Three popular therapies lead to significant improvements in veterans

Three popular complementary and integrative health (CIH) therapies – yoga, tai chi, and meditation – lead to significant improvements in key outcomes perceived by Veterans receiving care in the Veterans Health Administration (VA) system, suggests a study in a special September supplement to Medical Care. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Our study showed that meditation, tai chi, and yoga appear to improve overall physical and mental health and reduced perceived stress," according to the new research, led by Dr. A. Rani Elwy of the VA Center for Healthcare Organization and Implementation Research at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Mass, and an Associate Professor in the Warren Alpert Medical School of Brown University.

Published today, the special issue of Medical Care documents progress toward implementing CIH therapies throughout the VA system – part of efforts to promote a "Whole Health" approach in VA care.

As required by the 2016 Comprehensive Addiction and Recovery Act (CARA), the VA has expanded research and education on CIH programs, focusing on the impact on pain, mental health, and chronic illness.

Improvements in patient-reported outcomes with CIH therapies

Dr. Elwy and colleagues performed a 12-month survey study to examine the impact on CIH therapies on 119 veteran's self-reported health and well-being. These Veterans completed 401 surveys over five different time point during the study.

The surveys focused on patient-reported outcomes (PROs) – an important target for efforts to improve healthcare, focusing on the most important problems and outcomes identified by patients themselves.

Overall, Veterans in the study reported using 14 different CIH therapies. Yoga was the most popular, with nearly half of Veterans participating. This was followed by meditation, acupuncture, and tai chi. Three CIH therapies were associated with significant improvements in PROs:

• Yoga was related to decreases in perceived stress.
• Tai chi was linked to improvements in overall physical and mental health functioning, anxiety levels, and ability to participate in social role activities.
• Meditation was also associated with improvements in physical functioning.

None of the CIH therapies resulted in improvement in Veterans' pain intensity or level of engagement in their health care. Larger studies with longer follow-up times may be needed to show significant effects on these outcomes, according to Dr. Elwy and coauthors.

They conclude: "It is time to focus on health and well-being, as defined by Veterans, and reaching these goals must include participation in CIH treatment approaches."

More progress in CIH implementation and research at the VA

Titled The Implementation of Complementary and Integrative Health Therapies in the Veterans Health Administration, the new supplement presents 11 original research papers and commentaries on the VA's progress in implementing and evaluating the impact of CIH therapies on Veterans' health outcomes.

Dr. Elwy and Dr. Stephanie L. Taylor of the HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles VA Medical Center are the supplement Guest Editors.

The special issue papers address strategies to build support for and implement CIH programs, to evaluate their effectiveness, and to promote their long-term sustainability.

We already know that CIH therapies are effective for the treatment of Veterans' chronic pain, posttraumatic stress, depression, and other chronic conditions. Now we need to develop, test, and use effective strategies to increase CIH use and sustainment."

Drs A. Rani Elwy and Stephanie L. Taylor, HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles VA Medical Center

In a commentary, Alison Whitehead and Dr. Benjamin Kligler of the VA Office of Patient-Centered Care and Cultural Transformation state: "As the VA continues to develop new and better ways of making CIH approaches available to all Veterans, and to collect data on the outcomes of this expanded access for Veterans and employees, we hope to demonstrate to the rest of the U.S. healthcare system how an emphasis on whole person care and self-management skills should become the new standard across the industry."