11830 Westline Industrial Drive St. Louis, Missouri 63146 COMPLEMENTARY THERAPIES FOR PHYSICAL THERAPY: ISBN-13: 978-0-7216-0111-3 A CLINICAL DECISION-MAKING APPROACH ISBN-10: 0-7216-0111-1 Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: [email protected]. You may also complete your request on-line via the Elsevier website at http://www.elsevier.com/permissions. Notice Neither the Publisher nor the Authors assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. The Publisher ISBN-13: 978-0-7216-0111-3 ISBN-10: 0-7216-0111-1 Vice President and Publisher: Linda Duncan Senior Editor: Kellie White Associate Developmental Editor: Kelly Milford Publishing Services Manager: Julie Eddy Project Manager: Rich Barber Design Direction: Julia Dummitt Working together to grow libraries in developing countries Printed in the United States www.elsevier.com | www.bookaid.org | www.sabre.org Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contributors Ellen Zambo Anderson, PT, MA, GCS Gary L. Goldberg, PhD Associate Professor Clinical Psychologist, Siegler Center for Department of Rehabilitation and Movement Integrative Medicine Sciences St. Barnabas Ambulatory Care Center, Livingston, Doctoral Programs in Physical Therapy New Jersey University of Medicine and Dentistry of New Jersey Assistant Professor, ICAM and Department of Newark, New Jersey Medicine University of Medicine and Dentistry of New Jersey Glenna Batson, PT, DSc Newark, New Jersey Assistant Professor Winston-Salem State University Susan Gould Fogerite, PhD Director, Wellness Partners in the Arts, Inc. Director of Research, Institute for Complementary Durham, North Carolina and Alternative Medicine (ICAM) Associate Professor, Department of Clinical Lab Judith E. Deutsch, PT, PhD Sciences Professor and Director, Rivers Lab School of Health-Related Professions University Department of Rehabilitation and Movement of Medicine and Dentistry of New Jersey Sciences Newark, New Jersey Doctoral Programs in Physical Therapy University of Medicine and Dentistry of New Jersey Richard Lund Newark, New Jersey Director Wellness Through Tai Chi Chantel Dickinson, PT Woodbridge, New Jersey Certifi ed Pilates Instructor Energy Balancing Pilates Studio Ellen D. Mandel, MS, PA-C, RD Englewood, New Jersey Assistant Professor Department of Physician Assistant Mary Lou Galantino, PT, PhD Seton Hall University Professor South Orange, New Jersey Doctoral Program in Physical Therapy The Richard Stockton College of New Jersey John Maypole, MD Pomona, New Jersey Assistant Professor of Pediatrics Adjunct Research Scholar Boston University School of Medicine Center for Clinical Epidemiology and Biostatistics Chief of Pediatrics University of Pennsylvania School of Medicine South End Community Health Center Philadelphia, Pennsylvania Boston, Massachusetts Bill Gallagher, PT, CMT, CYT Suzanne McDonough, PT, PhD Director Professor The East West Rehab Institute School of Health Sciences New York, New York University of Ulster Belfast, Ireland Susan Gerik, MD Associate Professor of Pediatrics and Family Patricia Quinn McGinnis, PT, PhD Medicine Associate Professor Director of Children’s Special Services Doctoral Program in Physical Therapy University of Texas Medical Branch The Richard Stockton College of New Jersey Galveston, Texas Pomona, New Jersey v vi CONTRIBUTORS Sheelagh McNeill PhD, LicAc, BAC, SMISCP James Stephens, PT, PhD Senior Orthopaedic Physiotherapist Clinical Assistant Professor Physiotherapy Department Department of Physical Therapy Sligo General Hospital Temple University The Mall Philadelphia, Pennsylvania Sligo, Ireland Cindy Wolk-Weiss, BSW John Musser, MD Director and Integrated Holistic Counselor Center for Clinical Epidemiology and Biostatistics Center for Healing Journeys University of Pennsylvania School of Medicine Bound Brook, New Jersey Philadelphia, Pennsylvania Perry Wolk-Weiss, DC Diane Rigassio Radler, PhD, RD Director and Chiropractor Assistant Professor Get Well Center Graduate Programs in Clinical Nutrition Bound Brook, New Jersey University of Medicine and Dentistry of New Jersey Lori Zucker, PT, DPT School of Health-Related Professions University Private Practice of Medicine and Dentistry of New Jersey Livingston, New Jersey Newark, New Jersey Cathy Caro Scarpito, PT Owner, ProCare Physical Therapy Piscataway, New Jersey Reviewers John A. Astin, PhD Shoshanna Katzman, MS, LAc Research Scientist Acupuncturist, Qigong Professional, and Energy California Pacifi c Medical Center Medicine Specialist San Francisco, California Director Red Bank Acupuncture and Wellness Center Simona Cipriani Tinton Falls, New Jersey Pilates, Massage Therapy, Feldenkrais The Art of Control David M. Kietrys, PT, MS, OCS Mount Kisco, New York Associate Professor Doctoral Program in Physical Therapy John Cottingham, PT, MS University of Medicine and Dentistry of New Christie Clinic in Rantoul Jersey-SHRP Department of Physical Therapy Stratford, New Jersey Rantoul, Illinois Sandy Matsuda, PhD, OTR/L Nancy Davidson, PT, MPH, Pac, LAc Assistant Professor Traditional Acupuncture and Rehabilitation Occupational Therapy Raleigh, North Carolina University of Missouri-Columbia Columbia, Missouri Moshe Frenkel, MD Associate Professor Diane Miller, JD, MS University of Texas, Medical Branch Legal and Public Policy Director Family Medicine National Health Freedom Action CAM Education