Presentation is loading. Please wait.

Presentation is loading. Please wait.

Integrative Health Care for Veterans

Similar presentations

Presentation on theme: "Integrative Health Care for Veterans"— Presentation transcript:

1 Integrative Health Care for Veterans
War Related Illness and Injury Study Center Washington, DC

2 Welcome Acupuncture Presenter Integrative Health Care Presenter
Jeanette Akhter, MD, MAc, Licensed Acupuncturist Integrative Health Care Presenter Kelly McCoy, PsyD Labyrinth Presenter Brenda Jasper, MEd, PA-C National Referral Program Coordinator Yoga Presenter Louise Mahoney, MS


4 What is Integrative Health Care?
New and growing approach to health care delivery Broader in focus than conventional care Coordinated health care Explicitly 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

5 Philosophy of Integrative Health Care
Mind, body, spirit, community Tradition and innovation Healing extends beyond cure Tailored toward patient goals Shared responsibility

6 Qualities of Integrative Health Care
Holistic, broad scope Scientifically-rigorous Values wisdom Motivational Patient-centered Prevention and treatment Interdisciplinary Healing environments and relationships Cross-trained providers Incorporates mind-body skills

7 Who can benefit? Individuals managing chronic illnesses
People facing acute health and life events Individuals who want to optimize wellness

8 Integrative Health Care for Veterans

9 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 communication National referral program Outpatient programs (DC, NJ, CA) Identified need for coordinated treatment approaches

10 Acupuncture Satisfaction Data
2010 total encounters 649 individual full body 890 group ear acupuncture Improvement in symptoms (n = 103) 45% yes, completely 51% yes, somewhat 3% no improvement <1% too early to tell Overall quality (n = 112) 70% excellent 20% very good 10% good <1% poor Would recommend to other Veterans (n = 130) 99% yes <1% no

11 Acupuncture Satisfaction Data
Yes, Completely Yes, Somewhat No Don’t Have This Problem Back Pain 22% 57% 13% 7% Musculoskeletal Pain 25% 64% 5% 6% Headaches 28% 47% 19% Upset Stomach 15% 26% 37% Constipation/Diarrhea 8% 16% 20% 55% Trouble Sleeping 51% 18% Energy Level 32% 53% 11% 4% Irritability/Angry Outbursts 27% 42% Concentration 10% Depression Anxiety 61% 3% Jumpy/Easily Startled 56% Disturbing Memories 46%

12 iRest® Yoga Nidra Satisfaction Data
2010 total encounters 1,318 sessions Improvement in symptoms (n = 165) 10% yes, completely 85% yes, somewhat 4% no improvement <1% don’t have symptoms Overall quality (n = 184) 66% excellent 30% very good 1% good 2% poor Would recommend to other Veterans (n = 184) 100% yes

13 Yoga Nidra Satisfaction Data
Yes, Completely Yes, Somewhat No Don’t Have This Problem Back Pain 8% 64% 19% 9% Musculoskeletal Pain 68% 11% 13% Headaches 10% 41% 16% 33% Upset Stomach 4% 18% 26% 51% Constipation/Diarrhea 15% 62% Trouble Sleeping 72% 6% Energy Level 12% Irritability/Angry Outbursts 14% 55% Concentration 20% Depression 52% 25% Anxiety 66% 17% 5% Jumpy/Easily Startled 22% Disturbing Memories 45%

14 Labyrinth Satisfaction Data
Would you walk the labyrinth again? (n = 227) 99% yes <1% no Descriptions of the labyrinth: Calming, relaxing, serene, awesome, soothing, wonderful, excellent, mellow, balanced, peaceful, meditative, rejuvenating, surprising, inspirational, therapeutic, centering, uplifting, helpful, purposeful, anchoring, euphoric 2010 total visits 481 How was your walk on the Freedom Labyrinth Path? (n = 227) 50% excellent 42% very good 7% fair <1% no value

15 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% yes Do you feel better after class than before? (n = 13) 100 % yes Would you participate in WRIISC yoga again? (n = 12)

16 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”

17 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-DC Results anticipated May-June 2012

18 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 2012 Acupuncture to Improve the Quality of Life in Veterans with TBI and PTSD PI: Anna Rusiewicz, PhD & Thomas Findley, MD PhD, WRIISC-NJ Results anticipated January 2012

19 Integrative Modalities Throughout the VHA System
Acupuncture Aquatic bodywork Aromatherapy Biofeedback Deep-breathing exercises Guided imagery Hypnotherapy Labyrinth Laughter yoga Mindfulness meditation Massage Progressive relaxation Tai Chi Qigong Reiki Spinal manipulation Structural integration Therapeutic touch Yoga with movement Yoga Nidra

