2026 Приложение к резюме Международного конгресса

Oral Abstracts

Oral Abstract Session 01: National Surveys and Large-Scale Data of IM

OA 01.01

Effects of Acupuncture for Pain Management among Inpatients with Cancer: A Secondary Analysis of University vs Public Hospital Settings

George S Yeung MD , Sanjay Reddy MD, Wendy Hartogensis PhD, MPH, Donald I Abrams MD, Anand Dhruva MD, Frederick M Hecht MD, Maria T Chao DrPH, MPA

UCSF, San Francisco, CA, United States

Purpose : Acupuncture is increasingly recognized as a safe and effective integrative therapy for cancer pain management. Most evidence comes from university hospitals, with limited data from public hospital settings. Understanding potential differences in acupuncture use, effectiveness, and implementation across hospital types is essential to promote equitable access and guide acupuncture’s integration into inpatient pain management.

Method(s) : We performed a secondary analysis of the Pragmatic Research of Acupuncture and pain Counseling eXtended to Inpatient Services (PRACXIS) randomized controlled trial evaluating acupuncture and pain counseling for hospitalized adults with cancer pain. The study was conducted at a university hospital (UH) and a public safety-net hospital (PH). The analysis consisted of two parts: First, we compared demographic and clinical characteristics of all cancer inpatients (UH n = 14,336; PH n = 1,146, 2019–2020). Second, we used intent-to-treat linear mixed models to examine heterogeneity of treatment effects among 447 randomized participants (UH n = 338; PH n = 109).

Results : Among all cancer inpatients, PH patients were more racially and linguistically diverse compared with UH (24.5% vs 12.6% Latino, 31.5% vs 14.5% Asian/Pacific Islander, 17.5% vs 5.0% Black/African American, 49.7% vs 76.8% White); and had higher metastatic disease rates (21.9% vs 12.9% metastatic). Among the randomized PRACXIS participants, differences in treatment outcomes varied by hospital. In the no-acupuncture group, UH patients showed significantly greater improvement in pain relief (–0.44 [95% CI –0.85, –0.03]), symptom severity (0.26 [95% CI 0.06, 0.46]), and symptom burden (0.43 [95% CI 0.17, 0.69]) than their PH counterparts. For patients who received acupuncture, between-hospital differences were reduced for pain relief (0.03 [95% CI -0.36, 0.43]), symptom severity (0.00 [95% CI -0.20, 0.20]), and symptom burden (0.15 [95% -0.11, 0.41]).

Conclusions : Acupuncture reduced between-hospital disparities in outcomes, suggesting that incorporating nonpharmacologic approaches may mitigate potential disparities in hospital-based pain management.

OA 01.02

Is there an Integrative Safety Net? A National Survey of Traditional, Complementary, and Integrative Health Services in US Safety-Net Primary Care Clinics

Dr Ariana Thompson-Lastad PhD 1 , Dr Isabel Roth DrPh 2 , Dr Stephanie Christian PhD 3 , Dr Nadine Ijaz PhD 4

1 University of California San Francisco, San Francisco, CA, United States

2 University of North Caroline, Chapel Hill, NC, United States

3 Memorial Sloan Kettering Cancer Center, New York, NY, United States

4 Carleton University, Ottawa, Ontario, Canada

Purpose : Safety-net clinics such as Federally Qualified Health Centers (FQHCs) provide primary care to one in nine people in the United States. Although treatment guidelines now recommend traditional, complementary and integrative medicine (TCIM) for chronic pain and other common conditions, little is known about the availability of TCIM within United States safety-net clinics. Group Medical Visits are a common model used in primary care to provide TCIM services. This is the first national survey of US safety-net clinics that aims to assess the prevalence and availability of TCIM and group medical visit programs.

Method(s) : Recruitment for this brief online survey was conducted through professional organizations and networks. All employees of safety-net health clinics (FQHCs, community health centers, Indian Health Service sites) were eligible to participate. Descriptive analyses were conducted.

Results : We received 123 responses from 93 safety-net clinics in 30 states, the District of Columbia, and Puerto Rico, with the most represented states being California (N=26), Oregon (N=7) and New York (N=7). TCIM practitioners most commonly employed by safety-net clinics included acupuncturists (n=36); midwives (n=30), yoga therapists or teachers (n=18), and chiropractors (n=17). The most widely available TCIM services included acupuncture, mindfulness, other mind-body practices, osteopathic manual treatment and herbal medicine. 56% of organizations offered group medical visits, most commonly for diabetes, chronic pain, or well-child care. Over half of respondents were interested in participating in future research on integrative healthcare and/or group medical visits.

Conclusions : This is the first national survey to investigate how widely TCIM and group medical visits are provided in US safety-net clinics. We identified many examples of these programs across the country, offering TCIM to patient populations often excluded from integrative health care and related research. Findings can inform future efforts to provide equitable access to guideline-concordant care, including group medical visits and integrative care.

OA 01.03

Research Interest in and Use of Complementary and Integrative Health Therapies among Older Adults on Glucagon-Like Peptide-1 Receptor Agonists

Dr. Sarah J Park ND, MPH 1 , Dr. Rachel L Rosen PhD 2 , Dr. Dennis Muñoz-Vergara DVM, MPH 1 , Dr. JoAnn E Manson MD, DrPH 1 , Dr. Gloria Y Yeh MD, MPH 3 , Dr. Peter M Wayne PhD 1 , Dr. Howard D Sesso ScD, MPH 1

1 Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States

2 Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States

3 Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States

Research suggests complementary and integrative health (CIH) therapies may enhance diabetes self-management. However, their role alongside glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy, where side effects can hinder adherence to medication and recommended lifestyle changes, remains largely unexplored.

Purpose : We conducted a cross-sectional analysis of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) 2024 questionnaire to examine whether self-reported GLP-1RA status was associated with CIH use or research interest among older US adults. A total of 15,732 participants were classified as Method(s) : GLP-1RA users for diabetes (DM-users) or weight management-only (WM-users), or non-users with diabetes or obesity. We estimated multivariable odds ratios (ORs) and 95% confidence intervals (CI) of lifetime and recent use of, as well as research interest in, any CIH category and each of six categories, including manual therapies, mind-body therapies, herbal products, acupuncture, spiritual practices, and cannabis/psychedelics.

Results : Among 592 GLP-1RA users (503 DM-users, 89 WM-users), over 75% reported having used at least one CIH therapy in their lifetime or in the past 12 months (most commonly, manual therapies, spiritual practices, and herbal products), while 60.5% reported interest in their research. Compared to non-users with diabetes, DM-users had 1.36 times the odds of lifetime cannabis use (95% CI: 1.03, 1.81), as well as greater research interest in all CIH categories except spiritual practices (all P≤0.05). WM-users had 2.13 times the odds of any lifetime CIH use (excluding spiritual practices) than non-users with obesity (95% CI: 1.10, 4.14), largely driven by significant associations for manual therapies and acupuncture (all P<0.05).

Conclusions : In this trial cohort of older adults, participants taking GLP-1RAs for diabetes were more likely to report interest in participating in research across most CIH categories, while those taking them for weight management-only were more likely to have ever tried manual therapies or acupuncture.

OA 01.04

Prevalence and Emerging Trends in Dietary Supplement Use Among U.S. Adults, 1999–2023: Two Decades of NHANES Data

Dr. Chun Sing Lam 1 , Dr. Kelli O’Connell 2 , Dr. Maria J. Monroy-Iglesias 2 , Dr Peng Wang 2 , Dr. Mengmeng Du 2 , Prof. Edward L. Giovannucci 3 , Dr. Jun J. Mao 1 , Dr. Elizabeth D. Kantor 2

1 Integrative Medicine and Wellness Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States

2 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States

3 Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States

Purpose : Dietary supplement use is widespread among U.S. adults, yet recent population-level data are limited. Understanding long-term and emerging trends, particularly following the COVID-19 pandemic, is essential for guiding research. This study aimed to evaluate national trends in dietary supplement use among U.S. adults from 1999 to 2023 and to assess changes in overall prevalence, supplement categories, and individual product use, with further evaluation of changes in use across pre- and post-pandemic periods.

Method(s) : We conducted a cross-sectional analysis of 11 cycles of the National Health and Nutrition Examination Survey (NHANES, 1999–August 2023), including 63,442 adults aged ≥20 years. Supplement use during the past 30 days was assessed overall, by supplement category (vitamins, minerals, multivitamin/multimineral [MVMM], botanicals, and non-vitamin non-mineral [NVNM] products), and by individual supplement type. Trends over time and differences between pre-pandemic and post-pandemic periods were examined using survey weighted regression and generalized linear models.

Results : Supplement use increased from 51.0% in 1999–2000 to 59.9% in 2021–2023 (P-trend <0.001). Use of vitamin D (5.1% to 29%) and vitamin K (0.3% to 2.1%), both excluding MVMM, notably increased. Supplements marketed for anti-inflammatory or immune-related functions—curcumin, ashwagandha, prebiotics/probiotics, and zinc—also grew, while several trace minerals declined. Supplement use with purported immune-related functions increased markedly in the latest cycle (Aug 2021–Aug 2023) compared with the pre-pandemic period.

Conclusions : Dietary supplement use among U.S. adults has continued to rise, with notable increases in specific vitamins and products marketed for immune-related, stress adaptation and anti-inflammatory functions. These patterns indicate a broadening of supplement use, with increased uptake of products marketed for specific health functions. The COVID-19 pandemic may have further heightened interest in immune-supporting products. Ongoing monitoring of supplement use trends is needed to understand their evolving public health implications in the U.S. adult population.

Oral Abstract Session 02: Mind-Body Practices for Oncology

OA 02.01

Teaching Cancer Survivors Coping Skills from a Mind-Body Intervention for Fear of Recurrence: Exploratory Outcomes from a Pilot Randomized Controlled Trial

Aimee J Christie PhD 1 , Caleb Bolden BA 2 , Elyse R Park PhD, MPH 2,3 , Gloria Y Yeh MD, MPH 3,4 , Conall O'Cleirigh PhD 2,3 , Hang Lee PhD 2,3 , Jeffrey Peppercorn MD 2,3 , Lynne I Wagner PhD 5 , Elisabeth C Henley BA 6 , Lara Traeger PhD 6 , Ade Adamson MD, MPP 7 , Anthony Sung MD 8 , Daniel L Hall PhD 2,3

1 The University of Texas at MD Anderson Cancer Center, Houston, TX, United States

2 Massachusetts General Hospital, Boston, MA, United States

3 Harvard Medical School, Boston, MA, United States

4 Beth Israel Deaconess Medical Center, Boston, MA, United States

5 Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States

6 University of Miami, Coral Gables, FL, United States

7 The University of Texas at Austin, Austin, TX, United States

8 The University of Kansas Medical Center, Kansas City, KA, United States

Purpose : Fear of cancer recurrence (FCR) is highly common and, if poorly managed, can be distressing and impairing. We developed a virtual, mind-body resiliency intervention for FCR in survivorship (IN FOCUS, NCT04876599 ), which was shown to be feasible and improved FCR post-intervention. The purpose of this study was to explore IN FOCUS effects on proposed intervention mechanisms: coping styles and perceived coping skills.

Method(s) : A single-blinded, 2-arm, randomized controlled trial was conducted from July 2021 to March 2022 comparing IN FOCUS (8 weekly, 90-minute, synchronous virtual group classes teaching cognitive behavioral techniques, relaxation training, meditation, adaptive health behaviors, and positive psychology skills) to usual care (synchronous virtual community group support referral) among cancer survivors with non-metastatic disease and clinically elevated FCR (FCR Inventory severity ≥ 16). Measures included coping styles (Brief COPE) and perceived coping skills (Measure of Current Status-Part A). Intent-to-treat analyses with separate general linear mixed models were used to identify group-by-time effects (Cohen’s d; 0.5 a medium effect, 0.8 a large effect) from baseline through 2 months and 5 months.

Results : Sixty-four survivors enrolled (age M=52 years, time since completing primary cancer treatment M=5 years). By 5 months, survivors randomized to IN FOCUS (vs. usual care) demonstrated multiple effects on coping in the medium to large range. Compared to usual care, IN FOCUS increased use of problem-focused coping using instrumental support (d=0.6), planning (d=0.6), active coping (d=0.5), and positive reframing (d=0.5). Similarly, IN FOCUS improved emotion-focused coping using venting (d=0.7), acceptance (d=0.6), humor (d=0.5), and religion (d=0.5). IN FOCUS also enhanced survivors’ coping confidence (d=0.8), relaxation skills (d=0.6), and assertiveness (d=0.5). Avoidance-focused coping and awareness of physical tension exhibited less robust changes by 5 months.

Conclusions : For cancer survivors with FCR, IN FOCUS shows promise of strengthening problem-focused and emotion-focused coping, reducing avoidance-focused coping, and enhancing perceived coping skills. Cancer survivors can enhance multiple aspects of coping with FCR through interventions such as IN FOCUS that teach mind-body resiliency techniques.

OA 02.02

Safe delivery of psilocybin-assisted therapy in oncology: models and stakeholder perspectives

Dr Suzanne Grant PhD

Western Sydney University, Sydney, NSW, Australia

Purpose : Existential distress in cancer is common and only partially addressed by standard therapies. Psilocybin-assisted therapy (PAT) shows promise, but models of delivery for oncology remain undefined. We conducted three qualitative studies—healthcare professionals (HCPs), people with cancer, and psychedelic researchers—to identify requirements for safe, acceptable, and legitimate PAT delivery in cancer care, focusing on governance, workforce, set/setting, and integration within oncology settings.

Method(s) : Semi-structured interviews (n=40) were conducted with Australian HCPs (n=11) from oncology, psycho-oncology, nursing, psychiatry, and pharmacy; adults with advanced cancer (n=15); and researchers conducting PAT studies (n=14). All received ethics approval (St Vincent’s HREC 2023/ ETH00860 ). Reflexive thematic analysis was applied. Interview guides focused on probed models of delivery and care (e.g., basic-support vs EMBARK), screening, dosing-day supports and preferred settings, types of practitioners to involve, and integration; HCPs and patients also completed brief knowledge/attitudes measures to contextualise interviews.

Results : Synthesis across groups highlighted: (1) multidisciplinary governance with oncology–palliative oversight; (2) the need for rigorous screening, preparation, skilled facilitation, and structured post-session integration; (3) trauma-informed, culturally responsive environments; (4) workforce training/ supervision and role clarity (e.g., co-facilitator models); and (5) clear referral/funding pathways. HCPs reported interest despite having knowledge gaps and implementation barriers. With a preference for team-based delivery. Patients prioritised safety, consent clarity, compassionate containment, and acceptable settings. Researchers emphasised therapist training, cost, supervision structures, and group therapy models.

Conclusions : Stakeholders endorse a research-led translation of PAT into oncology using integrative supportive-care models under defined governance. Core specifications include robust screening, preparation, skilled co-facilitation, safe environments, and structured integration, supported by workforce training and culturally safe practice. These study provides actionable input for protocols, model delivery design, and regulatory planning while providing an understanding of current limitations (evidence gaps, workforce readiness, resources).

OA 02.03

Impact of Mindfulness and Tai Chi on Sleep, Fatigue and Pain in Cancer Survivors: Results of a Hybrid Comparative Effectiveness and Preference Trial

Yan Ma 1 , Linda E. Carlson 2 , Jennifer M. Jones 3 , Oluwaseyi A. Lawal 2 , Devesh Oberoi 2 , Katherine-Ann Piedalue 2 , Daniel Santa Mina 3 , Michael Speca 2 , Peter M. Wayne 1

1 Osher Center for Integrative Health, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States

2 Department of Oncology, University of Calgary, Calgary, AB, Canada

3 Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada

Purpose : The MATCH (Mindfulness and Tai Chi for Cancer Health) study is a partially-randomized, patient-preference, comparative effectiveness trial to understand the effects of Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ) in distressed people after cancer treatment.

Method(s) : Participants with a preference for either MBCR or TCQ received their preferred intervention, while those without a preference underwent block randomization into either the MBCR or TCQ program. Further, within the preference and non-preference groups, all participants were randomized into immediate intervention or waitlist control in a 2:1 ratio. We evaluated the efficacy of MBCR and TCQ, whether participants’ choices impacted intervention effects, and correlations among changes in sleep, fatigue, and pain as planned secondary outcomes, assessed by Pittsburgh Sleep Quality Index, Functional Assessment of Chronic Illness Therapy - Fatigue, and Brief Pain Inventory, respectively.

Results : Participants (n=587, 75% female) had a mean age of 60.7 years, with all types and most stages of cancer. At post-intervention, compared with waitlist controls, the TCQ group had significantly improved sleep quality and effects remained significant after adjustment for age, sex, cancer stage, and preference (β =-1.90, 95% CI: -3.18, -0.62; p=0.004). Compared with waitlist controls, both MBCR and TCQ groups had significantly improved fatigue (MBCR: β=3.66, 95% CI: 0.25, 7.08; p=0.036. TCQ: β=3.42, 95% CI: 0.10, 6.73; p=0.043) and pain interference (MBCR: β=-1.10, 95%CI: -2.09, -0.11; p=0.029. TCQ: β=-1.52, 95%CI: -2.49, -0.55; p=0.002). Significant correlations were observed among score changes for sleep, fatigue, and pain interference, suggesting mild to moderate associations.

Conclusions : Compared to waitlist controls, MBCR and TCQ both improved fatigue and pain interference at post-intervention, and TCQ also improved sleep quality. Correlations across outcomes highlight the importance of addressing clusters of cancer symptoms within the framework of whole-person-health. Acknowledgements: NCCIH K23AT012475 and K24AT009282. Lotte & John Hecht Memorial Foundation (grant #4000).

OA 02.04

Scaling an Effective Intervention of Silence or Mindfulness Meditation to Reduce Anxiety, Emotional and Physiologic Distress for Cancer Patients Prior to Surgery

Dr. Maryanna D Klatt PhD 1 , Angela Emerson MPH 1 , Jacqueline Caputo MPH 1 , Yulia Mulugeta B.S. 1 , Nina Knight BS 1 , Dr. Beth Steinberg PhD 1 , Ramalakshmy Shankarganesh 1 , Dr. Anne-Marie Duchemin MD 2 , Dr. Elizabeth Palmer Kelly PhD 3 , Dr. Tim Pawlik , PhD, MPH, MTS, MBA, FACS, FSSO, FRACS 3

1 Center for Integrative Health, College of Medicine, The Ohio State University, Columbus, Ohio, United States

2 Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, Ohio, United States

3 Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Purpose : This study was conducted to scale and evaluate the effectiveness of a 10-minute audio-guided meditation/silence on the anxiety/emotional distress levels and vital signs of patients undergoing cancer surgery, which was previously shown to be effective with patients undergoing orthopedic surgery.

Method(s) : Consented patients awaiting cancer surgery were randomly assigned to 10-minutes of guided meditation or silence, administered through noise cancelling headphones in the pre-operative area. Emotional distress/anxiety and vital signs (i.e. pulse, respiration rate, and blood pressure) were assessed pre/post interventions.

Results : Patients who received either guided meditation or silence (n=61) achieved significant decreases on the Emotional Distress Scale (p=0.00001) pre to post intervention, with no significant differences between groups receiving meditation (n=28) or silence (n=33) (p=0.5298). Patients rated their anxiety levels on a scale of 1(no anxiety) to 10(high anxiety). Combining the groups, anxiety levels were significantly reduced pre/post intervention (p=0.00001) with no significant difference between groups (p=0.8178). Consistent with the emotional distress/anxiety findings when randomized conditions were combined, systolic blood pressure was significantly lower pre/post (p=0.0006), and diastolic blood pressure was lower but not significant (p=0.0537). There were no significant changes pre/post of pulse rate (p=0.9464) nor respiration rate (p=0.5248) following either intervention, and no significant differences pre/post of any vital signs between groups.

Conclusions : Providing either a 10-minute guided meditation or silence prior to surgery reduced anxiety, emotional distress, and some signs of physiologic distress in cancer patients. These mind/body interventions were successfully piloted in orthopedic surgery, then scaled to cancer surgery to address greater associated pre-surgical patient stress. Implementing either guided meditation or providing noise-canceling headphones for silent relaxation could be adopted as a low-cost standard practice in pre-operative care as a means to reduce and improve emotional distress/anxiety and correlated vital signs before surgery.

Oral Abstract Session 03: Integrative Health for Low Back Pain

OA 03.01

Which lumbar spinal stenosis patients will improve with nonsurgical treatment? A secondary analysis of a randomized controlled trial

Eric J Roseen DC, PhD 1 , Clair N Smith MS 2 , Asifa Rahim MPH 1 , Conor Deal 1 , Ryan Fischer DC, PharmD 1 , Natalia E Morone MD, MS 1 , Andrew Flack DC 3 , Charles Penza DC, PhD 3 , Pradeep Suri MD, MSc 4 , Paul E Dougherty DC 5 , Debra K Weiner MD 2 , Michael J Schneider DC, PhD 2

1 Boston University, Boston, MA, United States

2 University of Pittsburgh, Pittsburgh, PA, United States

3 Orlando VA Medical Center, Orlando, FL, United States

4 University of Washington, Seattle, WA, United States

5 Syracuse VA Medical Center, Syracuse, NY, United States

Purpose : Lumbar spinal stenosis (LSS) can be disabling and is a leading reason for spine surgery in older adults. While nonsurgical treatments are recommended for LSS, it remains unclear which patients will benefit most.

Method(s) : This is a secondary analysis of a clinical trial which randomized 216 adults with LSS to: manual therapy with individualized exercise (MTE); group exercise (GE); or medical care (MC). We evaluated the association of baseline characteristics with 2-month changes in primary outcomes: symptoms/function on the Swiss Spinal Stenosis questionnaire (SSSQ) and walking capacity on the self-paced walking test (SPWT). To explore heterogeneity of treatment effects, we evaluated unadjusted stratified estimates when comparing MTE vs. GE/MC. Additionally, we included an interaction term in models to test for statistical interaction.

Results : At baseline, participants (mean age=72, 54% female) had moderate LSS-related symptoms/impairment (mean SSSQ score=31.3) and limited walking capacity (mean=451 meters). The overall improvement on SSSQ was 2.5 points; larger improvements were observed among younger, non-white, non-smoking participants, and those with worse baseline symptoms/impairment. Overall improvement on the SPWT was 205 meters; larger improvements were observed among younger participants, those with higher baseline physical activity levels and participants without knee osteoarthritis. For SSSQ, the treatment effect was larger among adults aged <70 vs older adults (MTE vs. GE/MC; mean difference [MD]=-4.06, 95%CI=-6.29 to -1.83 vs. MD=-0.47. 95%CI=-2.63 to 1.69, respectively; p-for-interaction=0.02). For walking capacity, the treatment effect was larger among adults with hip osteoarthritis compared to those without (MTE vs. GE/MC; MD=500 meters, 95%CI=71 to 929, vs MD=13 meters, 95%CI=-120 to 147, respectively; p-for-interaction=0.007).

Conclusions : In a sample receiving nonsurgical treatments for LSS, we identified patient-level characteristics associated with larger improvements and/or treatment effects. If confirmed in larger randomized controlled trials, these findings may guide clinical decision-making to enhance clinical outcomes.

OA 03.02

Examining Interoceptive Sensibility as a Mechanism of Change in Movement-Based Interventions for Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial

Katherine E Gnall MS 1 , Crystal L Park PhD 2 , Tania Huedo-Medina PhD 3,4,5 , Wolf Mehling MD 6 , Erik Groessl PhD 7,8 , Angela R Starkweather PhD, ACNP-BC, FAANP, FAAN 9

1 University of Connecticut, Storrs, CT, United States

2 University of Connecticut, Storss, CT, United States

3 Ikerbasque Research Foundation, Bilbao, Basque Country, Spain

4 University of the Basque Country, Leioa, Basque Country, Spain

5 University of Connecticut, Storrs, MA, United States

6 University of California San Francisco, San Francisco, CA, United States

7 University of California San Diego, San Diego, CA, United States

8 Veteran's Affairs San Diego Health System, San Diego, CA, United States

9 Rutgers University, New Brunswick, NJ, United States

Purpose : While yoga is effective for chronic low back pain (CLBP), less is known about how yoga reduces pain nor whether it operates distinctly from other movement interventions. One proposed mechanism is improvement in interoceptive sensibility (IS; one’s awareness/interpretation of and response to internal sensations). The present secondary analysis from a randomized controlled trial (RCT) tested whether yoga results in changes to IS compared to stretching/strengthening and whether such changes account for yoga’s effect on pain.

Method(s) : 168 adults with CLBP (Mage=43.56, 66% female, 73.2% White) participated in a 12-week RCT (yoga versus stretching/strengthening) and completed assessments at baseline, mid-treatment, and post-treatment. Three subscales of the MAIA-2 (Not-Worrying, Self-Regulation, and Trusting) assessed IS. Pain was assessed via self-report pain severity/interference (BPI-SF) and laboratory-assessed pain sensitization (Quantitative Sensory Testing (QST); pressure, heat, and cold pain). Unconditional growth models assessed changes over time, and multilevel mediation analyses with Monte Carlo 95% confidence intervals tested IS as a mechanism of change.

Results : Not-worrying (p=.012), but not Self-regulation nor Trusting (ps>.05), changed over time. Path a was not significant for any IS domains (ps>.05). For the pain severity model, path b (IS domains predicting pain) was significant at the between-person level for Trusting (p=.02). For the pain interference model, path b was significant at the between-person level for Self-Regulation and Trusting (ps<.05). Across all QST measures, path b was significant at the between-person level for Not-Worrying (ps<.01). Path c (total effect) was not significant (ps>.05). None of the indirect effects were significant (95%CIs included zero).

Conclusions : Results suggest that aspects of interoceptive sensibility are associated with better pain outcomes among adults with CLBP. Additionally, movement interventions may help improve aspects of interoceptive sensibility, though yoga may not differ from more traditional stretching/strengthening programs in improving interoceptive sensibility and pain among adults with CLBP.

OA 03.03

Acupuncture vs. Pharmacotherapy for Chronic Low Back Pain: Comparative Risk of Adverse Events among Medicare Beneficiaries

Dr. James M Whedon DC, MS , Dr. Leah Grout PhD

Southern California University of Health Sciences, Whittier, CA, United States

Purpose : In 2020 Medicare initiated coverage of acupuncture for treatment of chronic low back pain (cLBP). The comparative safety of acupuncture vs. medication for management of cLBP has not been evaluated among Medicare beneficiaries. The only serious complication reported to be associated with acupuncture is pneumothorax, but its incidence is very low. By contrast, prescription analgesics carry a significant risk of adverse effects. The purpose of this study was to compare acupuncture vs. analgesic pharmacotherapy for the risk of adverse events among Medicare beneficiaries with cLBP.

Method(s) : Using a retrospective cohort design, we analyzed Medicare claims and administrative data spanning a four-year period. We included Medicare Part B beneficiaries with an episode of cLBP. The acupuncture cohort received acupuncture for cLBP; the pharmacotherapy cohort received an encounter for cLBP with a primary care physician, a prescription for analgesic medication from the same physician within seven days, and no acupuncture. We measured cumulative outcomes at six months, comparing risk of adverse outcomes between the two cohorts using multivariable modeling and weighted propensity scoring.

Results : The adjusted odds of any adverse event were 51.48% lower in the acupuncture group compared to the pharmacotherapy group (adjusted odds ratio=0.495, 95% CI: 0.481-0.489, p<0.0001). After adjusting for covariates, the cumulative risk of adverse events in the acupuncture group was 66.04% lower than in the pharmacotherapy group. The risk of adverse drug events in the acupuncture group was 47.22% lower than in the pharmacotherapy group. The risk of pneumothorax in the acupuncture group was 73.44% lower than in the pharmacotherapy group.

Conclusions : Among Medicare Part B beneficiaries with chronic low back pain, the risk of adverse outcomes, including adverse drug events and pnueumothorax was lower for those treated with acupuncture as compared to those who saw a primary care physician with a prescription for analgesics.

OA 03.04

Association Between Spinal Manipulative Therapy for Low Back Pain With or Without Sciatica and Opioid Use Disorder: A Retrospective Cohort Study

Dr. Robert J Trager DC 1,2,3 , Zachary A Cupler 4 , Jordan A Gliedt 5 , Ryan A Fischer 6 , Roshini Srinivasan 7 , Hannah Thorfinnson 8

1 Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

2 Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, United States

3 Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, NC, United States

4 Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, PA, United States

5 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States

6 Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, United States

7 Duke University Department of Medicine, Duke University Hospital, Durham, North Carolina, United States

8 Butler VA Medical Center, Butler VA Health Care System, Butler, Pennsylvania, United States

Purpose : Prior research has found that patients who receive spinal manipulative therapy (SMT) for low back pain (LBP) are less likely to be prescribed opioids. However, the clinical implications of this finding are uncertain. We tested the hypothesis that opioid-naïve adults receiving SMT for LBP would be less likely to be diagnosed with opioid use disorder (OUD) compared to matched controls prescribed ibuprofen through two years of follow-up.

Method(s) : We queried a United States data resource (TriNetX, LLC) for patients age ≥18 years who had a new episode of LBP with or without sciatica from 2015 to 2023, allowing for ≥2 years of follow-up to 2025. We excluded individuals with serious pathology, pre-existing OUD, and concurrent or prior opioid prescription within the preceding year. We divided patients into two cohorts: (1) SMT and (2) ambulatory ibuprofen prescription, using propensity matching for OUD risk factors. Our primary outcome was the risk ratio (RR) of OUD. We secondarily explored RRs for long-term opioid use and opioid prescription, and opioid mean prescription count. Analyses were conducted in TriNetX and R, using logistic regression for matching, standardized mean difference to assess cohort balance (threshold of ≤0.1), and contingency tables for RRs, using a significance threshold of P<.05.

Results : Following matching, 24,993 patients remained per cohort. Comparing the SMT cohort to ibuprofen cohort, there was a significantly lower incidence and risk of OUD [95% CI] (0.24% vs. 1.51%; RR=0.20 [0.15, 0.28]; P<.001), long-term opioid use (0.42% vs. 1.85%; RR=0.23 [0.18, 0.28]; P<.001), and opioid prescription (30.96% vs. 45.00%; RR=0.69 [0.67, 0.71; P<.001]). SMT recipients also received fewer opioid prescriptions [standard deviation] (1.0 [3.3] vs. 2.1 [5.7]; P<.001).

Conclusions : Adults receiving SMT for new LBP had a lower risk of OUD compared to matched controls prescribed ibuprofen. These findings corroborate existing guidelines which recommend first-line SMT for LBP. The role of SMT in mitigating opioid-related harms requires further investigation.

Oral Abstract Session 04: Integrative Research Training

OA 04.01

Summative Metrics from the Building Research across Inter-Disciplinary Gaps (BRIDG) Postdoctoral Research Training Program

Dr. Heather Zwickey PhD 1 , Dr. Yvonne Lin PhD 2 , Dr. Ryan Bradley ND, MPH 3 , Dr. Cathryn Booth-LaForce PhD 2

1 National University of Natural Medicine, Portland, OR, United States

2 University of Washington, Seattle, WA, United States

3 University of California San Diego, San Diego, CA, United States

Purpose : The National Center for Complementary and Integrative Health (NCCIH) addressed the need for rigorously trained clinical scientists in complementary and integrative health (CIH) by creating and supporting a T90/R90 postdoctoral clinical research training program.

Method(s) : Initially funded in 2015, the Building Research across Inter-Disciplinary Gaps (BRIDG) program sought to train the next generation of CIH researchers at the University of Washington in Seattle, WA (UW) and the National University of Natural Medicine in Portland, OR (NUNM). The T90 trainees (ND, DAOM, DC, PT) received rigorous clinical research training, individualized hands-on research experience, mentorship, and targeted didactic coursework in clinical research methodologies at UW. The R90 participants (conventionally trained PhD researchers) were exposed to CIH practices, developed CIH-focused research projects with mentorship, and received didactic coursework in complementary health disciplines at NUNM. T90/R90 trainees participated in a shared translational science curriculum delivered online every week and quarterly in-person retreats. Summative evaluation metrics included publications, grants, retention in research and career progression.

Results : Key outcomes of the BRIDG program include: the development of a cadre (n=20) of clinical researchers prepared to design and conduct rigorous multidisciplinary CIH research; a collaborative, distance-learning model for CIH research education; and a digital archive of didactic materials accessible to the broader research community. From 2015-2025, ten CIH practitioners and ten PhDs participated in BRIDG. Four of the trainees have received NIH K-awards, and seven have submitted grant applications. Overall, lessons learned include that CIH practitioners need additional time and mentorship to become competitive (e.g., publications and additional training); PhD scientists are largely attracted back to major academic research institutions; and advancement is dependent on the availability of faculty positions.

Conclusions : Based on summative evaluation metrics, the T90/R90 BRIDG program was effective in training multi-disciplinary CIH clinical researchers. The NIH has since sunsetted this program.

OA 04.02

Building Research Culture and Infrastructure at Complementary and Integrative Health (CIH) Institutions: Measuring What Matters

Dr. Heather Zwickey PhD 1 , Dr. Paul S Amieux PhD 2 , Dr. Michele Maiers DC, PhD 3 , Dr. Patricia M Herman ND, PhD 4 , Dr. Ian D Coulter PhD 4,5

1 National University of Natural Medicine, Portland, OR, United States

2 Bastyr University, Kenmore, WA, United States

3 Northwestern Health Sciences University, Bloomington, MN, United States

4 RAND, Santa Monica, CA, United States

5 University of California, Los Angeles, Los Angeles, CAN, United States

Purpose : Traditional CIH institutions have trained clinicians. Historically they did not include research programs or grants. As these institutions begin to build research departments, they are finding it increasingly difficult to compete against the much larger academic health science centers. Moreover, CIH institutions often lack research infrastructure and culture and the associated well-trained faculty and staff to conduct rigorous, high-quality studies. To assist institutions in developing infrastructure, the RAND Research Across Complementary and Integrative Health Institutions (REACH) Center program created a checklist and roadmap that institutions may use to build their research programs.

Method(s) : Using comparative analysis we identified the essential components of infrastructure and culture of successful and rigorous research programs and derived specific metrics for a checklist.

Results : The resulting checklist included: Do they have the documented full support of leadership at the institution to develop a research culture and infrastructure? Do they have a strategy for mentoring existing faculty and staff in research, or a formal collaboration with a research-intensive organization (such as RAND) to provide said mentoring? Do they have an IRB or access to an IRB at another institution? Do they have a Grants and Contracts Specialist or an Office of Sponsored Programs/Office of Research Administration? How many full time FTE are devoted just to research at the institution? Is there protected time for faculty to engage in research? Is there a research seed grant program at the institution? How many PubMed articles do they publish per year? Do they teach an Evidence-Informed Practice class, a Critical Evaluation of the Literature class, or a Research Methods and a Critical Thinking class.

Conclusions : CIH institutions need infrastructure and a culture to participate fully in research. This checklist will help them determine how to move from where they are to achieving that goal.

OA 04.03

Building Translational Science Literacy, Collaboration and Capacity in Complementary and Integrative Health Research: The UC San Diego REACH Center for Translational Science in Whole Person Health

Ryan Bradley ND, MPH 1 , Gene Kallenberg MD 1 , Jeff Dusek PhD 2 , Hemal Patel PhD 1 , Cassandra Vieten PhD 1

1 University of California, San Diego, La Jolla, CA, United States

2 University of California, Irvine, Irvine, CA, United States

Purpose : Greater understanding of whole person health (WPH) can be achieved by coupling CIH practice knowledge with modern scientific innovations. Therefore, the purpose of this session is to describe the framework, design and activities driving the recently NCCIH-funded UC San Diego REACH Center for Translational Science in Whole Person Health (UCSD REACH). UCSD REACH partners with complementary and integrative health (CIH) institutions aiming to build capacity for research through acculturation, training, ideation and collaboration on WPH research.

Method(s) : UCSD REACH’s approach includes: 1. Institutional assessment and tailored programming for faculty and staff, 2. Curriculum development aimed to broadly improve literacy, research skills and facilitate acculturation, 3. Focused investment in training and mentorship via a Scholar’s program, 4. Pilot grants to foster bi-directional idea generation and collaboration, and 5. Development of clear pathways to access additional UCSD research resources and opportunities.

Results : Initially, UCSD REACH has partnered with six CIH institutions (3 EAM, 2 DO, 1 DC, 1 ND, 1 PT). The curriculum consists of a series of three 15-hour stackable micro-courses focused on Translation Science in WPH, Clinical Research in WPH, and CIH Research in WPH designed with multi-disciplinary faculty from UC San Diego and UC Irvine to improve science literacy and knowledge. UCSD REACH has accepted seven REACH Scholars starting in January 2026. UCSD REACH is actively collaborating with the UCSD Office of Innovation to build awareness of commercialization opportunities through research, including SBIR grants. Research ‘Idea Generation’ sessions are scheduled, beginning with project ideation in response to the HEAL R15 opportunity. Active collaborations are underway with other national REACH programs.

