Whole Health

Bolton RE, Fix GM, VanDeusen Lukas C, Elwy AR, Bokhour BG. Biopsychosocial benefits of movement-based complementary and integrative health therapies for patients with chronic conditions. Chronic Illn. 2018 Jan 1:1742395318782377. doi: 10.1177/1742395318782377. [Epub ahead of print] PubMed PMID: 29914264.

OBJECTIVES

Complementary and integrative health practices are growing in popularity, including use of movement-based therapies such as yoga, tai-chi, and qigong. Movement-based therapies are beneficial for a range of health conditions and are used more frequently by individuals with chronic illness. Yet little is known about how patients with chronic conditions characterize the health benefits of movement-based therapies.

METHODS

We conducted focus groups with 31 patients enrolled in yoga and qigong programs for chronic conditions at two VA medical centers. Transcripts were analyzed using conventional content analysis with codes developed inductively from the data. Participants' descriptions of health benefits were then mapped to Engel's biopsychosocial model.

RESULTS

Participants described improvements in all biopsychosocial realms, including improved physical and mental health, reduced opiate and psychotropic use, enhanced emotional well-being, and better social relationships. Changes were attributed to physical improvements, development of coping skills, and increased self-awareness.

DISCUSSION

Patients with chronic illnesses in our sample reported multiple benefits from participation in movement-based therapies, including in physical, mental, and social health realms. Providers treating patients with complex comorbidities may consider referrals to movement-based therapy programs to address multiple concerns simultaneously, particularly among patients seeking alternatives to medication or adjunctive to an opiate reduction strategy.

Brown LM, Sawyer LM, Lensing SY, Taylor T, Bopp MM, Ferrier I, Sullivan DH. An outpatient Tai Chi program: Effects on veterans' functional outcomes. Nurs Forum. 2021 Apr;56(2):448-452. doi: 10.1111/nuf.12532. Epub 2020 Nov 26. PMID: 33241873.

PURPOSE

To evaluate the effectiveness of an evidence-based 12-week Tai Chi course designed to improve balance and physical function in a population of older veterans.

METHODS

Community dwelling veterans of all ages with gait and balance problems were invited to participate in the Tai Chi program. Participants completed the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falls Efficacy Scale-International (FES-I) at baseline and again at the end of the program. Descriptive statistics were used to summarize study participants' characteristics. The change from baseline to the end of the 12-week program was calculated for each of the three primary outcome variables (BBS, TUG, FES-I).

RESULTS

Twenty-two veterans, aged 58 years and above, with perceived gait and/or balance issues were enrolled in the program with completion by 11 veterans. Veterans who completed their final assessments showed the BBS, improved significantly (p = 0.004) from baseline to the 12-week assessment. The TUG scores improved by a median of 1.3 s (p = 0.022). There was not a significant change in the FES-I.

CONCLUSION

Preliminary findings provide evidence of the effectiveness of a 12-week Tai Chi program to improve functional outcomes for older veterans with mild to moderate gait and balance problems.

Gaddy MA. Implementation of an integrative medicine treatment program at a Veterans Health Administration residential mental health facility. Psychol Serv. 2018 Nov;15(4):503-509. doi: 10.1037/ser0000189.

A 4-week interdisciplinary integrative medicine program was recently added to the core treatment offerings for veterans participating in the Mental Health Residential Rehabilitation Program at the Dwight D. Eisenhower Veterans Affairs Medical Center. The new integrative medicine program teaches veterans about using meditative practices, nutrition, creative expression, tai chi, hatha yoga, sensory and breathing techniques, and lifestyle changes to enhance well-being. The groups are run by professionals from a variety of disciplines including recreation therapy, art therapy, occupational therapy, psychology, and nutrition. For the first 42 veterans to complete the program, the Short Form 12-item Health Survey was administered before and after participation in the integrative medicine program to assess the potential effectiveness of the program in enhancing physical and psychological well-being. In addition, a brief semistructured interview was used to assess veteran opinions about the program. Results suggest that the program was well received and that both physical and mental health scores improved from before to after treatment in this sample of veterans with complex behavioral health concerns. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Golden RE, Klap R, Carney DV, Yano EM, Hamilton AB, Taylor SL, Kligler B, Whitehead AM, Saechao F, Zaiko Y, Pomernacki A, Frayne SM; WH-PBRN-CIH Writing Group. Promoting learning health system feedback loops: Experience with a VA practice-based research network card study. Healthc (Amst). 2021 Jun;8 Suppl 1:100484. doi: 10.1016/j.hjdsi.2020.100484. Epub 2021 Jun 23. PMID: 34175097.

