An Integrative Group Wellness
P
Program
C
Concurrently
tl Reduces
R d
Pain
P i
and Stress,, and Improves
p
StressRelated Chronic Illnesses
Alba Rodriguez, PhD, CHt
Associate Director
Center for Integrative Wellness
Henry Ford Health System
Southfield, MI
arodrig1@hfhs org
arodrig1@hfhs.org
Academy Health Conference 6/27/10
Project Staff
Program Development and Presentation Team
R b tA
Robert
A. L
Levine,
i
Ph
Ph.D.,
D C.Ht.,
C Ht Director
Di t
HFHS Center for Integrative Wellness
Southfield MI
Southfield,
Ramon Nunez, D.Ac.
Waterford Center for Integrative Medicine
W t f d MI
Waterford,
Support Staff
Ronald M. Ball, B.S.
Jeffrey Nowicki, B.S.
HFHS C
Center
t ffor IIntegrative
t
ti Wellness
W ll
Southfield, MI
Background
• The increase in chronic pain and
stress-related ill-health conditions has
helped
p fuel the striking
g rise in
healthcare costs in the U.S.
• Chronic
Ch
i pain
i and
d stress
t
are intricately
i t i t l
related, and the importance of stress
as a causal and/or aggravating factor
in most chronic illnesses cannot be
underestimated
Research Objective
To examine the effectiveness of a
hands-off Integrative Group
Wellness Program (IGWP) to
reduce chronic pain & stress, and
improve stress-related ill-health
conditions.
conditions
Previous Studies
• RCT compared 1-on-1 treatments for chronic
back
b
c p
pain: Physical
ys c Therapy
e py ((PT)) vs.
s
Complementary & Alternative Medicine (CAM)
therapies
Results:
l
ELIMINATION
T
off chronic
h
i back
b k pain
i
PT=5% vs. CAM=16-25%
• Award-winning Chrysler “We’ve Got Your Back”
group
g
oup p
program
og
for
o c
chronic
o cb
back
c p
pain - 96
employees
Results: ELIMINATION of chronic back pain
p
Participants=55% vs. Untreated Controls=0%
*Poster
Poster #694 Mon. 8am, Levine et al.
Previous Studies
• “Pain Free in 2008” at Chrysler and HFHS
increased group sizes & expanded to ALL
chronic pain conditions
Results: ELIMINATION of all chronic pain
35% of all conditions
• “Stress and Pain-Free Living” (SPFL) at
Chrysler and HFHS in 2009 - Expanded
group programs to address stress & stressrelated conditions, in addition to all chronic
pain
Recruitment
• Chrysler
y
Back Pain Group
p Study:
y 290
in less than 90 days
• Stress & Pain Studies: Over 400 in
less than 30 days
• Corporate recruitment is ideal: easy &
fast using their communication
systems
t
Stress and Pain-Free
StressPain Free Study Design
• IRB
IRB-approved,
d controlled
t ll d clinical
li i l trial
t i l
• IGWP
– Delivered onsite
– 18-24 contact hours over 6-7 mo
(1.5-2 hrs/wk, every other wk)
– Group
p sizes: 50-85 p
per g
group
p
IGWP Intervention
• Guided
G id d R
Relaxation
l
ti
for
f New
N
Awareness:
A
Participants learn to relax, breathe properly, and
intervene with stress & automatic habits/patterns
th t h
that
have b
been supporting
ti
th
the persistence
i t
off stress
t
&
chronic pain
• Somatic
S
ti M
Movementt Ed
Education:
ti
S
Specific
ifi movementt
routines, based on Somatic Functional Therapy
(SFT)*, that help the brain recognize & release
muscles
l that
h are in
i reflex
fl contraction
i
to
reduce/eliminate pain & restore balanced posture
• Wellness
W ll
Activities:
A ti iti
P ti i
Participants
t take
t k responsibility
ibilit
for improving their condition by listening to guided
relaxation CDs and doing somatic routines at home
and
d at work
k
*SFT is a system
y
of movement reeducation and therapy
py
developed by Ramon Nunez, Sensei
Population Studied
• 421 Chrysler and HFHS employees attended
group sessions
– 1826 chronic pain conditions (pain duration >
3 months) at program start
start, incl
including
ding back
back,
hip, shoulder, neck, knee, headache, etc.
– 1191 chronic
h
illnesses
ll
at program start,
including insomnia, chronic fatigue, high
cholesterol,
h l
l high
hi h blood
bl d pressure, etc.