Conclusions : UCSD REACH is implementing a multi-pronged plan to build translational science literacy, collaboration and capacity in WPH research.

OA 04.04

RAND REACH Scholars Program: Revolutionizing Research Education for Complementary and Integrative Health Professionals

Dr. Heather Zwickey PhD 1 , Dr. Michele Maiers DC, MPH, PhD 2 , Dr. Ian D Coulter PhD 3 , Dr. Patricia M Herman ND, PhD 3

1 National University of Natural Medicine, Portland, OR, United States

2 Northwestern Health Science University, Bloomington, MN, United States

3 RAND, Santa Monica, CA, United States

Purpose : Developing a new research education model for early career clinician scientists within CIH clinical academic institutions.

Method(s) : We used key informants to assess the needs of and resources available to CIH institutions and their faculty and staff for research, while acknowledging the challenges faced by these institutions where research activity must be accommodated around academic demands and funded through student tuition.

Results : The RAND REACH Scholars Program consists of training and graduate coursework, an expanded research network, structured assistance on grants, projects and publications, and mentorship from experienced researchers and clinician scientists. A faculty scholar is given 20% release time to participate in the program. Scholars self-assess their research skills using an individual development plan and meet with the REACH Center leadership team monthly to develop a research project or continue an existing project. Didactic training includes weekly online coursework (e.g., Research Design, Scientific Writing, Grant Writing, Secondary Data Analysis), and an annual methods bootcamp. Mentorship can take several forms: a series of weekly mentoring sessions with specific mentor faculty on a predefined and agreed upon topic; working with the Collaboration Coordinator to be connected to external mentors; and/or identifying mentors they meet through the Idea Incubator gatherings, Help Desk interactions, coursework, and other Center activities. Mentors are chosen based on their substantial research track record, publications, relevance, and experience in negotiating the world of research. Of the 20 scholars enrolled now over two cohorts, 12 are DCs, 4 are NDs, 2 are DAOMs, 1 is an ND-DC, and 1 is an MPH. Three scholars have developed and received competitive pilot grants for projects.

Conclusions : The RAND REACH Scholars Program is building critical capacity in CIH research by equipping clinician-scientists in their home institutions with the skills, mentorship, and collaborative networks necessary for long-term success.

Oral Abstract Session 05: Provider Stress and Wellness

OA 05.01

Expanding a Pre-surgery Brief Mindfulness Exercise for Surgical Teams: Improving Focus, Stress, and Patient Safety

Dr. Maryanna D Klatt PhD 1 , Angela Emerson MPH 1 , Jacqueline Caputo MPH 1 , Odysseas Chatzipanagiotu MD 2 , Yulia Mulugeta BS 1 , Dr. Anne-Marie Duchemin MD 3 , Slate Bretz BS 1 , Dr. Elizabeth Palmer-Kelly PhD 2 , Dr. Beth Steinberg PhD 1 , Dr. Tim Pawlik MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS 2

1 Center for Integrative Health, College of Medicine, The Ohio State University, Columbus, Ohio, United States

2 Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

3 Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, Ohio, United States

Purpose : The study assessed the feasibility and impact of a 1-minute audio-guided meditation on self-reported stress and patient safety, initially implemented with an orthopedic surgical team then scaled to a cancer surgical team.

Method(s) : Before each surgery, attending surgeons granted permission via email. A research associate then briefed the surgical team in the operating room, after which the staff participated in a 1-minute audio-guided meditation. Team members were invited to complete a post-surgery survey via a QR code flyer.

Results : A sample size of 73 health care providers participated in the study. This included surgeons (n=20), an anesthesiologist (n=1), CRNAs (n=3), nurses (n=14), surgical techs (n=6), medical residents (n=11), PA/RNFAs (n=2), medical device reps (n=2), medical students (n=8), radiologic techs (n=2), and (n=4) surgical team members did not select a role. Among the 73 participating healthcare providers, responses to the brief meditation intervention were positive. On a 5-point Likert scale, 60% of participants agreed or strongly agreed that they felt calmer during surgery (mean = 3.69, SD = 0.76) and more clear-minded (mean = 3.64, SD = 0.82). Additionally, 56% reported that the exercise helped reduce their overall stress during the workday (mean = 3.58, SD = 0.93) and contributed to patient safety during surgery (mean = 3.65, SD = 0.95). Finally, 60% indicated they were likely to recommend the meditation exercise to other surgical teams (mean = 3.68, SD = 0.97).

Conclusions : Members of surgical teams responded favorably to the brief meditation intervention. Introducing a surgical team meditation exercise prior to the commencement of surgery may enhance team members' sense of calm and concentration, potentially contributing to improved teamwork, patient safety, and clinical outcomes. Continued research is warranted to determine optimal process and timing for successful implementation with the intent for a pre-surgical team meditation to become standard practice prior to surgery.

OA 05.02

Initial Outcomes from a Course in Human Flourishing to help Medical Students Thrive

Prof Aviad Haramati PhD , Ms. Katherine Bohigian BS

Georgetown University Medical Center, Washington, DC, United States

Purpose : To improve the well-being of students and faculty at Georgetown University SOM, a new course was developed for medical students, based on three frameworks of Human Flourishing. The premise is for students and faculty to thrive in medical school, various domains of Human Flourishing, such as meaning/purpose, character/values, and positive relationships, need to be aligned along with physical and mental well-being. This presentation will describe the development of the course and the initial outcomes.

Method(s) : Eight domains of Human Flourishing and operationalized into a 9-week course with each session addressing one of the domains and including an activity for discussion and reflection. To build capacity for course facilitators, a 3-day immersion training retreat was developed. This experiential 9-session course is taught to groups of 10 students with 2 faculty facilitators. Pre- and post-course surveys assessed a variety of parameters using validated instruments. Qualitative analysis was conducted on the responses to several open-ended questions.

Results : The course was piloted with 10 medical students in Fall 2023 and implemented for 20 first-year students in Spring 2024. In Spring 2025, 11 medical students participated. Quantitatively, an increase was observed in the Flourishing Index (68.6±13.2 to 75.6±8.1, P<0.04) and a decrease in Perceived Stress (20.2±5.2 to 16.9±4.0, P<0.07) after the course, both changes with significant effect sizes. Qualitative analysis suggested the experience was impactful to students in terms of new skills and insights they gained. Faculty training retreats were held for 10 participants in each of the past 3 years. Outcomes data from both the course and retreats provide strong impetus for continued investment in this program.

Conclusions : Operationalizing specific domains of Human Flourishing into a course that focuses on specific elements and tools that can be taught to medical students can lead to fostering self-awareness, self-reflection and improved well-being.

OA 05.03

Well-being as everyone’s responsibility: promoting occupational well-being through actionable data

Dr. Amy B Locke MD 1 , Dr. Megan Call PhD 2 , Dr. Angela Fagerlin PhD 2 , Dani Nives LCSW 2 , Whitney Werner MBA/MHA 2

1 University of Utah, SLC, UT, United States

2 University of Utah, SLC, Utah, United States

Purpose : With many possible drivers, improving the well-being of healthcare workers is a problem with multiple non-linear impacts. Understanding local drivers of well-being can help leaders and teams act to improve the work environment; however, most institutions survey their faculty and staff with a variety of instruments in a fragmented way, making it difficult to synergize action planning. Since first measuring burnout in 2016, we have continued to optimize data collection and utilization. In 2023, we successfully combined all engagement and well-being surveys administered at our institution into a single instrument as a part of a larger Well-being Strategy.

Method(s) : We brought together leaders from HR, Office of Faculty, Patient Experience, Communications, Wellness and other leaders for design and implementation. Beginning in 2023, the survey was administered to 24,000 individuals via Qualtrics. Leaders had access to interactive dashboards. We met with and encouraged leaders to use a quality improvement model to address issues. We shared institution-wide strengths and weaknesses and highlighted common themes.

Results : Our survey has an annual response rate of 60% . Unified communications provided guidance to leaders across the organization. Each leader has access to their team’s data, associated drivers, and resources to act. Results influenced content of the institution’s Strategic Plan and relevant committee work. Feedback on the process was collected at each step. Support for teams is available from HR, the Offices for Faculty and Wellness and includes a Joy in Work program based on the Institute for Healthcare Improvement’s model. Actions taken are shared widely to encourage adoption of best practices, including an annual hospital-wide poster fair.

Conclusions : This complicated project required time commitment and coordination. Ongoing opportunities include understanding matrixed teams, psychometric evaluation of the survey, coaching of teams, and accountability. Actionable data helps make our health system a better place to work.

OA 05.04

The Compassion Champion Model: A Peer-Led Framework for Cultivating and Sustaining Compassion in Organizations

Dr. Sivaranjani Penna MD 1,2 , Melanie Bateman RN, BSN 1,2

1 Welugu, Narberth, PA, United States

2 Bryn Mawr Hospital, Bryn Mawr, PA, United States

Purpose : Despite strong evidence linking compassionate healthcare to improved outcomes, clinician well-being, and reduced costs, compassion remains underprioritized in healthcare systems. There is a need for models that embed compassion into daily practice, transforming it from an aspirational ideal into an organizational norm. The Compassion Champion Intervention (CCI) is an integrative model that harnesses clinicians’ innate humanitarian capacity through structured training, peer reflection, and brief compassion practices within routine workflows to cultivate sustainable compassion as a foundation for clinician well-being, patient connection, and culture of care.

Method(s) : A nine-month mixed-methods design will assess feasibility and impact. Primary outcomes are compassion and burnout; secondary outcomes include patient experience and organizational engagement, assessed through validated measures. The intervention includes three phases: (1) identifying clinicians exemplifying compassionate care (top quartile on a compassion scale); (2) training them through six weekly 60-minute sessions on compassion, reflection, and communication; and (3) empowering them to lead weekly huddles and monthly Compassion Circles for four months, later transitioning to unit-led circles. Quantitative data will be analyzed using mixed-effects modeling; qualitative reflections through thematic analysis. A preliminary feasibility and acceptability survey was conducted.

Results : Among 32 respondents, feasibility was strongly endorsed (15.6% strongly agree; 53.1% agree) and acceptability was moderate (12.5% strongly agree; 37.5% agree). High neutral responses (22% for feasibility; 44% for acceptability) suggest opportunities to strengthen engagement and understanding. Positive effects are anticipated across primary and secondary outcomes.

Conclusions : The preliminary results support the feasibility of the model and lay the groundwork for larger-scale evaluation across varied healthcare environments. By transforming compassion from an individual virtue into a shared practice, it aligns clinician well-being with patient-centered care and organizational culture, laying the groundwork for larger-scale implementation and evaluation.

Oral Abstract Session 06: Implementation and Efficacy of Integrative Clinical Nutrition

OA 06.01

Nutrition-Based Group Medical Visits for Chronic Disease Risk Reduction: A Mixed Methods Evaluation

Martha Shepherd DO, MPH 1 , Divya Kaushal MS 2 , Sara Johnson Ph.D. 3,4 , Morgan Stine MPAP, PA-C 1 , Kimberly Gill RN, MPH, BSN 1

1 Vanderbilt University Medical Center, Nashville, TN, United States

2 Geisel School of Medicine, The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH, United States

3 ProChange Behavior Solutions, Narragansett, RI, United States

4 Health Enhancement Research Organization (HERO), Raleigh, NC, United States

Purpose : Fewer than 10% of U.S. adults meet fruit/vegetable guidelines, and only 7% reach fiber recommendations. The Ardmore Institute of Health’s Full-Plate Living (FPL) program is a fiber-focused, whole-food curriculum that can be offered as a group medical visit (GMV)). This quality improvement initiative at Metro Nashville Public Schools' (MNPS) Employee & Family Health Care Centers evaluated a 4-session FPL GMV in an employer-sponsored health center.

Method(s) : Participants over the age of 16 with any diet-related diagnosis. Biometrics and vital signs were recorded at each session. PROMIS-10 Global Health Scale, Rate Your Plate (RYP) tool, and a four-item fiber-specific subscale were captured in Epic at the initial and final sessions. A REDCap survey was administered to assess acceptability. Descriptives were examined, and paired t-tests were conducted. Open-ended responses were evaluated inductively.

Results : Twenty-six participants enrolled; 23 attended Session 1 (91% female; mean age = 54.1 years; 54.5% White, 36.4% Black). Retention at Session 4 was 87%. Complete paired pre- and post-data (n=19) showed an increase in RYP scores (Session 1 mean= 51.2 (8.78) to Session 4 (mean= 55.9 (7.92)) (p < 0.001, d = 0.51). Fiber scores increased from 6.7 to 8.4 (p < 0.001, d = 0.70). Thirty-two percent of participants reported an improved physical health score, and 26% experienced an improved mental health score. Two-thirds experienced a decrease in diastolic pressure (mean= –4.7 mmHg). The mean satisfaction score for FPL GMV was 9.42/10; 90% of participants agreed that “FPL enhanced my overall health and well-being”, and 100% were more confident making healthy choices. Qualitative findings highlighted the value of culinary demonstrations, peer accountability, and group support.

Conclusions : The results demonstrate the feasibility, acceptability, and effectiveness of integrating FPL GMV's into primary care settings and underscore that GMVs are a promising and scalable form of whole-person care for other lifestyle medicine pillars.

OA 06.02

Artificial Intelligence (AI) text-based Nutrition Assistant (InaⓇ) for Nutrition Support in Breast Cancer Survivors: A Preliminary Analysis

Gabriel Lopez MD 1 , Marissa Buchan RD, CSO 2 , Melanie Guirette PhD, RD 2 , Susan Bratton 2

1 University of Texas, MD Anderson Cancer Center, Houston, TX, United States

2 Savor Health LLC, New York, NY, United States

Purpose : Digital health technology using AI and machine learning (ML) offers a unique opportunity to enhance nutritional support for oncology patients by providing evidence-based recommendations in real-time.

Method(s) : Users across the US, including self-selected people with cancer, cancer-caregivers, or oncology health care providers, accessed a text-based AI-nutrition expert-platform (InaⓇ) for nutrition support and guidance. InaⓇ is powered by AI, ML, and a proprietary database of over 120,000 interventions based on clinical guidelines and peer-reviewed literature. Self-reported outcomes included baseline demographics, comorbidities, nutrition barriers, symptoms; as well as survey scores (1-5 Likert scale, 5 best) on user experience / satisfaction and engagement / adherence. We assessed (Spearman correlation) associations between user engagement (e.g., time on platform, messages sent, and surveys completed) and average survey scores. We examined (Kruskal-Wallis test) differences in comorbidities and nutrition barriers across tertiles of increasing message count.

Results : The subset analysis included 730 users (breast cancer, 726 women), average age 53 (range 26-82), majority overweight (31%) or obese (35%), 25% with metastatic disease. The top three self-reported nutrition barriers were related to time (not enough, 37%), cost (of healthy food, 35%), and nutrition knowledge (not sure what to choose, 33%). Engagement was high, with users remaining on the platform a median of 9 months. Overall user satisfaction was high (4.2 average). Higher message counts associated with significantly higher scores for overall experience, accuracy, help managing side effects, and likelihood of recommending Ina (p < 0.001). Users reporting nutrition barriers related to time and nutrition knowledge were also more likely to engage with Ina.

Conclusions : AI-nutrition support was well received by users with breast cancer, with engagement positively correlating with survey scores. Additional research is needed to understand which persons are more likely to benefit from AI-nutrition support and when to “prescribe” the intervention.

OA 06.03

Tailoring A Culinary Medicine Program to Support Positive Dietary Changes in Oncology Patients

Julia Schlossman MS, MD 1 , Sue Czap MS, RD 2 , Bailey Garlipp RD 2 , Sydney John MPH 2 , Alissa Huston MD 2,3

1 Boston Medical Center, Boston, MA, United States

2 Pluta Integrative Oncology & Wellness Center, Rochester, NY, United States

3 University of Rochester Medical Center, Rochester, NY, United States

Purpose : Nutrition serves as a critical component of supportive care for oncological patients. While there is evidence to support nutrition’s role in reducing cancer risk, there is inconsistent education or patients on nutritional recommendations. To address this need, we implemented a pilot study to assess the impact of a Culinary Medicine Program (CMP) on cancer patients’ eating habits, cooking confidence, and nutritional knowledge.

Method(s) : Patients were recruited from the Wilmot Cancer Institute (WCI) oncology clinics and the Pluta Integrative Oncology & Wellness Center (IOWC). Oncology-certified registered dieticians co-taught a four-class hybrid program. Sessions consisted of educational content and recipe demonstrations focused on four nutritional themes (curriculum from the Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics). Pre-/post-course surveys were distributed (adapted from Stanford Health Care) with the opportunity for qualitative feedback.

Results : A total of 24 pre- and 21 post-program assessments were completed with 88% retention. Following completion, participants reported eating more: fruit (52%; 11/21), vegetables (62%; 13/21), whole grain products, (43%; 9/21), and beans (43%; 9/21). In addition, 57% (12/21) reported eating less red meat and 62% (13/21) intake of added sugar. 71% (15/21) stated their cooking confidence increased and reported preparing a healthy meal daily. All participants had or were planning to prepare program recipes at home. 86% (18/21) reported being satisfied or very satisfied with the program, and 90% (19/21) noted they would recommend it to others. 6-month post program survey results will be reported. Qualitative feedback identified themes focused on the positive impact, education and feedback for future programs.

Conclusions : Implementation of a CMP demonstrated a positive change in participants’ dietary choices and cooking confidence with strong program retention. Although many participants reported baseline nutritional knowledge, post-program assessments and qualitative feedback demonstrated an overall improvement, underscoring the impact of a formal CMP for oncology patients.

OA 06.04

Primary Safety Results of Xanthohumol in Crohn's Disease: A Phase 2 Clinical Trial

Ryan Bradley ND, MPH 1 , Carina A. Staab DC, MEd 2 , Paige E. Jamieson PhD 3 , Blake O. Langley ND, MS, LAc 4 , Tom O. Metz PhD 5 , Jan F. Stevens PhD, PharmD 3

1 University of California, San Diego, La Jolla, CA, United States

2 National University of Natural Medicine, Portland, OR, United States

3 Oregon State University, Corvallis, OR, United States

4 Fred Hutchinson Cancer Center, Seattle, WA, United States

5 Pacific Northwest National Laboratory, Richland, WA, United States

Purpose : Basic science evidence suggests xanthohumol (XN), a polyphenolic compound from hops, may ameliorate the increased gut permeability, intestinal inflammation, and altered bile acid metabolism associated with Crohn’s disease. Therefore, the purpose of this research was to determine the safety and tolerability of supplemental xanthohumol in participants with Crohn’s disease via a Phase 2 clinical trial.

Method(s) : We conducted a randomized, triple-masked, placebo-controlled Phase 2 clinical trial of xanthohumol in human participants with Crohn’s disease under an FDA-approved IND. Candidates were screened using the Crohn’s Disease Activity Index (CDAI) to confirm they were not in remission. Eligible participants were randomized to either xanthohumol (24 mg/day) or a rice protein placebo for 8 weeks. Clinical laboratory toxicology measures (i.e., eGFR, BUN, Cr, RBC, WBC, PLT, ALT, AST, GGT, etc.), urine and stool collections, and adverse events were collected biweekly. Mean changes in lab parameters and changes in the proportion of participants with abnormal labs were used to determine clinical safety, while self-reported adverse events, CDAI and PROMIS-29 scores were used to assess tolerability.

Results : Twenty adults were randomized and 19 completed the trial. XN was well tolerated with adherence exceeding 95%. Neither halting nor stopping criteria were met, and all laboratory elevations were minor and transient in both groups. There were no attributable serious adverse events in either group, and all moderate AEs were short-term and self-resolving. Between group comparisons demonstrated differences for changes in BMI and GGT favouring XN: BMI: -0.67 (0.0, 1.3), p=0.04; GGT: -4.8 U/L, 95% CI 0.8–8.8, p=0.02. There were no significant changes in either CDAI or PROMIS-29 compared to placebo.

Conclusions : XN at 24 mg/day was safe and well tolerated in adults with active CD, supporting further research in inflammatory bowel disease. Changes in BMI and GGT may reflect beneficial effects on hepatic and metabolic health.

Oral Abstract Session 07: Integrative Health Policy

OA 07.01

Traditional, Complementary, and Integrative Healthcare, Global Advocacy Roadmap - Positive and Negative Determinants of the Implementation of the global Traditional Medicine Strategy

Dr. John S Finnell ND, PhD, MPH, MS 1,2,3 , Dr. Tabatha Parker ND 4

1 Bastyr University Research Institute, Bastyr University, Kenmore, WA, United States

2 Dept. of Epidemiology, UTHealth Houston School of Public Health at Austin, Austin, TX, United States

3 Central Texas Veterans Health Care System, Austin, TX, United States

4 Helfgott Research Institute, National University of Natural Medicine, Portland, OR, United States

Purpose : Traditional, Complementary, and Integrative Healthcare (TCIH) perspectives remain underrepresented in global health policy discussions. Therefore, a rapid-cycle analysis was conducted to characterize civil society perspectives on the implementation of the global Traditional Medicine Strategy 2025–2034 (TM Strategy).

Method(s) : The questionnaire was ananymous and inclusive of the perspectives of key decision-makers, deliverers, and recipients of the TM Strategy, and was administered, electronically via REDCap, from September to December 2025. The study was determined to be exempt from IRB review (Bastyr University IRB: #25-0017). Statistical analyses were conducted using STATA Stata 18.0.

Results : Descriptive statistics revealed broad response (N=334) across Stakeholder Role (%): Patient (10.9%), Health Care Practitioner (46.3%), Medical Doctor (25.5%), Educator (25.2%), Researcher (26.1%), Government (5.9%), Policy Maker (7.8%), Other (11.2%). Respondents were well represented across Geographic Scope (%): Country-level (28.7%), African (7.4%), Americas (6.5%), Eastern Mediterranean (1.9%), European (22.2%), South-East Asia (4.6%), Western Pacific (2.5%), International (11.1%), Regional or Local (15.1%). The majority (58%) of respondents agreed or strongly agreed that the TM Strategy addresses the needs and challenges of TCIH in their region.

Conclusions : The results show broad response across stakeholder roles, stakeholder type, role in healthcare, and geographic scope. A limitation was the electronic questionnaire required access to technology. A strength was questionnaire translation from English to Chinese, French, Portuguese, Russian, and Spanish. A clear majority of respondents reported the following strategies as being very or extremely important to the implemntation of TCIH: 1) strengthening regulation and governance; 2) ensuring safety, quality, and efficacy; 3) integration of TCIH into national health policies, programs, and service delivery; 4) education, accreditation, and licensing of TCIH practitioners; 5) digital innovation and interoperability; and 6) promoting public health literacy and awareness of TCIH.

OA 07.02

Is It Time to Include Meditation, Yoga, and Tai Chi in Health Promotion Policies? Proposing Evidence-Based Strategies and Action Steps

Dr. S. Prasad Vinjamury MD (Ayurveda), DACM, MPH 1 , Ms Marita La Monica MPH, RYT 2

1 Southern California University of Health Sciences, Whittier, CA, United States

2 City University of New York, New York, NY, United States

Purpose : Non-communicable diseases (NCDs) account for 81% of global deaths and affect 60% of Americans living with chronic conditions. Despite widespread use and growing evidence, traditional, complementary, and integrative health care (TCIH) practices such as meditation, yoga, and tai chi lack systematic incorporation into health promotion and primary disease prevention policies. This abstract examines policy gaps, reviews high-quality evidence, and proposes action steps for integrating TCIH practices into national health promotion frameworks.

Method(s) : Analysis of current U.S. health promotion policies, including Healthy People initiatives, revealed that TCIH practices are not explicitly integrated despite their relevance to primary prevention. Systematic reviews and meta-analyses were examined to assess the evidence base for meditation, yoga, and tai chi in addressing modifiable NCD risk factors.

Results : Policy Gaps: Current Healthy People frameworks fail to achieve 66% of trackable objectives, with disproportionate impacts on low-income and racially diverse populations. TCIH practices remain unarticulated in Leading Health Indicators despite addressing physical, mental, and social health dimensions. Evidence: High-quality studies demonstrate that yoga controls cardiovascular risk factors including hypertension, metabolic syndrome, and diabetes. Meditation shows sustained effects on stress reduction, blood pressure, insulin resistance, smoking cessation, and cognitive function. Tai chi demonstrates significant improvements in balance, cardiorespiratory fitness, mobility, and reduction in falls and stroke risk among older adults. Provider-based systems including Traditional Chinese Medicine, Ayurveda, chiropractic, and naturopathy also emphasize lifestyle-based, person-centered approaches to wellness that are evidence informed.

Conclusions : Evidence-Based Strategies: (1) Create national frameworks integrating WHO's TCIH strategy and PAHO's culturally appropriate health promotion approaches; (2) Explicitly utilize meditation, yoga, and tai chi in health promotion policies with programs targeting underserved populations; (3) Increase NCCIH funding for prevention research and TCIH workforce development. Action Steps: Urge HHS to integrate TCIH into Healthy People initiatives; establish reimbursement for TCIH primary prevention services; implement community-based and school-based programs; fund randomized controlled trials; support credentialing and training standards for TCIH professionals. These low-risk, accessible practices offer culturally responsive tools to address health inequities and reduce the NCD burden.

OA 07.03

Acupuncture and Herbal Medicine in Transition: Trends, Challenges, and Opportunities for Integration

DR Belinda J Anderson PhD, MA(Ed), LAc

Pace University, New York, NY, United States. Albert Einstein College of Medicine, New York, NY, United States

Purpose : The acupuncture and herbal medicine (AHM) profession in the United States faces significant challenges, including declining numbers of practitioners, school closures, and shifting healthcare dynamics. At the same time, opportunities are emerging through expanded insurance coverage, policy initiatives, and research advancements. This study aimed to analyze the forces shaping the profession and identify future directions for integration into mainstream healthcare.

Method(s) : A comprehensive review of national data sources, including licensure statistics, accreditation reports, federal policy developments, insurance coverage trends, and peer-reviewed publications, was conducted. These findings were synthesized with emerging initiatives from professional organizations and governmental agencies to generate a strategic overview of the profession’s current status and trajectory.

Results : Between 2018 and 2023, the number of licensed acupuncturists declined by 8.9%, with parallel decreases in school enrollment and accredited programs. Contributing factors included the COVID-19 pandemic, demographic shifts, and financial pressures. Despite these challenges, use of acupuncture in the U.S. continues to rise, supported by expanded insurance and Medicare coverage. Legislative efforts (HR 3133) seek to grant provider status to licensed acupuncturists, which could transform employment opportunities and access to care. Research output has grown rapidly, supported by the NIH National Center for Complementary and Integrative Health. Emerging areas of focus include implementation science, practice-based research, big data and AI applications, and the Whole Person Health framework. The 2023 formation of the AHM Coalition and the inclusion of Traditional Medicine diagnoses in ICD-11 further strengthen professional legitimacy and integration.

Conclusions : The AHM profession stands at a critical juncture. While structural vulnerabilities threaten sustainability, growing policy recognition, insurance expansion, and robust research create opportunities for deeper integration into U.S. healthcare. Strategic alignment around advocacy, research, and whole person health frameworks will be essential to ensure the profession’s relevance and long-term contribution to addressing chronic pain, the opioid crisis, and patient-centered care.

OA 07.04

Integrating Thai Traditional Medicine into Health Promotion in Thailand: Towards Strategic Development Pathways

Ritichai Pimpa , ZhiMin Xiao, Nestor Asiamah

University of Essex, Colchester, Essex, United Kingdom

Purpose : This study investigates the challenges and opportunities that shape strategic development pathways for enhancing health promotion at the primary care level in Thailand through the integration of Thai Traditional Medicine (TTM). Although TTM has deep cultural roots and significant preventive health potential, its integration into the national healthcare system remains limited.

Method(s) : Fifteen in-depth, semi-structured interviews were conducted with key stakeholder experts. These participants included practitioners, policymakers, professional council members, academics, and interdisciplinary professionals working across various regions of Thailand. The data was analysed using the framework analysis method, guided by five domains based on the Ottawa Charter for Health Promotion. Each domain was examined in terms of both its challenges and potential opportunities.

Results : Several key challenges emerged, including unsupportive policies and systemic limitations, unclear career pathways and workforce issues, as well as widespread misconceptions and negative public perceptions of TTM. However, the study also identified promising avenues for development. These include a growing societal shift toward holistic and preventive health, the potential of community-driven and elderly-focused health services, and the richness of Thai cultural heritage, which offers a strong foundation for building a health-oriented economy.

Conclusions : The findings suggest that the effective integration of TTM into primary care requires comprehensive systemic reform, well-defined governance structures, and the creation of official civil service pathways for TTM practitioners. Promoting collaborative governance and building public trust will be crucial for positioning TTM as a central pillar in Thailand’s culturally-rooted, holistic health promotion strategy.

Oral Abstract Session 08: Stress, Coping, and Resilience

OA 08.01

Feasibility and Acceptability of Group-Based Interventions (offered in English and Spanish) for Caregivers of Children with LAD

Dr. Elyse Park Ph.D., MPH, FAPOS 1,2 , Brett Goshe PhD 1,2 , Isabelle Miranda BA 1 , Lucy Finkelstein-Fox PhD 1,2 , Pam Nourse MBA 3 , Renee Williams MBA 3 , Gabriella Nicolosi BA 4 , Karen A Lopez BA 3 , Ruth DeLa Cruz BA 3 , Esteban Barreto PhD 5,2 , Rachel A Millstein PhD 2 , Giselle K Perez PhD 1,2 , Brittain Mahaffey PhD 6 , Carolina E Abuelo MD, MSc 2 , Brian Winklosky MA 7 , Rachel Goodman BS 1 , Rosalie Rippey Mdiv 3 , Dr. Karen Kuhlthau PhD 2,8

1 Mongan Institute, Massachusetts General Hospital, Boston, MA, United States

2 Harvard Medical School, Boston, MA, United States

3 Federation for Children with Special Needs, Boston, MA, United States

4 St. John's University, New York, NY, United States

5 Center for Academic Development and Enrichment, Massachusetts General Brigham, Boston, MA, United States

6 Stony Brook Medicine, Stony Brook, NY, United States

7 Boston Children's Hospital, Boston, MA, United States

8 Department of Pediatrics, Massachusetts General Brigham, Boston, MA, United States

Purpose : Caregivers of children with learning and attention difficulties (LAD) often experience significant stress, negatively impacting their health. Massachusetts General Hospital (MGH) partnered with the Massachusetts Federation for Children with Special Needs (a statewide community-based organization for families of children with disabilities and special health care needs), to adapt and assess the feasibility and acceptability of a mind-body group intervention and a group health education program to improve caregivers’ stress management and resilience.

Method(s) : Two interventions, the Stress Management and Resiliency Training (SMART-LAD) and its comparator, Health Education Program (HEP-LAD), were adapted and offered in English and Spanish to caregivers of children with LAD. Caregivers completed baseline and post-treatment surveys. Primary outcomes are feasibility (completion rate, response rate, # sessions attended) and acceptability (comfort level, content satisfaction).

Results : We reached our target enrollment of 28 caregivers who comprised 4 groups (n=16 English participants and n=12 Spanish participants with a SMART-LAD and HEP-LAD group in each language). 94.6% screened were eligible (35/37); 80% (28/35) enrolled. 89% (25/28) completed the follow-up survey. Participants were all women, average age 43 years, 46% White, 45% Hispanic, 48% married, and 36% employed full time. Of the 28 participants enrolled, 25 (89.2%) attended at least one group session. Of participants who attended sessions, 64% attended 6 or more sessions (16/25). Among SMART-LAD participants, 78% (11/14) attended 6 or more sessions, and 69.2% were satisfied with the SMART-LAD content. 73.9% (17/23) were satisfied with teleconferencing, and 79.1% (19/24) felt satisfied with the number of sessions. 91.7% (22/24) of participants expressed comfort/trust in the groups.

Conclusions : Both interventions for caregivers of children with LAD were feasible and acceptable. The SMART-LAD program may have fostered deeper engagement and content satisfaction. Overall, the program structure and processes functioned well in both arms and both languages.

OA 08.02

Feasibility and Acceptability of a Dyadic Mind-Body Resiliency Intervention for Cancer Survivors and Caregivers: A Randomized Pilot Trial (Project ForTe)

Dr. Elyse Park Ph.D., MPH 1,2 , Brett M. Goshe PhD 1,2 , Anna Barata PhD 1,2 , Lucy Finkelstein-Fox PhD 1,2 , Joanna Cloutier BA 1 , Emelia Farnam BA 1 , Katie Holmbeck BA 1 , Elizabeth Waldron PhD 1,2 , Giselle K Perez PhD 1,2 , Laura Malloy LICSW 1 , Isabelle Miranda BS, BA 1 , Wren Hager BA 3 , Nora Horick MS 1,2 , Areej El-Jawahri MD 1,2

1 Massachusetts General Hospital, Boston, MA, United States

2 Harvard Medical School, Boston, MA, United States

3 Wellesley College, Wellesley, MA, United States

Purpose : Caregivers of cancer survivors struggle with chronic and ongoing stress spanning the survivorship continuum. The primary goal of this randomized pilot trial was to determine the feasibility and acceptability a mind-body resiliency group intervention, simultaneously delivered to cancer caregivers and survivors, and determine its preliminary efficacy for improving resiliency and stress coping among caregivers and survivors.

Method(s) : From 7/2023-3/2024, 47 dyads were randomized to a 9-session virtual mind-body resiliency or 3-session online support group (CanCare). Eligibility criteria included curvivors (completed curative intent treatment ≥3 months to 5 years) and metavivors (diagnosed with metastatic illness ≥3 months) with an identified caregiver (family member/friend) who received care at Mass General Cancer Center. We hypothesized that > 45% enrollment of eligibles, >70% study retention, >70% completion of >6 sessions and > 75% intervention satisfaction.

Results : We enrolled 47 survivor (64% metavivors; 47% female, mean age 62) and caregiver (62% partners; 66% female; mean age 57) dyads. 85% were white, 2.1% Black, and 14.9% Hispanic. Only 10% of potential eligibles enrolled; the most common reasons for refusal were not having the need or the time. 75% of intervention participants completed >6 sessions, and 81.9% completed the study. 83.7% of intervention participants were satisfied (overall, met needs, program quality and helpfulness); notably, 97.3% were comfortable in groups. Moderate effect size improvements were seen in resiliency (B=3.8; 95% CI = -0.50, 8.2; Cohen’s D= 0.37) and stress management (B=3.1; 95% CI=0.6, 5.5; Cohen’s D=0.47).

Conclusions : We conducted a pilot randomized trial in which we established the feasibility (study retention, intervention engagement) and acceptability (overall satisfaction) of a simultaneously delivered group mind-body resiliency intervention for survivors and caregivers. However, dyadic enrollment was challenging, and we did not meet our enrollment goal. Results show promising effects on improving stress coping and resiliency.

OA 08.03

Examining perceptions of movement-focused vs. meditation/breathwork-focused yoga with the Essential Properties of Yoga Questionnaire

Camille L Garnsey , Katherine E. Gnall, Erika Osherow, Sarah Ahmadi, Dr. Crystal Park PhD

University of Connecticut, Storrs, CT, United States

Purpose : Yoga has shown efficacy in improving physical and mental health and supporting well-being. As practiced in the West today, yoga typically integrates physical postures, breathwork, and meditation. However, yoga is a broad discipline, and classes vary considerably in the elements emphasized. Little is known about how participants perceive these differences. This secondary analysis of an 8-week pilot RCT compared participants’ perceptions of yoga elements across two distinct yoga conditions.

Method(s) : Stressed adults (N = 40, Mage = 19.8, 93% female, 70% White) participated in a pilot trial testing two types of asynchronous online yoga. Participants were randomized to either a.) a condition emphasizing physical postures and active movement (i.e., movement-focused; n = 20) or b.) a condition emphasizing breathwork and meditation (i.e., meditation-focused; n = 20). Participants engaged in eight hour-long weekly sessions. At post-intervention, they completed the Essential Properties of Yoga Questionnaire (EPYQ) assessing perceived emphasis across six elements of yoga. Three elements were intentionally manipulated in the design of the two conditions (i.e., meditation/mindfulness, breathwork, physicality), and three were not (i.e., acceptance/compassion, mental/emotional awareness/release, body awareness). Independent-samples t-tests with 1,000 bootstrap samples (bias-corrected 95% CIs) compared conditions.