Project St. Paul, Minnesota Galveston, Texas Jim Oschman, PhD Mary Lou Galantino, PT, PhD Nature’s Own Research Association Professor Dover, New Hampshire Doctoral Program in Physical Therapy The Richard Stockton College of New Jersey Adam Perlman, MD, MPH Pomona, New Jersey Hunterdon Endowed Professor of Adjunct Research Scholar Complementary and Alternative Medicine Center for Clinical Epidemiology and Biostatistics Executive Director and Associate Professor University of Pennsylvania School of Medicine Institute for Complementary and Alternative Philadelphia, Pennsylvania Medicine School of Health-Related Professions University Earlene Gleisner, RN of Medicine and Dentistry of New Jersey Reiki Master, Author, Publisher Newark, New Jersey Private Practice Laytonville, California Carla Oswald Reed, PT Guild Certifi ed Feldenkrais Practitioner, Physical Martha Hinman, PT, EdD, MHEd Therapist Professor, Department of Physical Therapy Movement to Wholeness Director, Transitional DPT Program Sterling, Virginia Hardin-Simmons University Abilene, Texas vii viii REVIEWERS Ellen C. Ross, PT, PhD Dalia Zwick, PT, PhD Professor and Program Director Post-Professional PT Senior Rehabilitation Supervisor Physical Therapy Premier Health Care Department of Rehabilitation and Movement New York, New York Sciences University of Medicine and Dentistry of New Jersey Newark, New Jersey Judith C. Stern, MA, PT, Certifi ed Teacher of the AT Senior Faculty American Center for the Alexander Technique Private Practice Rye, New York Judith E. Deutsch In loving memory of my father, Hans P. Deutsch, who taught me to value intellectual pursuits, hard work, and perseverance—but more importantly, kindness and love To my husband, Joel Stern, and our children, Sarah and Daniel, whose love and joy make my life whole Ellen Zambo Anderson To my husband, Scott, and our children, Kevin, Derek, and Taylor, whose laughter and love have complemented my life in immeasurable ways Preface WHO WILL BENEFIT FROM THIS BOOK? ORGANIZATION The purpose of the book is to provide physical The book is organized into two parts. Chapters 1 to therapy students and clinicians with a book on 3 describe CAM, the clinical decision-making model complementary therapies (CAM) that are most that is used throughout the book, and potential likely encountered in rehabilitation. We feel it is modifi ers of the clinical decision-making approach. important that the reader practice a clinical deci- The second part has fi ve sections. Each section is sion-making approach that incorporates principles defi ned by the domain of CAM as established by of evidence-based practice. The process to evaluate NCCAM. They are as follows: Whole Medical the appropriateness of a complementary therapy Systems, Mind Body Interventions, Biologically based on evidence, patient preferences, and their Based Therapies, Energy Therapies, and Manual clinical experience is modeled and reinforced Body-Based Therapies. An overview of the domain throughout the book. Given the rapid rate of dis- is provided in each section, followed by chapters covery in CAM, the evidence-based content may that include a case scenario for which a complemen- become outdated, but the general principles of tary therapy is investigated, described, and either CAM and the process to evaluate it will not. included or not, in the plan of care. For example, in the Mind-Body Interventions section, there are spe- cifi c chapters on Yoga and Tai Chi. In the Manual WHY IS THIS BOOK IMPORTANT TO Body-Based Therapies, there are chapters on The THE PROFESSION? Ida Rolf Method of Structural Integration, Felden- Why write another book on complementary and krais, Alexander, Craniosacral Therapy, and Pilates. alternative medicine (CAM) or therapies? Clearly, the public, not only in the United States but around DISTINCTIVE FEATURES OF THIS BOOK the world, is interested in and seeking these thera- pies. Our clients are performing their own web In this book the reader will fi nd: searches and arriving for physical therapy sessions • A background and description of CAM use and with pointed questions. We are being asked to serve research as consultants, advisors, and in some instances, as • A clinical decision-making process for incorpo- providers of the so-called complementary thera- rating complementary therapies into a rehabili- pies. It is important to do this in an educated tation plan of care manner. • Legal, ethical, and cultural modifi ers that infl u- In parallel with the public’s interest in CAM is ence clinical decision-making for CAM the development of evidence-based practice. Tools • Overview chapters on each of the National for evaluating effi cacy of therapies are available. Center on Complementary and Alternative The evidence-based approach, with its triad of Medicine’s (NCCAM) fi ve domains of comple- patient values, clinician expertise, and evidence, mentary and alternative medicine offers an excellent model for evaluating comple- • Specifi c therapy chapters that model the clinical mentary therapies. decision-making process The ability to address our client’s queries using • Case scenarios for which the integration of a an evidence-based approach is the reason we have complementary therapy into a plan of care is written this book. We have placed the evidence- considered based approach into the larger context of physical • A