- Student in CAM Research Course

1. “Research is a wholly separate world compared to what I have lived in. It has its own language and thought process.” -Student in CAM Research Course

2. Bringing Community CAM Practitioners into the Research Process: Bridging the Gap Between Practice and Research Suzie Zick ND MPH, Rita Benn, PhD Linda Diane Feldt RPP, NCTMB Geri Day, MSN

3. Overview of Presentation • Philosophy • Purpose of the course • Course description and design • CAM research projects • Course evaluation • Future directions • Resources

4. Philosophy Behind the Course • Popularity and use of CAM • Funded studies needed to demonstrate safety and efficacy of CAM • Research can lead to policy development for: • Government regulations and initiatives • Insurance decisions • Programs in medical institutions • Researchers are MDs and PhDs and may not be trained as CAM practitioners

5. Career Development of CAM Practitioners UM-CAMRC P50 Grant (S. Bolling, PI, S. Warber, Co-PI) • Recognized the importance of meaningful CAM participation in the design and implementation of research • Planned for CAM practitioners to create original research studies • Included plans for teaching CAM practitioners about research

6. Research your Passion In CAM Course Goals: • To teach CAM practitioners to critically evaluate the research literature • To facilitate CAM providers giving accurate scientific information about CAM • To provide additional training to CAM practitioners who had an interest in participating in research and teaching at the university level

7. Recruitment & Selection of Course Participants • Advertisements • Developed criteria for participation • Practitioners completed an application packet • 11 practitioners with varying backgrounds chosen

8. Course Structure &Description • Two instructors, different backgrounds • Course offered as a two-part sequence • Focus of section one: Evaluation of Literature • Focus of section two: Grant Proposal Design • 7 Classes, Fall semester 2002 • Variety of instructional methods • Adult learning principles • Reading and homework assignments

9. Knowledge Concepts Human subjects requirements Funding mechanisms Research terms Research designs Research biases Funding Role of research personnel Measurement tools Appropriate placebo/control groups Role of research in CAM Study sample and recruitment issues Introduction to study statistics Sample size and power Mixed methods research Acquired Skills How to conduct an electronic literature search How to use academic libraries How to identify research collaborators How to use scientific language How to write sections of research proposals How to critique research studies How to identify and choose an appropriate measurement tool How to write hypotheses How to write specific aims Knowledge and Skill Competency Areas

10. Research Course Session Topics • Scientific Study: Research Design and Terms • Evaluating the Scientific Literature • Designing Research Questions: Formulation and Process • Developing a Grant Proposal • Writing Background and Significance Sections • Study Design: Sample, Instruments, Placebo • Basic Statistics and Human Subjects

11. Learning how to do computer literature searches was an important part of the class.

12. Example of Session ContentSession 5: Background & Significance • Writing a background and significance for your research question • Scientific Writing Style • Finding Research Partners • Homework

13. Research Project Themes of CAM Practitioners • Energy Healing for Treatment of Terminally Ill Patients • Effect of Peppermint on Post-Operative Nausea in Orthopedic Patients • Self-Massage Compression for Carpal Tunnel Syndrome • The Effects of CAM Therapies on Quality of Life in a Chiropractic Practice • The Effects of Chair Massage in the Workplace • Mushrooms for Patients With San Joaquin Valley Fever • The Use of Art Therapy for Improving Quality of Life of Cancer Patients • Hands of Light Energy Healing Treatment of Sexually Abused Women • The Use of Hypnosis for the Treatment of Pain in Severe Burn Patients

14. Course Continuation • Request to continue course by students in order to complete the writing of an entire grant proposal • Consultation model -Monthly sessions, 2 hours in length -Discussion of one or two proposals per session -Email/phone support in-between sessions • 4 students, winter and spring semester, 2003

15. Peppermint & Its Effect on Post Operative Nausea

16. PROTOCOL FOR PEPPERMINT & PONV STUDY Patient experiences an episode of nausea or vomiting If nauseated, patient rates using VAS Nurse puts on mask and offers aromatherapy holding bottle 2 inches beneath patient’s nose instructing to take 3 deep breaths YES Is nausea/vomiting reduced/relieved? NO The patient is offered the same aromatherapy process Patient rates the nausea at the 10-minute interval YES Is nausea/vomiting reduced/relieved? NO The patient is offered aromatherapy or conventional treatment until relieved Patient is relieved

17. Self-Massage Compressionfor Carpal Tunnel Study A DB, RCT pilot study. Outcomes: 1. hand strength. 2. pain and numbness. Arms: Control: Placebo Experimental: Self massage compression.