BACKGROUND

We tested the capacity of the 60-site VA Women’s Health Practice-Based Research Network (WH-PBRN), embedded within VA, to employ a multisite card study to collect women Veterans’ perspectives about Complementary and Integrative Health (CIH) and to rapidly return findings to participating sites and partnered national policy-makers in support of a Learning Health System (LHS) wherein evidence generation informs ongoing improvement.

METHODS

VA primary care clinic clerks and nurses distributed anonymous surveys (patient feedback forms) at clinics for up to two weeks in fiscal year 2017, asking about CIH behavior and preferred delivery methods. We examined the project’s feasibility, representativeness, acceptability, and impact via a tracking system, national administrative data, debriefing notes, and three surveys of WH-PBRN Site Leads.

RESULTS

Twenty geographically diverse and largely representative VA Medical Centers and 11 Community-Based Outpatient Clinics volunteered to participate. Over six months, N = 1,191 women Veterans responded (median 57; range 8-151 per site). In under three months, we returned local findings benchmarked against multisite findings to all participating sites and summary findings to national VA partners. Sites and partners disseminated results to clinical and leadership stakeholders, who then applied results as warranted.

CONCLUSIONS

VA effectively mobilized an embedded PBRN to implement a timely, representative, acceptable and impactful operations project.

IMPLICATIONS

Card studies by PBRNs within large, national healthcare systems can provide rapid feedback to participating sites and national leaders to guide policies, programs, and practices.

Jimenez ER, Juarez J, Struwe L, Cohen MZ. Tai Chi as a Complementary Therapy for Depression and Anxiety Among U.S. Veterans in a Mental Health Inpatient Setting. J Am Psychiatr Nurses Assoc. 2023 Sep 21:10783903231201592.

BACKGROUND

Depression and anxiety are two of the top five mental illnesses veterans report. Treatment for depression and anxiety includes medications and psychiatric treatment in inpatient, outpatient, and residential treatment programs; the use of complementary and alternative medicine (CAM) can have beneficial results by decreasing symptoms, recognize patients' preference for CAM, and be cost-effective.

AIM

This study aimed to evaluate the effects of Tai Chi on depression and anxiety symptoms on inpatient psychosocial or substance use disorder (SUD) rehabilitation treatment program residents since little evidence exists regarding the effectiveness of Tai Chi on participants in residential mental health treatment programs. METHOD: A mixed-method, cohort design with 88 participants (41 usual treatment without Tai Chi, 47 intervention) used a demographic survey, Hamilton Anxiety Scale, Quick Inventory of Depressive Symptomatology, self-report, and the Patient Health Questionnaire-9 at Weeks 1 and 4 of the treatment program. After Week 4, the intervention group responded to six open-ended questions about Tai Chi's effects on their overall depression and anxiety.

RESULTS

The anxiety level of the intervention group was significantly decreased, as evidenced by the Hamilton Anxiety Scale scores (p = .02). However, the measures of depression did not differ between the groups. Two themes, mindfulness and satisfaction, were identified from the written responses regarding the Tai Chi intervention.Conclusion: Tai Chi effectively reduced symptoms of anxiety that varied by age and ethnicity. This study increased the insight regarding the benefit of including Tai Chi as a complementary therapy for those participating in residential treatment programs.

