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Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach

Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach Edited by J. E. Deutsch and E. Z. Anderson 352 pp, $54.95 St Louis, MO, Saunders/Elsevier, 2008 ISBN-13: 978-0-7216-0111-3 According to data from the 2002 National Health Interview Survey, “36% of U.S. adults aged 18 years and over use some form of complementary and alternative medicine (CAM).”1 This value increases to 62% when prayer is added to the category of CAM.1 Furthermore, this survey revealed varied reasons why adults were using CAM, including “they believed that it would help them when combined with conventional medical treatments”; “thought CAM would be interesting to try”; “because a conventional medical professional suggested they try it”; and “because they felt that conventional medicine was too expensive.”1 In another survey on CAM use and patient perceptions, between 63% to 72% of adults who both saw a physician and concurrently used a CAM protocol reported that they “did not disclose at least one type of CAM therapy to their medical doctor.”2 It is clear from the reported prevalence of CAM use that conventional health care practitioners need to be more informed about CAM and ready to discuss and advise clients on the use of these practices. Although written primarily for physical therapists, Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach, by Judith E. Deutsch and Ellen Zambo Anderson, offers such an opportunity. The organization of the book is based on the classification system developed by the National Center for Complementary and Alternative Medicine, which is 1 of 27 institutes and centers that make up the National Institutes of Health.3 This classification system includes 4 primary domains: mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine, as well as a fifth category, whole medical systems, which is derived from the overlap of the 4 domains. Separate chapters provide background information on each of these categories. The authors make it clear that their intent is to provide only a brief introduction to each therapy or medical practice in these chapters. A thorough list of recommended readings for more in-depth information is routinely provided. Each of these background chapters is followed by chapters that use a case-based approach to explore the potential integration of a specific CAM therapy (such as acupuncture), other body therapies, or dietary supplements, into a conventional treatment plan. An evidence-based practice approach is used to evaluate the strength of the research on CAM and its efficacy and safety for the patient. The book is helpful in taking the reader through a step-by-step process of performing both comprehensive and targeted on-line literature searches for mechanistic as well as outcome research. Specific search databases and keyword strategies are provided in each of these chapters, and a summary of the search results is typically provided in both table and discussion formats. The reader is subsequently taken through the chapter's evaluation of the literature and the clinical decision-making process, which is directed toward integration of CAM or referral to a CAM practitioner. The authors used a variety of contributors with varied backgrounds in both conventional and alternative medicine regimens. One might fear that the authors of a chapter would exhibit a bias in the interpretation of the evidence for CAM, particularly if they were trained in that particular modality. For the most part, however, this bias is absent in the presentation for each particular therapy and in the preliminary review of the literature. It is clear that cases were selected to demonstrate where some preliminary evidence might support the use of CAM with the condition and issues described in each case. Thus, despite what appeared to be weak evidence for the efficacious use of CAM in a few of the cases, each author always elected to use CAM anyway. Practitioners of conventional medicine who are skeptical of CAM may be surprised to learn the amount of available research evidence that does provide some justification and support for the use of most CAM therapies, depending in part on the type of medical condition. These do not include just review articles and case studies but also meta-analyses and randomized clinical trials. The step-by-step approach to evidenced-based practice literature searches and the evaluation used in each of these chapters are helpful to those who are new to evidence-based practice. The recommendations of search terms and search strategies are exceptionally useful and worthwhile to anyone who wishes to conduct their own comprehensive or targeted reviews. In this book, Deutsch and Anderson have been successful in introducing the reader to a comprehensive variety of CAM therapies that are within the domains described by the National Center for Complementary and Alternative Medicine. Despite some biases that are evident in the clinical decision-making process within the case-based chapters, the authors remain objective and evidence-based in most of their writing. This book was easy to read and quite informative as a basic textbook. The authors are to be commended for tackling this topic in the midst of widespread skepticism in conventional medicine for the implementation of CAM. Health practitioners can no longer turn a blind eye to the fact that a large percentage of their patients are using nonconventional and alternative therapies—often without their knowledge. Now is the time to explore CAM use by patients and to engage in an informed clinical decision-making process and patient-practitioner dialogue in clinical practice. Back to top Article Information Financial Disclosures: None reported. References 1. Complementary and alternative medicine use among adults: United States, 2002. National Center for Health Statistics Web site. http://www.cdc.gov/nchs/pressroom/04news/adultsmedicine.htm. Accessibility verified June 3, 2008 2. Eisenberg DM, Kessler RC, Van Rompay MI, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med. 2001;135(5):344-35111529698PubMedGoogle ScholarCrossref 3. What is CAM? National Center for Complementary and Alternative Medicine Web site. http://nccam.nih.gov/health/whatiscam/. Accessibility verified June 3, 2008 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach

John, Demetra
JAMA , Volume 299 (24) – Jun 25, 2008
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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.299.24.2902
Publisher site
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Abstract