20 VA Integrative Health Clinic and Program
Salt Lake City, UT VAMC Acupuncture Aquatic bodywork Stress management class: guided imagery, relaxation techniques, biofeedback, qigong, awareness and reframing of thought patterns Medical hypnosis Yoga with movement Herbal/nutritional supplement/drug interaction education Meditation Qigong Tobacco cessation Weight management class: nutrition, exercise, psychotherapy, hypnosis

21 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 transition Benefits persisted to 24 months Spinal-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,

22 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 groups Greatest 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,

23 Acupuncture

24 (acupuncture video 1)

25 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: Growth Development Movement Maintaining body temperature Protection against illness Overall regulation

26 Qi is Our Life Force 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. 26

27 Qi Imbalance Qi depletion, obstruction, disorganization
Causes of imbalance Injury Illness Environmental exposure Poor quality nourishment Lack of physical exercise

28 Qi Moves with a Rhythm, Inside a Boundary
YANG/Sympathetic Arousal Daytime, summer Awake and alert Inhale Exhale Nighttime, winter Rest and digest YIN/Parasympathetic Restoration 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.

29 Acupuncture Helps Restore Balance
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 29


31 How Does Acupuncture Work?
Local effect Mechanical stimulation of connective tissue Adenosine release Increase local blood flow “Gate” mechanism

32 How does Acupuncture Work?
Increases release and binding of endogenous opioids Basal forebrain Limbic system Brainstem fMRI studies Positron emission tomography studies



35 Goals of Acupuncture Unique - focused on individual Veteran’s needs
Physical Mental Emotional Spiritual

36 Method Ask Listen Observe Palpate Choose specific points
Observe results

37 Washington, DC WRIISC Acupuncture Options
Full body, individual series of treatments Unique design for the individual’s presentation

38 DC Acupuncture Options
Group Ear Acupuncture Five points on each ear Balance of sympathetic/parasympathetic nervous systems as well as emotional balance Can be used for detoxification Often affects sleep patterns Multiple venues at DC WRIISC


40 Acupuncture Interest at WRIISC-DC
Year 2010 649 full body acupuncture treatments 145 Gulf War Veteran treatments 890 ear acupuncture treatments 103 Gulf War Veteran treatments

41 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 example 41

42 Acupuncture Helps Veterans Get All The Way Home - Safe and Sound
the mind find a place to rest, the body release trauma's imprint and the spirit come back home – safe and sound.

43 Acupuncture Research – Selected Bibliography
Berman, B. M., Langevin, H. M., Witt, C. M., Dubner, R. (2010). Acupuncture for chronic low back pain. New England Journal of Medicine, 363, 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. Blitzer, L., Atchison-Nevel, D., & Kenny, M. (2004). Using acupuncture to treat major depressive disorder: a pilot investigation. Clinical Acupuncture and Oriental Medicine, 4, 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): 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,

44 Acupuncture Research – Selected Bibliography (continued)
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): 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, Hicks J, Hicks A, Mole P. Five element constitutional acupuncture. Edinburough: Elsevier, 2004. 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, 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,

45 Acupuncture Research – Selected Bibliography (continued)
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. Leo, 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, 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, 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.

46 Acupuncture Research – Selected Bibliography (continued)
Plank S, Goodard J. The effectiveness of acupuncture for chronic daily headache: An outcomes study. Mil Med 2009; 174(12): 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): 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, Spira A. Acupuncture: A useful tool for health care in an operational medicine environment. Mil Med 2008; 173(7): 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,

47 (acupuncture video 2)

48 Yoga Nidra

49 (yoga nidra video 1)

50 (yoga nidra video 2)

51 Labyrinth

52 (labyrinth video)

53 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 carving at a temple in Halebid, India, circa 2500 BC Labyrinth from the Atlantic Bronze Age, Galicia (Spain)

54 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 insomnia Also associated with many of the benefits seen in sitting meditation and yoga Benson, H., "The relaxation response: therapeutic effect," Science Dec 5;278(5344): PMID:

55 Labyrinths at VA Veterans, staff, and volunteers can walk a labyrinth at: Albany VAMC Canandaigua VAMC Seattle VAMC Memphis VAMC Washington, DC VAMC

56 Labyrinth Resources Labyrinth Society Worldwide Labyrinth Locator
Worldwide Labyrinth Locator

57 Labyrinth - Practice Not like a maze: no dead ends Pace is up to you
Opportunity to slow down, relax, relieve stress, reflect, meditate Path winds in a circular pattern towards a midpoint, one way in and the same way out. 9/11 Memorial Labyrinth at Boston College

58 Reasons for Walking the Labyrinth
To relax To express intent For physical healing As a pilgrimage To meditate To ask a question For emotional healing To ease grief For inspiration To pray For ceremony or ritual Just for fun!

