““Research is a wholly Research is a wholly separate world compared to separate world compared to what I have lived in. It has what I have lived in. It has

its own language and its own language and thought process.” thought process.”

--Student in CAM Research CourseStudent in CAM Research Course

Bringing Community CAM Bringing Community CAM Practitioners into the Practitioners into the

Research Process:Research Process:Bridging the Gap Bridging the Gap

Between Practice and ResearchBetween Practice and Research

Suzie Zick Suzie Zick ND MPHND MPH, Rita Benn, , Rita Benn, PhDPhD

Linda Diane Feldt Linda Diane Feldt RPP, NCTMBRPP, NCTMB

Geri Day, Geri Day, MSNMSN

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

Philosophy Behind the CoursePhilosophy Behind the Course

Popularity and use of CAMPopularity and use of CAM Funded studies needed to demonstrate safety Funded studies needed to demonstrate safety

and efficacy of CAMand efficacy of CAM Research can lead to policy development for:Research can lead to policy development for:

Government regulations and initiativesGovernment regulations and initiatives Insurance decisionsInsurance decisions Programs in medical institutionsPrograms in medical institutions

Researchers are MDs and PhDs and may not Researchers are MDs and PhDs and may not be trained as CAM practitionersbe trained as CAM practitioners

Career Development of CAM Career Development of CAM PractitionersPractitioners

UM-CAMRC P50 Grant UM-CAMRC P50 Grant

(S. Bolling, PI, S. Warber, Co-PI)(S. Bolling, PI, S. Warber, Co-PI) Recognized the importance of meaningful CAM Recognized the importance of meaningful CAM

participation in the design and implementation of participation in the design and implementation of researchresearch

Planned for CAM practitioners to create original Planned for CAM practitioners to create original research studiesresearch studies

Included plans for teaching CAM practitioners Included plans for teaching CAM practitioners about researchabout research

Research your Passion In CAMResearch your Passion In CAM

Course Goals:Course Goals: To teach CAM practitioners to critically To teach CAM practitioners to critically

evaluate the research literature evaluate the research literature To facilitate CAM providers giving accurate To facilitate CAM providers giving accurate

scientific information about CAMscientific information about CAM To provide additional training to CAM To provide additional training to CAM

practitioners who had an interest in practitioners who had an interest in participating in research and teaching at the participating in research and teaching at the university leveluniversity level

Recruitment & Selection Recruitment & Selection of Course Participantsof Course Participants

Advertisements Developed criteria for participation Practitioners completed an application

packet 11 practitioners with varying

backgrounds chosen

Course Structure &DescriptionCourse 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

Knowledge and Skill Competency AreasKnowledge and Skill Competency AreasKnowledge ConceptsKnowledge Concepts Human subjects requirementsHuman subjects requirements Funding mechanismsFunding mechanisms Research termsResearch terms Research designsResearch designs Research biasesResearch biases FundingFunding Role of research personnelRole of research personnel Measurement toolsMeasurement tools Appropriate placebo/control groupsAppropriate placebo/control groups Role of research in CAMRole of research in CAM Study sample and recruitment issuesStudy sample and recruitment issues Introduction to study statisticsIntroduction to study statistics Sample size and powerSample size and power Mixed methods researchMixed methods research

Acquired SkillsAcquired Skills How to conduct an electronic How to conduct an electronic

literature searchliterature search How to use academic librariesHow to use academic libraries How to identify research How to identify research

collaboratorscollaborators How to use scientific languageHow to use scientific language How to write sections of How to write sections of

research proposalsresearch proposals How to critique research How to critique research

studiesstudies How to identify and choose an How to identify and choose an

appropriate measurement toolappropriate measurement tool How to write hypothesesHow to write hypotheses How to write specific aimsHow to write specific aims

Research Course Session TopicsResearch 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

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

Example of Session ContentExample of Session ContentSession 5: Background & SignificanceSession 5: Background & Significance

Writing a background and significance Writing a background and significance for your research questionfor your research question

Scientific Writing StyleScientific Writing Style Finding Research PartnersFinding Research Partners HomeworkHomework

Research Project Themes Research Project Themes of CAM Practitionersof 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

Course ContinuationCourse 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

Peppermint & Its Effect on Post Peppermint & Its Effect on Post Operative Nausea Operative Nausea

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

Is nausea/vomiting reduced/relieved?

The patient is offered the same aromatherapy process

Patient rates the nausea at the 10-minute interval

The patient is offered aromatherapy or conventional treatment until relieved

Is nausea/vomiting reduced/relieved?