Results : The meditation-focused condition was rated higher on meditation/mindfulness (Ms = 3.60 vs. 2.63; p = .005) and mental/emotional awareness/release (Ms = 4.39 vs. 3.60; p = .02). Movement-focused classes were rated higher on physicality (Ms = 2.40 vs. 3.36; p < .005) and body awareness (Ms = 3.52 vs. 4.06; p = .02). No significant differences were observed for acceptance/compassion or breathwork (ps > .05).

Conclusions : Participants perceived the intended differences in physicality and meditation but not in breathwork, suggesting breathing may feel central to yoga regardless of explicit breathwork practices. Without intentional manipulation, differences also emerged in emotional awareness and body awareness, suggesting classes with distinct emphases may naturally direct attention toward different elements. These findings provide insight into perceptions of yoga’s core elements. Future research is warranted to examine how perceived emphasis relates to intervention mechanisms and effectiveness.

OA 08.04

Measuring Holistic Ways of Coping for Black Women in the Context of Clinical Practice and Research

Dr. Vanessa N. Oliphant PhD in Clinical Psychology , De'ja Broyles M.A., Coutney Harold M.S.

University of Mississippi, Oxford, MS, United States

Purpose : The purpose of this study is to emphasize the importance of measuring holistic ways of coping for Black women in the context of clinical practice and research. There is a need for greater emphasis to be placed on the lived experiences of Black women and to assess and affirm the ways in which they have found survival strategies in their protective coping.

Method(s) : The current study used an African-centered psychological measurement to assess the degree to which Black women endorse culturally specific coping strategies. Specifically, the Africultrual Coping Systems Inventory (ACSI) was used to measure Black women’s use of collective coping, spiritual-centered coping, ritual-centered coping, and cognitive emotional debriefing.

Results : 282 cisgender women who self-identified as African American/Black (M age = 20) completed the ACSI measure. By conducting an exploratory analysis, results indicated that the Black women in the sample were less likely to use ritual-centered coping (M = 1.54, SD = 2.07), more likely to use cognitive emotional debriefing (M = 12.04, SD = 8.46), and equally used spiritual-centered coping (M = 7.40, SD = 6.07) and collective coping (M = 7.39, SD = 5.83).

Conclusions : Overall, this study can provide important implications for Black women's use of culturally relevant coping strategies and emphasize the need to assess and affirm their survival strategies in the context of clinical practice and psychological research. By doing this, we can better identify areas to improve clinical interventions and future research that centers Black women.

Oral Abstract Session 09: Clinical Efficacy and Implementation of Traditional Chinese Medicine

OA 09.01

Enhancing Safe Use of Chinese Herbal Medicine: A National Herb–Drug Interaction Database for TCM Practitioners

Dr Phoebe Zhou

Western Sydney University, Westmead, NSW, Australia

Purpose : The concurrent use of Chinese herbal medicine with conventional drugs is increasing globally, yet evidence-based guidelines for safe co-administration remain lacking. To address this, the NICM Health Research Institute and UnityHealth Pty Ltd have developed a pioneering Chinese Herb–Drug Interaction Database for healthcare professionals. This project aims to enhance safety and communication in integrative medicine, supporting practitioners with evidence-based tools to guide safe prescribing, foster collaboration, and improve patient outcomes worldwide.

Method(s) : Since 2017, this initiative has progressed through rigorous phases of literature review, data synthesis, and interaction and evidence evaluation. The information supporting each interaction is derived from a comprehensive literature review of both English and Chinese databases (i.e. PubMed and CNKI) and compiled into detailed monographs with key extracted data. Based on the available literature and levels of evidence, each monograph provides practitioner guidance and commentary on the strength of evidence. The monographs and conclusions are reviewed by toxicologists and pharmacologists before uploading to the system.

Results : The database now has included detailed monographs for 200 commonly used Chinese herbs, with 544 specific herb–drug pairings and 607 comprehensive interaction reports. Notably, the evidence-based classification system highlights few potential safety concerns but primarily beneficial interactions that may enhance clinical outcomes. Among the monographs, 4 describe likely significant interactions with strong evidence, 104 identify potential interactions with limited evidence, and 294 suggest possible therapeutic synergies. This nuanced approach empowers TCM practitioners with practical, clinically relevant information to optimize patient safety, improve communication, and support integrative treatment strategies.

Conclusions : Supported by the Australian Government’s National Industry PhD Program (2024–2027), this project anticipates a significant advancement in supporting TCM practitioners with an evidence-based tool to guide safe and effective herb–drug co-administration. Integrating this resource into clinical practice will enhance safe prescribing, encourage multidisciplinary collaboration, and ultimately improve patient health outcomes within integrative healthcare settings worldwide.

OA 09.02

Integrating Pathway-Guided Herbal Medicine for Cancer Symptom Management: Experience and Patient-Reported Outcomes from the MSKCC Herbal Oncology Program

Dr. Lingyun Sun 1 , Dr. Yen-Nien Hou 1 , Dr. Chun Sing Lam 1 , Dr. Hyowoun Jyung 1 , Dr. Susan Chimonas 2 , Dr. Jun J. Mao 1

1 Integrative Medicine and Wellness Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States

2 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States

Purpose : Cancer patients frequently experience treatment-related symptoms with limited effective conventional options. Integrating Chinese herbal medicine (CHM) may offer supportive benefits, yet evidence from Western academic oncology settings is scarce. The Memorial Sloan Kettering Cancer Center (MSKCC) established the Herbal Oncology Program (HOP) in 2019 to standardize CHM prescribing through a pathway-guided approach. This study aimed to evaluate patient-reported outcomes and safety following pathway-guided CHM use for cancer symptom management in routine clinical practice.

Method(s) : From June 2024 to June 2025, trained physicians and advanced practice providers (APPs) prescribed CHM using a pathway (consists of 29 CHM) for cancer-related symptoms. Follow-up phone calls 4–6 weeks post-dispensation assessed adherence, symptom changes, and adverse events. Response rate was defined as the proportion reporting improvement among those who took CHM. Demographics and clinical data were extracted from electronic records; prescription and dispensing data were analyzed descriptively to calculate symptom-specific response rates.

Results : Among 219 patients (mean age=56.1 years; 78.1% female), 235 CHM prescriptions were issued, with 80.0% collected. The most common indications were mood disturbance (n=45, 19.1%), nausea/vomiting/reflux (n=39, 16.6%), and constipation (n=31, 13.2%). Of 142 prescriptions taken by patients who completed follow-up, 99 reported symptom improvement (response rate=69.7%). Response rates were highest for fatigue (81.0%), mood disturbance (77.8%), constipation (75.0%), and insomnia (75.0%). Mild adverse events occurred in 7.2% of patients.

Conclusions : This study found that prescribing CHM by physicians and APPs for cancer-related symptom based on guided pathway is feasible, well-tolerated and suggested potential benefits in improving various cancer symptoms. Further rigorous research and education program are needed to support safe and evidence-informed-based use of herbal medicine in oncology care.

OA 09.03

Whole Systems Traditional Chinese Medicine Utilization Among Women Undergoing Frozen Embryo Transfers at an Academic Medical Center: A Retrospective Cohort Study

Dr. Samuel N Rodgers-Melnick PhD, MPH, LPMT, MT-BC 1,2,3 , Dr. Lee Hullender Rubin DAoM, MS, LAc, FABORM 1,4 , Dr. Sung Tae Kim PhD, HCLD 5,6 , Dr. Lucas Jones PhD 1 , Dr. Rebecca Flyckt MD 5,6 , Dr. Christine Kaiser DACM, LAc, FABORM 1,6

1 Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States

2 Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States

3 Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, United States

4 Rosefinch Health LLC, Portland, OR, United States

5 Department of Reproductive Endocrinology and Infertility, University Hospitals of Cleveland, Cleveland, OH, United States

6 Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States

Purpose : To investigate sociodemographic and clinical variables associated with Whole Systems Traditional Chinese Medicine (WS-TCM) utilization alongside Frozen Embryo Transfers (FETs) after in vitro fertilization.

Method(s) : We conducted a retrospective review of all autologous FETs performed within an academic medical center’s fertility clinic among women aged 21-42. One FET cycle per patient was randomly selected for analysis. After conducting bivariate analyses, we employed a logistic regression model to examine independent associations with attending ≥1 WS-TCM appointment between 120 days pre- and 12 days post-FET. WS-TCM treatment modalities included individualized acupuncture, nutritional and lifestyle modifications, and focused dietary supplements.

Results : Of 799 women, 162 (20.3%) utilized WS-TCM. WS-TCM users resided in neighborhoods with higher median income ($83,024 vs. $75,602, p=.002). Their previous medical histories included higher (p<.05) rates of cervical dysplasia (19.8% vs. 12.7%), recurrent pregnancy loss (25.9% vs. 12.9%), migraine/headache (12.6% vs. 13.3%), musculoskeletal pain (37.0% vs 27.5%), thyroid disorders (24.7% vs. 16.6%), polyps of the genital tract (22.8% vs. 15.5%), abnormal uterine/vaginal bleeding (16.0% vs. 9.7%), pain associated with genital organs (21.0% vs. 14.1%), hemorrhage in early pregnancy (13.0% vs. 7.5%), and undergoing more assisted reproductive technology (ART) cycles. Higher neighborhood median income (adjusted odds ratio: 1.36), recurrent pregnancy loss (2.15), and undergoing ≥3 vs. 0-1 ART cycles (1.78) were independently associated with higher odds of WS-TCM engagement, while higher BMI (0.79), undergoing preimplantation genetic testing (0.61), and having a history of salpingitis/oophoritis/pelvic inflammatory disease (0.59) or high-risk pregnancy supervision (0.53) were associated with lower odds.

Conclusions : Within this cohort, multiple pain- and reproductive health-related diagnoses were more prevalent among individuals utilizing WS-TCM. Findings inform factors that may influence clinicians’ and patients’ decisions to refer or pursue WS-TCM (e.g., migraine, musculoskeletal pain, recurrent pregnancy loss) and covariates that should be accounted for in future observational studies of WS-TCM’s effectiveness.

OA 09.04

Understanding Traditional, Complementary, and Integrative Medicine Researchers’ Perceptions of Generative Artificial Intelligence Chatbots in the Research Process: A Large-Scale International Survey

Dr. Jeremy Y. Ng MSc, PhD 1,2,3,4 , Ms. Jamie Tan 1,2 , Dr. Karthik Adapa MD, PhD 5 , Dr. Prashant K. Gupta PhD 6 , Dr. Shao Li MD 7 , Dr. Darshan Mehta MD 8,9,10,11 , Dr. Melinda Ring MD 12,13 , Dr. Manisha Shridhar PhD 5 , Dr. João Paulo Souza MD, PhD 14 , Dr. Tetsuhiro Yoshino MD, PhD 15 , Dr. Myeong Soo Lee PhD 16 , Dr. Holger Cramer PhD 1,2

1 Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany

2 Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Baden-Württemberg, Germany

3 Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

4 School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia

5 Department of Health Systems, World Health Organization-South East Asia Regional Office, New Delhi, Delhi, India

6 All India Institute of Ayurveda, New Delhi, Delhi, India

7 Institute for TCM-X, MOE Key Laboratory of Bioinformatics, Bioinformatics Division, BNRist, Department of Automation, Tsinghua University, Beijing, Beijing, China

8 Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States

9 Center for Comprehensive Healing, Massachusetts General Hospital, Boston, Massachusetts, United States

10 Osher Center for Integrative Health, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, United States

11 Department of Medicine and Psychiatry, Harvard Medical School, Boston, Massachusetts, United States

12 Osher Center for Integrative Health at Northwestern University, Chicago, Illinois, United States

13 Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

14 BIREME (Latin American and Caribbean Center on Health Sciences Information), Pan American Health Organization / Regional Office for the Americas Region, World Health Organization, São Paulo, São Paulo, Brazil

15 Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Kanto, Japan

16 Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Chungcheong, Korea, Republic of

Purpose : While GenAI may streamline labour-intensive processes, concerns remain regarding algorithmic bias, transparency, data privacy, authorship, and overreliance on automated outputs. In traditional, complementary, and integrative medicine (TCIM), GenAI may support research design, evidence synthesis, and dissemination, however, little is known about how TCIM researchers perceive its benefits, limitations, and ethical implications. This study explores the attitudes and perceptions of TCIM researchers toward the use of GenAI chatbots in the research process.

Method(s) : An anonymous, web-based, cross-sectional survey was distributed to corresponding authors of TCIM-related articles indexed in OVID MEDLINE (December 2014–December 2024). Names and email addresses were extracted through a custom-built R-based software, and invitations were distributed using SurveyMonkey. The survey included closed- and open-ended questions assessing GenAI awareness, prior use, perceived benefits and challenges across research stages, and ethical and methodological considerations.

Results : A total of 716 complete responses were received, with 89.7% (n=642) identifying as TCIM researchers from diverse global regions. Overall, 74.07% (n=417) were familiar with GenAI chatbots, 39.04% (n=219) were likely to use them in future research, and 43.67% (n=245) had received institutional training. Respondents reported usefulness in understanding or selecting methodology (47.55%, n=243) and developing research questions (46.5%, n=239). Key concerns included algorithmic bias (51.13%, n=248) and limitations related to scientific complexity (45.66%, n=221). Many viewed GenAI’s future impact positively (73.64%, n=380), and over half considered it “very important” to scientific research (54.37%, n=280).

Conclusions : TCIM researchers show both optimism and caution regarding GenAI. While many see potential to enhance methodological rigour and efficiency, concerns about bias, ethics, and limited training highlight the need for guidance to support responsible integration in TCIM research.

OA 09.05

Establishing an Integrative Care Model of Traditional Chinese Medicine and Western Medicine for Pediatric Atopic Dermatitis in Taiwan

Dr Min-Chieh Shih M.D. 1 , Dr Pei-Shan Yang 2 , Professor Chang-Ching Wei 3,4 , Professor Po-Yuan Wu 4,5 , Professor Hung-Rong Yen 1,6,7

1 Division of Integration of Chinese and Western Medicine, Department of Chinese Medicine, China Medical University Hospital, Taichung, -, Taiwan

2 Department of Chinese Medicine, Taichung, -, Taiwan

3 Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, China Medical University Children Hospital, Taichung, -, Taiwan

4 School of Medicine, College of Medicine, China Medical University, Taichung, -, Taiwan

5 Department of Dermatology, China Medical University Hospital, Taichung, -, Taiwan

6 Chinese Medicine Research Center, China Medical University, Taichung, -, Taiwan

7 School of Chinese Medicine, and International Master Program in Acupuncture, College of Chinese Medicine, China Medical University, Taichung, -, Taiwan

Purpose : Pediatric atopic dermatitis (AD) is a common chronic inflammatory skin disorder that severely affects children’s quality of life and imposes a substantial socioeconomic burden. In Taiwan’s dual-track healthcare system, integrating Traditional Chinese Medicine (TCM) with Western medicine provides an opportunity to enhance clinical outcomes and patient-centered care.

Method(s) : A collaborative care model combining TCM and Western medicine was established at China Medical University Hospital, Taichung, Taiwan for children aged 0–18 years diagnosed with moderate-to-severe AD (SCORAD ≥ 25). The multidisciplinary team included TCM physicians, pediatric allergists, dermatologists, nurses, pharmacists, and case managers. Participants received integrative medicine treatment—herbal medicine, topical herbal lotion, and herbal bath therapy—with conventional medications as needed. Clinical outcomes were assessed at baseline, 4 weeks, and 9 weeks using SCORAD, Children’s Dermatology Life Quality Index (CDLQI), Dermatitis Family Impact (DFI), and caregiver SF-36, alongside immunological markers.

Results : Thirty children (mean age 7.1 years) completed the 9-week program. After 4 weeks, significant improvements were observed in SCORAD (55.3→38.5, p<0.001), eczema extent (52.6%→36.1%), pruritus (7.1→4.5), and sleep disturbance (6.5→3.8). Both CDLQI and DFI scores improved significantly (p<0.001), indicating enhanced quality of life for patients and caregivers. Eosinophil percentage decreased from 12.0% to 8.5%. At 9 weeks, clinical improvements were sustained without symptom rebound, while corticosteroid use decreased.

Conclusions : This integrative care model effectively improved disease severity, patient well-being, and caregiver quality of life in pediatric AD. Beyond clinical benefits, it also provided a structured training platform for medical students and residents, fostering interprofessional collaboration between TCM and Western medicine. The model demonstrates Taiwan’s leadership in developing evidence-based integrative pediatric care and serves as a replicable framework for global application.

OA 09.06LB

Inequitable Discrepancies in Payment for Acupuncture under Medicare Part B

Dr. Louis A. Kazal, Jr. MD

Geisel School of Medicine at Dartmouth, Hanover, NH, United States

Purpose : In 2020 the Centers for Medicare and Medicaid Services (CMS) initiated reimbursement for acupuncture for treatment of chronic low back pain. Following the CMS decision, the number of encounters for acupuncture accelerated rapidly, despite CMS rules that restrict payment for acupuncture services to medical physicians and certain specialties working under their supervision. Independent licensed acupuncturists are ineligible for payment. While encounters did increase, the restrictive terms of coverage may compromise adequate and equitable patient access to acupuncture. The purpose of this study was to describe trends and patterns in payment and nonpayment for acupuncture under Medicare Part B.

Method(s) : We employed a cross-sectional design to examine 2020-2023 Part B Medicare claims. Acupuncture services were identified by procedure code and summarized mean payments by place of service category. Acupuncture services were defined as paid if the associated payment amount was greater than zero; unpaid services as those with payment amount of zero. We categorized paid and unpaid services by claim type, setting, year, clinician specialty, and line diagnosis.

Results : Acupuncture services provided under Medicare Part B for the period 2020-2023 totaled 1,575,147. Mean payment for acupuncture provided in a physician office visit setting was $36.61. Frequency of acupuncture services increased each year during the four-year period. Among all services billed, 48% were paid. The highest number of total acupuncture services was provided in California (235,103); Montana had the lowest number of total services (65). Physical Medicine and Rehabilitation had the highest number of total services, and the most paid services. ICD-10 code M5459 (other low back pain) was the most frequent diagnosis for which acupuncture was provided.

Conclusions : The frequency of acupuncture services increased each year during the four-year period. We found unwarranted variation in rates of successful claims for reimbursement of acupuncture services by state, clinical specialty, and diagnosis.

Oral Abstract Session 10: Manual Therapies

OA 10.01

Combined chiropractic care and Tai Chi for chronic neck pain: A pilot pragmatic randomized trial

Peter M Wayne PhD 1,2 , Wren M Burton DC, MPH 1,2 , Matthew H Kowalski DC 1 , Cynthia R Long PhD, PStat 3 , Jacob McCarey MS, BS 3 , Daniel Litrownik BA 1,2 , Karen Kilgore PhD 1 , Jacqueline Guzman BA 1 , Kristina Twalhooven BA 1,2 , Viviane Nguyen BS 1,2 , Emma Dubinsky BA, MS 1,2 , Thomas J Hagan DC 4 , Pamela M Rist PhD 1,2 , Robert Vining DC, DHSc 3

1 Osher Center for Integrative Health, Boston, MA, United States

2 Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States

3 Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States

4 Khalsa Chiropractic, Cambridge, MA, United States

Purpose : Chronic neck pain (CNP) is a significant public health concern. While individual complementary and integrative health (CIH) therapies show promise in reducing CNP-related disability and pain, little is known about the safety and effectiveness of combined multimodal manual and mind-body CIH therapies.

Method(s) : Forty-eight individuals with CNP were enrolled in a pilot three-arm randomized, mixed-methods trial evaluating validated community-based multimodal chiropractic care (10 sessions over 16 weeks), chiropractic care combined with 16 weeks of virtual Tai Chi instruction, and enhanced usual care (EUC)—usual care plus neck pain educational materials. Primary outcomes focused on trial feasibility and descriptive summaries of four clinical measures–Neck Pain Disability Index (NDI), Bothersomeness of Pain (BOP), Pain on Movement (POM), and Pain Intensity (PI).

Results : Feasibility milestones for participant recruitment (2.8/month), retention (87.5%), data completeness (>85%), and safety monitoring were all achieved. Adherence to chiropractic care was also acceptable (>93%), but attendance in online Tai Chi classes was slightly below expectations. Administrative issues regarding recruitment, training, and monitoring the fidelity of community-based chiropractic care and Tai Chi, as well as ensuring secure data exchange between community practices and the research team, were successfully addressed. The chiropractic care and combined chiropractic care plus Tai Chi groups showed declines in NDI and BOP scores from baseline to week 16, which persisted through week 24. Declines in NDI and BOP over time were slightly less in the EUC group compared to the other two groups. All groups showed similar declines over time in POM and PI.

Conclusions : Feasibility results, along with patient-reported clinical outcomes and qualitative insights, support and guide a follow-up, multi-site, fully powered 2 x 2 factorial trial to assess the independent and combined effects of chiropractic care and Tai Chi for CNP.

OA 10.02

Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study

Dr. Robert J Trager DC 1,2,3 , Dr. Anthony N Baumann MD, DPT 4 , Dr. Collin M Labak MD 5 , Dr. Kelsey L Lewis DC 1 , Jaime A Perez PhD 6 , Dr. Christine M Goertz DC, PhD 7 , Dr. Andres Schuster MD 8

1 Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

2 Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, United States

3 Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, NC, United States

4 Department of Orthopaedic Surgery, Cleveland Clinic Akron General, Akron, OH, United States

5 Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

6 Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

7 Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States

8 Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

Purpose : Cervical artery dissection (CeAD) has been proposed as a sequela of spinal manipulative therapy (SMT), however, care-seeking for CeAD symptoms (e.g., neck pain/headache) may overestimate observed associations. Among adults experiencing new neck pain/headache, we tested the null hypothesis of no significant CeAD risk within 30 days following SMT compared to matched ibuprofen-prescribed controls.

Method(s) : We searched United States TriNetX Linked health records/claims data (2010-2025) for adults experiencing new episodes of neck pain/headache receiving (1) chiropractor-administered cervical SMT or (2) outpatient visit with ibuprofen prescription, excluding those with previous cerebrovascular disease and/or CeAD, using propensity matching to minimize confounding. We examined the risk ratio (RR) of CeAD (primary outcome), exploring cumulative incidence, CeAD subtypes, absolute risk difference (RD), and negative control outcomes.

Results : After matching, there were 431,492 patients per cohort. Comparing the SMT to ibuprofen cohort, CeAD risk was lower while RD was minimal [95% CI] (RR=0.53 [0.35, 0.83]; RD =-6.3 [-10.8, -2.0] P=0.004) events per 100,000 patients. Carotid artery dissection risk was lower; vertebral artery dissection risk was not significantly different. Data quality supported balanced confounders and minimal follow-up loss (<3%). Negative control outcomes were partially balanced.

Conclusions : This study found no increased CeAD risk after chiropractor-administered cervical SMT compared to ibuprofen prescription in adults with neck pain/headache. Despite the rarity of these events, all clinicians, including chiropractors, should maintain vigilance for CeAD symptoms. Additional multidisciplinary research is warranted to further address potential confounding and examine patient subgroups (e.g., migraine) and stroke.

OA 10.03

The association of neighborhood socioeconomic status with access to chiropractic providers: a geospatial analysis of two US geographic regions

Ryan A Fischer DC 1 , Shikhar Shrestha MS, PhD 2 , Robert J Trager DC 3,4 , Robert B Saper MD, MPH 5 , Eric J Roseen DC, PhD 1

1 Boston Medical Center, Boston, MA, United States

2 Tufts University, Boston, MA, United States

3 University Hospitals, Cleveland, OH, United States

4 Case Western Reserve University, Cleveland, OH, United States

5 Cleveland Clinic, Cleveland, OH, United States

Purpose : Chiropractic care (i.e., manual therapy, individualized exercise, and patient education) is a guideline-concordant approach for first-line management of common and disabling musculoskeletal conditions such as low back pain. However, variability in geospatial access to chiropractic care, and whether variability relates to neighborhood socioeconomic status, is understudied.

Method(s) : In this geospatial analysis, we evaluated the association between neighborhood socioeconomic status and the number of chiropractic providers in two US geographic regions. Neighborhood socioeconomic status was defined using the area deprivation index (ADI) for each neighborhood (defined as a census block group) in Suffolk County, Massachusetts and Cuyahoga County, Ohio. Higher ADI scores (range: 1-10) indicate worse socioeconomic status. Chiropractic providers in each county were identified by triangulating publicly available data (e.g., state board/licensing websites, payor directories, provider websites). Geographic information systems software was used to illustrate ADI-ranked neighborhoods and plot provider locations. We identified providers within a catchment area from the neighborhood centroid based on assumed travel distances, i.e., 0.5- and 5-miles for Suffolk and Cuyahoga counties, respectively. To evaluate the association of ADI rank with the number of chiropractic providers, we estimated incident rate ratios (IRRs) using a Poisson model adjusted for neighborhood population size.

Results : We identified 92 and 214 chiropractic providers within 628 and 1135 census block groups in Suffolk and Cuyahoga counties, respectively. A one unit increase in ADI rank was associated with a decrease in the expected count of providers in the catchment area, by 27% (IRR=0.73, 95%CI: 0.72-0.75) in Suffolk County and 4% (IRR=0.96, 95%CI: 0.96-0.97) in Cuyahoga County.

Conclusions : Geographic areas with worse neighborhood-level socioeconomic status had fewer chiropractic providers after controlling for population size. Further work is needed to evaluate and encourage equitable geographic distributions of chiropractic providers.

OA 10.04

Mediators of the Effect of Chiropractic Care on 52-week Outcomes for Active-duty US Military Members with Low Back Pain in a Pragmatic Clinical Trial: A Secondary Data Analysis

Zacariah K Shannon DC, MS, PhD 1 , Cynthia R Long PhD 1 , Robert D Vining DC, DHSc 1 , Joan Walter JD 2 , Ian Coulter PhD 3 , Christine M Goertz DC, PhD 4

1 Palmer College of Chiropractic, Davenport, Iowa, United States

2 N/A, N/A, N/A, United States

3 RAND Corporation, Santa Monica, California, United States

4 Duke University, Durham, North Carolina, United States

Purpose : The purpose of this work is to explore pain and non-pain factors as mediators of the effect of chiropractic care on 52-week outcomes in a clinical trial subsample comparing usual medical care plus chiropractic care to usual medical care alone for US active-duty military personnel with low back pain.

Method(s) : We used linear mixed effects regression models weighted by the inverse probability of missingness to predict and replace missing outcome values and generate a dataset with complete outcome data. We analyzed the complete dataset using natural effect models to evaluate change in individual mediators measured at the end of the 6-week chiropractic care intervention period as mediators of 52-week outcomes. We explored mediation of pain measures (Roland-Morris Disability Questionnaire (RMDQ) and numerical pain rating scale (NPRS), by non-pain measures (PROMIS-29: fatigue, sleep disturbance, and social role) and vice versa. Models were adjusted for confounding by trial allocation variables and baseline mediator and outcome values.

Results : One hundred forty-four participants provided outcome data after 12 weeks and were included. Participants were mostly male (79%) between 18-50 years old (mean=33). Total natural effect (TNE) difference estimates favored chiropractic care for 52-week RMDQ and non-pain outcomes, with a negligible difference in NPRS. Indirect effects through RMDQ mediated 17% and 33% of the effect on 52-week sleep disturbance (TNE= 4.89, 2.65 to 6.96) and social role (TNE= 2.29, 0.16 to 4.45). Indirect effects through non-pain factors were smaller with the largest effect occurring through social role which mediated 19% of the effect on 52-week RMDQ (TNE= 1.97, 0.31 to 3.68).

Conclusions : Change in pain-related disability and intensity were important drivers of the effect of chiropractic care on 52-week sleep disturbance and social role outcomes.

OA 10.05

Massage as a non-invasive therapy for children with irritable bowel syndrome (IBS)

Maria Mascarenhas MBBS , Alain Benitez MD, MTSR

University of Pennsylvania, Philadelphia, PA, United States

Purpose : Irritable bowel syndrome (IBS) is a disorder characterized by abdominal pain and altered defecation patterns impacting quality of life (QoL). Treatments differ depending on the subtype; therapies often do not completely relieve symptoms. Myofascial release (MFR) is a massage technique targeting the fascia. MFR applied during osteopathic manipulations have resulted in improvement of abdominal pain, distention, constipation and QoL in adults. The purpose is to share the project’s feasibility, acceptability, and effect on symptoms and QoL of abdominal wall MFR intervention in children with IBS.

Method(s) : Children meeting Rome IV criteria for IBS were enrolled and received six one-hour abdominal MFR sessions during six weeks by a certified MFR massage therapist and were educated on administering self-MFR at home using a rubber ball. Validated pediatric questionnaires, the PedsQLTM Gastrointestinal Symptoms Module and the Pediatric Quality of Life InventoryTM were administered at baseline, end of intervention, and one month post intervention. Outcomes were analyzed using Mixed Model for Repeated Measures method.

Results : Of the 16 children enrolled, 14 (median age 16 years, 50% female) completed 6 MFR sessions and questionnaires. Self-MFR practice averaged three times per week and 7 minutes per day. Total GI symptom score significantly improved at end of intervention (p=0.005) and one month post intervention (p=0.0005). QoL total scores significantly improved at end of intervention (p=0.02). Similarly, caregivers reported total GI symptom and QoL scores significantly improved at both timepoints (p<0.05). No adverse events were reported.

Conclusions : Abdominal MFR therapy is feasible and is well-tolerated in children with IBS. Preliminary results show that six weeks of MFR improves overall IBS-associated symptoms and QoL up to one month following the intervention. Randomized controlled trials will further evaluate the efficacy of abdominal MFR in IBS and variability between IBS subtypes that would support implementation as a non-invasive therapy for children with IBS.

OA 10.06LB

Mindfulness in the Orthopedic Waiting Room: Three Randomized Controlled Trials Testing Pragmatic Optimizations for Acute Pain and Anxiety Relief

Adam W. Hanley PhD , Kennedi Childs

Florida State University, Tallahassee, Florida, United States

Purpose : Orthopedic clinic waiting rooms represent a predictable yet underutilized opportunity to deliver brief, nonpharmacologic pain management. Prior work suggests that ultra-brief, audio-guided mindfulness can reduce acute pain, but uncertainty remains regarding robustness and whether pragmatic design optimizations enhance outcomes. This study evaluated the effectiveness of ultra-brief mindfulness interventions delivered during routine orthopedic waiting time and tested whether patient choice, auditory enhancements, or content reconfiguration improved reductions in pain and anxiety.

Method(s) : Three single-site randomized controlled trials were conducted in an orthopedic radiography waiting area (total N = 1,225). Adults presenting with pain completed pre- and post-intervention assessments of pain unpleasantness (primary outcome), pain intensity, and anxiety using 0–10 numeric rating scales. Study 1 (N = 283) tested patient choice versus random assignment to mindfulness or injury-management education. Study 2 (N = 296) compared mindfulness alone with mindfulness plus monaural tones, theta-range binaural beats, or binaural beats with ambient music. Study 3 (N = 646) used a dismantling design to compare four mindfulness variants differing in psychoeducation dose and attentional focus versus injury-management education. Interventions lasted 3–6 minutes and were delivered via pre-recorded audio. Outcomes were analyzed using generalized linear mixed models under an intention-to-treat framework.

Results : Across all trials, mindfulness interventions produced significantly greater reductions in pain unpleasantness, pain intensity, and anxiety than injury-management education (all ps < .01). In Study 1, mindfulness reduced pain unpleasantness by 1.12 points (18.9%), whereas education showed minimal change. Patient choice did not moderate outcomes. In Study 2, all mindfulness conditions yielded comparable symptom reductions, with no benefit from auditory enhancements. In Study 3, all mindfulness variants outperformed education, including a practice-only condition without psychoeducation.

Conclusions : Ultra-brief, audio-guided mindfulness delivered during orthopedic waiting time reliably reduces acute pain and anxiety. Core mindfulness practice appears sufficient, supporting scalable implementation in routine orthopedic care.

Oral Abstract Session 11: Integrative Health Chronic Pain Research

OA 11.01

Young Black Adults’ Chronic Pain, Integrative Medicine Use, and Intervention Preferences

Dr. De'Sha Wolf PhD, MCR

Portland State University, Portland, OR, United States

Purpose : Nearly 20% of U.S. black adults experience chronic pain, yet prevention and treatment efforts neglect 18-44 year olds who make up 39% of the population. Foundational data on young Black adults' biopsychosocial pain characteristics, management, and use of integrative medicine is severely lacking. This presentation shares preliminary results from an NCCIH K01 award examining the sensory, behavioral, and social aspects of chronic pain among young Black adults, using national and local data.

Method(s) : Quantitative data came from 3,461 Black adults ages 18-44 with EHR-documented chronic pain in the NIH All of Us dataset. We examine age-related differences in pain intensity, PROMIS self-rated health, health care utilization, pain comorbidities, and social measures. Qualitative data will come from pilot interviews with 14 Black adults living with complex chronic pain in the Pacific Northwest. Analyses examine environmental influences on pain, management strategies, access to integrative medicine, and intervention preferences.

Results : The sample was majority female, low-income, with at least some college. Preliminary analyses indicate pain ratings over the past 7 days averaged 4-5 out of 10 (worst). Headache, low-back, abdominal, and chest pain were most common. 29% reported poor/fair social satisfaction, 32% poor/fair mental health, and 41% poor/fair physical health. 41% saw a mental health professional, 6% a traditional healer, and 12% a chiropractor. Interviews reveal minimal access to pain management programs for young Black adults. Participants preferred natural over pharmacologic treatments, which they viewed as overprescribed. They also emphasized addressing mental health in pain interventions led by culturally-congruent teams.

Conclusions : These preliminary analyses provide the first national snapshot of emerging and young-to-middle age Black adults’ chronic pain experiences and integrative medicine utilization. They highlight age as a key factor in designing interventions to reduce pain and improve wellness across the lifespan for Black adults.

OA 11.02

Mindfulness-Based Stress Reduction for Rheumatoid Arthritis: Feasibility and Preliminary Results from the DREAMER-1 Pilot Trial

Sarah L Patterson MD , Wendy Hartogensis PhD, Sarah Fisher MS, Krish Rai MS, Patricia Katz PhD, Patricia Moran PhD, Frederick Hecht MD

University of California, San Francisco, San Francisco, CA, United States

Purpose : Most individuals living with rheumatoid arthritis (RA), the most common autoimmune rheumatic disease, experience persistent symptoms despite pharmacologic treatment. Mindfulness-Based Stress Reduction (MBSR) is an 8-week program that teaches mindfulness and stress resilience skills and has demonstrated psychological benefits, but its use in RA has not been rigorously evaluated. The Defining Stress REsilience And Mindfulness Effects in Rheumatoid Arthritis (DREAMER-1) pilot study aimed to adapt MBSR for individuals with RA and evaluate feasibility, acceptability, and preliminary efficacy.

Method(s) : We enrolled adults with physician-confirmed RA not in remission and without a regular mindfulness practice. During phase 1, we developed teacher training components to address RA-related challenges in MBSR courses, yielding Mindfulness-Based Stress Reduction for Rheumatic Diseases (MBSR-RD). In Phases 2–3, 38 participants were randomized to MBSR-RD or treatment-as-usual (TAU). Acceptability, adherence, and safety were measured. Select patient-reported outcomes (PROs) were assessed using PROMIS instruments at baseline and post-intervention. Exploratory efficacy analyses used linear mixed models to estimate mean net between-group differences in change in PROMIS T-scores from baseline to post-intervention.

Results : All 38 participants (100%) completed the study. Among those assigned to MBSR-RD, 83% attended ≥6 of 8 classes, 78% attended the retreat, and mean home practice averaged 46 minutes/day. All participants reported they would recommend the program; 94% rated quality as “good” or “excellent.” MBSR-RD produced significantly greater improvements in depressive symptoms versus TAU (mean –4.83 PROMIS T-score; 95% CI –8.96 to –0.70) and trends toward improvements in pain (–3.15; 95% CI [-6.92, 0.61]), fatigue (–3.61; 95% CI [-7.49, 0.27]), and sleep (–1.96; 95% CI [-4.29, 0.37]). No intervention-related adverse events occurred.

Conclusions : DREAMER-1 demonstrates that MBSR with the inclusion of components to accommodate participants with RA is feasible, acceptable, safe, and may improve important PROs. These findings support a fully powered randomized trial to evaluate efficacy and mechanisms.

