continue to be aware of your labyrinth experience, even into the next day

Take a moment to sit quietly and reflect on your walk

You may wish to journal or draw to express your experienceThank yourself for the gift you have given yourselfWalk the labyrinth again, as many times as you wishUse a finger labyrinth to relax anywhereSlide64

Life is walking a labyrinth,

I cannot always know which way I will turn,

or even see far ahead, but there are no tricks.

It is not a maze, no chance of getting lost,trust in the path that has been laid for meor in the path that I have chosen.

Walk it in trust, stop when a break is necessary,and know that the center is always there. - Elizabeth H. WigginsSlide65

Yoga for VeteransSlide66

If you can breathe…..

you can do yogaSlide67

What is Yoga?

Developed from ancient East Indian religious practice

Word derived from Sanskrit root “

yuj” meaning to bindGenerally conceptualized as union of mind, body, and spiritPhilosophy outlined in the Yoga Sutras attributed to Patanjali in the 2nd century BCE

Goal of practicing yoga is to end sufferingSlide68

8 Limbs of Yoga

Yama

– moral commandments

Niyama – disciplineĀsana – postures (what most call “Yoga” in the United States – also termed “

Hatha” yoga)Pranayama – control or expansion of breath Pratyahara – freedom from domination of the senses and external objects

Dharana – concentrationDhyana – meditationSamadhi – super-consciousnessSlide69

Physical Practice of Yoga (Asana)

Most yoga we practiced today in US based on teachings of

Krishnamacharya

(November 18, 1888 – November 3, 1989)Developed active form of yoga (Ashtanga) Also practitioner of Ayurvedic medicineFather of

T.K.V. Desikachar Teacher of Iyengar (Iyengar - introduced use of props – philosteach people at any level)T.K.V Desikachar Yoga practice is adapted to fit the individual and particular situation of each student – a therapeutic approach – called it Viniyoga initiallyMentor of

Richard Miller, developer of iRestSlide70

Western Yoga

Most Yoga postures practiced today in the west developed around the turn of the 20

th

centuryInfluenced by British Physical culture – gymnastics – brought to Indian palaces during colonizationSlide71

Do we need Research on Yoga and Veterans?

PubMed search of “Yoga”

>1500 published articles

PubMed search of “Yoga” and “Veteran”19 published articles – only 2 used Veterans as subjectsThe effectiveness of Yoga to help reduce chronic low back pain (Groessl, 2008)Yoga as physical fitness in a Veteran nursing home (Hamilton-Word V, 1982)Slide72

Evidence for Yoga as Therapy

Study

Target

Population

Sample SizeResultsGroessl et al, 2008Low back pain

Veterans33Significantly less: Pain, Depression, FatigueSherman et al, 2005Chronic low back painCivilian Adults

101Both exercise and yoga reduced pain, yoga superior in medication use reduction

Da Silva et al, 2007Fibromyalgia

Civilian females33

RY & RYT improve FIQ scores & reduce VAS scores – RY continued to provide benefit after study

Vera et al, 2009

Sleep and HPA

axis

Healthy yoga

practioners

& controls

26

Long term yoga

practice improves SSQ, increase in

cortosol

Pal et al, 2009

Autonomic

funcition

Healthy volunteers

60

Practice of slow breathing for 3 months improves

autonomic function, fast breathing does notSlide73

Reviews

Literature Review

Target

ResultsYang, (review of 32 articles

Chronic diseases Weight loss, lower BP, lower blood glucose, lower cholesterolKirkwood et al, (2005)review of 8 studiesAnxiety

Positive but inconclusive resultsChou & Huffman, (2007)Chronic low back painSmall advantage of yoga over exercise in some but benefits of yoga last longer than benefits of yogaSlide74

Summary of Benefits

Reduced back pain

Lowered stress

Increased functional abilityImproved sleepIncreased cardiovascular healthLower cholesterolDecrease general pain such as experienced in fibromyalgiaImproved autonomic functionSlide75

Possible Mechanisms of Action

?

Improve structural/postural alignment

Improve muscle tone and flexibilityEnhance function and regulation of autonomic nervous system and re-setting of chronic pain responseModulation of hormonesSlide76
Slide77

WRIISC-CA Yoga

January, 2010 – Program start

Mat classes – meet once/week

Mixed gender mat classWomen only mat classJuly 2010, Chair yoga class added 62 referrals to WRIISC yoga through CPRS consult38 have attended at least onceSlide78

WRIISC-CA Yoga (cont’d)

Mixed gender mat class

20 referrals, 18 have attended at least once

4 have completed post 12 week assessmentsWomen only mat class24 referrals, 9 have attended at least once, 3 have completed at least 12 weeksChair yoga15 referral, 13 have attended at least one session6 have completed at least 12 week Slide79

Barriers to Attendance?