18. Compression Points

19. Initial Areas of Interest for Research • Malpresentation in labor - using Cranialsacral Therapy to help the baby turn • Yellow Dock Rumex crispus oil used for healing tissue trauma • Carpal Tunnel Syndrome relief through self administered massage compression

20. Impact of Class • Clarified which project was achievable • Gained skills to design research • Making progress towards pilot study • Using skills in teaching, professional reading and evaluating techniques and products • Able to advise on research issues within professional associations • Better source of information for conventional practitioners (e.g. MD referrals) • Inform clients about studies in popular literature

21. Next Steps • Include greater detail in protocol • Confirm PI • Complete IRB application • Apply for funding (possible sources already identified) • Launch the pilot study • Publish results and go from there

22. Course Evaluation Approach • National Academy of Science Model : - What occurred? What were the outcomes? What explains the outcomes? • Mixed Methods • Rating Assessment of skills & knowledge • Pre-Post Assessment of Personal Learning Goals • Qualitative Responses to Questions

23. Course Evaluation Ratings • 16 questions related to knowledge and skills • Sample Examples of Questions -Understanding different study designs -Understanding the role of bias in research -Knowledge of health research measurements • Mean Course Value in Meeting Goals=4.56 • 75% of items at least as 4 or 5, none below 3

24. Examples of Qualitative Questions • Please tell us what the term “research” means to you now. • Did you find yourself thinking about the implications of scientific research during or after the classes? What were those? • What “aha” moment did you have about research, if any, during this course? • In what ways did your understanding of research change throughout the course? • How do you hope to use what you have learned in this course? • What, if anything, did you find conflicting with your understanding of CAM?

25. Qualitative Themes Five Major Areas: • Acquiring a New Language • Slow Process of Scientific Research • The Dilemma of the Scientific Method • Increased Confidence Levels • Enjoyment of Relationship with Colleagues

26. “I think any culture with its own inherent rules of behavior needs a lingo to help order the behavior inherent to the context.”

27. “The idea of pinpointing one symptom and trying to find the silver bullet to fix it was solidified in my mind. At some point, when this one treatment has proven itself on many people, then it is recognized as a viable treatment. The process, to me, is very slow, expensive and tedious. History and nature are faster (and better) ‘teachers’ than science.”

28. “We are doing narrow studies to answer multifactorial questions. CAM is about holism, and the ‘gold standard’ research study is far from holistic.”

29. “I don't believe that double blind, randomized, placebo controlled studies are sufficient to do good nutritional research…The idea of researching one component to affect one endpoint with statistical significance as compared to a control group can miss the main point. We are multiple pathway organisms that have ‘upstream’ modulators that don't communicate in a unidirectional path.”

30. “That a person with only a bachelor’s degree and a lot of chutzpah and brains can make a research study that they’re passionate about happening. That was truly a revelation for me...This class was a boon to me in many ways – I felt supported in expressing my ideas that have previously been met with skepticism or impotence.”

31. Recommendations for Improvement • Shorten length of the class • Increase the number of classes and course duration) • Continue to break the course into 2 sections: • one focusing on understanding, communicating about, and critiquing research and grants • second focusing on writing a research proposal • Invite teachers with expertise in areas, such as animal research • Increase the use of assigned readings • Identify and use a CAM research methodology textbook

32. Future Directions • Develop NIH and/or University-Based Fellowship for Community based CAM practitioners • Outreach to CAM professional associations

33. Resources Power Point on APHA conf. web site & LDF site Look for Article in Alternative Therapies and Healthin press Contact Us: Suzie Zick szick@umich.edu Linda Diane Feldt feldt@holisticwisdom.org www.holisticwisdom.org/hwpages/powerpoint.html Rita Benn ritabenn@umich.edu Geri Day geri_day@bshsi.com UM-CAMRC 715 E. Huron St. Suite 1W Ann Arbor MI 48104 734-998-7715 or 877-800-9887 camrc@umich.edu www.med.umich.edu/camrc/