OA 11.03

Psychological Factors as Mediators of the Effectiveness of Telehealth Mindfulness-Based Interventions for Pain and Pain-Related Conditions

Dr. Stephanie L. Taylor PhD 1,2 , Dr. Collin Calvert PhD 3,4 , Dr. Alexander C. Haley PhD 4 , Dr. Roni Evans PhD 4 , Dr. Jenna Adamowicz PhD 5,6 , Dr. Kelli Allen PhD 7,8 , Dr. Gert Bronfort PhD 4 , Lee Cross MPH 3 , Dr. Elizabeth Goldsmith MD 3,4 , Dr. Alexis Grant PhD 5,6 , Dr. Brent Leininger PhD 4 , Dr. Marianne Matthias PhD 9,10,11 , Dr. J. Greg Serpa PhD 2,1 , Dr. Brent Taylor PhD 12,4 , Dr. Diana Burgess PhD 3,4

1 VA, Los Angeles, CA, United States

2 UCLA, Los Angeles, CA, United States

3 VA, Minneapolis, MN, United States

4 University of Minnesota, Minneapolis, MN, United States

5 VA, New Haven, CT, United States

6 Yale, New Haven, CT, United States

7 VA, Durham, NC, United States

8 University of North Caroline, Chapel Hill, NC, United States

9 VA, Indianapolis, IN, United States

10 Indiana University, Indianapolis, IN, United States

11 Regenstrief Institute, Indianapolis, IN, United States

12 VA, Minneapolis, MH, United States

Purpose : Mindfulness meditation is an evidence-based therapy for chronic pain for which some have explored possible mechanisms of action. However, these mechanisms can vary widely depending on the mindfulness-based intervention (MBI). As such, we intended to study possible mechanisms of action of two similar MBIs for pain.

Method(s) : We used data from our Learning to Apply Mindfulness to Pain (LAMP) pragmatic randomized controlled trial comparing usual care with virtual group or self-paced MBIs. The LAMP MBIs included education on adaptive pain behaviors and mindfulness, and used shorter, less formal mindfulness practice than standard MBIs. We examined whether mindfulness, pain self-efficacy, pain catastrophizing, and stress mediated the treatment effects on two pain and seven pain-related biopsychosocial outcomes at 10-weeks and 6-months using mediation models.

Results : The MBIs improved pain catastrophizing, pain self-efficacy and mindfulness but did not affect perceived stress. Pain catastrophizing and pain self-efficacy had large mediating effects between the MBIs and pain interference, pain intensity, physical functioning, social functioning, anxiety, fatigue, sleep disturbance, depression, and post-traumatic stress disorder. Mindfulness also mediated the above relationships with smaller effects between MBIs and all outcomes except for pain interference, pain intensity, physical functioning, and social functioning.

Conclusions : This study improves our understanding of mechanisms by which MBIs can affect pain and important pain-related outcomes. Reduced pain catastrophizing and increased pain self-efficacy were apparent mechanisms of action improving pain interference, pain intensity and other biopsychosocial outcomes in our MBIs, whereas increased mindfulness was the apparent mechanism of action improving psychological and sleep-related outcomes.

OA 11.04

Are we underestimating the impact of context effects on healing? Insights from 4 trials evaluating integrative health interventions for chronic low back pain

Dan Cherkin PhD

U.W. Osher Center for Integrative Health, Seattle, WA, United States

Purpose : To optimize the healing potency of health care interventions, we should consider how we might promote both their specific and contextual effects. This would require a major reconceptualization of how we design and provide health care. This presentation explores findings of four effectiveness trials of interventions for chronic back pain to stimulate thought about the importance of both specific and contextual effects on outcomes.

Method(s) : All 4 trials included the treatment under study, a credible active comparison group and a “usual care” group. The primary outcome was percentage of participants improving by a clinically meaningful amount on the Roland-Morris Disability Questionnaire. Primary endpoints ranged from 8 to 26 weeks after initiating treatments.

Results : In all four trials, outcomes did not differ significantly between the specific treatments and active comparison groups (e.g., in the acupuncture trial, about 60% of participants improved in the needling tailored to TCM diagnosis, standardized point needling, and toothpick stimulation in standardized points groups). The percentages of participants improving in the usual care groups was similar across trials (38% to 45%). In all trials, percentages of participants improving with active interventions was about 50% greater than that for usual care.

Conclusions : These findings raise questions relevant for finding ways to improve patient care, including: • Is just providing patients with a credible intervention in an engaged and caring manner, regardless of specific treatment, an effective treatment? • Why not re-conceptualize specific non-specific effects as specific effects (e.g., listening to patient, caring)? In the emerging Whole Person Health context, we should recognize that many contextual factors can promote healing. A rational system designed to optimize patient outcomes and reduce suffering should embrace strategies for optimizing the totality of effects.

Oral Abstract Session 12: Integrative Digital Health Interventions

OA 12.01

Mindfulness Without Borders: Feasibility Insights from Two Pilot Studies of a Spanish-Language Digital Mindfulness Program for Cancer Survivors in Bogotá and Chicago

David Victorson 1,2 , Raúl Murillo 3 , Nicolás Martínez-Ramos 4 , Bruriah Horowitz 5,2 , Christina Sauer 5,2 , Judy Guitelman 6 , Elena Navas 7 , Gabrielle Osher 5 , Madeline Cetilin 5 , Dershung Yang 8 , Claudia Tellez 5

1 Northwestern University Feinberg School of Medicine, Evanston, IL, United States

2 Osher Center for Integrative Health at Northwestern University, Chicago, IL, United States

3 Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogotá, Distrito Capital, Colombia

4 Pontificia Universidad Javeriana, Bogotá, Distrito Capital, Colombia

5 Northwestern University Feinberg School of Medicine, Chicago, IL, United States

6 Alas-Wings Latina Breast Cancer Alliance, Chicago, IL, United States

7 Global Health Beat Foundation, Evanston, IL, United States

8 Bright Outcome, Buffalo Grove, IL, United States

Purpose : Spanish-speaking cancer survivors face barriers to culturally tailored support. To inform the development and implementation of our 9-week digital mindfulness program Wakeful, we conducted single-arm pilot studies in Bogotá, Colombia (n=50) and Chicago (n=40). Bogotá participants were young adult survivors who received the 9-week program, while Chicago participants were adult survivors who received the same program plus optional weekly Zoom meetups. We examined feasibility, acceptability, and engagement across sites to identify implementation facilitators and barriers.

Method(s) : Participants were Spanish-speaking cancer survivors recruited through community and clinical partners. Baseline surveys assessed sociodemographic, clinical, and psychological characteristics. Engagement metrics were automatically captured through the digital platform. Acceptability was assessed post-intervention via usability and satisfaction questionnaires. Descriptive statistics characterized both samples; t-tests and chi-square tests examined differences in baseline distress and engagement between Bogotá and Chicago cohorts, including subgroup analyses comparing Chicago participants who did and did not attend optional Zoom meetups.

Results : Both sites reported high usability (≥96%), enjoyment (82–92%), and satisfaction (92–100%). Bogotá participants had higher baseline anxiety and depression than Chicago participants. Chicago participants engaged longer (5.4 vs. 3.8 weeks), logged in more often, and completed more classes. Meetup attendees in Chicago exhibited markedly greater engagement (e.g., 8.6 vs. 2.9 classes completed; p<.001). Bogotá participants spent more total minutes on structured class content but engaged less in independent practice and social features.

Conclusions : The Spanish version of Wakeful was feasible and acceptable across two culturally and contextually distinct Spanish-speaking cancer survivor populations. Higher baseline distress did not predict greater engagement, underscoring the possible importance of synchronous social reinforcement to sustain use. Optional meetups were associated with substantially higher adherence, suggesting that hybrid asynchronous–synchronous formats may optimize engagement. Findings highlight key contextual, cultural, and structural factors to consider when scaling digital mindfulness programs in global oncology survivorship settings.

OA 12.02

Patient Experiences of Mind–Body Processes in Chronic Pain: Our Whole Lives Virtual Group Visits

Nathaniel Glassy Ph.D., ALM 1,2 , Noah Babbott-Bryan 1 , Joshua Phillips 1 , Laura Orozco Segura 1 , Dr. Paula Gardiner MD, MPH 1,2 , Niina Haas MA 3

1 Cambridge Health Alliance Center for Mindfulness and Compassion, Malden, MA, United States

2 UMass Chan Medical School, Worcester, MA, United States

3 BrightOutcomes, Buffalo Grove, Il, United States

Purpose : Chronic musculoskeletal pain reduces quality of life and functioning. Mindfulness-based group interventions can shape lived pain experiences by enhancing interoceptive awareness and emotion regulation, and introduce relational processes including universality, shared hope, and accountability for self-management. Our Whole Lives (OWL), a 24-week randomized trial of an online integrative group visit program, combines mindfulness and self-management strategies.

Method(s) : We report on the qualitative analysis of participants in the intervention arm. Virtual focus groups used a semi-structured guide, and rapid matrix analysis applied an a priori framework aligned with the interview structure. We summarized matrix cells and identified recurring experiential domains including interoception, emotion regulation, self-management, compassion, and group dynamics consistent with Yalom’s therapeutic factors of group process (i.e., universality, shared hope).

Results : Thirty-five adults with chronic musculoskeletal pain completed interviews (mean age 50 years). Most were female (69%). Self-identified race: White 74%, Black 14%, Asian 6%, multiracial 6%, Hispanic/Latine ethnicity 11%. Participants reported pain intensity remained generally stable, yet their relationship to pain and their bodies shifted. Many described increased awareness of bodily sensations, and clearer differentiation between physical pain and emotional responses, using practices including body scans, mindful eating, breathing or mindful pauses to pace activity and respond to tension. Self-management became more deliberate and compassionate; participants treated pain as a signal for care through kinder self-talk, breaks, movement, despite self-compassion being initially difficult. Group processes, including feeling less alone, mutual validation, and a safe, nonjudgmental space with the facilitator, fostered universality, hope, and accountability for mindfulness practice.

Conclusions : Digital tools like community forums, live group sessions, and tracking prompts can enhance awareness of bodily sensations and emotional cues related to pain. Clinicians should measure success beyond pain intensity, focusing on function, acceptance, and self-management. Combining mindfulness with supportive group education empowers patients to manage chronic pain and prioritize quality of life.

OA 12.03

A Whole Health Team Approach vs. Modified Cognitive Behavioral Therapy and Usual Care for Chronic Pain: Findings from the wHOPE Randomized Clinical Trial

Dr. Karen H. Seal MD, MPH 1 , Professor Benjamin J. Morasco PhD 2 , Dr. Aaron M. Martin PhD 3 , Dr. Kavitha P. Reddy MD 4 , Dr. Theresa M. Van Iseghem PhD 5 , Dr. Rendelle E. Bolton PhD, MPH 6 , Dr. Barbara G. Bokhour PhD 7 , Dr. Lauren M. Denneson PhD 8 , Dr. Denise Esserman PhD 9 , Dr. Natalie Purcell PhD, MPA 1 , Dr. Jacob T. Painter Pharm.D, MBA, PhD 10 , Dr. William C. Becker MD 9

1 University of California, San Francisco, San Francisco, CA, United States

2 Mental Health and Behavioral Sciences Service, Oregon Health & Science University, Portland, OR, United States

3 Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States

4 Washington University School of Medicine, St. Louis, MO, United States

5 St. Louis University’s School of Family & Community Medicine, St. Louis, MO, United States

6 VA Bedford Healthcare System, Bedford, MA, United States

7 University of Massachusetts Chan Medical School, Worcester, MA, United States

8 Oregon Health & Science University, Portland, OR, United States

9 Yale School of Medicine, New Haven, CT, United States

10 University of Arkansas for Medical Sciences, Little Rock, AR, United States

Purpose : Over 30% of U.S. veterans experience chronic pain, often treated with pharmacologic therapies that offer modest benefit and carry substantial risks. While evidence for a Whole Health approach is promising, no randomized clinical trials have evaluated its effectiveness. This study compared a Whole Health Team (WHT) intervention with modified Cognitive Behavioral Therapy for Chronic Pain (mCBT-CP), and both were compared to Usual Care (UC) for reducing long-term pain interference among veterans with moderate to severe chronic pain.

Method(s) : The Whole Health Options and Pain Education (wHOPE) trial was a virtually-delivered pragmatic, individually randomized clinical trial conducted at six VA health systems (Sept 2020–Jan 2025), with 12-month follow-up. Of 7,141 veterans screened, 793 enrolled, and 764 were randomized to WHT (n=343), mCBT-CP (n=339), or UC (n=82). WHT involved interdisciplinary care by a medical provider, integrative health provider, and Whole Health coach focused on personalized health planning. mCBT-CP was delivered via manualized group sessions; UC participants received standard VA pain care. The primary outcome was the Brief Pain Inventory Interference (BPI-I) score at 12 months. Secondary outcomes included pain severity, nonpharmacologic therapy use, treatment satisfaction, global impression of change, and PTSD symptoms.

Results : Among 764 participants (mean age 60.5 years; 66.5% male; 72% with high-impact chronic pain), 632 (82.7%) completed 12-month follow-up. WHT participants showed significantly greater improvement in pain interference vs. mCBT-CP (mean difference, 0.58; P=.02) and UC (0.77; P=.002). Clinically meaningful improvement (≥30% reduction in BPI-I) occurred in 41% (WHT), 31% (mCBT-CP), and 28% (UC). WHT also led to greater nonpharmacologic therapy use, higher treatment satisfaction, improved global impression of change, and reduced PTSD symptoms than mCBT-CP and/or UC.

Conclusions : WHT significantly improved pain interference and secondary outcomes compared with mCBT-CP and UC. Findings support consideration for broader implementation of coordinated, whole-person, nonpharmacologic pain care in integrated health systems.

OA 12.04

Mixed-Methods Studies to Inform Feasibility and Acceptability of Bedtime App-guided Mindfulness Meditation for Patients with Insomnia

Yan Ma 1 , Peter Wayne 1 , Janet Mullington 2 , Suzanne Bertisch 3 , Gloria Yeh 4

1 Osher Center for Integrative Health, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States

2 Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States

3 Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States

4 Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States

Purpose : Mindfulness meditation (MM) apps for sleep have become popular, while little is known about the use of MM apps specifically at bedtime, or the efficacy and mechanisms of such practice on insomnia symptom severity and pre-sleep arousal.

Method(s) : In Phase 1, we conducted a mixed-methods single-arm pilot study to explore the feasibility of 4 weeks of app-guided bedtime MM practice in 10 participants with insomnia disorder with sleep initiation difficulties. In Phase 2, we conducted focus groups (16 patients with chronic insomnia and 8 experienced instructors) to identify facilitators and barriers to app use and inform intervention refinement for a future randomized controlled trial.

Results : Phase 1 completion rates were over 90% with 95% completion of in-lab studies, 100% completion of questionnaires, 91% adhered with the intervention. Self-reported measures suggested improvement in sleep quality (Pittsburgh Sleep Quality Index change of -3.7, 95% CI: -6.7, -0.7), insomnia severity (Insomnia Severity Index change of -4.5, 95% CI: -7.7, -1.4), and pre-sleep arousal (Pre-sleep Arousal Scale change of -7.7, 95% CI: -13.1, -2.3). Qualitative data revealed benefits and skills imparted by mindfulness including: decreased catastrophizing; acceptance/non-reactivity; body awareness/relaxation; self-kindness; awareness of sleep hygiene/bedtime routine; earlier defusing of stress; increased focus and presence; and calm throughout the day. In phase 2, suggestions from experienced instructors included setting up appropriate expectations, instructions on novel content and repetitive practice, integrating sleep hygiene tips in bedtime app use and MM practice.

Conclusions : The study of bedtime app-guided MM for insomnia disorder with both in-lab and remote home sleep assessments is feasible and acceptable. In preparation for future efficacy or mechanistic studies, it is important to refine the MM app intervention and study protocol according to clinical sleep recommendations to minimize heterogeneity in implementing the practice, and to decrease risks of app use at night. Acknowledgement: Harvard Osher pilot grant, NCCIH K23AT012475.

Oral Abstract Session 13: Clinical Mind-Body Research

OA 13.01

Integrative Interventions for Chronic Multisymptom Illness in Veterans

Barbara L. Niles Ph.D. 1,2 , Craig Polizzi Ph.D. 1,2 , Chenchen Wang MD, MSc 3 , Anica Pless Kaiser Ph.D. 1,2 , Maria Ting B.S. 1 , DeAnna Mori Ph.D. 1,2 , Thomas Crow Ph.D. 1

1 VA Boston Healthcare System, Boston, MA, United States

2 Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States

3 Tufts University School of Medicine, Boston, MA, United States

Purpose : Over a quarter of Veterans who served in modern wars are estimated to suffer from Chronic Multisymptom Illness (CMI), defined as including musculoskeletal pain, fatigue, and mood-cognition problems. Although current clinical practice guidelines recommend mind-body treatments to improve management of symptoms, evidence to support these interventions was conducted primarily on female populations and may not apply to predominantly male Veterans. Accumulating studies show high patient satisfaction and promising outcomes for mind-body treatments for Veterans with a variety of disorders. However, the evidence to support these therapies for CMI remains weak, especially for Veteran and military populations, and should be bolstered.

Method(s) : Participants were 114 Veterans who served in the 1990-1991 Gulf War and met criteria for CMI, also labeled Gulf War Illness for Veterans of this era. Veterans were randomized to one of two 12-week, twice weekly group interventions: Tai Chi (n = 58) or Wellness (n = 56). Assessments were conducted at baseline, posttreatment, and 3- and 9-month follow-up.

Results : Both interventions were associated with reductions in health symptoms (Health Symptoms Inventory), pain interference (Brief Pain Inventory), and depressive and anxiety symptoms (Depression Anxiety Stress Scale) and improvements in mindfulness (Mindful Attention Awareness Scale). No differences in outcomes were detected between the Tai Chi and Wellness interventions (all p’s> .05). The positive changes in pain interference, mindfulness, quality of life, and PTSD symptoms were sustained at 9-month follow-up.

Conclusions : Integrative group interventions were associated with improvements in health outcomes among veterans with Gulf War Illness. Improvements in health symptoms are particularly noteworthy given longitudinal studies using the same scale have reported stability or worsening of symptoms over time. Many of the treatment benefits persisted at the 9-month follow-up, suggesting these interventions may have lasting impact and can slow the decline for Veterans with CMI.

OA 13.02

Economic Evaluations of Mindfulness-Based Stress Reduction for Mental and Physical Wellbeing: A Systematic Review

Dr. Rebecca L Acabchuk PhD 1 , Dr. Eric Loucks PhD 1 , Dr. Patricia Herman 2 , Dr. Simon Goldberg PhD 3 , Dr. Blair Johnson 4 , Laura Haygood 1 , Regan Gregory 1 , Nana Amma Larbi MD 1 , Dr. Shufang Sun 1 , Chen Li PhD 4

1 Brown University, Providence, RI, United States

2 RAND, Santa Monica, CA, United States

3 University of Wisconsin, Madison, Wisconsin, United States

4 University of Connecticut, Storrs, CT, United States

Purpose : Mindfulness-Based Stress Reduction (MBSR) is a group-based program with evidence for improving anxiety, stress, chronic pain, depression, and quality of life. Despite its demonstrated benefits, MBSR remains underused in healthcare. Policymakers and insurers typically request economic data to guide coverage decisions. In response, this systematic review summarizes findings on the cost-effectiveness of MBSR, examining how results vary by clinical population, type of analysis and length of follow-up. By synthesizing the most recent economic evidence and highlighting gaps, this review aims to guide coverage/reimbursement decisions and identify priority areas for expanding access to MBSR.

Method(s) : Eligible studies evaluated standard or slightly modified MBSR programs reporting at least one economic outcome. A scientific librarian searched nine databases through March 2025. Screening and data extraction were performed in duplicate using CHEERS 2022 criteria, including risk of bias and grading tools for economic quality. Data were synthesized across populations, cost categories and perspectives (payer, societal). Clinical areas were mapped to identify cost-effectiveness evidence and gaps.

Results : Eleven studies from six countries met inclusion criteria; data indicate favorable cost-related results for MBSR in nine studies. Five were randomized controlled trial-based economic evaluations, all showing cost-effectiveness; four reported cost savings from a payer/healthcare perspective (back pain, k=1; fibromyalgia, k=1; and mental health, k=2). Two Markov models predicted MBSR to be cost-effective for back pain across populations. Three studies using partial economic analyses (no health outcomes) found MBSR reduced healthcare costs for pain-related conditions (k=2) and mixed mental health (k=1).

Conclusions : This systematic review of MBSR economic evaluations finds consistent evidence of cost-savings/effectiveness and improved outcomes for chronic pain and mental health. Knowledge gaps remain for MBSR digital delivery, preventive care and other health outcomes. While quality appraisal is ongoing, preliminary findings suggest MBSR may offer a cost-effective, scalable public health strategy.

OA 13.03

Augmenting benzodiazepine receptor agonists with acupuncture and yoga

Dr. Gurjeet Birdee MD , Amanda Mixon MD, Kristin Swygert PhD, Kimberly Beiting MD

Vanderbilt University Medical Center, Nashville, TN, United States

Purpose : Benzodiazepine receptor agonists (BRZA), including benzodiazepines and z-drug hypnotics, are commonly prescribed to older adults for anxiety and insomnia despite significant risks. Integrative therapies such as acupuncture and yoga, which are evidence-based for treating insomnia and anxiety, may support BRZA deprescribing. The purpose of this study was to evaluate the feasibility, acceptability, and appropriateness of augmenting BRZA deprescribing protocols with a combination of acupuncture and yoga in older adults.

Method(s) : This single-arm clinical feasibility study enrolled adults aged ≥65 years who used BRZA at least four times in the last month. Participants underwent a 12-week intervention combining weekly sessions of acupuncture, yoga, and BRZA deprescribing with a psychiatric nurse practitioner. Feasibility outcomes included enrollment, treatment adherence, and acceptability ratings. BRZA use, insomnia (PROMIS Sleep Disturbance), and anxiety (PROMIS Anxiety) were assessed at baseline, 4, 8, and 12 weeks.

Results : Of 487 patients screened, 23 participants enrolled, with 14 completing the study (60% female, median age 70 years). Participants attended a median of 11.5 yoga sessions, 12 acupuncture sessions, and 11 psychiatric nurse practitioner sessions, with a median of 5.6 days/week of home yoga practice. Participants rated the intervention highly on acceptability (median score = 20/20), appropriateness (median score = 15/15), and feasibility (median score = 20/20). Among regular BRZA users (n=10), the mean reduction in BRZA dose at 12 weeks was −3.27 mg diazepam equivalents (SD 6.23), with 20% achieving full discontinuation. Insomnia and anxiety scores improved slightly. Participants who completed the intervention demonstrated high engagement with integrative therapies.

Conclusions : Augmenting BRZA deprescribing protocols with acupuncture and yoga is feasible, acceptable, and appropriate for older adults. This combined intervention may support BRZA dose reduction and discontinuation while addressing withdrawal symptoms and promoting self-regulation. Future randomized controlled trials are warranted to evaluate long-term outcomes and comparative efficacy.

OA 13.04

ASMR Media as a Biopsychosocial Health and Wellbeing Tool

Marcus Washington M.A. Industrial/Organizational Psychology , Dr. Catherine Daus Doctorates in Industrial/Organizational Psychology

Southern Illinois University Edwardsville, Edwardsville, Illinois, United States

Purpose : ASMR media contains specific sounds and visuals that produce Autonomous Sensory Meridian Response (ASMR), a sensory phenomenon characterized by tingling sensations and feelings of relaxation, with multiple studies reporting biopsychosocial outcomes. The current study aimed to explore 1) ASMR’s biopsychosocial responses, 2) differences between ASMR “experiencers” (AEs) and “non-experiencers” (non-AEs), 3) the impact of education on ASMR outcomes, 4) the utility of ASMR media as a health and wellbeing tool, and 5) the need for a more rigorous understanding of the ASMR experience.

Method(s) : Sixty-one participants were recruited from a Midwestern university and assigned to one of four 2x2 mixed ANOVA conditions. First, participants were randomly assigned to an education group (education vs. no education) and then to an experience group based on their physical sensations (AE vs. non-AE).

Results : Wilcoxon signed-rank tests were used for within-subject comparisons, Mann-Whitney U tests for main effects, and Kruskal-Wallis H tests for interaction effects. Analyses revealed that ASMR stimulation produced tingling sensations, non-tingling sensations (waves, vibration, spreading sensations), pain reduction (rrb = 1.00 for all groups), relaxation (rrb ranged from .97 to 1.00 across groups), and stress reduction (rrb ranged from .97 to 1.00 across groups). Furthermore, ASMR-induced wellbeing was the same for all groups, regardless of experience (rrb ranged from .008 to .226 across outcomes) or education (rrb ranged from .035 to .185 across outcomes).

Conclusions : The results of this study support the use of ASMR media as an accessible, cheap, and effective health and wellbeing tool. The ASMR-Misophonia Synesthesia Spectrum (AMSS) was developed to provide an empirical and theoretical definition of the ASMR experience, while the revised ASMR Experiencer Questionnaire (R-AEQ) was developed to allow researchers to categorize participants within the AMSS.

Oral Abstract Session 14: Nature Therapy

OA 14.01

ROOT: A Nature-Based Intervention for Perinatal Biopsychosocial Recovery

Dr. Charlotte V. Farewell PhD , Dr. Jenn Leiferman PhD

University of Colorado - Anschutz Medical Campus, Aurora, CO, United States

Purpose : Perinatal women (e.g., pregnant through 12-months postpartum) experiencing adverse social determinants of health face exacerbated stress-related health outcomes, yet few interventions address their biopsychosocial recovery in accessible, non-pharmacological ways. Nature-Based therapeutic Interventions have demonstrated efficacy among non-pregnant adults in promoting biological, psychological and social processes leading to enhanced well-being, particularly among underserved populations. The Restorative Outdoor Opportunities for Thriving (ROOT) intervention was developed to buffer anxiety and foster holistic well-being in perinatal women experiencing socioeconomic disadvantage.

Method(s) : ROOT is a six-session nature-based therapeutic intervention that was co-developed using Community-Based Participatory Research methods. Phase 1 of this project consisted of a comprehensive literature review and theory identification. Phase 2 included longitudinal mixed-methods data collection (n=223) from perinatal women experiencing socioeconomic disadvantage at 4 timepoints across the perinatal period. Phase 3 consisted of an iterative curriculum development and refinement process with an interdisciplinary community advisory board and pilot testing intervention strategies.

Results : Phase 2 baseline findings revealed associations between nature exposure, enhanced psychological needs fulfillment (autonomy, competence, relatedness) and informed the importance of prevention strategies that promote biological (e.g., sleep), psychological (e.g., mindfulness) and social (e.g., peer support) resources to foster perinatal well-being. ROOT integrates didactic content and experiential practices, based in relational forest therapy and mind-body strategies, to target these resources through six group-based sessions facilitated by community-based doulas and delivered across the perinatal period. Pilot testing is in progress and findings will begin to inform biopsychosocial mechanisms of the ROOT intervention.

Conclusions : The development of ROOT represents a novel and timely contribution to perinatal mental health research and practice. ROOT addresses a critical gap in perinatal care by offering a nature-based, non-pharmacological intervention that incorporates a focus on basic needs tailored to underserved and high-risk women. This work is especially relevant given the growing recognition of the role that environmental exposures play in shaping stress physiology, mental health, and recovery across the perinatal period.

OA 14.02

Advancing Equity in Nature RX through Expert Insights on Inclusive and Accessible Nature Prescriptions:A Qualitative Interview Study

Alexandra Haney 1 , Varsha Ganesh 1 , Timothy Chen 1 , Bruriah Horowitz 1 , Christina Sauer 1 , David Victorson 2

1 Feinberg School of Medicine, Chicago, IL, United States

2 Feinberg School of Medicine, Evanston, IL, United States

Purpose : Growing public health research supports the positive relationship between nature contact and improvements in human health. While nature prescriptions (Nature RX) have been shown to increase meaningful nature experiences, not all populations have equitable access to safe, high-quality natural spaces. This study aimed to identify key strategies and considerations for making nature prescription consultations more inclusive and accessible for traditionally marginalized or underrepresented populations by learning from experienced nature prescribers.

Method(s) : Experienced nature RX providers participated in a 45-minute recorded Zoom interview about strategies to enhance inclusivity and accessibility in nature prescription consultations. Transcripts were analyzed using a Grounded Theory approach (open, axial, and selective coding) to develop higher order categories and themes. Dedoose software was used.

Results : Interviews with 15 experts generated 39 unique codes. Axial and selective coding resulted in 15 categories and five overarching themes: “Accessibility and Infrastructure Barriers” focused on environmental and transportation constraints; “Safety and Risks” addressed nature settings and privacy; “Historical Stigmas and Anxieties” related to exclusion and representation; “Personal Preferences and Identities” centered on personalized goals and community support; and “Combatting Location-Based Constraints” focused on ways to feasibly access nature in an urban environment. Themes underscored the need to address safety concerns tied to racial and ethnic identity, acknowledge historical exclusion from nature, ensure culturally relevant prescription approaches, and foster community-based trust. Experts also emphasized equitable technological access and clear communication as key to effective engagement.

Conclusions : Findings underscore that inclusivity in nature prescription consultations requires more than access - it calls for cultural humility, contextual awareness, and recognition of systemic inequities shaping people’s relationships with nature. Incorporating diverse representation, personalized goals, and community-centered delivery models can strengthen trust and relevance. Future Nature RX initiatives should integrate equitable design, practitioner training, and policy support to ensure that all individuals can safely and meaningfully connect with nature.

OA 14.03

Nature Rx: A novel program prescribing nature in local parks to patients in an urban healthcare setting

Aaditya Pallerla BS 1,2 , Ria Jindal BS 1,2 , Marcus Grewal BS 1,2 , Sanjana Katiyar 1,2 , Harini Pallerla MS 1,2 , Dr. Sian Cotton PhD 1,2 , Dr. Barbara Walker PhD 2,3

1 University of Cincinnati Department of Family and Community Medicine, Cincinnati, OH, United States

2 University of Cincinnati Osher Center for Integrative Health, Cincinnati, OH, United States

3 University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, OH, United States

Purpose : With rising urbanization limiting green spaces, nature-based interventions offer healthcare systems ways to support wellbeing. In response, the University of Cincinnati Osher Center for Integrative Health (OCIH), in partnership with the Cincinnati Parks Foundation, developed a Nature Rx program. The first step to incorporating nature prescriptions was establishing an order entry process into the electronic health record. The order was designed both to track recipients and enable program staff to provide resources to patients. The program encourages nature-based activities. This pilot study describes an evaluation of referred patients to identify areas for improvement.

Method(s) : An initial descriptive study was conducted to assess the demographics of patients referred to the Nature Rx program. Using the EPIC electronic health record system, a chart review was completed for current OCIH patients who received a nature prescription since January 2025. Collected data included age, gender, ZIP code, referring provider, race, and both primary and secondary clinical diagnoses. Data was analyzed using RStudio and the ggplot2 package.

Results : 83 patients were prescribed Nature Rx in 2025. The mean age was 56 and 82% female. 73% of patients were Caucasian and 14% were African American. 83% of the patients were referred from two providers. The patients represent 48 zip codes across the Cincinnati area. 25% of patients came from four zip codes comprising high-income suburbs. There were forty primary diagnoses, the most common being hypertension, anxiety, and low back pain.

Conclusions : This pilot study demonstrated feasibility of getting Nature Rx into the electronic health record. Over 80% of all referrals came from just two providers, so there is a need to increase program awareness among providers. The results also show that a majority of these patients were Caucasian females. Future efforts should focus on expanding referrals to additional populations, especially those in more urban areas.

OA 14.04

Impact of a Novel Forest Immersion Experience on the Well-Being of Individuals in an Urban Academic Setting

Ria Jindal BS 1,2 , Sanjana Katiyar 2 , Harini Pallerla MS 2 , Dr. Sian Cotton PhD 1,2 , Dr. Barbara Walker PhD 2

1 University of Cincinnati College of Medicine, Cincinnati, OH, United States

2 University of Cincinnati Osher Center for Integrative Health, Cincinnati, OH, United States

Purpose : Shinrin-Yoku, the Japanese practice of entering a forest and mindfully breathing its air, has been associated with mental and physiological benefits, including reduced cortisol levels, improved mood, and enhanced parasympathetic activity. The purpose of this study was to evaluate overall well-being through a forest immersion experience for higher education faculty and students.

Method(s) : Six forest immersion sessions were conducted by certified guides in local forests near an urban campus that were approximately two hours in length. All participants completed a post-session evaluation. A subset of 23 participants completed pre- and post-intervention assessments, including the Positive and Negative Affect Schedule, the Maslach Burnout Inventory, and open-ended survey items. Participants who completed the pre- and post-intervention assessment also received a 6-month follow-up survey. Data was analyzed using SPSS.

Results : 61 participants engaged in the program (77% female; 30% aged 20–29). Post-session surveys showed that 98% of participants felt calmer, 63% reported increased connection to self and nature, and 29% felt more energized. 95% found forest immersion beneficial, and 94% would participate again. In the subset with pre- and post-data (n=23), participants showed a significant increase in positive affect (p=0.022) and decrease in negative affect (p<0.001); burnout levels and social connection did not change significantly. In the 6-month follow-up, all 14 responses showed a significant decrease in negative affect from pre to post [NA pre = 18.97, NA post = 10.7] and pre to follow-up [NA pre = 18.97, NA follow-up = 13.7] (p<0.005). Participants recorded engaging in a great to moderate amount in the outdoors since the initial program, and 100% were interested in future forest immersion experiences.

Conclusions : This urban academic pilot study illustrates how forest immersion can improve short-term mood, energy, and connection in students and faculty. Future directions include expanding the sample size and offering a forest immersion series.

Oral Abstract Session 15: Integrative Group Medical Visits

OA 15.01

Introducing an Innovative Approach to Chronic Pain Using Pain Reprocessing Therapy and Whole Health in a Group Medical Visit Format: A Mixed-Methods Pilot Study

Jonathan Takahashi MD, MPH , Linda S. Park PhD, MSSW

University of Wisconsin, Madison, WI, United States

Purpose : Pain Reprocessing Therapy (PRT) is an evidence-based, mind-body approach to treating chronic pain based on the current neuroscience of predictive processing and neuroplasticity. Integrating neuroscience education, psychology, and mindfulness, PRT has demonstrated effectiveness as an individual therapy. This mixed-methods pilot study explored a novel group medical visit (GMV) format for introducing patients to PRT together with a Whole Health approach to supporting “what matters most” in patients’ lives.

Method(s) : The Healing Chronic Pain GMV consisted of six, once-weekly, 2-hour sessions with a physician and health coach. The curriculum included didactic and experiential learning, writing/reflection, discussion, and guided practice, supported by a printed manual and website with links to home practice resources. Nine, eight and seven patients completed the pre-post survey at 6-week, 3-month, and 6-month follow-up time points, respectively (Roland-Morris Disability Questionnaire, Pain Anxiety Symptom Scale Short Form-20, and PROMIS-29). Semi-structured interviews with five patients were transcribed and analyzed using thematic analysis.

Results : Qualitative analysis revealed multiple effects and an evolution in patients’ perspectives and attitudes during the GMV. Four themes emerged: (1) Remembering life with chronic pain prior to the GMV, characterized by lack of agency and isolation; (2) Cognitive reappraisal of pain symptoms, including understanding neuroplastic pain and letting go of catastrophic thinking about pain; (3) Empowerment, feeling greater agency and hope; and (4) Feeling less alone, through validation and emotional support. Pre-post RMDQ, PASS-20, and PROMIS-29 Pain Interference and Pain Intensity measures showed statistically significant improvements at 3-month follow-up.

Conclusions : This mixed-methods study showed that an innovative GMV introducing patients to PRT and Whole Health was feasible and impactful. Participants felt more connected and supported, gained a new understanding of pain and neuroplasticity, and experienced a greater sense of empowerment and hope. This pilot study can help inform program development and research on innovative and effective treatment for chronic pain.

OA 15.02

Optimizing Scalability and Operational Efficiency for Group Medical Visits: The UCSF Experience

Gabriela Gutierrez, Dr. Maria Chao PhD, Christine Pollak, Deborah Caldwell MPH, Louise Lo, Dr. Chloe Atreya MD, PhD, Professor Kavita K. Mishra MD, MPH

UCSF, San Francisco, CA, United States

Purpose : Group medical visits (GMVs) provide scalable, patient-centered integrative oncology care but face operational challenges. This project aimed to assess and improve workflows for GMVs at the UCSF Osher Center for Integrative Health and Helen Diller Comprehensive Cancer Center, focusing on patient access, staff and clinician support, and documentation standardization, to optimize efficiency and scalability across diverse therapeutic foci and patient populations.