Location not convenient

No transportation

No childcareConflicts with work scheduleClass held during high traffic commute timeNot psychiatrically or medically stableSlide80

Pilot Results, n=13

Feasibility – Will Veterans participate in yoga?

Yes, if it is convenient and consistent

SF-12 – Health and Well-BeingIncrease in energy – most significantTrend toward improvement in most others areas except depressionMcGill Pain Short FormDecrease in pain intensity Slide81

Results (cont’d)

PTSD Checklist (PCL-M)

Small trend downward

Flanders Fatigue ScaleSmall trend upwardYoga Satisfaction Questionnaire Slide82

Yoga Satisfaction – n=12

Yoga class quality: 5 item scale from poor to excellent:

All answered either “Excellent” or “Very Good”

Do you feel better after class than you did before? All answered “Yes” Would you participate in WRIISC yoga again?All answered “Yes”Would you recommend WRIISC yoga to a friend?All answered “Yes”Have your symptoms improved?3 answered “Yes, completely”

6 answered “Yes, somewhat”Slide83

Veteran Comments

“It is one thing I look forward to because for that short amount of time I have hope”

–

Female Operation Iraqi Freedom Veteran“Best thing in years”

– Male Korean War Veteran“Wonderful for body and soul” –Female Gulf War I Veteran

“Great class, should meet 2x per week” – Male Vietnam War Veteran” Slide84

Other Benefits

Provides opportunity for Veterans to bond with other Veterans in a positive space

Relief from social isolation cause by the illness

Sense of belonging to a groupLets Veterans know that the VA cares about themSlide85

NamasteSlide86

Application of Integrative Health CareSlide87

Factors to Consider

Does this approach fit with treatment goals?

Risks and benefits

Contraindications, modificationsResearch findingsLevel B evidence base or higherVeteran’s self-report

Provider qualificationsCoordination among care providersExpense and availabilitySlide88

Integrative Health in the VA System of Care

VA Office of Patient Centered Care and Cultural Transformation

Post-Deployment Integrated Care Initiative (PDICI)

PlanetreePolytrauma Service, Recreational Therapy

James A. Haley VA Chronic Pain Rehabilitation ProgramTraining standards & occupational codesSlide89

Resources

National Center for Complementary and Alternative Medicine at the National Institutes of Health

http://nccam.nih.gov/

White House Commission on Complementary and Alternative Medicine Policy http://www.whccamp.hhs.gov/Consortium of Academic Health Centers for Integrative Medicine

http://www.imconsortium.org/Slide90

VA Resources

VA

Listservs

Acupuncture Listserv, Integrative Health Care ListservVA employees may email Dr. Elizabeth Hakas to join (Elizabeth.Hakas@va.gov)Integrative health care in the VHAHCS: www.warrelatedillness.va.gov/WARRELATEDILLNESS/education/conferences/2010-sept/slides/2010_09_15_SmeedingSJW_Developing-an-Integrative.ppt

Washington, DC WRIISC: www.warrelatedillness.va.gov/dc/Clinical/cam-main.aspPalo Alto, CA WRIISC: www.warrelatedillness.va.gov/paloalto/cam.asp

East Orange, NJ WRIISC: http://vaww.newjersey.med.va.gov/planetree/complementarytherapies.htmlPlanetree: http://www.planetree.org/about.htmlSlide91

Free for Veterans

Acupuncturists Without Borders Military Stress Recovery Clinics

http://www.acuwithoutborders.org/msrpclinics.php

List of clinics nationwide that offer free acupuncture for VeteransYoga for Vets

http://www.yogaforvets.org/List of yoga studios nationwide that offer at least 4 free yoga classes for VeteransLabyrinth Society http://www.labyrinthsociety.org/

Worldwide Labyrinth Locator http://labyrinthlocator.com/Slide92

Thank you

Veterans

Bonnie Benetato, Jeanette Akhter, Cory Jecmen, Kathryn Berndtson, Alyssa Adams, Thomas Nassif, Michelle Prisco, Antoinette Lomax, Adrian Johnson, Jacqueline Cherry, Mary Lewis, Becca Handel, Susan Santos, Ron Teichman, Louise Mahoney, Florence Chau, Rita Torres, Melissa Blatt, Anna Rusiewicz, Connie Singleton, Leslie Hurd, Stephen

Ezeji-Okoye, Sandra Smeeding, An-Fu Hsiao, Stephen Hunt, Matthew Reinhard, Gudrun Lange, Wes Ashford, Michael Peterson, VA Office of Public Health and Environmental Hazards