Munro, S., Komelski, M., Lutgens, B., Lagoy, J., & Detweiler, M. (2019). Improving the Health of Veterans Though Moving Meditation Practices: A Mixed-Methods Pilot Study. Journal of Veterans Studies, 5(1), 16–23. DOI: http://doi.org/10.21061/jvs.v5i1.128

This study explores the use of low-to-moderate intensity mindfulness-based exercises ("moving meditation") to improve Veteran physical activity level and physiological health and psychological well-being including posttraumatic stress disorder (PTSD) symptomology. 12-week, pre- and post-test intervention, mixed methods pilot. Setting/Subjects: Veterans with a history of posttraumatic stress disorder receiving care at the Department of Veterans Affairs Medical Center in Salem, Virginia. All Veterans participated in bi-weekly classroom instruction prior to a 6-10 minute warm up period of Qigong exercises, followed by a 30 minute period of Taijiquan/Qigong or mindful-meditative walking, followed by a 6-10 minute cool down period of light movement. Overall physical activity was measured for a one-week period before and after the 12-week intervention period with an Actigraph accelerometer. Physiological health indices were measured pre- and post- 12-week intervention, including salivary cortisol, Hgb A1C, fasting glucose, gonadal panel (FSH, LH, testosterone), albumin, hs-CRP, and sex hormone-binding globulin. Veterans' mental well-being was measured by the Center for Epidemiological Studies-Depression Scale, the PTSD Checklist (PCL-C), the Cohen Perceived Stress scale, and the Beck Anxiety Inventory. Participants reported increased frequency and enjoyment of physical activity; improvement in Hgb A1C; improvement in balance and movement awareness; improvement in emotional regulation and focus; and reported reduced depression, stress and anxiety, and PTSD symptoms that benefitted social interactions. Moving meditation as part of a multifaceted treatment approach may increase physical activity, improve physiological health, and enhance mental well-being, particularly with respect to PTSD.

Niles BL, Mori DL, Polizzi CP, Pless Kaiser A, Ledoux AM, Wang C. Feasibility, qualitative findings and satisfaction of a brief Tai Chi mind-body programme for veterans with post-traumatic stress symptoms. BMJ Open. 2016 Nov 29;6(11):e012464. doi: 10.1136/bmjopen-2016-012464. PubMed PMID: 27899398; PubMed Central PMCID: PMC5168527.

OBJECTIVE

To examine feasibility, qualitative feedback and satisfaction associated with a 4-session introduction to Tai Chi for veterans with post-traumatic stress symptoms.

DESIGN

We observed and reported recruitment and retention rates, participant characteristics, adherence, and satisfaction across 2 cohorts. We also examined qualitative feedback provided by questionnaires, focus groups and individual interviews.

MAIN OUTCOME MEASURES

Rates of recruitment and retention, focus group and individual feedback interviews, self-reported satisfaction.

PARTICIPANTS

17 veterans with post-traumatic stress symptoms.

RESULTS

Almost 90% (17/19) of those eligible following the telephone screen enrolled in the programme. Three-quarters (76.4%) of the participants attended at least 3 of the 4 Tai Chi sessions. Qualitative data analysis revealed themes indicating favourable impressions of the Tai Chi sessions. In addition, participants reported feeling very engaged during the sessions, and found Tai Chi to be helpful for managing distressing symptoms (ie, intrusive thoughts, concentration difficulties, physiological arousal). Participants also reported high satisfaction: 93.8% endorsed being very or mostly satisfied with the programme. All participants (100%) indicated that they would like to participate in future Tai Chi programmes and would recommend it to a friend.

CONCLUSIONS

Tai Chi appears to be feasible and safe for veterans with symptoms of post-traumatic stress disorder (PTSD), is perceived to be beneficial and is associated with high rates of satisfaction. This study highlights the need for future investigation of Tai Chi as a novel intervention to address symptoms of PTSD.

Reb AM, Saum NS, Murphy DA, Breckenridge-Sproat ST, Su X, Bormann JE. Qigong in Injured Military Service Members. J Holist Nurs. 2017 Mar;35(1):10-24.

BACKGROUND

Wounded, ill, and injured (WII) Military Service members experience significant stress and are at risk for developing chronic conditions including posttraumatic stress disorder and depression. Qigong, a meditative movement practice, may positively affect their ability to engage in successful rehabilitation.

PURPOSE

We assessed the feasibility of Qigong practice in WII Service members returning from combat; effects on stress, sleep, and somatic symptoms; satisfaction; and participants' experience with the practice.

DESIGN

Single-group, pre- and posttest, mixed methods approach.

METHOD

Twenty-six WII were enrolled. The program was designed to include 20 classes over 10 weeks. Participants completed self-report questionnaires, practice logs, and an exit interview.

