Interprofessional Integrative Medicine Training for Preventive Medicine Residents

Integrative medicine training was incorporated into the Rutgers New Jersey Medical School Preventive Medicine residency at the Rutgers Biomedical and Health Sciences Newark Campus as a collaboration between the Rutgers New Jersey Medical School and the School of Health Related Professions. Beginning in 2012, an interdisciplinary faculty team organized an Integrative Medicine program in a Preventive Medicine residency that leveraged existing resources across Rutgers Biomedical and Health Sciences. The overarching aim of the programs was to introduce residents and faculty to the scope and practice of integrative medicine in the surrounding Newark community and explore evidence-based research on integrative medicine. The faculty team tapped into an interprofessional network of healthcare providers to organize rotations for the preventive medicine residents that reflected the unique nature of integrative medicine in the greater Newark area. Residents provided direct care as part of interdisciplinary teams at clinical affiliates and shadowed health professionals from diverse disciplines as they filled different roles in providing patient care. The residents also participated in research projects. A combination of formal and informal programs on integrative medicine topics was offered to residents and faculty. The Integrative Medicine program, which ran from 2013 through 2014, was successful in exposing residents and faculty to the unique nature of integrative medicine across professions in the community served by Rutgers Biomedical and Health Sciences

Massage Therapy for Osteoarthritis of the Knee: A Randomized Dose-Finding Trial

In a previous trial of massage for osteoarthritis (OA) of the knee, we demonstrated feasibility, safety and possible efficacy, with benefits that persisted at least 8 weeks beyond treatment termination.We performed a RCT to identify the optimal dose of massage within an 8-week treatment regimen and to further examine durability of response. Participants were 125 adults with OA of the knee, randomized to one of four 8-week regimens of a standardized Swedish massage regimen (30 or 60 min weekly or biweekly) or to a Usual Care control. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog pain scale, range of motion, and time to walk 50 feet, assessed at baseline, 8-, 16-, and 24-weeks.WOMAC Global scores improved significantly (24.0 points, 95% CI ranged from 15.3-32.7) in the 60-minute massage groups compared to Usual Care (6.3 points, 95% CI 0.1-12.8) at the primary endpoint of 8-weeks. WOMAC subscales of pain and functionality, as well as the visual analog pain scale also demonstrated significant improvements in the 60-minute doses compared to usual care. No significant differences were seen in range of motion at 8-weeks, and no significant effects were seen in any outcome measure at 24-weeks compared to usual care. A dose-response curve based on WOMAC Global scores shows increasing effect with greater total time of massage, but with a plateau at the 60-minute/week dose.Given the superior convenience of a once-weekly protocol, cost savings, and consistency with a typical real-world massage protocol, the 60-minute once weekly dose was determined to be optimal, establishing a standard for future trials.ClinicalTrials.gov NCT00970008

Mean change (95% CI) in outcomes at 8-weeks post-baseline (primary endpoint).

<p>Values are mean with 95% confidence intervals; negative values indicate improvement;</p>†<p>Significant (non-overlap) compared to Usual Care;</p>‡<p>Significant (non-overlap) compared to Group 1.</p

30- and 60-Minute Massage Protocols.

<p>*Accounting for time spent in transition including the welcome, transition to the massage room, taking off jewelry, and other preparatory activities.</p

Dose-Response Curve.

<p>Dose-response curve plotting dose (total minutes over the course of 8-weeks of massage) (x-axis) vs. improvement (change in WOMAC Global scores after 8-weeks). Dose-response effects plateaued at 480-minutes (Group 3), with no significant improvements noted in the 720-minute (Group 4) dose.</p

Changes in outcomes at 24-weeks post-baseline.

<p>Values are mean with 95% confidence intervals; negative values indicate improvement.</p

Demographic Characteristics and Baseline Values.

<p>Values are mean ± SD except otherwise stated.</p

Improvement in WOMAC-Global Scores at Assigned Doses of Massage.

<p>Improvement in WOMAC-Global Scores at Assigned Doses of Massage.</p