Exploring Integrative Medicine in Swedish Primary Care
Condition: Back or Neck Pain of at Least 2 Weeks Duration
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Research over the last years have reported an increased popularity of complementary therapies
      (CTs) and an integration of CTs into mainstream medical settings, health care organizations
      and insurance plans. These trends may present both new challenges and new opportunities for
      health care provision. In Sweden and elsewhere, major challenges include the great variety
      and quality of CT provision within health care and a lack of national and international
      recommendations of how integrations of CTs with conventional care should be modelled, i.e.
      lack of conceptual models for delivering integrative medicine (IM). This may partly be a
      result of a scarce evidence base in support of IM provision within public health care
      services, e.g. lack of IM compared to usual care in randomised clinical trials. It remains
      largely unknown whether comprehensive models of IM are clinically or cost effectively
      different from conventional care provision.

      Back and neck pain are costly, conventionally managed in primary care and two of the most
      common conditions treated by CTs. We have developed a comprehensive collaborative consensus
      model for IM adapted to Swedish primary care. The aim of this pilot study was to explore the
      feasibility of a pragmatic randomised clinical trial to investigate the effectiveness of the
      IM model versus conventional primary care in the management of patients with non-specific
      back/neck pain.
    

Detailed description: 
      Study objectives included the exploration of recruitment and retention rates, patient and
      care characteristics, clinical differences and effect sizes between groups, selected outcome
      measures and power calculations to inform the basis of a full-scale trial.
    

Intervention name(s): Integrative care; Usual care
Intervention type(s): Procedure; Procedure
Intervention description(s): In short, integrative care was up to 10 complementary therapy treatments delivered to the patient in addition to the usual care over an intervention period of up to 12 weeks. The integrative care was provided by a multidisciplinary team coordinated by a gate keeping general practitioner with clinical knowledge and experience of CTs and senior licensed/certified CT providers representing Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong.; The usual care treatment was coordinated by the patient's general practitioner and complied with the clinical practice routines at the participating primary care units. Conventional procedures included but were not exclusive to advice, prescription of drugs, sick leave and physiotherapy/physical therapy. There were no constraints to the provided usual care as the study aimed to pragmatically reflect the general practitioners' standard care and treatment as usual.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Integrative medicine; Primary care; Swedish massage therapy; Manual therapy; Naprapathy; Shiatsu; Acupuncture; Qigong; Pragmatic ranomized controlled pilot trial; Health services research