Americans are increasingly using complementary and integrative medicine for pain and other health problems, according to national surveys. Researchers at Kaiser Permanente Washington Health Research Institute (KPWHRI) are using rigorous scientific methods to evaluate the effectiveness — including cost-effectiveness — of complementary and integrative therapies delivered in real-world practice.
Several KPWHRI studies concern musculoskeletal conditions such as back pain, which accounts for a large portion of visits to alternative providers. National guidelines for treating back pain now include 6 complementary and integrative approaches: 4 of them — acupuncture, massage, mindfulness, and yoga — on the strength of Kaiser Permanente research.
The stress-reducing aspects of some treatments may be more important than the physical ones. Also, complementary and integrative practitioners often approach their patients with optimism, offer suggestions for ways they can achieve more balance in their lives, and coach them on becoming more involved in their own healing and self-care. This has led to a project in implementation science in which KPWHRI researchers are learning to optimize mindfulness training to work for a greater number of patients. Qualitative research is an important component of this research and Associate Investigator Clarissa Hsu, PhD, has led these efforts for multiple projects.
Projects embedded in the delivery system are also a focus at KPWHRI. Large, multisite projects have included complementary and integrative health components. For example, a pragmatic trial carried out in Kaiser Permanente clinics in Georgia, Hawaii, Oregon, and Washington tested a primary care-based integrated behavioral health intervention that included a yoga-based adaptive movement component.
DeBar LL, Justice M, Avins AL, Cook A, Eng CM, Herman PM, Hsu C, Nielsen A, Pressman A, Stone KL, Teets RY, Wellman R. Acupuncture for chronic low back pain in older adults: Design and protocol for the BackInAction pragmatic clinical trial. Contemp Clin Trials. 2023 Mar 27;128:107166. doi: 10.1016/j.cct.2023.107166. [Epub ahead of print]. PubMed
Roseen EJ, Pinheiro A, Lemaster CM, Plumb D, Wang S, Elwy AR, Streeter CC, Lynch S, Groessl E, Sherman KJ, Weinberg J, Saper RB. Yoga versus education for veterans with chronic low back pain: A randomized controlled trial. J Gen Intern Med. 2023 Jan 17. doi: 10.1007/s11606-023-08037-2. [Epub ahead of print]. PubMed
Matthews SW, Sherman KJ, Binick S, Chien AJ. Optimizing narrowband UVB phototherapy: Is it more challenging for your older patients? Cutis. 2022 Aug;110(2):E45-E52. doi: 10.12788/cutis.0617. PubMed
Jones SMW, Sherman KJ, Bermet Z, Palazzo LG, Lewis CC. An experimental study to inform adoption of mindfulness-based stress reduction in chronic low back pain. Implement Sci Commun. 2022;3(1):87. doi: 10.1186/s43058-022-00335-w. PubMed
Joyce C, Kelly KC, Gurnani S, Sherman KJ, Roseen EJ, Saper RB. "In class we were all one."A qualitative exploration of yoga and educational interventions for predominantly low-income and minority adults with chronic low back pain. J Integr Complement Med. 2022 Aug 1. doi: 10.1089/jicm.2022.0557. Online ahead of print. PubMed
![]() Andrea J. Cook, PhDSenior Biostatistics Investigator |
![]() Clarissa Hsu, PhDAssociate Investigator |
![]() Robert D. Wellman, MSSenior Collaborative Biostatistician |
![]() Lorella Palazzo, PhDCollaborative Scientist |
![]() Marlaine Gray, PhDAssistant Investigator |
![]() Laurel Hansell, MA, MPHCollaborative Scientist |
![]() Kimberly Arthur, MPHCollaborative Scientist |
Susan D. Reed, MD, MPH
Harborview Medical Center; University of Washington (UW) Department of Obstetrics and Gynecology