Method(s) : From August 2024 to March 2025, a comprehensive three-phase operational review of GMVs was conducted, including: (1) data collection through ethnographic observation, interviews with clinicians and staff, and time utilization analysis; (2) operational needs assessment categorized by impact and feasibility; and (3) implementation of select workflow improvements targeting patient, clinician and staff experience, as well as sustainability in the health system.

Results : Systematic analysis of 13 GMV series (1,297 visits annually), averaging 4.6 sessions per series (range 1-8), identified key areas for improvement. Time studies showed administrative staff spent an average of 6.2 hours (range: 2-15) managing each GMV series. Optimization opportunities critical for scalable operations, included improvements in: (a) recruitment, (b) triaging, scheduling, and billing, (c) onboarding and consent automation, (d) intra- and inter-session workflows, telehealth support, and content adaptation, (e) follow-up, and (f) research implementation.

Conclusions : System-wide improvements enhanced patient access, staff workflows, and documentation for GMVs, reducing inconsistencies and enabling research integration. EHR automation, particularly for consent, and collaboration with multiple institutional teams, i.e., EHR, IT, and compliance, emerged as high-impact interventions. These were critical but resource-intensive, underscoring the need for sufficient time and staffing allocation. Future efforts will focus on integrating AI tools to streamline telehealth GMV transcription workload and advancing operational research to support scalability of GMV programming.

OA 15.03

Integrative Group Medical Visits for Long COVID: An Innovative, Accessible Model for Complex Patient Care

Carla Kuon MD 1,2 , Sandra Oreper MPh 1 , Gabriela Gutierrez MS4 1 , Maria Chao DrPh, MPA 3,2

1 University of California, San Francisco, CA, United States

2 Osher Center For Integrative Health, San Francisco, CA, United States

3 Zuckerberg San Francisco General, San Francisco, CA, United States

Purpose : This study evaluated the feasibility and impact of a Group Medical Visit (GMV) model for Long COVID care at UCSF’s OPTIMAL-IH clinic between June 2023 and August 2025.

Method(s) : 196 patients participated in 20 GMV cohorts, with a median of 9.8 attendees per cohort. Intake assessments, PROMIS-29 surveys, laboratory tests, and satisfaction surveys were collected across three GMV sessions.

Results : The majority were female (63.3%), White (74%), with an average age of 52.76 years. Less than half had private medical insurance (47.9%). Patients completed intake assessments, PROMIS-29 surveys, lab tests, and satisfaction surveys across three GMV sessions. The PROMIS-29 V2.0 survey assessed symptom severity across physical and mental health domains, highlighting high levels of fatigue, reduced physical function, and sleep disturbances, which significantly impacted quality of life. Qualitative feedback underscored the value of GMVs, with themes including gratitude for knowledge gained, feeling cared for, appreciation for personalized lab-based recommendations, renewed hope, empowerment, and reduced isolation. Patient satisfaction ratings were high, with instructor evaluation averaging 4.9/5 and overall series ratings at 4.8/5.

Conclusions : The GMV model proved to be a sustainable, accessible, and affordable approach to Long COVID care, as visits were billable to insurance. Minimal attrition was observed, and the model demonstrated its potential to improve access to whole-person care for a complex patient population. Limitations included subjective survey data and challenges in data collection due to brain fog and fatigue among participants. Despite these limitations, this study is the first to combine objective and subjective data on Long COVID in a GMV setting, making it a replicable and resource-efficient model for outpatient clinical care. Findings emphasize the importance of addressing physical, mental, and social aspects of Long COVID through innovative care models.

OA 15.04

The Impact of Integrative Group Medical Visits on Dietary Behaviors in Adults with Chronic Pain and Depression: A Secondary Analysis of a Randomized Controlled Trial

Dr. Sarah J Park ND, MPH 1 , Malik Tiedt BS 2 , Alexandra Wuopio 3 , Dr. Paula Gardiner MD, MPH 4,5

1 Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States

2 Columbia University, New York, New York, United States

3 Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States

4 Cambridge Health Alliance, Cambridge, MA, United States

5 University of Massachusetts Chan Medical School, Worcester, MA, United States

Purpose : Chronic pain and depression frequently co-occur and may be associated with pro-inflammatory dietary patterns. However, interventions to promote dietary behavior change in this population are understudied.

Method(s) : We conducted a secondary analysis of a randomized controlled trial to examine the effects of an Integrative Group Medical Visit (IGMV) program on dietary behaviors in adults with chronic pain and depression, compared to a standard primary care visit. We estimated multivariable odds ratios (ORs) and 95% confidence intervals (CIs) of increasing the proportion of participants who frequently read Nutrition Facts labels and met the Recommended Dietary Allowance (RDA) for fruit and vegetable intake between baseline to week 9 and week 21. Secondary outcomes included intake of individual food groups and use of dietary supplements.

Results : Among the 155 participants, the mean age was 50.5 years, and the majority of participants were female (86%), Black (56%), earned less than $30,000 annually (63%), and participated in food assistance programs such as SNAP and/or WIC (67%). At baseline, 49% of participants reported frequently reading Nutrition Facts labels, and 32% met the RDA for fruit and vegetable intake. IGMV increased the odds of frequently reading Nutrition Facts labels by 483% (95% CI: 2.11, 16.09) and of meeting the RDA for fruit and vegetable intake by 239% (95% CI: 1.48; 7.77) at week 9. Significant increases were also observed for intake of fruits, vegetables, whole grains, and cinnamon, while the frequency of consuming fast food was reduced (all P<0.05).

Conclusions : These findings suggest that IGMV program participation may lead to modest dietary improvements among adults with chronic pain and depression.

Oral Abstract Session 16: Clinical Acupuncture

OA 16.01

Assessing Feasibility and Acceptability of Acupuncture for Long COVID-Related Pain

Dr. Nikki Gentile MD, PhD 1 , Dr. Dan Cherkin PhD 1,2 , Rachel Geyer MPH 1 , Aiko Bailey LAc 1 , Wu-Hsun Tom Yang ND, LAc 1 , Andrew Humbert PhD 3 , Iman Majd MD, MSA, LAc 2

1 Department of Family Medicine, University of Washington, Seattle, WA, United States

2 UW Medicine Osher Center for Integrative Medicine, Seattle, WA, United States

3 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States

Purpose : Acupuncture is effective for chronic pain conditions but has not been studied for Long COVID pain. This study evaluated the feasibility and accessibility of conducting a randomized trial comparing acupuncture with usual care to reduce pain in patients with Long COVID.

Method(s) : We conducted a pragmatic, randomized feasibility trial with the UW Long COVID Clinic. Adults with chronic pain attributed to Long COVID were randomized to usual care or to 8 acupuncture treatments. Prespecified feasibility outcomes included: timely Wrecruitment (≥60 participants within 5 months), treatment retention (≥75% completing ≥6/8 visits), questionnaire completion (≥70% at all timepoints; ≥75% at final), intervention fidelity (≥80% adherence), and participant adherence to recommendations (≥50% retaining press needles ≥3 days). Patient reported outcomes, collected at baseline, 4, 8, and 20 weeks, included Pain, Enjoyment, and General Activity (PEG) scale, PROMIS-29, PROMIS-Cognitive Function, Patient Reported Self-Efficacy, and Pain Catastrophizing Scale.

Results : 93 participants enrolled in <3 months; 46 randomized to acupuncture and 47 to usual care. Recruitment, retention, questionnaire completion, and fidelity exceeded targets (e.g., 83% completed ≥6/8 visits; fidelity 95%). Completion rates exceeded 80% at all time points. Participants had moderate pain severity, were primarily female (65%), white (71%), and covered by private insurance (58%). Musculoskeletal pain (87%) and headache (70%) were most common. Mean baseline to 8-week reduction in PEG was 0.8 (SD = 1.4) for usual care and 2.1 (SD = 2.0) for the acupuncture group, corresponding to a standardized effect size of 0.77. Participants described high acceptability, citing the relaxing environment and provider empathy.

Conclusions : This feasibility study confirmed acupuncture is feasible and acceptable treatment for Long COVID pain. A multisite trial to evaluate scalability is planned.

OA 16.02

Effectiveness of Short-Duration Acupuncture Sessions on Quality of Life During Infusion Therapy at an Academic Cancer Center

Dr. Jacob D. Hill ND, MS, FABNO , Dr. Jasmin Hundal MD, Dr. Caitlin Rader DO, Ning Guo MS, Dr. Laura Shoemaker DO, Dr. Thuy Nguyen DAOM, LAc, Dr. Robert Saper MD, MPH

Cleveland Clinic, Cleveland, Ohio, United States

Purpose : Acupuncture is an evidence-based integrative oncology intervention increasingly adopted by cancer patients and oncology providers for managing cancer-related side effects. Existing research predominantly examines 30–60-minute sessions administered weekly or biweekly over 6–12 weeks. Evidence regarding short-duration sessions and the cumulative effects of repeated brief treatments remains limited. Our team investigated the preliminary effectiveness of brief acupuncture sessions delivered concurrently with infusion therapy.

Method(s) : We conducted a quality assessment/quality improvement project examining acupuncture for adults receiving infusion therapy at an academic cancer center. Patients received brief (20-minute) acupuncture sessions during infusion to address symptoms and improve quality of life. The Edmonton Symptom Assessment Survey (ESAS) was administered pre- and post-treatment. We analyzed pre/post changes in ESAS scores, compared outcomes across treatment frequencies (1, 2, or 3+ sessions), determined the probability of achieving a minimal clinically important difference (MCID, ≥1 point change), identified response predictors, and explored symptom score changes across subgroups (e.g., gender, cancer type).

Results : Among 139 patients receiving acupuncture, 64.8% were female (n=90) and 84.2% White (n=117). Significant pre/post improvements (p<0.05) were observed in anxiety, depression, drowsiness, appetite loss, nausea, pain, dyspnea, fatigue, and wellbeing. Patients receiving only 1 session of acupuncture presented with significantly worse baseline symptoms across most ESAS domains compared to those receiving 2 or 3+ sessions. The probability of achieving MCID decreased significantly with multiple treatments. Increasing age positively predicted treatment response for appetite loss, and response patterns for tiredness and drowsiness differed significantly among patients with hematological malignancies, solid tumors, and benign hematological conditions.

Conclusions : Brief acupuncture sessions administered during infusion therapy yielded significant improvements across multiple cancer-related symptoms. Observed patterns of reduced baseline symptom severity and decreased probability of achieving MCID among patients receiving multiple treatments may indicate cumulative therapeutic benefit.

OA 16.03

Integrating Acupuncture into Acute Pain Care in the Emergency Department: An Implementation Science Approach Using the AIHI Framework

Professor Zhen Zheng PhD 1 , Dr Heng Cheok MBBS, FACEM 2 , Ms Letty Bastian MNSc 2 , Mr Tom Collins MPhysio 2 , Prof Tony Zhang PhD 1

1 RMIT University, Bundoora, Victoria, Australia

2 Northern Health, Epping, Victoria, Australia

Purpose : Pain accounts for one in two presentations to the emergency department (ED), and opioids are used to treat more than 60% of these cases despite their side effects and risk of dependence. Acupuncture is a safe, effective, non-pharmacological analgesic option, but has not been systematically integrated into ED workflows. The Personalised Acupuncture in Northern Hospital Emergency Department for Acute Pain (PANDA) project applies an implementation science approach to bridge this gap, aiming to develop an integrative, interprofessional model of acute pain care.

Method(s) : The Acupuncture in Hospital Implementation (AIHI) framework, adapted from the EPIS (Exploration, Preparation, Implementation, Sustainment) and CFIR (Consolidated Framework for Implementation Research), guides a four-stage, iterative process. The AIHI framework enables systematic identification of contextual determinants, co-design of strategies with clinicians and experts, and evaluation of real-world implementation outcomes to inform scale-up.

Results : Stage 1 (Exploration) includes surveys and audits that identified key barriers, including limited patient and staff knowledge, unclear referral pathways, and restricted ED space. Stage 2 (Preparation) involves co-designing an acupuncture-in-ED protocol with international experts and frontline staff, developing tailored education and workflow strategies and identifying champions and opinion leaders. Stage 3 (Implementation) has two part-time registered acupuncturists embedded in the ED five days per week. Implementation strategies include feedback loops, audit dashboards, and regular evaluation of implementation, clinical and system outcomes (% of patients referred for and receiving acupuncture, pain intensity, function, anxiety, analgesic use, length of stay). Stage 4 (Sustainment) focuses on cost-effectiveness and value-based healthcare analyses to inform future integration and policy translation.

Conclusions : Guided by the AIHI framework, PANDA is expected to demonstrate the real-world integration of acupuncture into acute pain care in the Emergency Department through a systematic implementation science approach. This approach will provide a replicable pathway for integrative and interprofessional models that advance translational research and transform pain management in emergency settings.

OA 16.04

Effect of K-Style Contact Needle Technique on Cancer-Related Fatigue in Palliative Care Patients: A Randomized Controlled Trial

Keiko Ogawa-Ochiai MD, PhD 1 , Nozomu Murakami 2 , Yumi Ikejiri 3 , Yasuhiko Tatsuzawa 4 , Masahide Kaji 5 , Takumi Taniguchi 6 , Keisuke Yamada 6 , Hirofumi Hirana 7 , Masao Ogawa 8 , Yutaka Tatsuno 9 , Hongyang Li 1 , Keita Mori 10 , Hideki Ishikawa 11

1 Hiroshima University, Hiroshima, Hiroshima, Japan

2 Kouseiren Takaoka Hospital, Takaoka, Toyama, Japan

3 Shimura Hospital, Hiroshima, Hiroshima, Japan

4 Shimura Hospital, Kanazawa, Ishikawa, Japan

5 Toyama Prefectural Central Hospital, Toyama, Toyama, Japan

6 Kanazawa University, Kanazawa, Ishikawa, Japan

7 Shinseikai Toyama Hospital, Imizu, Toyama, Japan

8 NHO Kanazawa Medical Center, Kanazawa, Ishikawa, Japan

9 Independent School for Integrative Medical Specialist, Kanazawa, Ishikawa, Japan

10 Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan

11 Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan

Purpose : Cancer-related fatigue (CRF) is a prevalent and debilitating symptom in palliative care, for which effective treatments remail limited. This study evaluated the effectiveness and safety of the Contact Needle Technique (CNT)—a non-invasive form of traditional Japanese acupuncture—for reducing CRF.

Method(s) : In this multicenter, single-blind, randomized controlled trial, 119 patients with advanced (stage III or IV) cancer and moderate-to-severe fatigue (score ≥ 4 on a Numerical Rating Scale [NRS]) were randomized to receive either CNT or sham CNT weekly for four weeks. The primary outcome was the change in fatigue NRS scores. Secondary outcomes included the Cancer Fatigue Scale (CFS), Support Team Assessment Schedule-Japanese version (STAS-J), Palliative Prognostic Index (PPI), Palliative Performance Scale (PPS), salivary amylase activity (SAA), and adverse events.

Results : Although no significant intergroup difference was observed in the primary outcome via t-test, a multiple regression analysis at week 4 revealed a significant treatment effect for CNT (β = 1.548, p = 0.029). CNT also significantly improved STAS-J scores (β = 1.758, p = 0.044) and reduced SAA levels at week 2 and the final evaluation (p < 0.05). No serious adverse events were observed.

Conclusions : CNT may represent a safe, gentle, and potentially effective intervention for fatigue and related distress in advance cancer patients receiving palliative care. Further research is needed to confirm these findings and evaluate the long-term outcomes.

Oral Abstract Session 17: Leveraging Tech for Health

OA 17.01

Effects of Virtual Reality on Pain and Anxiety in Patients Undergoing Bone Marrow Biopsy

Shiran Konganige, Savannah Mohacsi, Shigang Xiong, Jonathan Pai, Genevieve Nelson, Zehui He, Denice Tsa-Wei, George Yaghmour, Hannah Wolfson, Jacek K Pinski

USC/Norris Comprehensive Cancer Center, Los Angeles, CA, United States

Purpose : Bone marrow biopsy (BMB) is a commonly performed invasive procedure in which pain and anxiety remain significant despite local anesthesia. Anticipatory anxiety is associated with greater pain, and pharmacologic sedation may prolong recovery and cause adverse effects. Virtual reality (VR) offers a potential non-pharmacologic, distraction-based adjunct, though evidence for its effectiveness remains mixed. This study evaluated the feasibility, tolerability, and preliminary effectiveness of a commercially available immersive VR device during BMB.

Method(s) : Participants in the experimental arm used a Meta Quest 3 headset displaying standardized natural landscape content with ambient audio, allowing communication and procedural awareness. Pain was measured using the Visual Analogue Scale (VAS) pre-procedure, during aspirate collection, and post-procedure. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI), and physiologic stress response was measured via serum cortisol levels pre- and post-procedure. Feasibility was defined as successful initiation and uninterrupted use of VR throughout the procedure, including comfort and proper headset fit.

Results : Thirty patients were analyzed (17 VR, 13 control). Feasibility was achieved in 94% of VR participants; one discontinued due to sinusitis-related discomfort. No adverse effects or workflow disruptions occurred. Median peri-procedural and post-procedural pain scores were lower in the VR group (5.5 and 1) than controls (7 and 2), though differences were not statistically significant (p=0.32, p=0.77). Median post-procedural state anxiety was lower with VR (28 vs 35.5; p=0.16). Cortisol levels decreased significantly in the VR group (−31.8 ng/L; p=0.04) but not in controls.

Conclusions : VR was safe, feasible, and well tolerated, with favorable trends toward reduced pain, anxiety, and physiologic stress. These findings support further evaluation in larger studies and suggest screening for sinus-related symptoms may enhance feasibility.

OA 17.02

Mindful Self Compassion Training for Palliative Care Providers Using a Virtual Reality Platform

Dr Paula Gardiner MD MPH

Cambridge Health Alliance, Malden, MA, United States

Purpose : Rates of workplace burnout in healthcare continue to rise, compromising wellbeing and the delivery of quality patient care. Healthcare professionals face stigma and the individualized burden of seeking help, contributing to poor coping strategies and turnover. A large hospice in the northeast United States underwent an educational intervention the usability of a novel virtual immersive platform (Chiron) to deliver a guided Mindful Self-Compassion curriculum (MSC) to a decentralized workforce.

Method(s) : Hospice clinicians participated in this single-arm, mixed methods pilot study. They were onboarded to the platform at their workplace and then scheduled to attend 5, 90-minute mindful self compassion sessions remotely. The primary outcome was platform usability, assessed using the System Usability Scale. Secondary outcomes included compassion satisfaction, burnout, and secondary traumatic stress, assessed by the Professional Quality of Life (ProQOL) scale. We conducted semi-structured participant interviews. We used descriptive statistics and an inductive approach to thematically analyze data.

Results : Participants (n=27) were largely female, White and non-Hispanic. The majority (74%) were registered nurses or social workers with 5+ years of experience in hospice. Mean usability scores improved from 64.22 (s.d 18.23) at baseline, considered marginal, to an acceptable 70.12 (s.d 19.10) at follow-up. We observed promising yet non-significant trends in mean ProQOL subscale scores with minor decreases in burnout (49.2 to 48.4) and secondary trauma (50.4 to 45.7). Qualitatively, participants appreciated Chiron’s interactive features and landscape, which felt well-suited to learning and applying MSC skills at work and inspired meaningful dialogue and connection with colleagues.

Conclusions : It is feasible to deliver a self compassion curriculum to health care providers using a virtual platform. Future directions include evaluating the effectiveness of Chiron compared to other organizational, team-based tools, methods of delivery of MSC training, and impact on retention and turnover.

OA 17.03

Nasal Navigation Without Sedation: Enhancing Transnasal Endoscopy with Virtual Reality

Saloni Dangoria BA , Dr. Vrinda Bhardwaj MD, FAAP, Elena Gareau BS, Sarah Khan, Dr. Jeffrey I Gold PhD

Children's Hospital Los Angeles, Los Angeles, CA, United States

Purpose : Parents and healthcare providers are increasingly seeking non-sedative alternatives during routine medical procedures due to the known short- and long-term effects of sedation. In contrast to traditional endoscopic techniques that necessitate general anesthesia, Transnasal Endoscopy (TNE) is performed while the patient is awake. Virtual Reality (VR) has emerged as a promising non-pharmacological intervention to improve patient comfort and compliance. This study investigated the efficacy of VR in pediatric patients undergoing TNE.

Method(s) : 37 patients underwent TNEs (n=22 1 TNE; n=11 >1 TNE; n=4 aborted TNE) totaling 46 TNE procedures using Meta Quest/Meta 3. Patients chose their favorite streaming content to watch during the procedure. Self-report Facial Affective Scale (FAS) was collected pre- and post-TNE reflecting patient's anxiety levels pre- and peri- the TNE procedure. Patients completed the Gold-Rizzo Immersion and Presence Questionnaire (GRIP) to report overall satisfaction, immersion, and realism with the VR.

Results : Preliminary findings revealed a pre- (M=0.52) and a peri- (M=0.75) FAS anxiety score, reflecting an increase of 0.22 (p<0.001) during the non-sedated procedure. When asked if they experienced distress before or during their procedures, 54.3% of participants responded “yes.” Despite high levels of reported anxiety, 93.5% of patients reported VR helped tolerate the procedure at least somewhat. Post-intervention impressions of the VR revealed patients largely enjoyed the VR experience (63.0% a lot, 32.6% a little), felt that the VR grabbed their attention (54.3% a lot, 37% a little), and were interested and involved in the VR experience (54.3% a lot, 41.3% a little).

Conclusions : VR can be used effectively to complete a TNE procedure by managing distress, discomfort, and procedural anxiety, thus eliminating the negative effects of sedation for upper gastrointestinal tract evaluations. Future research should explore how VR can be used as an alternative to sedation during other routine medical procedures.

OA 17.04

Physiological and Psychological Interaction Patterns in Mind-Body Interaction Therapy (MBIT): Reaction Dynamics, Narrative Analysis, and AI-Enhanced Case Generation Using Large Language Models (LLMs)

Prof. Yu Du PhD

University of Colorado Denver, Denver, CO, United States

Purpose : Hypertension is increasingly understood through a biopsychosocial framework. Mind-Body Interaction Therapy (MBIT) offers a holistic approach that promotes self-regulation across physiological, psychological, and spiritual dimensions. This longitudinal mixed-methods study examined hypertensive patients receiving MBIT—with and without concurrent antihypertensive medication—to identify patterns in physiological reactions, emotional narratives, and their interdependencies.

Method(s) : During a 28-day intervention, daily patient-reported outcomes captured somatic and emotional responses such as sweating, yawning, temperature shifts, and emotional release. K-Means clustering analyzed symptom diversity and temporal dynamics. Narrative and sentiment analyses categorized themes from over 22 patient-generated topics. Bayesian network (BN) modeling explored probabilistic relationships among emotional, physical, and lifestyle variables. As a scalability test, a large language model (LLM) was fine-tuned on study data to generate synthetic, clinically plausible patient reports.

Results : Distinct response trajectories emerged: the MBIT-only group showed more concentrated and stable symptom patterns, indicating a coherent self-regulatory process, while the medication-assisted group showed greater variability, suggesting complex drug–mind-body interactions. Reaction clusters were tight in Days 1–7 but became more dispersed by Day 28, reflecting individualized physiological integration. Narrative analysis revealed four thematic domains: Emotional Unburdening and Healing, Physical Sensation and Regulation, Reflections on Healthcare Experience, and Sleep Quality and Recovery, with sentiment trends generally positive. BN modeling identified Positive Emotional State, Living Conditions, and Health Literacy as key upstream factors influencing physical symptoms and psychological well-being. The LLM generated coherent narratives aligning with these themes, demonstrating utility for augmenting qualitative insight.

Conclusions : MBIT supports an interconnected process of physiological and emotional regulation in hypertension care. Integrating clustering, narrative analytics, and causal modeling offers a robust framework for understanding mind-body dynamics. LLM-based narrative generation shows promise for enhancing qualitative data and accelerating pattern discovery in future research.

Oral Abstract Session 18: Integrative Health for Psychological Trauma

OA 18.01

The effects of mindfulness-based intervention on obsessive-compulsive symptoms among young adults with childhood trauma: the roles of non-attachment and cortisol as potential psychological and physiological mechanisms

Professor Diane Joss PhD

Harvard Medical School, Boston, MA, United States

Purpose : The objective of this study was to elucidate the psychological and physiological mechanism of how mindfulness-based interventions (MBIs) affect Obsessive-Compulsive Symptoms (OCS). Childhood trauma increases the risk for developing OCS, Mindfulness-Based Interventions (MBIs) can be beneficial for reducing OCS, but existing mechanistic understandings are still based on exposure therapy theories, which does not capture the unique features of MBIs. Therefore, this study aimed to investigate the potential psychological and physiological mechanisms of MBI for OCS among a sample of childhood trauma survivors.

Method(s) : Young adult childhood trauma survivors were randomized to an 8-week program of MBI (N=21) vs. an active control of Stress Management Education (N=19). Symptom checklist-90 (SCL90) was administered before and after the 8-week interventions, with the depression, anxiety and OCS subscales analyzed in this study. Non-Attachment Scale (NAS) was administered before and after the intervention to measure psychological flexibility and the capacity to “let go” the desire of control over external and internal experiences. Morning awakening cortisol was collected at 15 minutes intervals within the first hour after awakening, from which Areas Under the Curve (AUCs) were calculated for pre- and post-intervention samples. Path analysis was conducted using statistical software R to test hypothesized paths of psychological and physiological mechanisms in which MBI-induced changes in non-attachment, and MBI-induced changes in morning awakening cortisol, drove the post-MBI changes in OCS severity.

Results : Path analyses revealed that only in the MBI arm, but not in the active control arm, after controlling for score changes of depression and anxiety, post-intervention score changes of “non-attachment”, and post-intervention changes of morning awakening cortisol, directly predicted post-intervention changes of OCS (p<0.05).

Conclusions : Findings from this study suggests a potential unique mechanism of MBI for improving OCS through cultivating the mentality of “non-attachment”, while also highlighting the role of cortisol in OCS symptom changes.

OA 18.02

Feasibility, acceptability and therapeutic mechanisms of a self-knowledge and self-compassion-based group intervention for healing from psychological trauma

Professor Diane Joss , Professor Zev Schuman-Olivier MD

Harvard Medical School, Boston, MA, United States

Purpose : Psychological trauma is a leading cause of mental illnesses, yet effective treatments for trauma-related disorders are still lacking. Most existing psychotherapy techniques focus on symptom alleviation instead of wholistic transformations of trauma-induced maladaptive psychological schemas. Self-concepts are at the core of psychological schemas, and enabling patients to reconstruct self-knowledge from a compassion-based framework is the key to wholistic healing. Therefore, we developed a group-based telehealth intervention program focused on enhancing self-knowledge for trauma survivors. The 16-week program, called Program for Alleviating and Resolving Trauma and Stress (PARTS), incorporates therapeutic elements from mindfulness-based interventions, self-compassion training, and the Internal Family Systems (IFS) framework. The purpose of this study is to test the feasibility and acceptability of PARTS for patients with Post-Traumatic Stress Disorder (PTSD).

Method(s) : Patients with PTSD were randomized (1:1) to PARTS (n=30) vs. an active control of Nature-Based Stress Reduction for Trauma Survivors (NBSR-T). The two arms were compared on intervention adherence, treatment satisfaction, as well as changes in symptoms of PTSD and complex PTSD.

Results : More participants in the PARTS than in the control arm rated facilitators (p=0.04) and group experience (p=0.05) as excellent. Both arms had statistically significant reduction of PTSD symptom severity at the end of the 16-week interventions (p<0.001), without significant group differences (p = 0.4). PARTS arm had a significant mechanistic pathway of “decentering” to “self-compassion” to reduciton of complex PTSD symptom severity.

Conclusions : This study demonstrated the feasibility and acceptability of PARTS as a group-based treatment for trauma-related symptoms.

OA 18.03

Mind-Body for PTSD: Remotely Delivered Tai Chi and Wellness for Veterans

Barbara L. Niles Ph.D. 1,2 , Craig Polizzi Ph.D. 1,2 , Maria A. Ting B.S. 1 , DeAnna L. Mori Ph.D. 1,2

1 VA Boston Healthcare System, Boston, MA, United States

2 Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States

Purpose : Although Posttraumatic Stress Disorder (PTSD) has traditionally been considered a psychological disorder, a growing evidence base indicates it is systemic, affecting physical health and wellness. Mind-body interventions for PTSD have shown promise in addressing symptoms and studies of Tai Chi have demonstrated improvements in physical functioning, mental health, and quality of life for individuals with a variety of chronic conditions. Thus, Tai Chi may have a salutary impact on PTSD. Remote interventions can reduce barriers to treatment engagement and have potential for large dissemination. In a study to evaluate the feasibility and acceptability of two virtually delivered mind-body interventions for Veterans with PTSD and chronic pain, PTSD outcomes were considered.

Method(s) : A randomized trial examined two 12-week, twice weekly integrative interventions: Tai Chi and Wellness. Over three group cohorts, 42 Veterans were recruited and randomly assigned to one of the two group interventions. Veteran-reported PTSD symptoms were collected weekly via remote platform. Diagnostic interview assessments of PTSD were conducted at baseline and post-treatment and qualitative interviews at post-treatment.

Results : Feasibility was demonstrated by high engagement and completion rates: 67% of Veterans received a full treatment dose (at least 18 of 24 sessions) and 78% completed the post-treatment assessment. The gold-standard Clinician Administered PTSD Scale (CAPS) showed an overall decline in PTSD symptoms posttreatment (η2p= .342, p<.001) and over 40% of Veterans no longer met diagnostic criteria for PTSD at posttreatment. No significant differences between the two interventions were detected.

Conclusions : Despite treatments for PTSD and pain with proven efficacy, many Veterans cannot or choose not to access them. This study demonstrates that virtual interventions promoting health and wellness are feasible, acceptable, and associated with reductions in PTSD symptoms. Integrative interventions may be more approachable and accessible and can provide appealing alternatives to traditional “talk therapy” for PTSD.

OA 18.04

The Impact of Yoga on Symptom Clusters of Posttraumatic Stress Disorder: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Dr. Sinead M Sinnott PhD 1,2 , Dr Laura E Laumann PhD 3,4 , Dr Katherine E Gnall PhD 5,1,2 , Dr Crystal L Park PhD 5 , Dr Yin Wu PhD 6 , Menaja Raja BS 5 , Annmarie Khawand BS 1 , Dr Linda Pescatello PhD 7

1 Massachusetts General Hospital, Boston, MA, United States

2 Harvard Medical School, Boston, MA, United States

3 Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States

4 Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, MA, United States

5 Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States

6 Department of Research, Hartford Hospital/Healthcare, Hartford, MA, United States

7 Department of Kinesiology, University of Connecticut, Storrs, CT, United States

Purpose : Posttraumatic Stress Disorder (PTSD) is a disruptive, multifaceted disorder, which impacts an estimated 6.8% of people in the United States (U.S.) at some point in their lives. Yoga has been shown to reduce PTSD symptoms overall, though little is known about the extent to which it reduces specific PTSD symptom clusters. In this systematic review and meta-analysis, we examine the relationship between yoga and change in each of the PTSD symptom clusters. We hypothesized that yoga participation would be associated with significant reductions in each PTSD symptom cluster, particularly hyperarousal.

Method(s) : We searched Pubmed, PsycInfo, CINAHL, and SPORTDiscus for eligible studies through July 2025. Studies were included if they were yoga intervention randomized controlled trials, enrolled trauma survivors, and reported PTSD subscale scores. Standardized mean difference scores were computed and compared. A National Institutes of Health quality assessment tool was used to assess risk of bias.

Results : In our direct models (k = 9 studies), yoga led to reductions in intrusion (d = -0.31, p =.027) and total PTSD (d = -0.29, p = .030) symptoms. When accounting for age, yoga also improved avoidance (d = -2.28, p = .003) and hyperarousal (d = -1.92, p =.007) symptoms, as well as intrusion and total PTSD symptoms, such that yoga led to greater symptom improvements among younger age groups. Substantial risk of bias was found across studies.

Conclusions : Yoga showed the most robust effects for reducing intrusion and total PTSD symptoms. After accounting for age, yoga demonstrated efficacy in reducing avoidance and hyperarousal symptoms, in addition to improving intrusions and total PTSD symptoms. Yoga’s emphasis on mindfulness in the present moment may allow for attentional awareness that is protective against intrusions.

Oral Abstract Session 19: Research of Traditional Health

OA 19.01

Quantitative Study on the Effect of Yin/Yang Forces of Tai Chi Movement on the Flow of Blood and Electrical Energy in the Body

Michael J. Pirrello, Ethan R. Tran , Jeremiah A. Susanto, Alan Guo, William Ma, Shin Lin Ph.D

University of California, Irvine, Irvine, CA, United States

Purpose : Chen Style Tai Chi emphasizes movements based on the principle of “within the Yin, there is Yang”, as illustrated in the Tai Chi symbol. The purpose of this pilot study is to determine how a slow (Yin) movement with increasingly more force (Yang) can affect the flow of blood and electrical energy in the body.

Method(s) : Subjects were 10 healthy male/female college students. Blood flow/perfusion was measured as “flux” at the PC8 acupoint (right palm) with laser Doppler flowmetry (Moor DRT-4 monitor) and energy flow was measured as “Before Polarization conductance (BP)” from LU1 acupoint (right thumb) to a ground electrode (lower arm) with Motoyama's Single Square Voltage Pulse method using a Continuous AMI instrument (from California Institute of Human Science). Subjects pressed their right palm downwards against 0.0/2.5/5.0/7.5/10.0 lbs. of weight on a pulley to simulate Chen Style “White Crane Opening Wings” (5 cycles/minute).

Results : Consistent with our previous studies, laser Doppler flowmetry showed that blood flow/perfusion increased to a peak as the hand pressed down on increasing amounts of weight. Similarly, the flow of electricity measured as BP also increased with weight. In a typical experiment when the subject did 6 repetitions of the downward movement against various amounts of weight, the mean peak sizes were 2434,SD27/2444,SD25/2485,SD37/2556,SD56/2685,SD124 (arbitrary units) for 0.0/2.5/5.0/7.5/10.0 lbs. of weight; when the three most prominent peaks at each weight level were selected for analysis, the means were 2485/2551/2629/2923, respectively.

Conclusions : This pilot study indicates that when the hand presses effortlessly (Yin) in a slow-downward (Yin) movement, there is only a small increase in electrical conductance within the lower arm. However, when the hand presses down with increasing effort (Yang), the flow of energy increases with the level of force, in keeping with the Tai Chi principle of “within the Yin, there is Yang”.

OA 19.02

Ancestral Knowledge and Gastrointestinal Health: Ethnographic Insights from Traditional Healers in Morelos, Mexico

Zephelline A Huerta BA

Icahn School of Medicine at Mount Sinai, New York, NY, United States

Purpose : Gastrointestinal (GI) disorders in Latine communities often go underdiagnosed due to systemic disparities and culturally discordant care. Many continue seeking traditional healers. This study examines how traditional healers in Morelos conceptualize and treat GI illness to inform more culturally responsive and integrative approaches within allopathic medicine.

Method(s) : An ethnographic study was conducted in Morelos, Mexico, with ten traditional healers (4 curanderas, 4 terapeutas, 2 integrative practitioners) recruited through community networks. Semi-structured Spanish-language interviews were documented through field notes and analytic memos, then inductively coded and thematically analyzed through constant comparison.

Results : Across interviews, healers described GI illnesses as manifestations of a single underlying imbalance within both the digestive and emotional systems rather than distinct physiological diseases. Treatment was “rebalancing” both systems through four interconnected modalities. (1) Herbal medicine—teas and tinctures of estafiate (Artemisia mexicana), pasiflora (Passiflora caerulea), caña fístula (Cassia fistula), hoja de guayaba (Psidium guajava), and epazote (Dysphania ambrosioides) (2) Manual therapies—abdominal massage and ventosas (cupping); (3) Energetic and spiritual interventions—limpias (spiritual cleanses), prayer, and biomagnetism; and (4) Lifestyle and dietary counseling. Across all interviews, healers stressed honesty, compassion, and referral to biomedical care when appropriate.

Conclusions : Traditional healers in Morelos conceptualize gastrointestinal illness as the embodied convergence of physical, emotional, and spiritual imbalance, with complementarity to biomedicine. Their attention to relationships, emotional wellbeing, and shared meaning challenges the tendency in Western medicine to separate the body from the mind and spirit and to overlook other healing systems that remain deeply valued and widely practiced today. These findings encourage allopathic clinicians to explore the emotional and cultural dimensions of digestive illnesses, ask patients about traditional remedies, and understand healing as both relational and contextual. Doing so will give a better understanding of patient experiences, foster culturally responsive dialogue, and provide care that is more comprehensive, compassionate, and effective.