Patient is relieved

YES

YES

NO

NO

Self-Massage CompressionSelf-Massage Compressionfor Carpal Tunnel Studyfor Carpal Tunnel Study

A DB, RCT pilot study.A DB, RCT pilot study.

Outcomes:Outcomes: 1. hand strength. 1. hand strength. 2. pain and numbness. 2. pain and numbness.

Arms:Arms:Control: Placebo Control: Placebo Experimental: Self massage Experimental: Self massage compression.compression.

Compression Compression PointsPoints

Initial Areas of Interest for Initial Areas of Interest for ResearchResearch

Malpresentation in labor - using Cranialsacral Malpresentation in labor - using Cranialsacral Therapy to help the baby turnTherapy to help the baby turn

Yellow Dock Yellow Dock RumexRumex crispus oil used for healing crispus oil used for healing tissue trauma tissue trauma

Carpal Tunnel Syndrome relief through self Carpal Tunnel Syndrome relief through self administered massage compressionadministered massage compression

Impact of ClassImpact of Class

Clarified which project was achievableClarified which project was achievable Gained skills to design researchGained skills to design research Making progress towards pilot studyMaking progress towards pilot study Using skills in teaching, professional reading and Using skills in teaching, professional reading and

evaluating techniques and productsevaluating techniques and products Able to advise on research issues within professional Able to advise on research issues within professional

associationsassociations Better source of information for conventional Better source of information for conventional

practitioners (e.g. MD referrals)practitioners (e.g. MD referrals) Inform clients about studies in popular literatureInform clients about studies in popular literature

Next StepsNext Steps

Include greater detail in protocol Include greater detail in protocol Confirm PIConfirm PI Complete IRB applicationComplete IRB application Apply for funding (possible sources already Apply for funding (possible sources already

identified)identified) Launch the pilot studyLaunch the pilot study Publish results and go from therePublish results and go from there

Course Evaluation ApproachCourse Evaluation Approach

National Academy of Science Model :National Academy of Science Model :

- What occurred? What were the outcomes? - What occurred? What were the outcomes?

What explains the outcomes? What explains the outcomes? Mixed MethodsMixed Methods

Rating Assessment of skills & knowledge Rating Assessment of skills & knowledge Pre-Post Assessment of Personal Learning GoalsPre-Post Assessment of Personal Learning Goals Qualitative Responses to QuestionsQualitative Responses to Questions

Course Evaluation RatingsCourse Evaluation Ratings

16 questions related to knowledge and skills16 questions related to knowledge and skills Sample Examples of QuestionsSample 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=4.56Mean Course Value in Meeting Goals=4.56 75% of items at least as 4 or 5, none below 375% of items at least as 4 or 5, none below 3

Examples of Qualitative QuestionsExamples of Qualitative Questions Please tell us what the term “research” means to you Please tell us what the term “research” means to you

now.now. Did you find yourself thinking about the implications Did you find yourself thinking about the implications

of scientific research during or after the classes? of scientific research during or after the classes? What were those?What were those?

What “aha” moment did you have about research, if What “aha” moment did you have about research, if any, during this course?any, during this course?

In what ways did your understanding of research In what ways did your understanding of research change throughout the course?change throughout the course?

How do you hope to use what you have learned in How do you hope to use what you have learned in this course?this course?

What, if anything, did you find conflicting with your What, if anything, did you find conflicting with your understanding of CAM?understanding of CAM?

Qualitative ThemesQualitative Themes

Five Major Areas:Five Major Areas: Acquiring a New LanguageAcquiring a New Language Slow Process of Scientific ResearchSlow Process of Scientific Research The Dilemma of the Scientific MethodThe Dilemma of the Scientific Method Increased Confidence LevelsIncreased Confidence Levels Enjoyment of Relationship with ColleaguesEnjoyment of Relationship with Colleagues

““I think any culture with its own inherent I think any culture with its own inherent rules of behavior needs a lingo to help order rules of behavior needs a lingo to help order

the behavior inherent to the context.”the behavior inherent to the context.”

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

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

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

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

Recommendations for ImprovementRecommendations 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

Future DirectionsFuture Directions

Develop NIH and/or University-Based Develop NIH and/or University-Based Fellowship for Community based CAM Fellowship for Community based CAM practitionerspractitioners

Outreach to CAM professional Outreach to CAM professional associationsassociations

ResourcesResourcesPower Point on APHA conf. web site & LDF

siteLook for Article in Alternative Therapies and

Health in pressContact 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/