Roseen Eric J, Hurstak Emily E, Kim Ryung S, Gao Qi, Greco Carol M, Vago David R, Saper Robert B, Kligler Benjamin, McKee M Diane, Dusek Jeffery A
Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA, USA.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Glob Adv Integr Med Health. 2025 Jun 2;14:27536130251345481. doi: 10.1177/27536130251345481. eCollection 2025 Jan-Dec.
BACKGROUND: The integrative medicine (IM) clinic is an innovative care model that may increase access to guideline-concordant nonpharmacologic treatment use in healthcare delivery systems for prevalent conditions such as low back pain (LBP). OBJECTIVE: To describe the use and effectiveness of IM services for LBP in IM clinics. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: Adult patients with LBP enrolled at seventeen IM clinics. MEASURES: Patterns of IM service use were assessed over 12 months. Changes in clinical outcomes were assessed between index visit and 12-month follow-up using linear mixed-effects models. Primary (pain interference, physical function) and secondary (pain intensity, anxiety, depression, fatigue, sleep disturbance, social participation) outcomes were obtained from the PROMIS-29 instrument. RESULTS: We identified 660 participants with LBP (mean age = 51.6 years, 75% female). Over the 12-month study period, common IM services were IM consults (56%), acupuncture (44%), chiropractic care (24%), physical therapy (19%), and massage (17%). Over two-thirds (70%) of participants received at least one guideline-concordant nonpharmacologic treatment. Participants with follow-up outcome data (n = 443, 67%) reported a modest reduction in pain interference with life activities in the short- and long-term (2-month mean difference [MD] = -1.47, 95%CI = -2.98, -0.64; 12-month MD = -1.98, 95%CI = -3.12, -0.88). By contrast, improvements in physical function were not statistically or clinically significant (2-month MD = 0.37, 95%CI = -0.28, 1.01; 12-month MD = 0.69, 95%CI = -0.31, 1.69). At 12 months, small improvements were observed on all secondary outcomes (pain intensity, anxiety, depression, and social participation) except fatigue and sleep disturbance. CONCLUSIONS: Most patients with LBP receiving care at IM clinics received at least one guideline-recommended nonpharmacologic treatment. However, improvements on clinical outcomes were relatively small. Additional multi-site studies are needed to explore the optimal implementation approach.
背景：综合医学（IM）诊所是一种创新的护理模式，在医疗保健系统中，对于腰痛（LBP）等常见病症，它可能会增加获得符合指南的非药物治疗的机会。 目的：描述IM诊所中IM服务对LBP的使用情况和效果。 研究设计：前瞻性队列研究。 研究对象：在17家IM诊所登记的成年LBP患者。 测量指标：在12个月内评估IM服务的使用模式。使用线性混合效应模型评估首次就诊和12个月随访之间临床结局的变化。主要结局（疼痛干扰、身体功能）和次要结局（疼痛强度、焦虑、抑郁、疲劳、睡眠障碍、社会参与）通过PROMIS-29工具获得。 结果：我们确定了660名LBP参与者（平均年龄=51.6岁，75%为女性）。在12个月的研究期间，常见的IM服务有IM咨询（56%）、针灸（44%）、整脊治疗（24%）、物理治疗（19%）和按摩（17%）。超过三分之二（70%）的参与者接受了至少一种符合指南的非药物治疗。有随访结局数据的参与者（n = 443，67%）报告在短期和长期内，生活活动中的疼痛干扰有适度减轻（2个月平均差值[MD]= -1.47，95%置信区间[CI]= -2.98，-0.64；12个月MD = -1.98，95%CI = -3.12，-0.88）。相比之下，身体功能的改善在统计学上或临床上均无显著意义（2个月MD = 0.3
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