OA 19.03

Targeted Treatment in Major Depression Using Ayurvedic Dosha Subtypes: Development of the ADSM

Clare Andriola B.S. 1,2 , Kiran Monteverdi B.S. 1,2 , Divjot Uppal 1 , Grace Reed B.S. 1 , Sarah Koh 1 , Natalie Sekowski Sekowski 1 , Jennifer Rand MS, AYT 1 , Yumi Munir B.S. 1 , Eliot Steer PhD, AP 3 , Shraddha Ravani PhD 2 , Aparna Upadhyaya NP 2 , Dr. Sudha Prathikanti MD, AP 1,2 , Juha Lee 1

1 UCSF Department of Psychiatry and Behavioral Sciences, San Francisco, CA, United States

2 UCSF Osher Center for Integrative Health, San Francisco, CA, United States

3 Palo Alto University, Palo Alto, CA, United States

Purpose : Major depressive disorder remains a leading cause of disability and is often undertreated in primary care. Ayurveda, a traditional Indian system of medicine, describes three constitutional types—Vata, Pitta, and Kapha—whose imbalance reflects distinct psychophysiological patterns. Depression subtyping through this lens may enhance personalization and outcomes. This project developed and validated the Ayurvedic Depression Subtyping Measure (ADSM), a standardized tool to classify depression by dosha subtype within conventional psychiatric frameworks.

Method(s) : The ADSM was created through a three-phase process. 1.) A Delphi panel of experts in Ayurveda, psychiatry, and psychology developed a 24-item instrument capturing dosha-based depressive features. 2.) In an online study (n = 345), correlations between ADSM classifications and the Major Depressive Episode Screener were assessed using one-tailed Pearson tests. 3.) A clinical validation with 30 adults diagnosed via the MINI compared ADSM subtype classifications with practitioner diagnoses using Cohen’s kappa to evaluate convergent validity.

Results : ADSM subtypes correlated significantly with probable depression severity, supporting construct validity. Agreement between practitioner-assigned and ADSM subtypes was moderate to strong, confirming convergent validity. Classical patterns emerged, with Kapha-type depression—marked by lethargy, heaviness, excessive sleep, and social withdrawal—most prevalent, corresponding to melancholic presentations described in Western psychiatry. The ADSM was feasible to administer in research and primary care contexts, supporting its scalability and clinical utility.

Conclusions : The ADSM provides an empirically grounded framework for integrating Ayurvedic subtyping into modern depression care. By translating dosha principles into a standardized format, the tool enables personalized, constitution-based interventions aligned with evidence-based psychiatry. Within a broader UCSF clinical trial exploring dosha-specific yoga for depression, the ADSM represents an early step toward establishing validated, culturally informed measures that operationalize traditional constructs for use in integrative mental health practice.

OA 19.04

Evaluating the Psychosocial Effects of a Contemplative Photography Exhibition: Results from a Single Arm Study

Joanna Ho 1 , Jingli Wang 1 , Darshan Mehta MD, MPH 2,3 , David Victorson PhD 4,5

1 Great Wisdom Buddhist Institute, Brudenell, PE, Canada

2 Harvard Medical School, Boston, MA, United States

3 Osher Center for Integrative Medicine at Harvard University, Boston, MA, United States

4 Northwestern University Feinberg School of Medicine, Evanston, IL, United States

5 Osher Center for Integrative Health at Northwestern University, Chicago, IL, United States

Purpose : Mental health challenges motivated Zhen-Ru, the spiritual teacher of Great Wisdom Buddhist Institute and Great Enlightenment Buddhist Institute Society, to explore photography as a means of alleviating mental stress. Drawing from years of Buddhist practice, this exploration resulted in an immersive, contemplative photo art exhibition designed to foster reflection and healing. We evaluated the exhibition’s short-term perceived psychological effects, including whether personality styles influenced attendee experiences.

Method(s) : Photo exhibit attendees (N = 217; 181 Chinese speaking, 36 English speaking) completed pre- and post-surveys including single items assessing contentment, relaxation, gratitude, meaning/purpose, stress, pain, fatigue, and sadness. Attendees also completed the 10-item Big Five personality scale and expectancy items. We used ANCOVA to test pre–post changes (adjusting for expectancy) and multiple regression analyses to examine the role of baseline personality traits in predicting change scores on each single-item indicator.

Results : Significant pre–post improvements were observed across all indicators (p < .05), with moderate effect sizes (Cohen’s d = 0.4–0.6). Regression analyses indicated that baseline personality accounted for 1–15% of the variance (adjusted R 2 ) in change scores across outcomes. Higher baseline negative emotionality consistently predicted greater improvements in mood, relaxation, contentment, stress, grief, and sadness (βs = .19–.33, ps < .05). Openness was inversely associated with change in contentment (β = −.15, p = .027), and Agreeableness was inversely associated with change in pain (β = −.19, p = .010). No other personality domains were significant predictors. There was no evidence of problematic multicollinearity or assumption violations.

Conclusions : Experiencing the photo exhibit was associated with immediate improvements in multiple indicators of psychological wellbeing among primarily Chinese Buddhist attendees. Baseline personality - particularly negative emotionality - was meaningfully related to the magnitude of these improvements, suggesting individuals with greater initial distress may derive the largest short-term benefits from contemplative art experiences like this.

Oral Abstract Session 20: Implementation of Whole Person Care

OA 20.01

“That would be amazing:” Patient Perceptions of a Whole Health Approach to Primary Care

Dr. Kelly Dvorin PsyD , Aileen McGrory MA, MPP, Dr. Eileen Dryden PhD, Dr. Ekaterina Anderson PhD, Juliet Wu, Dr. Barbara Bokhour PhD, Justeen Hyde PhD

Center for Health Optimization and Implementation Research (CHOIR) VA Bedford Healthcare System, Bedford, MA, United States

Purpose : Trusted relationships between patients and healthcare teams are at the core of Whole Health (WH), a holistic approach that supports tailored care aligned with what matters most to patients. The U.S. Department of Veteran Affairs (VA) is at the forefront of implementing WH in Primary Care (PC). Although there are provider-identified benefits and challenges, there has been less focus on patients’ views of WH. This study explored PC patients’ perceptions of WH care.

Method(s) : Seventy-three Veterans from three VA facilities were interviewed following PC appointments. Patients were sampled from providers scoring high or low on a patient-reported, validated measure of person-centered communication. Transcribed interviews were analyzed using rapid qualitative analysis. Interview summaries captured key insights aligned with study domains. Data on positive care experiences and perceptions of WH were analyzed for common and unique themes.

Results : Patients overwhelmingly identified relationships as critical to positive PC experiences and quality care. They valued feeling known, cared about, listened to and respected, as well as longitudinal relationships with providers. Although most participants had not heard of ‘Whole Health,’ many thought WH-aligned conversations (e.g., asking ‘what matters most’) would deepen relationships with providers and enhance care by facilitating sharing of concerns, conveying caring, and enabling providers to address multiple factors impacting patients’ health and well-being. Additionally, many valued the focus on well-being and inclusion of complementary and integrative health modalities.

Conclusions : Patients identified strong relationships with providers as an essential part of high-quality care. While concerns exist about PC teams’ limited capacity, this study found incorporating communication strategies and resources aligned with a WH approach may further strengthen care relationships and increase patient engagement. A WH approach offers healthcare systems the opportunity to reinforce their commitment to patient priorities and preferences. This includes prioritizing provider retention to support development and sustainment of robust patient-provider relationships.

OA 20.02

Heals on Wheels: Development and Implementation of Community-Based Workshops for Integrative, Whole Person Pain Care in Underserved Communities

Dr Catherine Justice DPT 1 , Jadyn Knox BS 2 , Dr Stefanie Stevenson MD 1 , Dr Kate Shafto MD 1,3 , Dr Tegan Reeves PhD 1 , Jacinta Rebang MPH, PMP 1 , Dr Sue Haddow MD 1 , Dr Arti Prasad MD 1

1 Hennepin Healthcare Systems, Minneapolis, MN, United States

2 Hennepin Healthcare Research Institute, Minneapolis, MN, United States

3 University of Minnesota, Minneapolis, MN, United States

Purpose : Chronic pain is a pervasive health issue that disproportionately affects low-income and other marginalized populations, who often lack resources and experience healthcare access barriers. The experience of chronic pain is complex and related to multiple domains, warranting the need for whole-person, evidence-based and accessible programming models. The Heals on Wheels (HoW) program addressed this through the development and implementation of integrative pain workshops for underserved communities throughout Hennepin County, Minnesota.

Method(s) : A multidisciplinary team developed a 4-week curriculum for 1-2 hour-long weekly workshops, hosted by community organizations serving populations at increased risk of disproportionate chronic pain impact. A worksheet was distributed to participants at the start and end of each workshop to explore perceptions of: pain, overall state, favorite moments, and future suggestions. Qualitative exploration of the worksheets was employed through transcription and thematic analysis.

Results : Throughout 2022-2025, 13 workshop series occurred with 9 different community organizations, with total attendance of 369 (average 7.10/session). 265 questionnaires were completed by 163 unique individuals (71.82%). Average reported pain at the start of sessions was 5.40, reducing to 3.26 at the end (-2.14). Themes of before group state were: 1)Stable; 2) Health Concerns; 3) Overwhelm; and 4) Hope. Themes after group were: 1) Relaxed, calmer, tired; 2) Improvement, relief; 3) Gratitude, hope; and 4) Neutral. Dominant themes were relaxation, calmness, gratitude, and hope. Less common was the neutral or no change from a small subset. There were twelve themes of favorite part of workshops. including specific skills/techniques. Additionally, roughly 1/10 participants highlighted the importance of sharing and hearing others’ stories. Themes for future suggestions were dominantly expressions of positive feedback; other themes included wanting more time, session structure, and specific activities (e.g. hypnosis, aroma therapy).

Conclusions : The HoW workshops were acceptable and feasible to implement. HoW is an innovative and accessible integrative healthcare delivery model.

OA 20.03

Whole Health Implementation Strategies for a Transformed Healthcare System: The Use of Data Informed Models of What Matters and Scaling Strategies That Work in the Veterans Health Administration

Dr. Kathy H. Hedrick PhD 1 , Dr. Amy S. Collings PhD 1 , Dr. Sara M. Bozeman PhD 1 , Dr. Adam J. Zananski DPT 1 , Bree Ferrell MS, RD, IFNCP, LE 1 , David W Huffman MS 2

1 VHA Office of Patient Centered Care and Cultural Transformation, Washington, DC, United States

2 Huffman Leadership Solutions LLC, Ankeny, IA, United States

Purpose : This session outlines the enhancement of Whole Health System (WHS) implementation consultation strategies within the Veterans Health Administration (VHA). It builds on current open consultation methods by incorporating a more targeted, data-driven team-focused strategy1,2,3. This study aims to enhance implementation strategies, augment consultation approaches, identify specific next steps, and scale these strategies nationally. The goal is to continuously improve consultation methods, prioritizing resources and ensuring effective national-level transformation in veteran healthcare services.

Method(s) : A multi-phase approach was used to refine WHS implementation consultation strategies. Initially, a needs assessment identified key areas: data-informed understanding and national highlights. Focus teams were formed: Data Integration and Model Implementation. Data was collected at two stages: needs assessment and post-implementation. Quantitative and qualitative data were analyzed to assess effectiveness. This data-driven approach was customer-focused, resulting in effective scaling of implementation practices across the nation, enhancing overall consultation strategies.

Results : Between FY23–FY24, the FIT Data Integration Team provided 63 consultative services across VHA. Data-driven consultations led to improved WHS coding, tracking, and documentation. Sites reported increased understanding of healthcare coding taxonomies and enhanced alignment with strategic implementation goals. Qualitative feedback highlighted the new consultation approach as empowering and supportive. Common themes included increased data literacy, scalability of successful models, and enhanced collaboration. Overall, these consultations resulted in more consistent implementation practices and greater confidence in WHS data usage.

Conclusions : Data-informed, team-based consultation supports VHA’s WHS transformation by using measurement to drive change. Embedding data consultation into strategy fostered operational shifts, increased data literacy, and enhanced strategic planning. The FIT focus team’s relational engagement with technical expertise promoted sustained engagement, psychological safety, and trust4. This model offers a replicable strategy for complex healthcare transformation, bridging the gap between measurement and action. It exemplifies how measuring what matters can scale successful practices across a large healthcare system.

OA 20.04

The Ripple Effect: Coaches’ Perspectives on How Health and Wellness Coaching Improves the Lives of Veterans

Dr. Kelly Dvorin PsyD 1 , Dr. Ekaterina Anderson PhD 1 , Dr. Sophia Bartels PhD 1 , Dr. Kimberlee Flike PhD, MSN, RN 1,2 , Matthew Martel 1 , Zenith Rai MPH 1 , Dr. Justeen Hyde PhD 1

1 Center for Health Optimization & Implementation Research (CHOIR) VA Bedford Healthcare System, Bedford, MA, United States

2 Solomont School of Nursing, University of Massachusetts Lowell, Lowell, MA, United States

Purpose : Health and Wellness Coaching (HWC) is a vital element of the Department of Veteran’s Affairs (VA) Whole Health System, which focuses on delivering person-centered, holistic care centered on what matters most to patients. Coaches support and empower patients to identify and work towards health and wellness goals. HWC is a highly patient-, rather than diagnosis-driven, approach guided by patients’ values and priorities. While outcomes research on HWC in VA is developing, there is a need to continue building the evidence. Therefore, we sought to understand what coaches have observed as key impacts of the HWC process.

Method(s) : We conducted qualitative interviews with 21 coaches and 7 coach supervisors as part of a larger evaluation of HWC in VA. Interview transcripts were coded in ATLAS.ti. A detailed thematic analysis was conducted on content related to impacts on Veterans.

Results : Coaches identified a variety of impacts across multiple domains: shifts in internal processes or mindsets (e.g., increased confidence, motivation, and self-awareness), behavioral changes (e.g., quitting smoking, increased exercise, greater engagement in healthcare), and physical health outcomes (e.g., weight loss, lowered A1C). A major finding was that Coaches observed cascades of change in which one change spilled over into another and to another, or a “ripple effect.” For example, improvements in sleep hygiene led to changes in diet, and to having more energy, and ultimately to greater family engagement.

Conclusions : Coaches painted a complex picture of how improvements manifest in Veterans’ day-to-day lives, describing interconnected and “rippling” patient impacts spanning multiple aspects of functioning (i.e., mental, behavioral, physical). This has implications for how we understand and measure HWC outcomes. As studies on HWC effectiveness are developed, it will be critical to utilize methodology that is well-suited to this complexity. It will also be important to examine the pathways that lead to the changes we elucidated.

Oral Abstract Session 21: Clinical Studies of Yoga

OA 21.01

Feasibility and Impact of Inpatient Yoga Therapy for HSCT Patients Across Two Global Settings

Smitha Mallaiah MSc, C-IAYT

University of Texas M D Anderson Cancer Center, Houston, Texas, United States

Purpose : Hematopoietic stem cell transplantation (HSCT) is a lifesaving treatment, but is also physically and emotionally challenging. This pilot study examined the feasibility and acceptability of culturally tailored inpatient yoga therapy (YT) for HSCT patients in the United States and India. By addressing cultural context and resource variability, this research examined scalability, whole-person supportive care models, and the application of YT for inpatient settings in high- and middle-income settings.

Method(s) : A prospective, single-arm pilot was conducted at MD Anderson (USA) and HCG Bengaluru (India). Adults undergoing autologous or allogeneic HSCT received up to 12 individualized yoga sessions, beginning 2 weeks pre-transplant through 30 days post-transplant while inpatients. Protocols were co-developed with local clinicians and yoga therapists and tailored to cultural and institutional contexts. Delivery methods included in-person, virtual, and hybrid formats. Outcomes included validated symptom and quality of life (QOL) measures (GAD-7, PHQ-9, FACT-BMT), satisfaction surveys, and qualitative interviews.

Results : Thirty patients enrolled (15 per site). MDA patients attended more sessions (mean 10 vs. 8), with high engagement at both sites. Clinically meaningful reductions in anxiety, depression, fatigue, and pain were observed. QOL scores (FACT-BMT) were consistently higher in the U.S. cohort, and Indian participants reported higher psychological burden, with both groups deteriorating in QOL post-transplant. Both groups valued the intervention’s emotional and physical support. Delivery was feasible in both high- and middle-income settings, with patients preferring in-person sessions during hospitalization and virtual formats post-discharge

Conclusions : Delivering YT during inpatient hospitalization for HSCT patients is a novel and challenging setting, yet we found it is a feasible and culturally adaptable across diverse environments. Findings support scalable, low-cost YT interventions to improve outcomes, reduce distress, and expand whole-person care. Culturally tailored approaches can help close equity gaps in cancer care and align with global goals to measure meaningful outcomes and scale effective integrative therapies.

OA 21.02

Cost effectiveness of yoga versus transdiagnostic cognitive behavioral therapy for emotional disorders

Dr Danielle C. Mathersul PhD 1,2 , Prof Erik J. Groessl PhD 3,4

1 Murdoch University, Perth, WA, Australia

2 Veterans Affairs Palo Alto, Palo Alto, CA, United States

3 University of California San Diego, San Diego, CA, United States

4 Veterans Affairs San Diego, San Diego, CA, United States

Purpose : Mental health conditions are the leading cause of years lived with disability. While evidence-based cognitive behavioral therapy (CBT) is efficacious, response rates typically average only ∼50%. Yoga may offer another option. We examined preliminary cost-effectiveness of yoga versus transdiagnostic CBT (t-CBT) for improving adult mental health from a recently completed non-inferiority randomized controlled trial.

Method(s) : Across 2022 to 2024, 123 community-dwelling Australian adults (85% female, mean age 38.75) diagnosed with an anxiety, depressive, or posttraumatic stress disorder were randomized to either 10-weeks group t-CBT or 10-weeks group yoga (weekly, 90-min telehealth sessions). The study was prospectively registered (ACTRN12622000544774) and had ethics approval. The primary outcome was the Kessler Psychological Distress Scale (K10; clinical improvement: scores decreasing by 5+ points). A functional impact measure was converted to Assessment of Quality of Life (AQoL)-4D utility scores (post-minus-pre, by intervention group). Intervention costs were estimated using data tracked during the study. Interventions were delivered by trainees and thus, personnel costs were reduced by 50%. Incremental cost and incremental effectiveness were calculated before being combined into an incremental cost-effectiveness ration (ICER). Costs were viewed from an organizational perspective and 3-month time horizon was used.

Results : The mean cost to deliver 10 sessions of group t-CBT was $289/participant versus $159/participant for group yoga. Incremental cost was $130 and incremental 3-month-adjusted effectiveness was .0178. Change in utility scores over time did not significantly differ by intervention, however, 3% more participants had clinically significant improvement (K10) with yoga versus t-CBT. Therefore, the ICER for t-CBT versus yoga was ∼$7,300/QALY.

Conclusions : Yoga costs less to deliver than t-CBT. Yoga had slightly better clinical efficacy (K10) and t-CBT had slightly better functional outcome (AQoL4D), yet differences were not statistically significant. Data are preliminary yet suggest yoga may be a cost-effective option for improving adult mental health.

OA 21.03

Is a structured Yoga Intervention Comparable to Conventional Pharmacological Care in Managing Knee Osteoarthritis?

Kavita Bakshi MSc

University of Patanjali, Haridwar, Uttarakhand, India. Patanjali Research Foundation, Haridwar, Uttarakhand, India

Purpose : Knee osteoarthritis (KOA) affects over 374 million people globally, demanding safer and more effective treatments for the increasing aging population. Conventional Care (CC) of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) primarily address symptoms but often causes adverse effects. Yoga offers a holistic approach enhancing joint function and well-being. In alignment with World Health Organisation’s healthy aging and traditional medicine goals, this study compares the effectiveness of Conventional Care of NSAIDs and a structured Yoga Module (YM) in improving clinical outcomes in KOA.

Method(s) : A randomized controlled trial was conducted on 89 patients with KOA with age 45 to 70 years, symptom duration ≥6 months, Numeric Pain Rating Scale (NPRS) ≥4, and Kellgren-Lawrence grade between 1 to 3. Patients were assigned to CC, or a 45-minute YM for 60 days. Outcomes of pain (NPRS), inflammation (C-Reactive Protein), anxiety (Hamilton Anxiety rating scale, HAM-A), and quality of sleep (Pittsburgh Sleep Quality Index, PSQI) were assessed at baseline, day 30 and day 60.

Results : Participants with mean age and standard deviation of 56.4 ± 6.98 years with 67.4% female participants completed the study. YM significantly reduced pain (p ≤ 0.001), inflammation (CRP, p = 0.007), anxiety (HAM-A, p ≤ 0.001), and improved sleep quality (PSQI, p ≤ 0.001) compared to CC, which also showed changes in pain (p ≤ 0.001), inflammation (CRP, p = 0.45), anxiety (HAMA, p ≤ 0.001) and sleep quality (PSQI, p = 0.38). Overall, YM demonstrated superior efficacy in modulating, inflammation and improving sleep outcomes.

Conclusions : Both interventions improved pain and anxiety; however, yoga showed greater, sustained benefits, including reduced inflammation and better sleep. These findings suggest an immunomodulatory effect of yoga, supporting its role as a safe, integrative, and non-pharmacological pain management therapy that complements conventional care and promotes healthy aging in patients with KOA.

Oral Abstract Session 22: Measuring Whole Health

OA 22.01

Measuring What Matters: Development of the Whole Person Health Index for Integrated Health Self-Assessment

Stephen J Blumberg PhD , Paul J Scanlon PhD, Kristen Cibelli Hibben PhD

National Center for Health Statistics, Hyattsville, MD, United States

Purpose : Whole person health is central to an emerging National Institutes of Health (NIH) strategy for addressing chronic disease. In collaboration with NIH, the National Center for Health Statistics (NCHS) developed the Whole Person Health Index (WPHI), a brief, person-centered tool for integrated health self-assessment. The WPHI consists of nine items measuring general health, quality of life, social and family connections, diet, physical activity, stress, sleep, existential wellbeing, and health management ability. Each item is rated on a five-point scale — excellent (5), very good (4), good (3), fair (2), or poor (1) — with the sum of responses indicating overall health status.

Method(s) : The WPHI was tested in rounds 10 and 11 of NCHS’s Research and Development Survey (RANDS), using adult samples from commercial survey panels. Items underwent cognitive interviewing and pilot testing, and responses were compared with established measures in each domain. Descriptive and psychometric analyses assessed item performance and the index’s structure across population subgroups.

Results : Forty cognitive interviews conducted in summer 2024 confirmed that respondents interpreted items within their intended scope. In RANDS 10 (April-May 2024, n = 5,017), individual WPHI items showed moderate correlations (0.3 < ρ < 0.7) with related validated scales, supporting construct validity. Data from RANDS 11 (January-March 2025, n = 4,778) demonstrated that WPHI has strong internal consistency. Factor analyses supported a single-factor model, and measurement invariance was confirmed across sex, race/ethnicity, and education, though differential item functioning was noted for self-rated health by age.

Conclusions : The WPHI is a concise yet comprehensive measure of whole person health. Its items effectively capture intended constructs, and the index score is reflective of a single underlying concept. Now included in the National Health Interview Survey and deployed in NIH’s All of Us cohort, the WPHI offers a broadly applicable tool for monitoring whole person health.

OA 22.02

Pain University: Improving Veteran Well-Being Using an Interdisciplinary Whole Health Approach for Veterans Experiencing Persistent Pain

Ms. Kelly V Joyce MSPT 1 , Dr. Wesley Kurszewski DPT 1 , Ms. Carly Greeson MS, RD 2

1 Tomah VA Medical Center, Tomah, WI, United States

2 VA Office of Patient Centered Care and Cultural Transformation, Temple, TX, United States

Purpose : Pain University was developed in 2017 to support the need for a Veteran-centric, non-pharmacologic approach to pain management at Tomah VAMC. The pain education-based program follows the VA’s Whole Health model of care, empowering Veterans to manage their pain using conventional and complementary health approaches.

Method(s) : Through a series of four, 60-minute sessions, Veterans share their personal experiences with pain through exploration of four pain neuroscience concepts. Sessions include the use of Whole Health tools such as Mission, Aspiration, and Purpose (MAP) and Personal Health Inventory (PHI) to align development of patient “battle plans” with Veteran-defined focus areas. In conjunction with clinical services, battle plans can include referrals for CIH treatments, movement modalities, and well-being services. Health and wellness coaches support Veterans as they execute their battle plan and work towards self-defined goals.

Results : Pain ratings and pain interference (PROMIS 6B) are assessed upon program entry and re-evaluated at 3 months, 6 months, and 12 months to gauge personal and program effectiveness. Statistically significant improvements in mean pain interference T-scores were noted at 3 months (n=16; mean change -5.86; p=0.0005) and 6 months (n=10; mean change -8.27; p=0.0056). While no significant change was noted in mean best pain ratings, a significant improvement was noted in mean worst pain ratings at 3 months (n=24; mean change -0.96; p=0.0256) and 12 months (n=13; mean change -1.54; p=0.0060).

Conclusions : The initial findings from Pain University underscore the value of using a holistic, Veteran-centric approach to improve the well-being of Veterans living with persistent pain through education and conservative management. This model has vital implications for advancing pain care amidst national changes brought about by the Comprehensive Addiction and Recovery Act (CARA) and can play an essential role in evolving healthcare practices within the VA system and the broader medical community.

OA 22.03

Health Risk Navigation Tool: Scaling Personalized Support for Whole-Person Health in the Workplace

Justin Jackson , Amy Locke MD, Paul Estabrooks PhD, Kayla Norton, Selim Sheikh MD, Ryan Burns PhD, Megan Miller, Rachel Weir MD

University of Utah, SLC, Utah, United States

Purpose : A Health Risk Navigation Tool, launched in 2024 as part of an employee wellness program, aims to connect benefit-eligible employees to personalized, evidence-based health support. Through a custom Health Risk Assessment (HRA), the tool integrates screening, coaching, and referrals to promote whole-person health and support value-based care transitions.

Method(s) : Employees were invited to complete an annual online HRA that incorporates validated measures of physical activity, nutrition, sleep, stress, mental health, and substance use. Responses were risk-stratified against public health benchmarks to identify individual health risks. Based on results, employees received tailored referrals to wellness resources and based on risk, were enrolled in Tailored Care Pathways for metabolic and behavioral health. Outreach was provided by Wellness Navigators and partners in Care Navigation, and Behavioral Health Integration. Completion of the entire program resulted in a reduction in cost of the employee’s insurance premium in the following plan year.

Results : In Year 1, 69% (10,899 of 15,759) of eligible employees completed the HRA. This resulted in over 141,000 health resource recommendations, with 84% of participants receiving at least one resource that they were ready to take action on. Tailored Care Pathways enrolled 1,461 employees, with 81% engaging in and completing the majority of the pathway. Primary care activation increased, with 1,037 employees requesting assistance, of which 70% initiated scheduling with a new provider. Behavioral health outreach addressed 143 urgent cases, including 43 individuals with very high-risk scores not previously in care.

Conclusions : The Health Risk Navigation Tool demonstrated strong engagement and a scalable model for personalized health support. Future efforts will focus on expanding navigator capacity, targeting under-reached job groups, integrating HRA data into clinical workflows, and piloting bundled service models through redesigned Tailored Care Pathways.

OA 22.04

Scaling the Integration of Well-Being Measurement in Healthcare Services: Lessons Learned from Early Adopters within the Veterans Health Administration

Bella Etingen PhD 1,2 , Omonyele L. Adjognon ScM 3 , Matthew B. Martel BS 4 , Dawne Vogt PhD 3,5,6 , Timothy P. Hogan PhD 4,2 , Tamara Schult PhD, MPH 7 , Barbara G. Bokhour PhD 4,8

1 Research and Development Service, Dallas VA Medical Center, Dallas, TX, United States

2 Department of Health Economics, Systems, and Policy, Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, United States

3 Center for Health Optimization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, United States

4 Center for Health Optimization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, United States

5 Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States

6 Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States

7 Office of Patient-Centered Care and Cultural Transformation, United States Department of Veterans Affairs, Washington, DC, United States

8 Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States

Purpose : The Veterans Health Administration (VHA) is working to incorporate the Well-Being Signs (WBS) measure, a three-item, psychometrically valid measure of psychosocial well-being, into care. However, best practices for incorporating well-being measurement into healthcare settings remain largely unknown. This evaluation assessed best practices and experiences with WBS implementation among early adopters within VHA Medical Centers.

Method(s) : We completed semi-structured interviews (n=25) with Whole Health Program (n=8) and clinical (n=3) leadership and healthcare team members (n=14). Participants were selected from five medical centers with the highest volume of WBS administration across VHA. Interviews provided data on strategies for promoting, and barriers and facilitators to, WBS use. We used rapid qualitative analytic techniques to generate insights into these three areas.

Results : Five strategies promoted WBS use: training and mentorship to healthcare teams on WBS integration into practice; embedding WBS into existing workflows; permitting a flexible approach to WBS integration; providing incentives to healthcare teams to reinforce WBS use; and tracking use and sharing that information with healthcare teams. Four barriers hindered use: competing priorities and staffing challenges; perceptions that the questions were difficult for Veterans to answer; interpretation and follow-up on WBS scores; and IT/Systems issues. Four facilitators bolstered use: use of informal WBS ‘Champions’ and open discussions regarding its use; fostering healthcare team member buy-in; visible leadership support; and the brevity/familiarity of the scale.

Conclusions : Our findings suggest strategies for healthcare systems looking to integrate well-being measurement into healthcare services, including: (1) make well-being measures easy for healthcare team members to find and use; (2) allow flexibility in how well-being measurement is incorporated into care and encourage this through leadership support, champions, accountability, and incentives, and; (3) provide training on how to measure well-being, integrate the information into care, and when to follow-up with patients who report poor well-being.

Poster Abstracts

Topic Area 01: Acupuncture

P 01.01

Self-administered acupressure to improve xerostomia in head and neck cancer patients: preliminary findings for a randomized controlled trial

Ms Xueyan Cheng

the University of Hong Kong, Hong Kong, Hong Kong, China

Purpose : Xerostomia is prevalent in patients with head and neck cancer (HNC). While acupuncture, grounded in traditional meridian theory, has demonstrated efficacy, the potential of self-administered acupressure remains unexamined. This study aimed to estimate the effect of self-administered acupressure for improving xerostomia in patients with HNC.

Method(s): A two-arm randomized controlled trial was conducted. The intervention group received a 90-minute acupressure training session from a registered Traditional Chinese Medicine practitioner, a follow-up session (60 min), instructional materials (booklet, videos), and a practice diary. Participants performed self-administered acupressure twice daily for 12 weeks. The control group received oral care education. Both groups received twice-weekly reminders. Self-reported xerostomia was measured using the Xerostomia Questionnaire (XQ) at baseline, 4 weeks, 12 weeks, and 24 weeks. Unstimulated and stimulated salivary flow were collected at baseline, 12 weeks and 24 weeks.

Results : Fifty-three participants were allocated to each group. Adjusted mixed-effects models showed the intervention group had significantly greater improvement in XQ scores at 4 weeks between-group difference in mean change: -6.86; 95% CI: -12.66 to -1.07, p=0.021) and 12 weeks (between-group difference in mean change: -8.59; 95% CI: -14.80 to -2.37, p=0.008) compared to controls. The effect was not sustained at 24 weeks (between-group difference in mean change: -0.77; 95% CI: -9.48 to 7.93, p=0.857). The model showed a significant group×time interaction (p=0.035). While between-group differences in salivary flow were non-significant, the intervention group showed significant within-group increases in unstimulated (mean change from baseline: 11.08, 95%CI 2.75 to 19.41, p=0.006) and stimulated saliva (mean change from baseline:8.48, 95%CI 1.76 to 15.19, p=0.010) at 24 weeks compared to baseline, which were not seen in the control group.

Conclusions : This study provides promising evidence that self-administered acupressure can significantly improve xerostomia in patients with HNC. Future studies should explore the practical implications of self-administered acupressure with larger samples and assess its long-term benefits.

P 01.02

Intraoperative Acupuncture for Total Knee Arthroplasty

Dr Thoa Ho Doctorate of Acupuncture and Oriental Medicine 1 , Mr Steven W. Li Student 1,2

1 Department of Veteran Affairs, Orlando, Fl, United States

2 Florida College of Integrative Medicine, Orlando, FL, United States

Purpose : The opioid epidemic necessitates effective, opioid-sparing strategies for perioperative pain management. Total knee arthroplasty (TKA), a common U.S. surgery, poses a high risk for postoperative opioid dependence. Consequently, non-pharmacological interventions like acupuncture have gained attention as adjuncts to multimodal analgesia protocols.

Method(s): To evaluate the effect of intraoperative auricular acupuncture points during TKA on postoperative pain, opioid use, hospital stay length, and emergency department visits within two weeks of surgery. Whole Health providers screened and referred interested patients for auricular acupuncture. Consent was documented in EMR. Acupuncture was performed after anesthesia induction, following a time-out. Outcomes included pain, ED visits, and hospital stay. Follow-ups occurred on postoperative day 1 and week 1.

Results : Patients who received intraoperative acupuncture during TKA had significantly lower postoperative pain levels. In traditional surgery, scores were 4.013 without acupuncture and 2.917 with acupuncture. In robotic surgery, scores were 3.615 without acupuncture and 3.167 with acupuncture. Acupuncture reduced oxycodone, morphine, and ketorolac use by 57%, 64%, and 95% in traditional surgery, and by 65%, 100%, and 18% in robotic surgery. ED visits were 16% without acupuncture vs. 12.5% with acupuncture. Hospital stays averaged 1.40 vs. 1.03 days in traditional surgery, and 1.22 vs. 1.00 day in robotic surgery. No needle site complications were reported. 76% would recommend acupuncture, and 55% reported benefits.

Conclusions : In response to the opioid crisis, this study evaluated intraoperative auricular acupuncture in total knee arthroplasty (TKA) at the Orlando VA Medical Center. Using six classical auricular points, we assessed pain, opioid use, hospital stay length, and ED visits. Findings support acupuncture as safe and effective, with reduced pain scores, decreased medication use, shorter hospital stays, and fewer ED visits. No complications were reported, and 76% of patients recommended it, with 55% reporting benefits.

P 01.03

Expanding Pediatric Integrative Care: A Protocol-Driven Auricular Acupressure Training for Front-line Providers

Ms Lisa Squires BSN 1 , Dr. Maria Mascarenhas MBBS 1 , Dr. Lynn Gershan MD, CM, DABMA 2 , Celia Hildebrand DAOM, LAc 3 , Dr. Winona Chua MD 4

1 University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, United States

2 University of Minnesota, Minneapolis, MN, United States

3 Andrew Weil Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States

4 University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, pa, United States

Purpose : Auricular acupressure (ear seeding) is an accessible, low-risk intervention with emerging evidence supporting its use in managing pain, anxiety, substance use, and nausea. To enhance pediatric integrative care offerings, we designed and implemented a structured training program for nurses, physician assistants, and nurse practitioners.

Method(s): We reviewed acupressure curricula at major acupuncture institutions and collaborated with a physician-acupuncturist and pediatric acupuncturist to develop a protocolized course. Online modules introduced historical context, Chinese Medicine theory, and ear anatomy. In-person sessions spanned two days—totaling 2 to 8 hours—featuring hands-on training using an electro-stimulation pen for point localization and MRI-safe Vaccaria seed placement on latex-free adhesive. Institutional approval and detailed policy development supported safe practice. The second day incorporated additional techniques, such as shonishin, tuina, and advanced protocols.

Results : Clinically, auricular seeds have been well tolerated in pediatric settings, including use in infants (for reflux, feeding, opioid withdrawal) and older children for anxiety, nausea, sickle cell pain, musculoskeletal pain, and headaches. Among adolescents in a refeeding eating disorder unit, seeds and acupressure bands helped alleviate anxiety, nausea, constipation, and low mood; patients often integrate these tools into meal support routines. Reported effects include rapid onset (e.g., improved mood, “need to take a nap,” increased activity) and a desire for repeated application. Seeds were generally tolerated for 3–5 days.

Conclusions : Our protocol-driven auricular acupressure training equips frontline providers with practical, low-risk tools to address pediatric symptoms. Initial clinical experiences suggest beneficial effects across a range of conditions. Further formal outcome studies are needed to quantify efficacy, establish standardized metrics, and support broader implementation.

