Chrysler Expands Group-Focused Integrative Pain Partnership with Henry Ford Health System CAM Group
Written by John Weeks
Group-Focused Integrative Pain Program for Chrysler Employees Better than CAM or PT in Henry Ford Health System Pilots
Summary: Preliminary data from two pilots projects from the Henry Ford Health Systems (HFHS) on chronic low back pain, one involving Chrysler employees, showed significant findings. One showed that one-on-one care involving chiropractors,
acupuncturists, neuromuscular therapists, hypnotherapists, massage
therapists and somatic education practitioners performed better than a
typical physical therapy protocol. The second, a group intervention
using complementary healthcare approaches, topped the other outcomes.
The group intervention succeeded in resolving pain to zero in over 50%
of the Chrysler employee participants. Chrysler has asked the program
designer, HFHS's research director for complementary and integrative
medicine Robert A, Levine, PhD, to start up 4 new groups this fall.
When will complementary healthcare disciplines begin exploring the
powerful potential for group-focused services?
Send your comments to
for inclusion in a future Your Comments article.
Robert Levine, PhD, directs complementary and integrative medicine research for theHenry Ford Health System
(HFHS). Levine is a research pharmacologist with a specialty in brain
function whose personal health issues moved him personally and
professionally
Robet Levine, PhD, Henry Ford Health System's integrative research leader
toward natural healthcare strategies 15 years ago. He
recently completed two intriguing integrative healthcare pilots
involving chronic back pain, each with the same inclusion criteria. One
involved employees of the Chrysler Corporation. That Levine and HFHS had Chrysler involved in one of the
studies makes outcomes particularly interesting. The pilot's yardstick
is not just statistical data. It is also Chrysler's real-world buy-or-not-to-buy
decision. Will the employer embrace and expand any part of the program?
Levine put Chrysler's response to the low back pilot this way: "They
said that if Toyota had their hands on the work of our team, they
wouldn't let us go. We are in discussion to set up four programs this
fall with two of them expanding to look at a range of chronic
diseases."
Group-focused program tops one-on-one services, CAM or conventional
Levine's 2 pilots allowed the comparison of three one-on-one strategies
(conventional physical therapy, plus two strategies with different mixes of complementary
healthcare practitioners) and a group intervention, using natural
healing approaches, with Chrysler employees. Interestingly, Chrysler's
excitement, and desire for expansion, was particularly related to the
outcomes of the more unusual treatment - the group treatment - which is
also significantly less expensive. In that group, services were
delivered by a practitioner team led by Levine to patients in a group
setting, instead of individual practitioners in a one-to-one setting.
_______________________________
Henry Ford/Chrysler Integrative Therapies Low Back Pain Pilot Preliminary Health Outcomes Comparisons of the "We've Got Your Back" Program
Model
Therapies
(#) and %
with pain
resolved
to "0"
Conventional
physical therapy
As practiced by
PTs in HFHS
one-on-one setting
5%
Comprehensive
CAM
Mix of chiropractic,
acupuncture and
neuromuscular
movement,
mind-body, plus
one-on-one setting
16%
Streamlined
CAM
Massage therapist
delivered non-
needling acu-point
stimulation,
mind-body therapy,
plus somatic
movement
re-education
one-on-one setting
25%
Chrysler group
intervention
Guided relaxation
plus somatic
movement
re-education
group setting
55%
Source: Robert A. Levine, PhD, Certified Hynotherapist, Henry Ford Health System.
_________________________________
Findings of hands-on and hands-off interventions
Levine notes that all of the interventions were better at bringing
participants to zero pain than was typical treatment by physical
therapists within the Henry Ford system. The "comprehensive CAM
approach" had each patient receiving a combination of treatments involving 34 contact hours, using a "fixed protocol," according to Levine.
Interestingly, the less intensive, "streamlined" complementary
healthcare approach, involving just 24 contact hours, without needles or
chiropractic care, scored better.
But like Chrysler, Levine is particularly intrigued with the group outcomes. Said Levine: "The Chrysler group intervention was more effective
than any of the 1-on-1 treatment strategies and 10 times more effective
than conventional PT!"