Edited by J. E. Deutsch and E. Z. Anderson 352 pp, $54.95 St Louis, MO, Saunders/Elsevier, 2008 ISBN-13: 978-0-7216-0111-3 According to data from the 2002 National Health Interview Survey, “36% of U.S. adults aged 18 years and over use some form of complementary and alternative medicine (CAM).”1 This value increases to 62% when prayer is added to the category of CAM.1 Furthermore, this survey revealed varied reasons why adults were using CAM, including “they believed that it would help them when combined with conventional medical treatments”; “thought CAM would be interesting to try”; “because a conventional medical professional suggested they try it”; and “because they felt that conventional medicine was too expensive.”1 In another survey on CAM use and patient perceptions, between 63% to 72% of adults who both saw a physician and concurrently used a CAM protocol reported that they “did not disclose at least one type of CAM therapy to their medical doctor.”2 It is clear from the reported prevalence of CAM use that conventional health care practitioners need to be more informed about CAM and ready to discuss and advise clients on the use of these practices. Although written primarily for physical therapists, Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach, by Judith E. Deutsch and Ellen Zambo Anderson, offers such an opportunity. The organization of the book is based on the classification system developed by the National Center for Complementary and Alternative Medicine, which is 1 of 27 institutes and centers that make up the National Institutes of Health.3 This classification system includes 4 primary domains: mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine, as well as a fifth category, whole medical systems, which is derived from the overlap of the 4 domains. Separate chapters provide background information on each of these categories. The authors make it clear that their intent is to provide only a brief introduction to each therapy or medical practice in these chapters. A thorough list of recommended readings for more in-depth information is routinely provided. Each of these background chapters is followed by chapters that use a case-based approach to explore the potential integration of a specific CAM therapy (such as acupuncture), other body therapies, or dietary supplements, into a conventional treatment plan. An evidence-based practice approach is used to evaluate the strength of the research on CAM and its efficacy and safety for the patient. The book is helpful in taking the reader through a step-by-step process of performing both comprehensive and targeted on-line literature searches for mechanistic as well as outcome research. Specific search databases and keyword strategies are provided in each of these chapters, and a summary of the search results is typically provided in both table and discussion formats. The reader is subsequently taken through the chapter's evaluation of the literature and the clinical decision-making process, which is directed toward integration of CAM or referral to a CAM practitioner. The authors used a variety of contributors with varied backgrounds in both conventional and alternative medicine regimens. One might fear that the authors of a chapter would exhibit a bias in the interpretation of the evidence for CAM, particularly if they were trained in that particular modality. For the most part, however, this bias is absent in the presentation for each particular therapy and in the preliminary review of the literature. It is clear that cases were selected to demonstrate where some preliminary evidence might support the use of CAM with the condition and issues described in each case. Thus, despite what appeared to be weak evidence for the efficacious use of CAM in a few of the cases, each author always elected to use CAM anyway. Practitioners of conventional medicine who are skeptical of CAM may be surprised to learn the amount of available research evidence that does provide some justification and support for the use of most CAM therapies, depending in part on the type of medical condition. These do not include just review articles and case studies but also meta-analyses and randomized clinical trials. The step-by-step approach to evidenced-based practice literature searches and the evaluation used in each of these chapters are helpful to those who are new to evidence-based practice. The recommendations of search terms and search strategies are exceptionally useful and worthwhile to anyone who wishes to conduct their own comprehensive or targeted reviews. In this book, Deutsch and Anderson have been successful in introducing the reader to a comprehensive variety of CAM therapies that are within the domains described by the National Center for Complementary and Alternative Medicine. Despite some biases that are evident in the clinical decision-making process within the case-based chapters, the authors remain objective and evidence-based in most of their writing. This book was easy to read and quite informative as a basic textbook. The authors are to be commended for tackling this topic in the midst of widespread skepticism in conventional medicine for the implementation of CAM. Health practitioners can no longer turn a blind eye to the fact that a large percentage of their patients are using nonconventional and alternative therapies—often without their knowledge. Now is the time to explore CAM use by patients and to engage in an informed clinical decision-making process and patient-practitioner dialogue in clinical practice. Back to top Article Information Financial Disclosures: None reported. References 1. Complementary and alternative medicine use among adults: United States, 2002. National Center for Health Statistics Web site. http://www.cdc.gov/nchs/pressroom/04news/adultsmedicine.htm. Accessibility verified June 3, 2008 2. Eisenberg DM, Kessler RC, Van Rompay MI, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med. 2001;135(5):344-35111529698PubMedGoogle ScholarCrossref 3. What is CAM? National Center for Complementary and Alternative Medicine Web site. http://nccam.nih.gov/health/whatiscam/. Accessibility verified June 3, 2008

Journal

JAMA – American Medical Association

Published: Jun 25, 2008

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