P 01.04

Analysis of the Effect of Muscular Activity on Blood Flow during Tai Chi Movement using Gaussian Process Machine Learning Modeling

William Ma, Anna Kwan, Alan Guo, Ethan R. Tran, Jeremiah A. Susanto, Michael Pirrello, Shin Lin Ph.D

University of California, Irvine, Irvine, CA, United States

Purpose : The purpose of this pilot study is to use Gaussian Process Machine Learning Modeling to analyze a set of highly complex data from measurements of the effect of varying muscle activity on blood flow at different acupuncture points in subjects performing a slow (Yin) but forceful (Yang) downward hand movement that simulate Chen Style Tai Chi “White Crane Opening Wings” which follows the Tai Chi principle of “within the Yin, there is Yang”.

Method(s): Subjects were 10 healthy male/female college students. Blood flow/perfusion was measured as “flux” with laser Doppler flowmetry (Moor DRT-4 monitor) at acupuncture points TH-5. LI-10, and LI-13 when the subjects were pressing downwards against various amounts of weight on a pulley (6 repetitions in 1 minute).

Results : While there appears generally to be an upward trend of blood flow when the hand was pressing against increasing amounts of weight, there was a high level of variability (mean values accompanied by high levels of SD) among the 10 subjects and among measurements at the 3 acupoints. However, with Gaussian Process Machine Learning Modeling, we were able to reduce the complexity of the data to the following set of predicted total blood flux during the downward movements. TH-5: baseline=975 (arbitrary units), 0 lb=2106, 5 lbs.=3247, 10 lbs.=4171; LI-10: baseline=1603, 0 lb.=3256, 5 lbs.=3558, 10 lbs.=4354; LI-13: baseline=2132, 0 lb.=3439, 5 lbs.=4357, 10 lbs.=5800.

Conclusions : Our analysis indicates that (1) the higher the slow (Yin) downward force (Yang) of the hand produces a higher level of blood flow, in keeping with the principle of “within the Yin, there is Yang” as illustrated in the Tai Chi symbol, (2) blood flow at LI-13>LI-10>TH-5, and (3) despite relatively high variance, there is strong overall correlation in blood flow pattern across different acupoints and levels of muscular activity during this Tai Chi-like movement.

P 01.05

Scaling Auricular Acupuncture (NADA Protocol) Training to Improve Acupuncture Access

Doctor Juli Olson DC, DACM, FAIHM 1 , Doctor Stephen Gregory DACM, LAc 2 , Doctor Claudia Voyles DAOM, LAc 3

1 VA Central Iowa, Des Moines, IA, United States

2 VA Portland, Portland, OR, United States

3 Central Texas VA Medical Center, Austin, TX, United States

Purpose : The Veterans Health Administration (VHA) developed an internal VHA National Acupuncture Detoxification Association (NADA) Protocol training for those who have scope to deliver auricular (ear) acupuncture. VHA previously successfully scaled a different auricular acupuncture training called Battlefield Acupuncture (BFA)/Battlefield Auricular Acupressure (BAA) indicated for pain. Veterans and field providers were eager for an acupuncture protocol to address a broader range of conditions beyond pain.

Method(s): This session shares the development of the VHA NADA Protocol training system and curriculum for healthcare providers, and discusses barriers and facilitators for launch. Infrastructure needed for the training included development of a training platform, training materials, Veteran-facing education, and national tracking information. Methods to evaluate the success of the program include tracking trainee numbers and subsequent clinical utilization through VHA dashboards from VHA electronic health record systems.

Results : Since launch, the program has trained 161 VA clinicians in 12 training events where 1,482 Veterans received the NADA Protocol. Additionally, 513 VHA employees experienced well-being NADA Protocol acupressure applications during training clinics. VA developed 21 national instructors during this period. In fiscal year 2023, 7,693 NADA Protocol encounters were tracked, in 2024 12,259, and in 2025 21,457 encounters. This represents year over year growth of 63% from fiscal year 2023 to 2024 and a 75% growth from fiscal year 2024 to 2025.

Conclusions : VHA’s prior success training a variety of professionals in the delivery of protocolized auricular acupuncture through the BFA/BAA training model paved the way for this new training. BFA/BAA limited use to pain diagnoses necessitated the use of another protocol. The NADA Protocol was a logical next step with a wider set of indications. The incorporation of the NADA Protocol into the largest healthcare system in the US provides a model for other institutions to train, adopt, and promote auricular acupuncture.

P 01.06

Battlefield Acupuncture: A Gateway to Whole Health

Jenny Rouchka MD

Robley Rex VAMC, Louisville, KY, United States

Purpose : Battlefield acupuncture (BFA) is a simple, fast, and effective auricular protocol using Chinese acupuncture points. The VA’s Whole Health (WH) model emphasizes self-management and is associated with decreased opioid use in Veterans with chronic pain. BFA can serve as a gateway to promoting Whole Health concepts. A shared medical appointment (SMA) is an efficient way to combine BFA with Whole Health education.

Method(s): Each SMA treats up to ten Veterans per provider. While Veterans are treated in a group setting, they learn Whole Health concepts, emphasizing combining passive and active treatments to reduce chronic pain. The vision is to establish weekly group BFA/WH clinics in every community-based outpatient clinic (CBOC). To start, clinics will rotate weekly across four CBOCs to accommodate limited staff and minimize clinic schedule disruption. Newly trained providers will co-lead with experienced staff and then transition to an independently led clinic after several months. Whole Health education can be provided by a Whole Health coach, BFA provider, or video resources.

Results : The first group BFA/WH clinic was established in August 2023 at the Robley Rex VAMC. Veterans reported decreased pain and increased self-efficacy. 47 providers were trained across multiple specialties, with one primary care provider (PCP) in each CBOC. 1,972 procedures were completed in 2025 with an average pain scale reduction of 1.23, with 809 done by PCPs with an average decrease of 2.16. Monthly community of practice calls and preceptorships supported clinical proficiency. Pre- and post-treatment pain scores, well-being indicators, Veterans’ experiences, and provider feedback will inform further program development.

Conclusions : Battlefield acupuncture combined with Whole Health education in a group setting is an efficient, peer supported, and Veteran-centered approach to chronic pain management.

P 01.07

Pinpointing Relief: Determining Optimal Acupuncture Sessions for Pediatric Pain and Distress

Elena P Gareau BS , Saloni Dangoria, Dr. Natalia Jaramillo PhD, Sarah Khan, Margaret J Klein, Monika Kobylecka LAc, Mikki Eason-Marchi DACM, BSN, LAc, RN, CPHON, Dr. Jeffrey I Gold PhD

Children's Hospital Los Angeles, Los Angeles, California, United States

Purpose : Acupuncture is an integrative therapy used with patients experiencing chronic and acute pain. Patients were recommended a minimum of 5 acupuncture sessions as part of a pediatric hospital’s clinical research program aimed at reducing pain and pain unpleasantness. The present study compares acupuncture treatment outcomes, through reductions in pain intensity and pain unpleasantness, to determine the optimal number of acupuncture sessions.

Method(s): Pain intensity and pain unpleasantness ratings were collected through self-report surveys pre- and post- each acupuncture session. Pain intensity was measured using the Faces Pain Scale – Revised (FPS-R) and pain unpleasantness was measured using a visual analog scale (VAS). Linear mixed models clustered by patient were used to examine associations between number of total acupuncture sessions and outcomes.

Results : 113 patients (ages 9-21) were enrolled (568 sessions total, 409 had complete pre-post treatment assessments). Patients received an average number of 5.03 (SD=2.8) sessions, with ten being the maximum number of sessions. Preliminary findings demonstrate significant mean reductions in both pain intensity and pain unpleasantness within each session. While the reduction in pain intensity was significantly greater with 5 compared to 2 sessions (estimate: -0.90 95% CI [0.12, 1.67], p<0.05), a more pronounced reduction was observed when comparing 7 to 5 sessions (estimate: -1.11 95% CI [-1.88, -0.348], p<0.01). A significant reduction was also observed in the change in unpleasantness rating comparing 7 to 5 sessions (estimate: -14.33 95% CI [-18.18, -10.48], p<0.0001).

Conclusions : These findings suggest patients with 7 sessions experienced the greatest reduction in pain intensity and pain unpleasantness compared to the recommended 5 sessions. Further research should expand upon these findings to investigate the impact of 7 acupuncture sessions on other health outcomes for pediatric patients.

P 01.08

The Importance of Measuring Context in the Study of Whole Person Health: Acupuncture Healing and Persistence of Clinical Effect

Dr Lisa A Conboy MA MS ScD 1 , Dr Xiaoming Sheng MSc, PhD 2

1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States

2 College of Nursing at the University of Utah, Salt Lake City, Utah, United States

Purpose : The last 50 years we have seen an increase in published biomedical science on acupuncture, how it works and for which conditions . Acupuncture has been incorporated into many health delivery systems and the results of such are arguably positive, such as Medicare coverage for acupuncture treatments for chronic Low Back Pain. Yet there remains a lack of consensus on how to model acupuncture as a treatment. Should acupuncture be conceptualized as a drug, with dose-response effects? Or is acupuncture treatment more of a behavioral intervention as it requires action on the part of the patient?

Method(s): All subjects from our Army funded RCT of acupuncture for Gulf War Illness trial (n=104) were invited to participate a resurvey 5 years post study completion. We considered if use of acupuncture after the trial ended was related to level of pain relief. We used general linear models to compare difference in McGill pain scores between different treatment groups and number of treatments after the trial ended.

Results : Fifty- one subjects from the original sample responded to the resurvey. Baseline to long term follow-up pain measures suggests that 71% of the clinical effect was maintained. We found that the number of treatments post-trial is related to treatment group during the trial, with the twice per week group (higher dose) having a higher number of treatments post study.

Conclusions : Data from high quality systematic reviews indicate that acupuncture treatment effects persist in the case of pain. But this effect is determined using studies that did not consider post-study use of acupuncture. Research including longer term outcomes will allow us to see persistence and variance in real world context. This is important information for persistence has ramifications for patient care and ultimate cost effectiveness.

P 01.09

The Impact of Treatment Frequency on Therapeutic Alliance and Clinical Outcomes in Acupuncture for Gulf War Illness

Dr Linnette M Johnson DCN 1 , Dr Angela Incollingo-Rodriguez PhD 2 , Dr Benjamin Nephew PhD 2 , Dr Lisa Taylor-Swanson PhD 1 , Dr Lisa Conboy ScD 3

1 The University of Utah, Salt Lake, Utah, United States

2 Worcester Polytechnic Institute, Worcester, MA, United States

3 Harvard Medical School, Boston, MA, United States

Purpose : This study examined how the therapeutic alliance (TA) develops during acupuncture for veterans with Gulf War Illness (GWI) and whether treatment frequency influences TA and clinical outcomes. Guided by Bordin’s framework, it examined when TA forms and their effect on patient outcomes, especially pain levels. The study hypothesized that stronger TA would predict better outcomes and that biweekly sessions would promote faster alliance formation. Findings aim to inform clinicians about TA’s role in integrative care.

Method(s): This secondary analysis used data from a randomized clinical trial including 104 veterans treated by experienced acupuncturists. Participants received either biweekly acupuncture for six months or a two-month waitlist followed by weekly sessions. TA was measured using the WAI-SR at multiple time points, and outcomes included pain, functioning, mood, and social support. Paired t-tests and hierarchical regression were used to assess changes and mediation effects. All procedures met ethical standards and controlled baseline clinical differences.

Results : Therapeutic alliance increased across all subscales in both groups. The weekly group started lower after the waitlist but improved rapidly once treatment began. Biweekly sessions led to significantly greater pain reduction, with the Task component of TA fully mediating this effect. Goal alignment was associated with better physical functioning, and Bond was associated with reduced anxiety. Although both groups reached similar TA levels by six months, early delays hindered initial alliance formation.

Conclusions : TA significantly influenced pain and functional improvements in veterans receiving acupuncture for GWI. More frequent treatment promoted faster, stronger alliance building and greater clinical benefit, particularly through task agreement and shared goals. Waitlisting slowed early alliance development, but consistent engagement helped patients recover relationship strength over time. These findings highlight TA as a key therapeutic mechanism in integrative care and emphasize the importance of active listening, collaboration, and clear goal setting in clinical practice.

P 01.10

Geographic Variation in Utilization of Acupuncture among Medicare Part B Beneficiaries

Dr. James M Whedon DC, MS 1 , Dr. Louis A Kazal MD 2 , Dr. Leah Grout PhD 1

1 Southern California University of Health Sciences, Whittier, California, United States

2 Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States

Purpose : In 2020, The Centers for Medicare and Medicaid Services (CMS) initiated coverage of acupuncture for treatment of chronic low back pain. However, CMS restricted the provision of acupuncture services to medical physicians and certain specialties working under physician supervision. Independent licensed acupuncturists are prohibited from billing Medicare for acupuncture services. Thus, the limited availability of acupuncture clinicians under Medicare may compromise adequate and equitable patient access to acupuncture. The purpose of this study was to quantify the utilization and treatment intensity of acupuncture under Medicare by state.

Method(s): We employed a cross-sectional design to examine 2020-2023 Medicare claims and quantify patient use of acupuncture by state. We measured utilization as acupuncture recipients per 100,000 Part B beneficiaries and treatment intensity as acupuncture visits per 100,000 Part B beneficiaries. To model utilization and treatment intensity across US states we estimated adjusted rates for each state using Poisson regression models with state-level covariates. Quintiles of rates for utilization and treatment intensity were mapped by state to illustrate geographic variation.

Results : The mean rate of utilization among all states was 235.4 recipients per 100,000 Part B beneficiaries. Utilization rates ranged from 1,337.3 in New Jersey to 13.0 in Montana. The mean rate of treatment intensity among all states was 1,721.9 services per 100,000 Part B beneficiaries. Treatment intensity rates ranged from 11,488.0 in New Jersey to 30.7 in Arkansas. Utilization and treatment intensity appeared to be relatively higher in west coast and northeastern states.

Conclusions : Utilization and treatment patterns related to acupuncture for Medicare Part B beneficiaries vary widely by state. The reasons for the variation are unknown, but the variation is likely related to both the availability of acupuncture services under Medicare and patient preference.

P 01.11

Use of Integrated Acupuncture and Respiratory Therapy to Facilitate Tracheostomy Weaning in Patients undergoing Neuro-rehabilitation

Dr. Roohi Banu BNYS, MD 1 , Pradeep Kumar BSc (RT) 1 , Dr. Archana Purushotham MD, PhD 1,2,3

1 Svatantra Integrative Neuro Rehab, Bengaluru, Karnataka, India

2 Baylor College of Medicine, Houston, Texas, United States

3 Michael E. DeBakey VA Medical Center, Houston, Texas, United States

Purpose : Patients often require tracheostomy following major neurological events such as strokes and brain trauma. Decannulation i.e. removal of the tracheostomy tube is an important step to achieve effective neurorehabilitation, but may be delayed by a variety of factors. We integrated conventional respiratory therapy with acupuncture in patients admitted to a neuro-rehabilitation facility to expedite weaning.

Method(s): The integrative treatment protocol consisted of: 1. Respiratory therapy – Two sessions daily (20–25 minutes) comprising chest percussion, vibration, postural drainage, tracheostomy tube downsizing, and corking trials. 2. Acupuncture – Administered five times per week targeting neuro-rehabilitation points GV20, LI4, ST36, Yintang, PC6, and auricular Shenmen. Retrospective chart review was used to record the length and course of the weaning period.

Results : 23 tracheostomized patients (aged 16–78 years; 15 males, 8 females; 7 ischemic strokes, 4 intracranial bleeds, 7 TBI, 3 intra-axial tumors) admitted to Svatantra Integrative Neurorehab between November 2024 and October 2025 were treated with this integrative protocol. Patients had undergone tracheostomies 132.7 ± 382.7 days prior to admission. 7 had a history of pneumonia prior to admission, and 1 had required recannulation after initial decannulation. All patients were successfully decannulated using the integrative protocol with a mean weaning period of 28.2 ± 17.7 days. None of the patients experienced any complications barring one who developed a local infection at the stoma site that was successfully treated.

Conclusions : Integrating acupuncture with structured respiratory therapy appears to be a safe and effective approach to facilitate tracheostomy weaning in patients undergoing neuro-rehabilitation. Hypothesized modes of action include enhancing lung capacity, improving clearance of secretions and neuromuscular coordination. Larger randomized controlled studies are required to confirm the efficacy of this integrative protocol.

P 01.12

Novel Adjunctive Approaches for Refractory Cryovasculitis-Associated Venous Ulcers: Evaluating the Role of Acupuncture Derived Plasma Induction in Healing Outcomes

Dr. Lorien S Ahn MD , Dr. Qiuxue T Tan MD, Dr. Lawrence Taw MD, Dr. Ranko Tutulugdzija DACM, L.Ac., A.P., Dipl AOM, MSAOM

UCLA, los angeles, ca, United States

Purpose : Cryoglobulinemic vasculitis-associated venous ulcers pose a significant therapeutic challenge due to chronic inflammation, ischemia, and poor tissue regeneration. This case report describes an elderly patient with refractory ulceration successfully treated with an integrative acupuncture protocol emphasizing plasma induction, angiogenesis, and fascia engagement. The intervention led to complete wound closure, suggesting acupuncture as a viable adjunctive therapy in complex vasculitic wound care.

Method(s): An 80-year-old female presented with bilateral lower extremity ulcerations secondary and mixed cryoglobulinemic vasculitis. The most severe lesion—a 2-inch wide ulcer over the right lateral malleolus—remained refractory to healing despite treatment with Rituximab, corticosteroids, and advanced wound dressings. Following Rituximab administration, the patient reported worsening symptoms, including cold extremities, progressive purpling of distal tissues, and systemic fatigue. Dermatology initiated topical therapy with timolol drops, silver sulfadiazine (Silvadene), and mupirocin, while pentoxifylline was prescribed to enhance peripheral circulation. Weekly acupuncture sessions were initiated at UCLA East-West Medicine.

Results : After four acupuncture sessions, eight of nine smaller ulcers closed with visible skin regeneration. Following eight sessions, there was a marked reduction in pain, edema, and discoloration, along with partial closure of the primary malleolar ulcer. At three months, complete healing of the primary ulcer was achieved, accompanied by restored skin tone, resolution of pain, and improvement in systemic symptoms, including increased warmth in the extremities and reduced fatigue. These outcomes align with clinical evidence supporting acupuncture’s efficacy in managing venous ulcers.

Conclusions : When combined with conventional medical treatment, acupuncture therapy may enhance local perfusion, modulate inflammation, and stimulate tissue regeneration—offering meaningful improvements in wound healing and symptom control, particularly in cases refractory to standard interventions. The systemic benefits observed in this case further support the potential of acupuncture as a complementary modality in the management of autoimmune and vasculitic disorders, warranting further investigation through rigorous clinical studies.

P 01.13

Effects of Xuanzhong (GB39) Acupoint on Learning, Memory and NMDAR Signalling Pathway in Vascular Dementia Rats

Dr Man Sze Lam MD (PhD) in Acupuncture and Tuina

Changi General Hospital, Singapore, Singapore, Singapore. Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China

Purpose : The study aims to elucidate the mechanism of acupuncture at Xuanzhong (GB39) acupuncture point in treating vascular dementia, providing experimental evidence for clinical acupuncture practice.

Method(s): Sixty SPF-grade adult male SD rats were randomly allocated to four groups: sham-operated (SVD), vascular dementia model (VD), memantine (VD+M), and GB39 acupuncture (VD+GB39). Vascular dementia was induced by bilateral common carotid artery ligation. Post-modelling, the VD+M group received intraperitoneal memantine and the VD+GB39 group received acupuncture at GB39 for 5 days per week over 4 weeks while the SVD and VD groups received no treatment. After interventions, 10 rats per group underwent novel object recognition, active avoidance and T-maze tests to assess recognition memory, associative learning, and working memory. Hippocampal morphology (CA1, CA3) was examined by HE staining. ELISA and Western blot were used to quantify bile acid metabolism-related proteins (CYP7A1, cholic acid, TGR5, FXR) and NMDAR signalling pathway-related proteins (NMDAR, CaMKII, CREB, BDNF) in liver and hippocampal tissues.

Results : The VD+GB39 group demonstrated significant cognitive improvements compared with the VD group, including increased exploration duration and recognition index in the novel object recognition test, reduced conditioned-stimulus latency in the active avoidance test, and fewer working-memory errors with higher working-memory indices in the T-maze test (P<0.05). Histological assessment showed that the VD+GB39 group exhibited well-preserved CA1 and CA3 hippocampal neurons, with orderly arrangement, minimal disruption, and only mild density reduction, indicating substantially less pathological damage than observed in the VD group. Protein analyses showed significant upregulation of bile acid metabolism–related proteins in the liver and hippocampus, as well as NMDAR pathway–related proteins in the hippocampus, in the VD+GB39 group compared with the VD group (P<0.05).

Conclusions : Acupuncture at the GB39 point may effectively alleviate learning and memory impairment in VD models by regulating bile acid metabolism and activating the NMDAR signalling pathway.

P 01.14

How Do Differing Definitions of “Acupuncturist” Result in Variation by State in Licensing and Counts of Acupuncturists?

Ms. Barbara A Gibson MS, C-IAYT

Southern California University of Health Sciences, Whittier, CA, United States

Purpose : While most states in the United States define licensed acupuncturists (LAc’s) as licensed providers who practice acupuncture in their state, 13 states list multiple practitioner types. This incongruity affects which types are considered fully licensed and what techniques they provide, creating confusion for patients, undermining where acupuncturists fit as healthcare providers, and necessitating more standardized definitions and licensing in the US. We present differences in state acupuncturist types and effects on license definitions and state counts.

Method(s): A database was created collecting LAc’s counts from each state via internet searches of state board agencies and verified by calling or emailing state board offices from January 2025 through June 2025. Data captured state registry dates from late 2024 – May 2025. Online, clerk verified, roster, and multiple practitioner type counts were recorded for each state. For the 13 states with multiple types listed as acupuncturist practitioners, types recognized as LAc’s were recorded.

Results : Counts from all 50 states and the District of Columbia were recorded. Of the 13 states with multiple practitioner types, six listed more than two types with three states recognizing more than one type as an LAc with calls and/or emails required to verify which types are recognized. Two states recognize physician acupuncturists as LAcs and one state recognizes acupuncture detoxification specialists as LAcs. State law and regulations verifications were required for some recognized types.

Conclusions : Incongruities in acupuncturist types on state board online registries create confusion when recording state counts of LAc’s. Recognizing the variability within states will help state and national healthcare registries determine who is actively practicing, what training and techniques these acupuncture practitioners can offer, and help determine acupuncture workforce needs. This may lead to more standardized definitions and licensing of acupuncturists in the US.

P 01.15

A Complex Adaptive System (CAS) perspective of the placebo effect

Dr Lisa A Conboy MA MS ScD 1 , Dr Claire Cassidy PhD, LAc 2 , Tanuja Prasad 3

1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States

2 Georgetown University, Washington, DC, United States

3 ApplyComplexity LLC, New York, New York, United States

Purpose : Is the placebo effect universally documented across medical systems? Some medical systems, such as the Asian Medicines (AMs) Ayurveda and Chinese Medicine do not have the concept of placebo response or effect as a part of their medical model. Why might this be? A possible answer is that these systems use medical models that are complex and are better modeled using qualities of Complex Adaptive Systems (CAS). AM's interventions include placebogenic factors. Here the patient can be modeled as an intelligent system, capable of interacting with medicines but always interacting within their lived context. We know from high quality placebo research that contextual elements of the therapeutic encounter can be related to placebo rate (eg https://pmc.ncbi.nlm.nih.gov/articles/PMC2364862/ ). Good science also tells us that biological and social qualities of patients are related to variation in placebo rate ( https://pmc.ncbi.nlm.nih.gov/articles/PMC3479140/,https://pmc.ncbi.nlm.nih.gov/articles/PMC2814899/pdf/nihms154054.pdf ).

Method(s): We will review selected functions of CAS appropriate to the modeling of AMs and offer exemplar models using data from 2 RCTs of Acupuncture treatment for Irritable Bowel Syndrome, and Gulf War Illness.

Results : Use of CAS modeling can show new ways of understanding illness and healing that support Whole Person Health. Our model shows how placebo effects can be understood using complex modeling and how we can additionally understand placebo responses using CAS modeling.

Conclusions : Asian Medicine models are descriptive and analytical, embracing and including the many types of emergent changes that can happen when one intelligent system (the patient) interacts with a practitioner-guided perturbation (treatment). Placebo effect is often termed a Complementary Medicine by scientists as it appears to be affected by a set of mechanisms as of yet to be fully understood. Using a complexity lens may be the solution to a better understanding of the mechanisms and actions of placebo.

P 01.16

Examination of the Actual Status and Usefulness of Acupuncture Intervention as Palliative Care at Hiroshima University Hospital

Yoshihiro Tamura

Hiroshima University Hospital, Hiroshima, Hirohshima, Japan

Purpose : Acupuncture and moxibustion in palliative care have attracted attention as supportive therapies that alleviate distress and anxiety, reduce stress, and improve patients’ quality of life (QOL). However, few studies have examined their actual clinical use in university hospitals. This study aimed to analyze the current practice and clinical impact of acupuncture treatment at Hiroshima University Hospital.

Method(s): A retrospective analysis was conducted on patients referred to Kampo clinical center and Integrative Medicine for acupuncture treatment by the Palliative Care Team or related departments between June 2023 and March 2025.

Results : A total of 49 patients were included in the study. Acupuncture points were selected according to Kampo (traditional Japanese) diagnostic patterns and meridian theory. Contact needle therapy was primarily used, with moxibustion or massage added depending on the patient’s condition. Among the 49 cases, 47 were cancer patients and 2 were non-cancer patients. The main treatment purposes were fatigue (26.2%), pain (20.4%), loss of appetite (12.6%), nausea/abdominal distension (6.8%), numbness (5.8%), and edema (4.9%). Among the 18 cases with documented Performance Status (PS), moderate impairment (PS 2–3) accounted for 61.8%. Positive changes after treatment were recorded in 40 patients, including relaxation, improvement of gastrointestinal symptoms, and pain relief. Pain improved in 9 of 17 cases, and fatigue improved in 5 of 10 cases. Furthermore, during the acupuncturist’s intervention, patients often expressed unrecognized symptoms or emotions, which were subsequently shared among the medical team and contributed to improved quality of care. Each patient received 1–16 sessions, totaling 206 treatments, and no adverse events were observed.

Conclusions : Acupuncture and moxibustion therapy in palliative care contributed to relaxation, alleviation of gastrointestinal symptoms, and pain relief, suggesting improved QOL. Furthermore, communication during acupuncture sessions facilitated emotional expression and information sharing, leading to better integrated care. The findings support the usefulness and safety of acupuncture in palliative care settings.

P 01.17

Acupuncture Practice Patterns Within the University of California Health System

Dr. Michelle L Dossett MD, PhD, MPH , Dr. Tae Youn Kim PhD, RN

University of California, Davis, Sacramento, CA, United States

Purpose : Electronic health record data can potentially provide useful information regarding clinical care and practice patterns. We examined data from the University of California (UC) Health Data Warehouse on acupuncture care, involving five medical centers and affiliated clinics.

Method(s): Data was extracted for all encounters with at least one of four acupuncture procedure codes (CPT 97810, 97811, 97813, 97814) occurring between January 2013 and December 2022. Number of patients receiving acupuncture, patient demographics, insurance coverage, and medical conditions associated with acupuncture visits were examined to understand practice patterns across sites.

Results : A total of 35,627 unique patients received acupuncture across five UC-affiliated health systems, representing a total of 277,697 acupuncture procedures over the last 10 years. The average age of acupuncture recipients was 53 years (SD 17) and 69% of recipients were female. UC acupuncture clinics serve a diverse group of patients with 60% identifying as White, 5% Black, 11% Asian, 14% other, and 13% Hispanic. Insurance status at the time of clinic visits varied across the five UCs with the proportion of private insurance ranging from 49% to 80% and Medicare coverage from 10% to 41%. Total acupuncture volume steadily increased over the 10-year period except for a decrease in 2020. The average number of acupuncture procedures per patient ranged from 4 to 11 across different sites. The most prevalent medical problems were associated with musculoskeletal conditions (back pain, 63%; soft tissue disorders, 45%; pain not elsewhere classified, 44%; joint disorders, 39%; neck pain, 22%; and spondylosis, 6%). Other common diagnoses associated with acupuncture care were anxiety or stress related disorders (15%).

Conclusions : There is variability in acupuncture patient populations and practice patterns across the five UC health systems that offer acupuncture. The UC Health Data Warehouse is a useful tool to begin understanding the scope of acupuncture care across the sites.

P 01.18

A Decentralized, Confirmatory Trial of Acupuncture for Gulf War Illness: Protocol and Study Launch

Dr. Lisa J. Taylor-Swanson PhD, MAcOM 1 , Dr. Catherine Elmore PhD 1 , Ms. Kirsten Rauk BS 1 , Dr. Linnette Johnson DCN, CNS, LDN 1,2 , Dr. Jamie Villanueva DAOM 1,2 , Mr. Anthony Beal MAOM 1,2 , Dr. Lisa A. Conboy MA, MS, ScD 2

1 University of Utah, SLC, UT, United States

2 Beth Israel Deaconess Medical Center, Boston, MA, United States

Purpose : Gulf War Illness (GWI) is a Chronic Multi-symptom Illness (CMI) characterized by fatigue, sleep and mood disturbances, cognitive dysfunction, and musculoskeletal pain, affecting up to 43% of individuals deployed to the Gulf theater of operations. The CARE study is a Phase II confirmatory trial of Acupuncture Therapy (AT) for the treatment of GWI. The purpose of this paper is to outline the study design and methodological framework of the trial, with the goal of providing a model for future naturalistic AT trials targeting veteran populations.

Method(s): The CARE study is a pragmatic, randomized, decentralized trial (DCT) overseen by three institutions: the University of Utah, Beth Israel Deaconess Medical Center, Harvard, and the University of California, Berkeley. Approximately 220 participants and 30 Licensed Acupuncturists (L.Ac) will be enrolled across six sites. Veterans will receive acupuncture tailored to their individual presentation. Primary outcomes are the 36-item Short Form Health Survey (SF-36) and the McGill Pain Scale. Secondary outcomes include fatigue, mood, sleep, anxiety, depression, social support and networks, stress, autonomic symptoms (HRV), interoception, cognition, patient-reported expectations, therapeutic alliance, and blood-based biomarkers. This whole-person measurement toolkit investigates multiple, potentially synergistic, markers of change. Linear mixed-effects regression models will compare primary outcomes between groups at six months.

Results : We have recruited LAcs in states with a high density of Veterans with GWI: FL, TX, WA, VA, CO and CA. Fifteen L.Acs have been recruited. This study is ongoing.

Conclusions : The primary objective of this research is to confirm AT for managing symptoms of GWI. Data will be collected using a whole-person health framework, which may contribute to a better understanding of the physiological and psychological impacts of GWI and the development of novel biomarkers to improve diagnostics and therapeutic treatments. Results from this study might also bolster the presence and availability of AT in veteran health settings.

P 01.19

Characteristics of Gulf War Illness Participants in an Acupuncture Study

Kai-Yin Hsu NP, MAOM 1 , Joe Chang PA, MAOM 2 , Beth Ann Schmidt M.Ac 3 , Anthony Beal MAOM 4 , Dr. Lisa Taylor-Swanson PhD, MAcOM 5 , Dr. Lisa Conboy Sc.D, MA, MS 4

1 Tufts Medical Center, Boston, MA, United States

2 Inspire Santa Fe Medical Group, Santa Fe, NM, United States

3 New England School of Acupuncture, Worceseter, MA, United States

4 Beth Israel Deaconess Medical Center, Boston, MA, United States

5 Universtiy of Utah, Salt Lake City, UT, United States

Purpose : Gulf War (GW) veterans report significantly more nonspecific multiple complex medical symptoms, including fatigue, sleep and mood disturbances, cognitive dysfunction, and musculoskeletal pain.

Method(s): Data was collected from a pragmatic RCT to test the effects of individualized acupuncture treatments for GWI. Baseline characteristics reported by veterans of the GW living with Gulf War Illness (GWI) were analyzed. This report focuses on sociodemographic characteristics, the SF-36 physical component scale score (SF-36P), and the McGill Pain scale at baseline.

Results : One hundred and four subjects underwent randomization. Mean age was 48.2 years old, 13% were female. Self-reported race: 80.8% White, 9.6% Black/African-American, 0.9% Asian, 0.9% American-Indian/Alaska Native, 1.9% multi-race, and 5.9% Other. Over one third of participants indicated a current diagnosis of anxiety (36%), depression (35%) and PTSD (33%). Other diagnoses included sleep apnea (28%), Chronic Fatigue Syndrome (CFS) (28%), Gastroesophageal reflux (19%), Irritable Bowel Syndrome (13%), Fibromyalgia (9%), Other diagnoses (7%) and Interstitial Cystitis (1%). Types of diseases experienced by participants were queried using a list of ICD-10 codes. The clusters of disease types are musculoskeletal disease (75%), unclassified (51%) and mental/neural (31%). Mean SF-36 score was 67.73 ( σ 23.48).

Conclusions : Gulf War Veterans diagnosed with GWI report many symptoms and diagnoses which may be influenced by toxic exposure during military service. Increased mental health conditions such as depression, anxiety, and PTSD were identified in this sample, as well as physical conditions of CFS. Further research is needed to identify and test safe and effective interventions for symptoms and conditions experienced by GW veterans.

P 01.20

Treating Autoimmune and Multi Autoimmune Syndrome through acupuncture and herbal medicine addressing dysregulated emotions, PTSD, and sustained stress, using Western biomedical research to inform treatment

Dr. Eugene L Mahoney DAHM 1 , Dr. Lisa Conboy 1 , Dr. Heather Zwickey 2

1 SIEAM, Seattle, WA, United States

2 Helfgott Institute, Portland, OR, United States

Purpose : This study examines how unresolved psycho-emotional trauma and immune dysregulation co-contribute to autoimmune disease and explores acupuncture as an integrative intervention targeting both immunological and emotional healing. While Western research implicates elevated cytokines (e.g. IL-6, TNF-α) and Treg/Th17 imbalance in chronic autoimmune progression, Chinese medicine traditions link emotional stagnation (anger, grief, fear) to qi disruption and disease. The objective is to present a trauma-informed model by which acupuncture may restore both immune homeostasis and psycho-emotional resilience.

Method(s): We conducted a comprehensive integrative review synthesizing (1) biomedical studies on trauma, cytokine pathways, Treg/Th17 dynamics, and gut microbiota; (2) classical Chinese medical texts (e.g. Nei Jing, Ling Shu); and (3) clinical acupuncture literature, including protocols such as the Eight Extraordinary Vessels, NADA auricular approach, electroacupuncture, and adjunct herbal and dietary strategies. A trauma-informed lens was applied to map emotional states (e.g. ACEs, threat-response mapping) onto acupuncture intervention design. In addition, clinical practice experience and a detailed case study were reviewed to illustrate real-world applications of these integrative approaches in managing autoimmune and psycho-emotional conditions.

Results : Converging evidence supports that acupuncture modulates immune function (reducing pro-inflammatory cytokines, rebalancing Treg/Th17, improving gut barrier integrity) while alleviating anxiety, depression, and trauma symptoms. Auricular and 8 extraordinary vessel-based protocols appear to reduce hyperarousal and support emotional regulation. Herbal and nutritional co-interventions further support mucosal health and regulatory immune signaling. Together these suggest a dual path of effect: emotional resolution enabling immune restoration, and immunological balance fostering psycho-emotional stability.

Conclusions : Autoimmune conditions are not purely biochemical; unprocessed trauma and emotional dysregulation are core to their persistence. Acupuncture represents a unique therapy bridging body and psyche, modulating immune pathways while facilitating emotional healing. An integrative protocol combining acupuncture, herbal support, nutrition, and trauma-informed assessment offers a promising pathway toward sustained remission. Future clinical trials should concurrently measure immunologic biomarkers and psychosocial outcomes to validate this whole-person model in integrative medicine.

P 01.21

Exploring pain and other clinical outcomes associated with acupuncture: analysis of clinical registry and case report data

Dr. Kathleen Lumiere DAOM, MS 1,2 , Dr. Lisa J Taylor-Swanson PhD 3

1 SIEAM, Seattle, WA, United States

2 Bastyr University, Kenmore, WA, United States

3 University of Utah, Salt Lake City, UT, United States

Purpose : Traditional East Asian Medicine (TEAM), particularly acupuncture, is widely practiced but often studied using methods that underrepresent its complexity. Pragmatic observational designs may better reflect real-world outcomes. This study, part of the international Pragmatic Data Analysis Project, evaluated patient outcomes for pain and global health using registry and case report data, reflecting the experience of patients and practitioners.