FINDINGS

Average attendance was 8.14 classes ( SD = 4.9); mean engagement was 5.7 ( SD = 3.5) weeks. Participants endorsed a high level of satisfaction with the practice. Qualitative themes included coping with stress; feeling more resilient and empowered; improvement in symptoms including sleep and physical function; and factors affecting practice. Participant-reported facilitators included accessibility and portability of the practice; barriers included scheduling conflicts and personal challenges. Participants recommended offering shorter programs with flexible scheduling options, increasing program awareness, and including significant others in future classes.

CONCLUSION

Qigong was safe, portable, and easily adapted for WII Service members.

Reid KF, Bannuru RR, Wang C, Mori DL, Niles BL. The Effects of Tai Chi Mind-Body Approach on the Mechanisms of Gulf War Illness: an Umbrella Review. Integr Med Res. 2019

Gulf War illness (GWI) is a chronic and multisymptom disorder affecting military veterans deployed to the 1991 Persian Gulf War. It is characterized by a range of acute and chronic symptoms, including but not limited to, fatigue, sleep disturbances, psychological problems, cognitive deficits, widespread pain, and respiratory and gastrointestinal difficulties. The prevalence of many of these chronic symptoms affecting Gulf War veterans occur at markedly elevated rates compared to nondeployed contemporary veterans. To date, no effective treatments for GWI have been identified. The overarching goal of this umbrella review was to critically evaluate the evidence for the potential of Tai Chi mind-body exercise to benefit and alleviate GWI symptomology. Based on the most prevalent GWI chronic symptoms and case definitions established by the Centers for Disease Control and Prevention and the Kansas Gulf War Veterans Health Initiative Program, we reviewed and summarized the evidence from 7 published systematic reviews and meta-analyses. Our findings suggest that Tai Chi may have the potential for distinct therapeutic benefits on the major prevalent symptoms of GWI. Future clinical trials are warranted to examine the feasibility, efficacy, durability and potential mechanisms of Tai Chi for improving health outcomes and relieving symptomology in GWI.

Sawyer LM, Brown LM, Lensing SY, McFadden D, Bopp MM, Ferrier I, Sullivan DH. Rapid conversion of Tai Chi classes from face-to-face to virtual during the COVID-19 pandemic: A quality improvement project. Nurs Forum. 2022 Jan 10. doi: 10.1111/nuf.12690. Epub ahead of print. PMID: 35005787.

PURPOSE

The purpose of this quality improvement project was to examine the feasibility of rapidly converting a Tai Chi program for older Veterans from face-to-face to virtual classes.

METHODS

Eighteen Veterans attending our face-to-face Tai Chi course were invited to transition to virtual classes. Feasibility was defined as the ability of program staff and participants to successfully connect and complete the initial and subsequent classes by VA Video Connect (VVC) with little to no technical difficulties, participant ability to participate in the course without safety concerns, and favorable feedback from participants and program staff.

RESULTS

Nine of 18 Veterans agreed to transition to the virtual program and attended a median (interquartile range) of 11 (4-15) classes; they were younger (62.7 + 11.5 vs. 70.5 + 7.0 years, p < .05) and more likely to have the knowledge and equipment needed to participate (78% vs. 0%, p < .01) than nonparticipants. Tai Chi instructors and participating Veterans reported being able to connect to and complete the classes virtually with only minimal technical problems. No adverse events were reported. Feedback from the instructors and Veterans was positive and included comments on ease of use and enjoyability.

CONCLUSION

Results suggest that virtual Tai Chi classes via VVC are feasible for some older Veterans.

Tate LM, Brown LM, Lensing SY, Taylor T, Bopp MM, Ferrier I, Sullivan DH. Increasing the availability of Tai Chi to veterans through a training of trainers course. Nurs Forum. 2020 Apr;55(2):223-226. doi: 10.1111/nuf.12419.

PURPOSE

The purpose of this nurse-led project was to increase the number of interprofessional Tai Chi instructors for veterans through a 5-week (32 hours) training of trainers (ToT) course led by a Tai Chi master trainer.