• 285 IGWP program participants filled out the
end-of-program survey (68%)
• 66 untreated controls also completed
p
the survey
y
Outcome Measures
•
•
•
•
•
Stress* and pain (NRS-Numeric Rating Scale)
Di bilit (O
Disability
(Oswestry
t Di
Disablility
blilit IIndex)
d )
Depression symptoms (PHQ-9)
Perceived stress (PSS - Perceived Stress Scale)
Sleep
S
eep qu
quality
ty ((PSQI
SQ - Pittsburgh
ttsbu g S
Sleep
eep Qu
Quality
ty
Index)
*Stress defined: Unhealthy automatic reaction to circumstances
Results
IGWP
Measure
Stress Elimination
St
Eli i ti (0
(0-10
10 scale)
l)
(“0” avg. stress at post)
P i Eli
Pain
Elimination
i ti (0
(0-10
10 scale)
l)
(“0” avg. pain at post)
Stress Reduction (0-10
(0 10 scale)
(Average stress in last week)
Pain Reduction (0
(0-10
10 scale)
(Average pain in last week)
Control
Pre
Post
Pre
Post p-value
NA
14%
NA
6%
=.074
NA
45%
NA
19%
<.001
4.84
2.45
4.44
3.97
<.001
3.74
1.35
4.57
3.41
<.001
IGWP – Breakdown byy Pain Area
Pain Area
B k pain
Back
i
Shoulder
Neck
Hip
Knee
Other areas
All pain areas
#
Reported
223
135
119
91
85
409
1062
Improved
Pain
>2 points
i t
Eliminated
Eli
i t d
on NRS
(NRS=0)
75%
41%
63%
52%
53%
36%
63%
43%
53%
42%
66%
50%
62%
45%
Other QOL Outcomes
Measure
Perceived Stress Scale
(lower score = less stress)
Oswestry Disability Inventory
(lower score = less disability)
PHQ-9 Depression Scale
(lower score = less depression)
Pittsburg Sleep Quality Index
(lower score = improved sleep quality)
IGWP
Pre Post
Control
Pre
Post
20.10 13.59 20.23
18.73
p-value
<.001
15 14% 9.77%
15.14%
9 77% 16.58%
16 58% 15.85%
15 85% <.001
< 001
8 85
8.85
4 35
4.35
9 03
9.03
7 59
7.59
< 001
<.001
8.13
4.09
7.97
7.05
<.001
Improvements in Stress-Related
Ill H lth Conditions
Ill-Health
C diti
IGWP
Control
# of
# of
Stress-Related Ill-Health Conditions Conditions % Improved Conditions % Improved
Insomnia or sleep disturbances
104
68%
19
42%
Chronic fatigue or low energy
88
69%
16
25%
High or unhealthy cholesterol
78
50%
18
33%
High blood pressure
67
43%
16
44%
Chronic heartburn/acid reflux/GERD
56
54%
14
7%
Oth conditions
Other
diti
252
56%
64
42%
All ill-health conditions
645
58%
147
36% p<.001
Summary of Group Wellness Programs
(2007-2010)
• Conducted 16 group programs
• Corporate Programs Onsite: Employees
of Chrysler;
y
Employees
p y
and eligible
g
dependents of HFHS & Dow Chemical
• Church Programs:
g
New Hope
p Missionary
y
Baptist Church
• Community Programs: HFHS West
Bloomfield Hospital
• Treated >1,100
>1 100 people with >4,600
>4 600 pain
conditions with 41% elimination overall
Conclusions
• IGWP simultaneously reduces chronic pain &
stress, while also improving stress-related
chronic
h
i ill-health
ill h l h conditions
di i
• Group programs are less expensive than
conventional
i
l 1-on-1
1
1 care
• Potential to help much larger numbers of
people
l in
i far
f less
l
time
i
• Probable cost savings over the long-term are
b i
being
tracked
t
k d (less
(l
ill-health,
ill h lth lless costs)
t )
• Reducing/eliminating chronic pain and stress
with
ith a cost-effective
t ff ti group approach
h will
ill
ultimately create a healthier population and
drive down healthcare costs
Implications
p
for Policy,
y, Deliveryy
or Practice
This cost-effective group approach has
th potential
the
t ti l tto revolutionize
l ti i how
h
chronic pain and stress are treated in
the U.S. because of its efficiency and
high
g degree
g
of effectiveness in helping
p g
people eliminate chronic pain and
reduce stress
Thank You!
For more information contact:
Center for Integrative
g
Wellness
(248) 386-5353
Dr. Alba Rodriguez
arodrig1@hfhs.org
((813)) 786-6641