59 Benefits of Walking the Labyrinth
Decreases stress Helps reconnect physical, emotional, and spiritual wellbeing Provides opportunity for personal space Offers strength and hope

60 Stages of Walking the Labyrinth
Releasing Receiving Renewal Chartres Cathedral labyrinth in Nature’s First Pattern by Gilchrist, 1996

61 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 ambiance Breathe deeply, center yourself, and put other things out of your mind If you wish, invoke the presence of a higher force for guidance Pause at the entrance to bow or in some way acknowledge the labyrinth

62 Walking the Labyrinth Walk at your own pace
There may be two-way traffic, cooperate It is okay to pass others or be passed Bring awareness to your experience, your body, your thoughts, and your feelings Pause in the center if you wish to meditate there Return by the same path you entered or, if you choose, walk directly out Upon exiting, turn and again acknowledge the labyrinth

63 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 experience Thank yourself for the gift you have given yourself Walk the labyrinth again, as many times as you wish Use a finger labyrinth to relax anywhere

64 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 me or 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. Wiggins

65 Yoga for Veterans

66 If you can breathe….. you can do yoga
From a 1982 paper in Geriatric Nursing about beginning a yoga program in a Veterans nursing home.

67 What is Yoga? Developed from ancient East Indian religious practice
Word derived from Sanskrit root “yuj” meaning to bind Generally conceptualized as union of mind, body, and spirit Philosophy outlined in the Yoga Sutras attributed to Patanjali in the 2nd century BCE Goal of practicing yoga is to end suffering

68 8 Limbs of Yoga Yama – moral commandments Niyama – discipline
Āsana – 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 – concentration Dhyana – meditation Samadhi – super-consciousness

69 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 medicine Father 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 initially Mentor of Richard Miller, developer of iRest Krishnamacharya taught at his school in Mysore - his pupils were primarily active young boys, he drew on many disciplines—including yoga, gymnastics, and Indian wrestling—to develop dynamically-performed asana sequences aimed at building physical fitness. This vinyasa style uses the movements of Surya Namaskar (Sun Salutation) to lead into each asana and then out again. Each movement is coordinated with prescribed breathing and drishti, "gaze points" that focus the eyes and instill meditative concentration. Eventually, Krishnamacharya standardized the pose sequences into three series consisting of primary, intermediate, and advanced asanas. Students were grouped in order of experience and ability, memorizing and mastering each sequence before advancing to the next. Though Krishnamacharya developed this manner of performing yoga during the 1930s, it remained virtually unknown in the West for almost 40 years. Hatha yoga is the sanctuary for those suffering any kind of pain

70 Western Yoga Most Yoga postures practiced today in the west developed around the turn of the 20th century Influenced by British Physical culture – gymnastics – brought to Indian palaces during colonization

71 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 subjects The 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) Answer is YES!

72 Evidence for Yoga as Therapy
Study Target Population Sample Size Results Groessl et al, 2008 Low back pain Veterans 33 Significantly less: Pain, Depression, Fatigue Sherman et al, 2005 Chronic low back pain Civilian Adults 101 Both exercise and yoga reduced pain, yoga superior in medication use reduction Da Silva et al, 2007 Fibromyalgia Civilian females 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 not Including only sample articles that may be of value for gulf war illnesses – those addressing chronic pain, Groessl – mean age = 55 – study significant because most non-Veteran studies are 60-70% women, this was 80% male Pre post design – baseline and 10 week follow-up Pranayama – slow controlled breathing can increase parasympathetic activity – they used alternate nostril breathing. Indian J Med Res. 2004 Aug;120(2): Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Pal GK, Velkumary S, Madanmohan. J Altern Complement Med. 2009 Mar;15(3):293-5. FMS – Randomized, no control group Relaxing yoga (RY) vs. Relaxing Yoga plus TuNa massage (ryt) 8 weeks, 1/week, 50 minutes Adapted Gharotes method of postures + 7 minutes diaphramatic breathing, 15 minutes guided relaxation

73 Reviews Literature Review Target Results Yang, (review of 32 articles
Chronic diseases Weight loss, lower BP, lower blood glucose, lower cholesterol Kirkwood et al, (2005) review of 8 studies Anxiety Positive but inconclusive results Chou & Huffman, (2007) Chronic low back pain Small advantage of yoga over exercise in some but benefits of yoga last longer than benefits of yoga Of the 32 articles reviewed, 12 described experimental studies, 18 described quasi-experimental studies and two described observational studies. Only 2 of the 12 true experimental studies (17,18) described the randomization method. Even though risk factors for chronic health conditions were used as keywords in the search strategy, many of the studies used healthy adult samples; only half of the 32 studies actually focused on subjects with diabetes (19–23), hypertension (10,11,18,24–27), or cardiovascular disease (28–31). Seven of the studies were conducted in the US; the others, in India and other countries.

