Haderlein Taona P, Zeliadt Steven B, Kloehn Alexander T, Lott Briana D, Toyama Joy, Resnick Adam, Elwy A Rani, Der-Martirosian Claudia, Taylor Stephanie L
VHA HSR&D Center for the Study of Health Care Innovation, Implementation, and Policy, Greater Los Angeles VA Medical Center, Los Angeles, California, USA.
Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, California, USA.
Telemed J E Health. 2025 Feb;31(2):176-184. doi: 10.1089/tmj.2024.0060. Epub 2024 Sep 11.
Virtual complementary and integrative health (CIH) therapy availability increased during the COVID-19 pandemic, but little is known about effectiveness. We examined the perceived effectiveness of in-person and virtual CIH therapies for patients with chronic musculoskeletal pain who recently started using CIH therapies. The sample included Veterans ( = 1,091) with chronic musculoskeletal pain, identified in the Veterans Health Administration's electronic health record based on initiation of CIH therapy use, who responded to VA's Patient Complementary and Integrative Health Therapy Experience Survey during March, 2021, to August, 2022. Using multivariable models with self-guided virtual (apps or videos) delivery as the reference, we compared patient-reported outcomes (pain, mental health, fatigue, and general well-being) associated with any yoga, Tai Chi/Qigong, or meditation use delivered: (1) only in-person, (2) only virtually with a live provider, (3) only virtually self-guided, (4) virtually self-guided + virtually provider-guided, or (5) hybrid in-person + virtual (self-or provider-guided). Under 10% of Veterans reported only in-person use; 54% used only virtual formats and 36% a hybrid of in-person and virtual. Forty-one percent reported improvement in general well-being, 40.6% in mental health, 37.1% in pain, and 22.7% in fatigue. Compared with Veterans using only self-guided virtual CIH therapies, Veterans using only in-person therapies were more likely to report improvement in fatigue (odds ratio [OR]: 1.8, confidence interval [CI]: 1.1-3.1) and general well-being (OR: 1.7, CI: 1.0-2.6). Many patients perceived health improvements from CIH therapies, with in-person users reporting more improvement in fatigue and well-being than those using virtual sessions and similar improvements in pain and mental health for in-person and hybrid users.
在新冠疫情期间，虚拟补充与整合健康（CIH）疗法的可用性有所增加，但对其有效性知之甚少。我们研究了近期开始使用CIH疗法的慢性肌肉骨骼疼痛患者对面对面和虚拟CIH疗法的感知有效性。样本包括1091名患有慢性肌肉骨骼疼痛的退伍军人，这些人是根据退伍军人健康管理局电子健康记录中CIH疗法的使用起始情况确定的，他们在2021年3月至2022年8月期间回复了退伍军人事务部的患者补充与整合健康疗法体验调查。以自我引导的虚拟（应用程序或视频）交付为参照，我们使用多变量模型，比较了与任何瑜伽、太极/气功或冥想使用相关的患者报告结局（疼痛、心理健康、疲劳和总体幸福感），这些疗法的交付方式为：（1）仅面对面，（2）仅与现场提供者进行虚拟交付，（3）仅自我引导的虚拟交付，（4）自我引导的虚拟交付+提供者引导的虚拟交付，或（5）面对面+虚拟混合（自我或提供者引导）。不到10%的退伍军人报告仅使用面对面疗法；54%仅使用虚拟形式，36%使用面对面和虚拟混合形式。41%的人报告总体幸福感有所改善，40.6%的人心理健康有所改善，37.1%的人疼痛有所改善，22.7%的人疲劳有所改善。与仅使用自我引导的虚拟CIH疗法的退伍军人相比，仅使用面对面疗法的退伍军人更有可能报告疲劳（优势比[OR]：1.8，置信区间[CI]：1.1 - 3.1）和总体幸福感（OR：1.7，CI：1.0 - 2.6）有所改善。许多患者认为CIH疗法改善了健康状况，面对面治疗的使用者报告在疲劳和幸福感方面比虚拟治疗的使用者有更多改善，而面对面和混合治疗的使用者在疼痛和心理健康方面有类似改善。