Levine suggests positive cost benefits - both as measured in employee
hours in time in treatment and practitioner hours: "For me to treat the
Chrysler employees one-on-one would take more than a year. In group,
they were treated in 24 contact hours. The group approach allows for
much more patient throughput."
In this case, the group treatment was more successful: 55% of Chrysler
employee participant reported that their chronic low back pain was at 0
after the treatment program. And the icing, to Levine, was that the
Chrysler employees also saw significant benefits in the areas of
depression, stress, sleeplessness, and resolution of other health
issues nominally unrelated to back pain.
Levine co-delivered the group program with
Ramon Nunez, a doctor of Oriental medicine who is "masterful at
movement re-education" according to Levine. Levine's own part was to
deliver what he calls "guided relaxation for new awareness." In an
internal memo shared with the Integrator, Levine writes: "We have achieved these results with a hands-off group
intervention that has patients taking responsibility for getting themselves out
of pain."
Chrysler in discussion for 4 new groups
Levine presented preliminary findings as a poster at the Integrative Medicine for Health Care Organizations
conference in April 2007 in San Diego. He is now seeking to find the
time to write them up, but he has some competition for his time from
his corporate partner. Why? Chrysler is exploring with Levine setting
up 4 new groups starting this fall.
Levine reveals that 2 of the potential groups will again focus on
chronic back pain. But it is the other two which particularly intrigue
Levine: "We would like to start two groups which focus on chronic
illness. We would like to have people with cardiovascular disease,
diabetes, obesity and gastrointestinal disorders all together in
group." Levine believes that there are enough common denominators
between individuals with each of these conditions that a program
targeting chronic conditions will prove beneficial.
Contact: Levine can be reached at
On the Chrysler
Group Intervention:
"We have achieved
these results with a
hands-off group
intervention that has
patients taking
responsibility for
getting themselves
out
of pain."
-Robert A. Levine
Comment:
Question: What do the work of integrative health care pioneers like Jon Kabat-Zinn, PhD, Dean Ornish, MD and HerbertBenson, MD and Eileen Stuart, PhD, RN have in common?
Answer:
Each has provided evidence of the effectiveness of natural healthcare
protocols for serious conditions - and each has done so through
whole-person oriented natural healthcare protocols delivered
principally to groups instead of one-to-one.
Levine's group work with Chrysler falls squarely into these camps. One looks forward to a full, scientific write up to explore the many questions regarding the structure of care delivery and the outcomes measures.
Yet what the work underscores is that the power of the group environment - while only piloted here - has proved to be profound. It is perhaps the most under-explored area for healthcare delivery of any
kind. Such an approach is particularly under-explored among the complementary,
alternative and integrative healthcare disciplines for which such
natural and patient empowering approaches are wholly aligned.
Why the lack of exploration? All disciplines, conventional and
complementary, have in common a self-interest in perpetuating the
one-to-one service delivery method they were schooled to practice.
In fact, complementary healthcare practitioners who don't like this
assertion may have just experienced an insight into the recoiling
conventionally-trained medical doctors often feel when confronted with
holistic care models. You mean all those years are for nothing and I have to change what I do? An exception in the natural healthcare practitioner community is the Community Acupuncture Network model in which care is delivered in open rooms and patients speak of the healing value of being in a group environment.
I look forward to the next stage findings for the Chrysler experience -
applying the group model to participants with diverse chronic
conditions. Meantime, all educators and practitioners who practice
healthcare would be served to deeply consider these outcomes.
Incorporating ways for any provider type to work in their practices
efficiently, as educators, should be part of fundamental healthcare
reform. Those disciplines which engage this practice-shifting learning
may have a leg up on others - at least in the mind of a discerning
employer.
Send your comments to
for inclusion in a future Your Comments article.
But like Chrysler, Levine is particularly intrigued with the group outcomes. Said Levine: "The Chrysler group intervention was more effective
than any of the 1-on-1 treatment strategies and 10 times more effective
than conventional PT!"
Levine suggests positive cost benefits - both as measured in employee
hours in time in treatment and practitioner hours: "For me to treat the
Chrysler employees one-on-one would take more than a year. In group,
they were treated in 24 contact hours. The group approach allows for
much more patient throughput."
Chrysler in discussion for 4 new groups