74 Summary of Benefits Reduced back pain Lowered stress
Increased functional ability Improved sleep Increased cardiovascular health Lower cholesterol Decrease general pain such as experienced in fibromyalgia Improved autonomic function

75 Possible Mechanisms of Action
? Improve structural/postural alignment Improve muscle tone and flexibility Enhance function and regulation of autonomic nervous system and re-setting of chronic pain response Modulation of hormones


77 WRIISC-CA Yoga January, 2010 – Program start
Mat classes – meet once/week Mixed gender mat class Women only mat class July 2010, Chair yoga class added 62 referrals to WRIISC yoga through CPRS consult 38 have attended at least once

78 WRIISC-CA Yoga (cont’d)
Mixed gender mat class 20 referrals, 18 have attended at least once 4 have completed post 12 week assessments Women only mat class 24 referrals, 9 have attended at least once, 3 have completed at least 12 weeks Chair yoga 15 referral, 13 have attended at least one session 6 have completed at least 12 week Many students have completed 40

79 Barriers to Attendance?
Location not convenient No transportation No childcare Conflicts with work schedule Class held during high traffic commute time Not psychiatrically or medically stable Palo Alto is a an expensive place to live and there are not many Veterans living nearby. Those with transportation have a long commute, heavy traffic Often clinicians are looking for anything that will help their patients and they refer Veterans that are not appropriate for “this” class at “this” time. Everyone can do yoga – but not every yoga class is appropriate for an individual. Estimated median household income in 2009: $118,989 (it was $90,377 in 2000) Palo Alto: $118,989 California: $58,931 Estimated per capita income in 2009: $66,125 Estimated median house or condo value in 2009: $916,644 (it was $776,000 in 2000) Palo Alto: $916,644 California: $384,200 Mean prices in 2009: All housing units: $922,616; Detached houses: $983,880; Townhouses or other attached units: $651,117; In 2-unit structures: $562,122; In 3-to-4-unit structures: $486,340; In 5-or-more-unit structures: $502,094; Mobile homes: $184,523; Occupied boats, RVs, vans, etc.: $14,304 Median gross rent in 2009: $1,675.

80 Pilot Results, n=13 Feasibility – Will Veterans participate in yoga?
Yes, if it is convenient and consistent SF-12 – Health and Well-Being Increase in energy – most significant Trend toward improvement in most others areas except depression McGill Pain Short Form Decrease in pain intensity Yes. if it fits with their schedule not too far and/or not at high traffic times The most consistent attended has been in the chair yoga class which is attached to an ongoing MOVE program group and meets right before their weekly group.

81 Results (cont’d) PTSD Checklist (PCL-M) Flanders Fatigue Scale
Small trend downward Flanders Fatigue Scale Small trend upward Yoga Satisfaction Questionnaire

82 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? Would you recommend WRIISC yoga to a friend? Have your symptoms improved? 3 answered “Yes, completely” 6 answered “Yes, somewhat” Reports from13 Veterans at 12 weeks

83 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”

84 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 group Lets Veterans know that the VA cares about them These are my observations. In the women’s group, 2 Veterans who did not know each other worked on the Veteran’s book project together and have received a lot of support from this endeavor. They have developed a friendship and are in contact outside of class. One Veteran said “this is the only thing I have at the VA now”

85 Namaste

86 Application of Integrative Health Care

87 Factors to Consider Does this approach fit with treatment goals?
Risks and benefits Contraindications, modifications Research findings Level B evidence base or higher Veteran’s self-report Provider qualifications Coordination among care providers Expense and availability

88 Integrative Health in the VA System of Care
VA Office of Patient Centered Care and Cultural Transformation Post-Deployment Integrated Care Initiative (PDICI) Planetree Polytrauma Service, Recreational Therapy James A. Haley VA Chronic Pain Rehabilitation Program Training standards & occupational codes

89 Resources National Center for Complementary and Alternative Medicine at the National Institutes of Health White House Commission on Complementary and Alternative Medicine Policy Consortium of Academic Health Centers for Integrative Medicine

90 VA Resources VA Listservs
Acupuncture Listserv, Integrative Health Care Listserv VA employees may Dr. Elizabeth Hakas to join Integrative health care in the VHAHCS: Washington, DC WRIISC: Palo Alto, CA WRIISC: East Orange, NJ WRIISC: Planetree:

91 Free for Veterans Acupuncturists Without Borders Military Stress Recovery Clinics List of clinics nationwide that offer free acupuncture for Veterans Yoga for Vets List of yoga studios nationwide that offer at least 4 free yoga classes for Veterans Labyrinth Society Worldwide Labyrinth Locator

92 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

Download ppt "Integrative Health Care for Veterans"

Similar presentations

Ads by Google