review of complementary therapy and its scien- therapist clinical decision making to offer the reader tifi c literature as it relates to the case scenario a framework for making those important clinical • Clinical hypothesis generation, examination, decisions. Our goal is to provide not only content intervention, and evaluation of addition of CAM information on CAM, but much more importantly, to the plan of care to suggest a process by which CAM can be • Resources for identifying practitioners, addi- evaluated. tional reading, and patient education materials xvii Acknowledgments As with the writing of most books, the work thanks go to our photographers, Joel Stern and and credit for this book is shared with many Karen Clarkson, and models Soraya Zahedi and individuals. We are fortunate to be surrounded by Taylor Anderson. Their images made this book colleagues, peers, friends, and students who have more attractive and complete. We appreciate the inspired, directed, and supported our work. There publishing staff consisting of Kellie White, Kelly are many people to thank. Milford, Teri Zak, Marion Waldman, and Andrew We are indebted to our contributors, who rep- Allen for their tireless support, patience, and gentle resent physical therapy, medicine, chiropractic, prodding. Finally, we are deeply grateful for our dietetics, clinical sciences, and complementary colleagues and students of the Doctoral Program in therapies. Their expertise and knowledge have pro- Physical Therapy at the University of Medicine and vided the breadth and enriched the content of the Dentistry of New Jersey-School of Health-Related book. We value the reviewers, who provided excel- Professions. The supportive environment that we lent feedback to clarify and enhance the text. Many work in has made this book possible. xix Foreword Complementary and alternative medicine The use of randomized controlled trials is impor- (CAM) is maturing. Increasingly, it is being tant in clinical decision making. Judy Deutsch and integrated into the mainstream of health care. This Ellen Anderson have taken the “top of the hierar- book is an excellent illustration of that. Physical chy” evidence-based approaches and merged them therapy is an established allied health science with with practical step-by-step approaches useful for an integral role in many areas of medicine, ranging health care delivery. In addition, this book pro- from assistance in managing congenital deformi- vides a useful description of the context of practice, ties to sports medicine to the aged. Its focus is on including legal and ethical issues, medical malprac- the whole person, a variety of symptoms and func- tice, professional standards, and quality of care tions, and on healing. Therefore, it is not surprising issues—all important components of delivering that it has a philosophical and practical affi liation appropriate integrative medicine. Especially inter- with CAM. When I was director of The Offi ce of esting are the case examples, in which the discus- Alternative Medicine at the National Institutes of sion is framed both theoretically and through Health (NIH) from 1995 to 1999, I found the most specifi c illustrations of how the principles outlined use of complementary medicine within the physical in the book are applied in real life. From these, any therapy department. As a military physician inter- practitioner with appropriate training can under- ested in integrative medicine in the Department of stand how to integrate these practices for their Defense, I found that practices such as acupuncture own use. and manipulation were already integrated into the After the smoke has cleared from the debate on PM & R clinics at places like Walter Reed and the science and complementary medicine, the suffering National Naval Medical Center. patient still stands before us. The patient is our Physical therapy has taken the lead in the inte- primary audience—the customer we serve. In the gration and establishment of standards for use of midst of confl icting agendas driven by economics, complementary and alternative medicine within new devices, family and social forces, professional health care. This book takes the next step by pro- turf, and reimbursement, it is the patient and service viding clear approaches to the use of evidence- to the patient that we must always keep in mind. based medicine and step-by-step clinical decision Many allied health practices and especially physical making for complementary medicine. Drs. Deutsch therapy, have emphasized patient-centered care. and Anderson have done an admirable job in pro- With this book, physical therapy leads the way in viding a blueprint for the integration of CAM and the practical integration of CAM into practice. This physical therapy that other health professionals can book is a guide for physical therapists on integrative emulate. The CCC and PICO approach that they medicine. The hope is that others will also read it, have provided form a rational framework for devel- use it, and improve on it in the years ahead. oping standards of care in integrative medicine. Evidence-based medicine processes can be Wayne B. Jonas complex. A single approach (e.g., using only “top President and CEO of the hierarchy” evidence for making clinical deci- Samueli Institute sions) is often not adequate in day-to-day practice. Alexandria, Virginia xi