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

Figueroa Gray M, Coleman K, Walsh-Bailey C, Girard S, Lozano P. An expanded role for the medical assistant in primary care: evaluating a training pilot. Perm J. 2021 Nov 29;25:20.091. doi: 10.7812/TPP/20.091. PubMed

Marshall A, Joyce CT, Tseng B, Gerlovin H, Yeh GY, Sherman KJ, Saper RB, Roseen EJ. Changes in pain self-efficacy, coping skills and fear avoidance beliefs in a randomized controlled trial of yoga, physical therapy, and education for chronic low back pain. 2022 Apr 8;23(4):834-843. doi: 10.1093/pm/pnab318. PubMed

Colgan D, Green K, Eddy A, Brems C, Sherman KJ, Cramer H, Oken B, Christopher M. Translation, cross-cultural adaptation, and psychometric validation of the English version of the postural awareness scale. Pain Med. 2021 Nov 26;22(11):2686-2699. doi: 10.1093/pm/pnab200. PubMed

Matson TE, Carrell DS, Bobb JF, Cronkite DJ, Oliver MM, Luce C, Ghitza UE, Hsu CW, Campbell CI, Browne KC, Binswanger IA, Saxon AJ, Bradley KA, Lapham GT. Prevalence of medical cannabis use and associated health conditions documented in electronic health records among primary care patients in Washington state. JAMA Netw Open. 2021 May 3;4(5):e219375. doi: 10.1001/jamanetworkopen.2021.9375. PubMed

Suri P, Meier EN, Gold LS, Marcum ZA, Johnston SK, James KT, Bresnahan BW, O'Reilly M, Turner JA, Kallmes DF, Sherman KJ, Deyo RA, Luetmer PH, Avins AL, Griffith B, Heagerty PJ, Rundell SD, Jarvik JG, Friedly JL. Providing epidemiological data in lumbar spine imaging reports did not affect subsequent utilization of spine procedures: secondary outcomes from a stepped-wedge randomized controlled trial. Pain Med. 2021 Jun 4;22(6):1272-1280. doi: 10.1093/pm/pnab065. PubMed