METHODS

This project was designed to evaluate the effectiveness of using the ToT model to increase the availability of Tai Chi to veterans. To understand how well the ToT course met learners' needs, a two-phase course evaluation was conducted.

RESULTS

Fifteen interprofessional employees enrolled in and completed the course. Most learners were white (67%) females (67%) with a median age of 50 years. All agreed that the training provided the skills, materials, and confidence to lead Tai Chi classes. Most (93%) indicated experiencing positive health benefits from the training and none experienced any negative effects. The 3-month follow-up evaluation indicated that 10 (67%) were teaching veterans in individual or group classes with two others assisting. Twelve instructors taught more than 150 veterans.

CONCLUSIONS

Overall, learners evaluated this ToT course positively and indicated their needs were met and felt prepared to teach Tai Chi despite being inexperienced. The course was a success with 80% of new instructors teaching or coteaching Tai Chi to veterans.

Tsai PF, Kitch S, Chang JY, et al. Tai Chi for Posttraumatic Stress Disorder and Chronic Musculoskeletal Pain: A Pilot Study. J Holist Nurs. 2018;36(2):147-158. doi:10.1177/0898010117697617

PURPOSE

Explore the feasibility of a Tai Chi intervention to improve musculoskeletal pain, emotion, cognition, and physical function in individuals with posttraumatic stress disorder.

DESIGN

Two-phase, one-arm quasi-experimental design.

METHOD

Phase 1: 11 participants completed one Tai Chi session, feasibility questionnaire, and were offered participation in Phase 2, a 12-week Tai Chi intervention. Ten participants participated in Phase 2. Pain intensity, interference, physical function scales, an emotional battery, and cognition tests were used for pre- and postintervention outcome measures. Paired t tests and thematic analysis were used for analysis.

FINDINGS

In Phase 1, most felt Tai Chi would benefit health (90.9%) and expressed interest in continuing Tai Chi (6.73 out of 7). Phase 2 results showed improvement in fear-affect (raw t = -2.64, p = .03; age adjusted t = -2.90, p = .02), fear-somatic arousal (raw t = -2.53, p = .035), List Sorting Working Memory (raw t = 2.62, p = .031; age adjusted t = 2.96, p = .018), 6-Minute Walk Test ( t = 3.541, p = .008), and current level of Pain Intensity ( t = -4.00, p = .004).

CONCLUSIONS

Tai Chi is an acceptable, holistic treatment to individuals with musculoskeletal pain and posttraumatic stress disorder. It may reduce pain, improve emotion, memory, and physical function.

Yost TL, Taylor AG. Qigong as a novel intervention for service members with mild traumatic brain injury. Explore (NY). 2013 May-Jun;9(3):142-9. doi: 10.1016/j.explore.2013.02.002.

PURPOSE

To describe the experience of internal qigong practice in service members diagnosed with mild traumatic brain injury (mTBI).

THEORETICAL FRAMEWORK:

The study used qualitative descriptive phenomenological methods originally described by Husserl and later refined by Giorgi.

METHODOLOGY

Participants were interviewed about their experiences while learning qigong to determine their level of interest, benefits, and/or adverse effects; ease of learning/performing the routine; and any barriers to practice.

SAMPLE

Six service members with mTBI receiving outpatient neurorehabilitation at the Defense and Veterans Brain Injury Center-Charlottesville Rehabilitation Center.

INTERVENTION

Participants learned Reflective Exercise Qigong, a form of qigong developed specifically to require less complex movement and balance than most forms of qigong, making it ideal for those with potential coordination and balance issues.

DATA COLLECTION

Semistructured interviews took place after four weeks of formal qigong instruction, then again after the subjects completed eight weeks. Interview data were analyzed with phenomenological methods described by Giorgi.

RESULTS

Four themes emerged from the interview data: "the physical experience of qigong," "regaining control," "no pain, a lot of gain," and "barriers to qigong practice." Participants offered examples of how qigong enabled them to control refractory symptoms after mTBI while decreasing reliance on pharmacotherapy. All agreed that qigong was uniquely conducive to the disciplined mindset of military service members and that the simplicity of Reflective Exercise qigong, compared with similar modalities such as tai chi and yoga, was well suited to individuals with decreased balance, cognition, and memory related to mTBI.