Complementary & Integrative Health

Research overview

Americans are increasingly using complementary and integrative medicine for pain and other health problems, according to national surveys. Researchers at Kaiser Permanente Washington Health Research Institute (KPWHRI) are using rigorous scientific methods to evaluate the effectiveness — including cost-effectiveness — of complementary and integrative therapies delivered in real-world practice.

Several KPWHRI studies concern musculoskeletal conditions such as back pain, which accounts for a large portion of visits to alternative providers. National guidelines for treating back pain now include 6 complementary and integrative approaches: 4 of them — acupuncture, massage, mindfulness, and yoga — on the strength of Kaiser Permanente research.

The stress-reducing aspects of some treatments may be more important than the physical ones. Also, complementary and integrative practitioners often approach their patients with optimism, offer suggestions for ways they can achieve more balance in their lives, and coach them on becoming more involved in their own healing and self-care. This has led to a project in implementation science in which KPWHRI researchers are learning to optimize mindfulness training to work for a greater number of patients. Qualitative research is an important component of this research and Associate Investigator Clarissa Hsu, PhD, has led these efforts for multiple projects.

Projects embedded in the delivery system are also a focus at KPWHRI. Large, multisite projects have included complementary and integrative health components. For example, a pragmatic trial carried out in Kaiser Permanente clinics in Georgia, Hawaii, Oregon, and Washington tested a primary care-based integrated behavioral health intervention that included a yoga-based adaptive movement component.

Recent publications on Complementary and Integrative Health

Innes KE, Selfe TK, Montgomery C, Hollingshead N, Huysmans Z, Srinivasan R, Wen S, Hausmann MJ, Sherman K, Klatt M. Effects of a 12-week yoga versus a 12-week educational film intervention on symptoms of restless legs syndrome and related outcomes: an exploratory randomized controlled trial. J Clin Sleep Med. 2020 Jan 15;16(1):107-119. doi: 10.5664/jcsm.8134. PubMed

Witt CM, Vertosick EA, Foster NE, Lewith G, Linde K, MacPherson H, Sherman KJ, Vickers AJ, Acupuncture Trialists’ Collaboration. The effect of patient characteristics on acupuncture treatment outcomes: an individual patient data meta-analysis of 20,827 chronic pain patients in randomized controlled trials. Clin J Pain. 2019 May;35(5):428-434. doi: 10.1097/AJP.0000000000000691. PubMed

Selfe TK, Wen S, Sherman K, Klatt M, Innes KE. Acceptability and feasibility of a 12-week yoga vs. educational film program for the management of restless legs syndrome (RLS): study protocol for a randomized controlled trial. Trials. 2019;20(1):134. doi: 10.1186/s13063-019-3217-7. PubMed

Becker WC, DeBar LL, Heapy AA, Higgins D, Krein SL, Lisi A, Makris UE, Allen KD. A research agenda for advancing non-pharmacological management of chronic musculoskeletal pain: findings from a VHA state-of-the-art conference. J Gen Intern Med. 2018 May;33(Suppl 1):11-15. doi: 10.1007/s11606-018-4345-6. PubMed

Kligler B, Bair MJ, Banerjea R, DeBar L, Ezeji-Okoye S, Lisi A, Murphy JL, Sandbrink F, Cherkin DC. Clinical policy recommendations from the VHA state-of-the-art conference on non-pharmacological approaches to chronic musculoskeletal pain. J Gen Intern Med. 2018 Apr 9. pii: 10.1007/s11606-018-4323-z. doi: 10.1007/s11606-018-4323-z. [Epub ahead of print]. PubMed