Method(s): Data were drawn from the ACU-Track Clinical Registry (n=221) and Convergent Points case reports (n=12), covering January 2021–November 2024. Inclusion criteria required baseline pain scores and TEAM treatment. Patient-reported outcome measures included combined pain scores (NPRS, VAS, PROMIS Pain), PROMIS-10 global health, and PGIC. Analyses employed descriptive statistics, paired t-tests, and correlation analyses (Pearson’s and Spearman’s), with significance set at p<0.05. Minimally clinically important difference (MCID) thresholds were applied to assess clinical significance.

Results : A total of 233 patients (62% female; mean age 53.5±16.7) were analyzed. Significant reductions in pain were observed: 29.3% at week 2 (p<0.0001), 44.1% at week 6 (p<0.0001), and 38.8% at 1 year (p=0.02). PROMIS global health scores improved 27.2% at week 6 (p<0.001) and 35.2% at month 9 (p<0.001). PGIC indicated ≥MCID improvement in 87.9% of patients. Moderate but significant correlations between PROMIS, PGIC, and pain outcomes underscore the reliability of patient-reported measures.

Conclusions : Patients receiving acupuncture experienced meaningful and lasting reductions in pain and improvements in global health, with benefits persisting up to one year. The convergence of PROMIS, PGIC, and pain outcomes supports the reliability of observed changes. While limited by attrition and lack of controls, these findings demonstrate the value of pragmatic data for evaluating TEAM therapies and contribute to evidence-based, patient-centered approaches for chronic pain management. Future work will refine analytic methods.

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Acupuncture Embedded in Primary Care: Real-World Outcomes from One of the Largest Reported FQHC-Based Acupuncture Cohorts

Lili Qiao DAOM, MHA , Alan Li MPH

North East Medical Services, San Francisco, CA, United States

Purpose : Federally Qualified Health Centers (FQHCs) serve aging and medically underserved populations, yet real-world evidence on acupuncture embedded in primary care remains limited. This study evaluated pain and quality-of-life outcomes and identified predictors of response among patients receiving acupuncture through the Integrative Medicine (IM) department at Northeast Medical Services (NEMS), an FQHC serving predominantly low-income, publicly insured Asian and immigrant communities in Northern California, United States.

Method(s): We conducted a retrospective observational analysis of de-identified longitudinal data internally abstracted from the Epic electronic health record system. The NEMS IM acupuncture program operates across 10 clinical sites (6 in San Francisco County, 2 in San Mateo County, and 2 in Santa Clara County). Patients receiving acupuncture for back pain (n=2,304), shoulder pain (n=1,418), or quality-of-life (QOL) concerns (n=2,568) between January 2024 and December 2025 were included. Analyses were restricted to patients with ≥6 visits for pain conditions or ≥2 QOL assessments. QOL was measured using a multilingual 10-item subset of the WHOQOL-BREF focused on physical and emotional domains; non-clinical domains were excluded. Mixed-effects models adjusted for baseline severity, demographics, comorbidities, visit frequency, and insurance payer. Final analyses were completed by December 31, 2025.

Results : Significant improvements were observed across all conditions (p<.0001). Mean back pain scores decreased from 5.09 to 4.30, shoulder pain scores from 4.99 to 4.03, and QOL scores increased from 40.73 to 43.90. Higher baseline severity and greater visit frequency predicted stronger improvement. Insurance payer type was not associated with outcomes.

Conclusions : In a large, multi-site FQHC acupuncture program embedded in primary care, acupuncture was associated with meaningful improvements in pain and quality of life. These findings support acupuncture as a scalable, preventive, and cost-conscious approach to chronic pain management in aging populations and justify broader implementation across safety-net health systems.

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Acupuncture to Improve Outcomes in Sepsis Patient: The ACTIONS trial

Sarah El Iskandarani MD 1 , Azziza Ahdoot MA 2 , Susan Q Li MS 3 , Raymond Baser MS 3 , Jun J Mao MD, MSCE 3 , Shaista Malik MD, PhD, MPH 4 , Alpesh Amin MD, MBA 4 , Gary Deng MD, PhD 4

1 Harvard Medical School, Cambridge, MA, United States

2 Lake Erie College of Osteopathic Medicine, Erie, PA, United States

3 Memorial Sloan Kettering Cancer Center, New York, NY, United States

4 University of California Irvine, Irvine, CA, United States

Purpose : Sepsis is a leading cause of death among hospitalized patients, costing around 270,000 lives and more than $24 billion per year in the US. Acupuncture has been shown to reduce mortality in sepsis animal models via neuroimmune modulatory mechanisms. However, human trials with sham control are lacking. We conducted a first-of-a-kind randomized sham-controlled acupuncture trial evaluating acupuncture as an early intervention to prevent clinical deterioration of sepsis patients.

Method(s): Patients hospitalized in general wards showing signs of emerging sepsis were randomized to true or sham electroacupuncture at bilateral ST-36 acupoints once daily for up to 10 days, or until ICU admission, death, or discharge, whichever occurred first. Feasibility (recruitment, attrition, delivery of interventions, and data completion) and clinical outcomes were evaluated on day 30.

Results : Forty patients were enrolled over 10 months, meeting the target recruitment rate. Two withdrew from the study. All patients provided clinical outcome endpoints. ICU admission rates within 30 days were 1/20 in the true acupuncture group and 5/20 in the sham acupuncture group (5% vs 25%; absolute risk reduction of 20%; (80%CI: -39%, -1%)), meeting a priori criteria deeming a larger trial being warranted. Mortality within 30 days was 2/20 vs 3/20. By day 30, hospital stays of all 20 patients totaled 198 days in the true acupuncture group (235 days in the sham group). Total number of ICU days were 6 in the acupuncture group and 33 in the sham group. No clinically significant adverse events were reported.

Conclusions : Conducting a randomized sham-controlled acupuncture trial in a fast-paced inpatient sepsis clinical setting is feasible. A signal toward reduction of clinical deterioration to ICU care was observed. Number of ICU days was also reduced. Acupuncture holds promise as a safe, inexpensive, non-pharmacological, and scalable adjunctive therapy in the management of sepsis.

Topic Area 02: Group Medical Visits

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Integrative Medicine Group Medical Visits for perimenopause and menopause. One solution for unmet needs

Dr. Debra G Bell MD

University of Washington, Osher Center for Integrative health, Washington, United States

Purpose : Driven by rising awareness and unmet needs in conventional care models, there is increasing public demand for effective care during perimenopause and menopause, Scientific literature highlights this gap and calls for improved approaches to managing menopausal symptoms. Offering group medical visits (GMVs) incorporating integrative medicine principles, can be a valuable approach to care for navigating these hormonal transitions. The GMVs, combine medical guidance, peer support, and integrative therapies to improve health outcomes during this life stage.

Method(s): A four-session GMV series using an integrative framework. Sessions were interactive, combining didactic teaching, experiential practices and peer support. Topics addressed included hormonal and non-hormonal treatments, nutrition, sleep, sexual health, and stress reduction. The Menopause Rating Scale was administered pre- and post-program. Qualitative data was collected to evaluate the experience.

Results : Preliminary results are based on the first of 4 cohorts of participants. The initial analysis demonstrates high satisfaction with the group format, valuing both medical insights and peer support. Qualitative feedback highlighted appreciation for the integrative approach, the opportunity to share experiences, and practical strategies for navigating this time of transition. Attendance and engagement remained strong throughout the four sessions, reinforcing the relevance of this model. Quantitative data showed improvement in MRS score in the majority of the participants. Complete results of the four cohorts will be available for presentation.

Conclusions : Group medical visits using an integrative medicine approach, offer a powerful, scalable model to support women through perimenopause and menopause. The approach addresses both the foundational components of health, and the complex symptoms experienced during this life stage. Participants gain not only symptom relief but also empowerment through education, shared experiences, and the cultivation of self-efficacy. As demand for menopause care grows this model offers a timely, effective response to a long-overlooked aspect of women’s health.

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“On a Pain Island”: Social Withdrawal and Quality of Life in People with Chronic Pain in Safety Net Primary Care

Nina Djukic MS 1,2,3 , Ariana Thompson-Lastad PhD 1 , Jhia Jackson 1 , Wendy Hartogensis PhD, MPH 1 , Denise Ruvalcaba 1 , Evelyn Garcia 1 , Julia Wu 1 , Samuel Solis 1 , Pamela Swedlow 4 , Jesse Wennik 4 , Maria T Chao DrPH, MPA 1

1 Osher Center for Integrative Health, University of California, San Francisco (UCSF), San Francisco, CA, United States

2 School of Medicine, University of California – San Francisco (UCSF), San Francisco, CA, United States

3 oint Medical Program, University of California – Berkeley, University of California – San Francisco (UCSF), Berkeley, CA, United States

4 San Francisco Department of Public Health, San Francisco, CA, United States

Purpose : Individuals living with chronic pain commonly experience stigma, including internalized stigma, an individual-level process of identity devaluation endorsed by >one-third of people with chronic pain. This includes social withdrawal, the avoidance of social contact and support. We explored pain-related stigma, social withdrawal, and quality of life among low-income, racially diverse individuals.

Method(s): We piloted a randomized trial of group-based integrative medicine among primary care safety- net patients with ≥3 months of chronic pain. Here we report mixed methods data from baseline surveys and semi-structured interviews at 3-month follow-up. Surveys included demographics, Internalized Stigma in Chronic Pain scale, Social Support and Pain Questionnaire, and quality of life (NIH PROMIS measures of global physical and mental health). We calculated descriptive statistics and Pearson’s correlation coefficient (r), and used abductive flexible coding for interview data.

Results : Participants (n=47) were all low-income, majority female (68%), mean age=57 (SD=15); 19% African American/Black, 55% Latine, 19% non-Latine White, and 4% ≥1 race. Participants had long-term, severe pain (mean pain duration=12.9y [SD=9.6], pain-intensity=7.7 [SD=1.5]). Average PROMIS Global Physical and Mental Health T-scores were >1 SD below U.S. population mean. Internalized stigma was negatively correlated with global physical health (r=-0.31, p=0.049), global mental health (r= -0.32, p=0.041), social functioning (r=-0.40, p=0.010), and pain-relevant social support (r=-0.43, p=0.0060). Social withdrawal was significantly negatively correlated with global physical health (r=-0.32, p=0.029) and social functioning (r=-0.33, p=0.026). Qualitatively, people described complex and bidirectional relationships between social withdrawal, social support, and quality of life.

Conclusions : Social withdrawal as a form of internalized stigma profoundly impacts the quality of life of low-income people with chronic pain. Interventions, such as Integrative Group Medical Visits (IGMVs), may improve chronic pain management in the safety net setting by addressing social withdrawal/internalized stigma along with pain-related outcomes.

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A Novel Whole-Person Pain Care Group Medical Visit and Community Workshop Training Program: Assessment of Individual and Organizational Growth

Dr Kate G Shafto MD 1,2 , Catherine Justice DPT 1 , Jadyn Knox BS 3 , Dr Susan Haddow MD 1 , Jacinta Rebang MPH 1 , Carrie Howard MA 4 , Lindsay Roberts MA 4 , Dr Arti Prasad MD 1

1 Hennepin Healthcare, Minneapolis, MN, United States

2 Bakken Center for Spirituality and Healing, Minneaoplis, MN, United States

3 Hennepin Healthcare Research Institute, Minneapolis, MN, United States

4 Stratis Health, Bloomington, MN, United States

Purpose : Chronic pain is highly prevalent, and Integrative Group Medical Visits (IGMVs) are an evidence-based model to improve access to non-pharmacological, whole-person pain care. Community workshop models further expand access. Literature on the impact of training in these models is limited. The Center for Teaching, Learning, and Coordination–Heals on Wheels (TLC-HoW) training program for IGMVs and community workshop implementation assessed participants’ individual and organizational-level growth.

Method(s): TLC-HoW partnered with clinical teams from two Minnesota healthcare organizations who participated in a 10-week/20-hour virtual training on whole-person, non-pharmacological pain care IGMV and community workshop implementation. Each clinic conducted two community-based workshops and an 8-week IGMV series. Individual growth was assessed using a 7-item Knowledge (range 0-6), Skills (range 0-9), and Attitudes (range 0-6) (KSA) questionnaire, administered pre-, mid-, and post-training, and 6-month follow-up. Organizational-level change was assessed through structured qualitative interviews with a 4-category maturity matrix (range 1-5) before and after program implementation.

Results : Average KSA scores (n=7) improved in Knowledge (+3.29), Skills (+3.86) and Attitudes (+0.57) from baseline to post-training with sustained improvement at 6-months. Average maturity matrix baseline scores for Foundational Capacity (3.38), Internal Processes (2.75), External Partnerships (2.75), and Sustainability (2.50) improved to 4.38 (+1.00), 4.08 (+1.33), 5.00 (+2.25), and 3.33 (+0.83), respectively. One clinic, in a larger health system, demonstrated substantial growth in External Partnerships, moving from 1.50 to 5.00 (+3.50), while Sustainability improved from 1.67 to 2.33 (+0.66). In the other, a smaller private practice, Sustainability moved from 3.33 to 4.33 (+1.0), with a 4.46 average across all categories.

Conclusions : The TLC-HoW program successfully trained clinical teams and advanced organizational capacity for integrative pain care, community engagement, and IGMV implementation and sustainability. Private clinics may have more flexibility in implementation and sustainability than larger organizations. The TLC-HoW program serves as a successful, scalable model for advancing holistic pain care.

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Integrative Group Medical Visit with Chair Yoga for Patients with Chronic Health Conditions

Paula Paula Gardiner 1 , Dr Richa Gawande Phd 1 , Julia Naganuma-Carreras 2

1 Cambridge Health Alliance, Cambridge, MA, United States

2 Harvard School of Public Health, Boston, MA, United States

Purpose : Little is known about the feasibility of implementing mind-body practices into an insurance-reimbursable Group Medical Visit (MY-GMV) to support at a community health center. We report on preliminary implementation feasibility, acceptability, and patient ideas for shaping the intervention.

Method(s): The Mandela Yoga Project (MYP) developed a peer-led yoga program. We conducted two pilots of a 6-week Mandela Yoga (MY) intervention integrated into a primary care group medical visit (GMV). Adult participants with chronic conditions were recruited via flyer, physician visits and messages. Feasibility, acceptability and feedback were assessed through attendance, surveys, and focus groups.

Results : Groups took place between Fall 2024 and Fall 2025. Adults (n=29) average 53 years old (SD=13), spoke English (n=21), Portuguese (n=6), and Spanish (n=3); half (55%) were POC. Among the 29, 21 (72%) attended >=3 sessions; insurance was billed for all visits; Of 29, 15/15 (100%) respondents would recommend a friend/family. Focus group themes included reduced pain/stress, value of breathwork, suggestions for accessibility, and benefits of the group including reducing isolation and hearing other people’s perspective and chronic pain. Participants also found benefit with having a clinician in the group who could provide medical care as well.

Conclusions : Yoga combined with a group medical visit was acceptable and feasible for primary care patients with chronic conditions. Future improvements include language access and recruitment, and cost effectiveness. Culturally resonant, community-rooted programs like MY-GMV could be a low-cost intervention in health centers.

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Initiation of Community Workshops and Group Medical Visits for Chronic Pain at Three Clinical Sites Across Minnesota

Jadyn Knox MA 1 , Catherine Justice DPT, C-IAYT, FAIMH 2 , Katherine Shafto MD, ABOIM 2,3 , Susan Haddow MD, IFMCP, ABOIM 2 , Jacinta Rebang MPH, PMP 2 , Arti Prasad MD, FACP 2

1 Hennepin Healthcare Research Institute, Minneapolis, MN, United States

2 Hennepin Healthcare Systems, Inc., Minneapolis, MN, United States

3 University of Minnesota - Bakken Center for Spirituality and Healing, Minneapolis, MN, United States

Purpose : Chronic pain is prevalent, while access to non-pharmacological, whole-person pain care is limited. Integrative approaches to pain management, delivered in a Group Medical Visit (GMV) model and community outreach improves access to whole-person care. However, utilization of these models is limited. The Center for Teaching, Learning, and Coordination–Heals on Wheels (TLC-HoW) program assessed implementation and delivery of GMVs and community workshops within three Minnesota regions.

Method(s): After undergoing training in the TLC-HoW model, clinical teams from three Minnesota healthcare organizations designed/developed, implemented, and facilitated pain-focused 8-visit GMV series and community workshops. Outcomes include: workshop and GMV attendance and GMV participant demographics, PROMIS-29 (pre- and post- GMV series), and a 1-item Global Impression of Change survey (post-GMV series), asking participants to reflect on their changes in well-being, with responses ranging from “very much worse” (-3) to “very much improved” (3).

Results : A total of 8 Community workshops reached 202 individuals with information and experiences of various integrative health practices, and 5 GMV series enrolled 58 participants. Across sites, 72.4% of participants attended ≥ 5 visits and 29.3% of participants attended all 8 visits. Participants identified as Black (17.2%), White (69.0%), Multiple Races (3.4%), Unknown (10.3%), and 3.4% identified as Hispanic. Participants identified as women (69.0%) and men (31.0%). Participant ages ranged from 26 to 82 across two clinical sites, with one serving 18- to 24-year-olds. Average baseline PROMIS-29 Physical and Mental Health Summary Scores were 37.4 and 39.6, which improved to 37.8 (+0.4) and 41.0 (+1.4), respectively. Participants' average rating of Global Impression of Change was +1.3, suggesting improved well-being after GMV participation.

Conclusions : The TLC-HoW program successfully initiated pain-focused GMV series and community workshops. Improvements in well-being and high attendance across varied regions and ages suggest the feasibility and utility of this model.

Topic Area 03: Health Coaching

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Expanding the Integrative Health Coaching Model: Coach Reflections on Delivering Care to Adults with Intellectual and Developmental Disabilities

Dr. Alyssa M Smith PhD 1 , Dr. Patricia Prelock PhD 1 , Sarah Pettineo BS 2 , Sydney Daniels BS 2 , Stasha Medeiros MS 2 , Dr. Karen Westervelt PhD 2

1 University of Arizona, Tucson, AZ, United States

2 University of Vermont, Burlington, VT, United States

Purpose : Adults with intellectual and developmental disabilities (IDD) experience significant health disparities and limited access to tailored wellness interventions. Integrative Health and Wellness Coaching (IHWC) offers a promising, person-centered model for supporting health behavior change, yet few studies address its adaptation for neurodiverse populations. This study explored how trained coaches delivering IHWC to adults with IDD perceived, adapted, and reflected on the coaching process to enhance accessibility, accessibility, and inclusivity.

Method(s): Four coaches participated in a six-week virtual IHWC program for adults with IDD. Following program completion coaches engaged in focus groups or interviews exploring preparedness, challenges, and recommendations for practice. Transcripts were analyzed using reflexive thematic analysis emphasizing experiential learning and adaptation processes. Themes were collaboratively developed to capture how coaches balanced intervention fidelity with individualized support and developed strategies for disability-affirming coaching implementation.

Results : Four themes were identified: (1) evolving confidence and preparedness through direct experience, (2) adapting communication and pacing to diverse needs, (3) balancing fidelity with flexible, client-centered modifications, and (4) reflection and growth through experiential learning. Coaches identified the need for structured disability training, peer supervision, and reflective debriefing to strengthen competency. Adaptations included visual aids, simplified language, and explicit goal scaffolding to enhance participant engagement and autonomy in the IHWC process.

Conclusions : Delivering IHWC to individuals with IDD requires adaptive communication, reflective practice, and flexible fidelity to core coaching principles while customizing approaches for accessibility. Findings underscore the need for neurodiversity-affirming training and supervision within the integrative health workforce. Incorporating experiential mentorship and co-learning models may advance health equity by preparing coaches to effectively engage neurodiverse populations and expand access to holistic, person-centered wellness interventions across integrative health settings.

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Relationship Between Exercise Counseling and Mental Health Outcomes in Asian Americans With Chronic Pain: A Retrospective Cohort Study

Jason Guo BS , Nathan Vu Pham BS, Dr Weijun Zhang DrPH

David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States

Purpose : Chronic pain is often comorbid with mental health conditions such as depression, anxiety, suicidal ideation, and sleep disturbance, contributing to poor quality of life. Among Asian Americans, mental health challenges are compounded by cultural stigma, language barriers, and low engagement with psychiatric services. Exercise counseling may offer a culturally acceptable, non-pharmacologic adjunct for improving mental health. This study examines whether exercise counseling is associated with improved mental health outcomes in Asian American adults with chronic pain.

Method(s): We conducted a retrospective cohort study using TriNetx electronic health records from 2010-2024. Asian American patients aged 18 and over with a diagnosis of chronic pain were included. Two cohorts were identified: (1) patients who received documented exercise counseling at least a month after diagnosis, and (2) propensity score-matched controls without exercise counseling, matched 1:1 on age and sex. Mental health outcomes including anxiety, suicidal ideation, mild/moderate depression, severe depression, and insomnia were compared using risk ratios.

Results : A total of 4,210 patients were included (2,105 in each cohort). Exercise counseling was associated with 50% reduced risk of suicidal ideation (RR=0.50, 95% CI: 0.27–0.95, p = 0.031), 32% reduced risk of mild/moderate depression (RR=0.68, 95% CI: 0.50–0.93, p = 0.014), 50% reduced risk of severe depression (RR=0.50, 95% CI: 0.28–0.90, p = 0.017), and 25% reduced risk of insomnia (RR=0.75, 95% CI: 0.58–0.98, p = 0.033). No significant association was observed for anxiety.

Conclusions : Exercise counseling is associated with significantly improved mental health outcomes, particularly lower rates of suicidal ideation, depression, and insomnia in Asian American adults with chronic pain. These findings highlight the potential role of culturally sensitive, non-pharmacologic interventions (exercise counseling) as an adjuvant to improve mental health outcomes in patients with chronic pain.

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Impact of Health and Wellness Coaching on COPD-related hospitalizations: Findings of a Large Database Study

Dr Ekaterina Anderson PhD 1,2 , Dr Renda Wiener MD, MPH 3,4,5 , Alexandre Vilela Braga MS 1 , Makayla Dones BA 1 , Dr Seppo Rinne MD, PhD 1,6 , Dr Marla Clayman PhD, MPH 1,2 , Dr Justeen Hyde PhD 1,4 , Dr Christian Helfrich PhD, MPH 7 , Dr Barbara Bokhour PhD 1,2 , Dr Steven Zeliadt PhD, MPH 8,7

1 VA Center for Health Optimization & Implementation Research (CHOIR), Bedford, MA, United States

2 University of Massachusetts Chan Medical School, Worcester, MA, United States

3 VA Center for Health Optimization & Implementation Research (CHOIR), Boston, MA, United States

4 Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States

5 Boston University Pulmonary Center, Boston, MA, United States

6 Dartmouth Hitchcock Medical Center, Lebanon, NH, United States

7 University of Washington, Seattle, WA, United States

8 VA Center for Veteran-Centered and Value-Driven Care, Seattle, WA, United States

Purpose : Health & Wellness Coaching (‘coaching’) is a promising person-centered intervention wherein a trained professional supports the setting and achieving of health and well-being goals in line with the client’s values and priorities. This practice is well-positioned to empower and engage patients to manage their health, especially chronic conditions. We sought to assess the relationship between coaching and hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (COPD) among patients receiving care at Veterans Health Administration (VA) facilities.

Method(s): Using administrative data, we built a national cohort of patients with COPD receiving VA care during 2021-2023. Retained in this analysis are those with >=2 coaching sessions during the study period (n=8,632) and those with none (340,452); we excluded single-session users. A Cox proportional hazard regression model, which included demographic and clinical covariates, was constructed to compare time to hospitalization, starting from last coaching session for coaching users and adjusted index date for non-users (tracked through 2024).

Results : 11.1% of coaching users and 8.6% of non-users experienced a hospitalization during the follow-up period. At 1 year, 95.3% of non-users remained hospitalization-free (95% CI: 95.29%-95.44%), compared to 93.4% of users (95% CI: 92.92%-93.99%). In adjusted analyses, coaching users still had a higher hazard of hospitalization than non-users (hazard ratio: 1.28; p<0.001).

Conclusions : Unlike prior studies, coaching did not lead to a reduced hazard of being hospitalized for COPD-related exacerbations among VA patients. Notably, however, prior interventions were delivered by clinicians and/or incorporated a prominent health education component, which differs from VA’s coaching and may explain the divergence in findings. Alternatively, our analyses may have insufficiently accounted for the more complex health needs of coaching users compared to non-users (identified in our prior work). Our findings highlight the importance of terminological clarity and the need to establish whether and how different forms of coaching affect clinical outcomes.

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Models for Integrating Health and Wellness Coaches into Healthcare Teams to Optimize Patient Care

Dr. Sophia M. Bartels 1 , Dr. Ekaterina Anderson 1 , Dr. Kelly Dvorin 1 , Dr. Kimberlee Flike 1,2 , Matthew B. Martel 1 , Zenith Rai 1 , Dr. Justeen K. Hyde 1,3

1 Center for Health Optimization and Implementation Research, Bedford VA, Bedford, MA, United States

2 Solomont School of Nursing, UMass Lowell, Lowell, MA, United States

3 General Internal Medicine, Boston University, Boston, MA, United States

Purpose : Health and Wellness Coaching is designed to help patients identify and pursue health and well-being goals aligned with what matters most to them. With team-based approaches being optimal for patient and healthcare system impact, there is growing need to identify determinants of and models for effective collaboration between coaches and other healthcare professionals. We highlight findings from a qualitative study examining models and determinants of coach integration into healthcare teams.

Method(s): As part of a quality improvement project evaluating Health and Wellness coaching implementation within the Veterans Health Administration (VHA), we identified five VHA sites whose coaches reported high healthcare team integration and work satisfaction. Within these sites, we conducted interviews with 21 coaches and 7 coach supervisors. Transcripts were coded in Atlas.ti and analyzed using thematic analysis.

Results : We identified six models of coach-healthcare team collaboration, listed from least to most integrated: 1) minimal coach-provider interaction (i.e., providers learning about coaching from Veterans, if at all); 2) coaches co-signing notes and receiving/providing warm handoffs; 3) coaches joining team huddles; 4) integration of coaching into diagnosis-based intervention teams; 5) leading initiatives together (e.g., Whole Health classes); and 6) fully coordinated care. The most common collaboration determinant was coaches’ co-location within clinics. Barriers included lack of provider buy-in for coaching, providers’ lack of time for collaboration with coaches or learning about coaching, and discordance between the patient-driven nature of coaching and directive care. Facilitators included demonstrating the value of coaching, leadership buy-in for coaching, coach supervisor support for integration, relationship-building with providers, and coaching certification, which increased perceptions of coach credibility.

Conclusions : These findings illustrate different models for collaboration between coaches and healthcare teams and highlight factors that support and hinder collaboration. Greater integration of coaches in care teams at scale has the potential to improve care coordination and patients’ overall health and well-being.

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Navigating the Health and Wellness Coaching Process: Strong Practices from the VA Healthcare System

Dr Ekaterina Anderson PhD 1,2 , Dr Sophia Bartels PhD, MSPH 1 , Dr Kimberlee Flike PhD, MSN, RN 3,1 , Dr Kelly Dvorin PsyD 1 , Zenith Rai MPH 1 , Matthew Martel BS 1 , Dr Justeen Hyde PhD 1,4

1 VA Center for Health Optimization & Implementation Research (CHOIR), Bedford, MA, United States

2 University of Massachusetts Chan Medical School, Worcester, MA, United States

3 University of Massachusetts Lowell, Lowell, MA, United States

4 Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States

Purpose : Health & wellness coaching is a person-centered, holistic intervention that empowers clients to set and achieve personally meaningful health and well-being goals. How Coaches assist clients in successfully navigating the coaching process in practice is still insufficiently understood. The Veterans Health Administration (VA) has built a robust coaching workforce as part of its Whole Health system of care. We sought to understand techniques that VA’s Coaches use to steer veterans through the phases of coaching.

Method(s): As part of a quality improvement mixed-methods evaluation, we conducted interviews with Coaches (n=21) and Coach supervisors (n=7) across 5 VA sites. Interview transcripts were coded in a qualitative analysis software and analyzed using content analysis.

Results : VA’s Coaches have a versatile arsenal of techniques for traversing the coaching phases. Viewing the early self-assessment stage as the cornerstone of the coaching process, Coaches prioritize the crafting of trusting relationships and tailor their approach to each client’s readiness for change. When facilitating goal setting, Coaches create opportunities for confidence-building via small, achievable steps; they also ensure the fit of goals to each veteran’s life context. To help veterans stay focused, motivated, and empowered to address barriers, Coaches utilize positive reinforcement, non-judgmental curiosity, and reflective listening. Use of these techniques is influenced by Coaches’ experience, personality, and organizational context (e.g., availability of high-quality supervision, coaching duration restrictions).

Conclusions : VA’s Coaches draw on a vast set of tools to help veterans move through the coaching process. There are opportunities to scale up these strong practices in VA and other health systems alike. Our findings highlight the great deal of contextual awareness, adaptability, and relational acumen that coaching requires, which speaks to the importance of continued professional development and robust supervision. Further, organizational structures and policies ought to allow Coaches the flexibility needed to effectively support veterans’ pursuit of goals.

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A Whole Health Approach to Physical Activity Promotion for People with Arthritis

Dr Karen Westervelt PT, ATC, PhD, NBC-HWC 1,2 , Mr Jake Brown BS 1,2 , Dr Gail L Rose PhD 1,2

1 University of Vermont, Burlington, VT, United States

2 Osher Center for Integrative Health at UVM, Burlington, VT, United States

Purpose : Arthritis affects 1 in 5 US adults - about 54 million people - and is the leading cause of work disability. Despite guidelines recommending 150 minutes of moderate aerobic exercise and two resistance sessions weekly, fewer than half of adults with arthritis meet these recommendations. To promote physical activity, the Arthritis Foundation offers the Walk With Ease (AFWWE) 6-week, self-directed walking program. At University of Vermont (UVM), we piloted a version combining AFWWE with Integrative Health and Wellness Coaching (IHWC), an evidence-based approach that supports sustained behavior change through collaborative, goal-oriented relationships. Students from our IHWC accredited training program, supervised by board-certified faculty, provide coaching. A previous evaluation of this IHWC model showed improved behavior change that was maintained for 12 weeks. Now, we are scaling this model to a community-level program for people with a common chronic condition. Our purpose is to share feasibility and preliminary walking outcomes.

Method(s): Participants received the AFWWE guidebook and motivational emails. At registration, they could opt to add weekly remote student coaching. Post-program and 6-week follow-up surveys obtained demographics, arthritis status, disability, exercise behaviors, and satisfaction.

Results : Fifty-eight individuals registered for UVM WWE (mean age 63; 88% female); 70% reported arthritis, 23% a disability. Thirty-nine began the program; 31 participants (79%) chose coaching. Seventeen completed the post-program survey. Participants reported a median of 4 exercise days/ week for 30–39 minutes/session, and 82% were confident they would continue being active. All expressed satisfaction with coaching, citing improved motivation and mood. At 6-week follow-up (n = 18), exercise levels were largely maintained and participants reported secondary benefits like improved diet and well-being.

Conclusions : This pilot demonstrates the feasibility of a student-coaching model embedded in an evidence-based walking program. It supports physical activity adherence and experiential learning and can be scaled to broader populations with chronic illness.

P 03.07

Sustained Gains from Health and Wellness Coaching: A Rapid Systematic Review

Katherine Smith MPH, ACC, NBC-HWC1 1 , Barbara Iachini MA, AFMC, NBC-HWC 1 , Elizabeth Ahmann ScD, RN, PCC, NBC-HWC 1 , Micah Saviet LCSW-C, NBC-HWC 2 , Dr Lisa A Conboy MA MS ScD 3 , Ron DeMartin 1

1 Notre Dame of Maryland University School of Integrative Health, Baltimore, MD, United States

2 Springer Institute, Cheverly, MD, United States

3 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States

Purpose : Health and Wellness Coaching (HWC) is an emerging profession supporting health behavior change. Research suggests HWC effectively facilitates behavior change across a variety of conditions and populations. Of interest is whether improvements last 6 months or longer once the coaching intervention ends, a time period defined as 'maintenance.'

Method(s): Guided by the Cochrane Interim Guidance for rapid systematic reviews, our rapid review was conducted across a single database, the Appendix A from the Sforzo et al Compendium of the health and wellness coaching literature (2017), and the Sforzo et al Addendum to the Compendium (2019), which included peer-reviewed, database articles meeting a modified version of health and wellness coaching as defined by Wolever et al (2013). Studies eligible for our rapid review included any study that explored client-related outcomes including a follow-up data collection (quantitative) subsequent to the immediate or first post-intervention data collection.

Results : From an initial pool of 231 studies, 44 met the inclusion criteria. Of those, 16 did not meet criteria for analysis, leaving 28 studies retained for analysis. In 25 of the 28 studies examined, some gains made as a result of the coaching intervention were sustained (whether partially or fully), or improved over time. 16 of the 28 studies explored sustained gains at 6 months or more. Of those 14 studies (87.5%) demonstrated some gains that were partially sustained, fully sustained, or even improved over the follow-up period.

Conclusions : HWC may offer an approach that can contribute to long-term sustainable behavior change. This review demonstrates that in many instances studies using health and wellness coaching interventions show sustained effects, and in some cases improvements, 6 months or longer after the end of the intervention. This held true across physiological, behavioral, psychological and health risk assessment variables.

P 03.08

Coaching for Clinicians

Droma Balgobin BSN 1 , Marci Resnicoff MSN 2

1 NYU langone NYU Langone Orthopedic Hospital, New York, NY, United States

2 NYU Langone hospital, new york, ny, United States

Purpose : The purpose of implimeting Coaching for Clinicans was to evaluate the impact of a pilot coaching program on reducing burnout, improving job satisfaction, and promoting work-life balance among PACU nurses. Grounded in Imogene King’s Theory of Goal Attainment, the program aimed to support clinician well-being through structured coaching sessions, with outcomes measured using the Whole Person Health Index and Goal Attainment Scale to guide future program development and sustainability.

Method(s ): An educational session on coaching was delivered to 12 PACU nurses, followed by a survey assessing comprehension and interest. Seventy-five percent expressed interest, and 6 nurses were randomly selected for a pilot program. Each participated in four 30-minute individual coaching sessions over eight weeks. Pre- and post-intervention assessments used the Whole Person Health Index (WPHI) and Goal Attainment Scale (GAS) to measure well-being and goal progress. Feedback was collected to evaluate satisfaction and inform future program development.

Results : Post-intervention results showed a 57% increase in average Whole Person Health Index (WPHI) scores, improving from 2.6 to 4.1, indicating enhanced physical, emotional, social, and spiritual well-being. Goal Attainment Scale (GAS) scores reflected progress in achieving personal goals. Participant feedback indicated high satisfaction, a desire for continued coaching, and suggestions for longer sessions. The pilot demonstrated that coaching effectively reduces burnout, enhances job satisfaction, and supports work-life balance among PACU nurses, with recommendations for program expansion.

Conclusions : The pilot program Coaching for Clinicans, demonstrated significant improvements in clinician well-being, goal attainment, and job satisfaction, supporting its effectiveness in reducing burnout among PACU nurses. Grounded in Imogene King’s Theory of Goal Attainment, coaching provided a structured approach to achieving personal and professional goals. Positive outcomes and participant feedback highlight the value of coaching in healthcare settings. Future recommendations include expanding the program to group formats, increasing session duration, and offering flexible scheduling to enhance sustainability.

Topic Area 04: Integrative Medicine Education

P 04.01

Identifying Gaps in Integrative Medicine Education: A Review of a Midwestern Public Medical School’s Preclinical Curriculum

Savannah N Rios B.S., Dr. Vincent Minichiello M.D.

University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States

Purpose : Integrative medicine is essential for delivering comprehensive and patient-centered care. University of Wisconsin School of Medicine and Public Health (UWSMPH) preclinical curriculum currently lacks formal integration of integrative medicine objectives. This limited exposure may hinder medical students’ knowledge, attitudes, and perceptions of integrative care. This study aims to systematically evaluate the UWSMPH preclinical curriculum, identify content gaps related to integrative medicine, and propose evidence-based recommendations to enhance integrative health education within medical student training.

Method(s): A systematic review of the UWSMPH curriculum repository was conducted to identify preclinical lecture materials addressing integrative health topics during the 2024-2025 academic year. Materials were categorized according to corresponding learning objectives, UWSMPH core competencies, and depth of integrative content. Using a framework adapted from the Integrative Medicine Fellowship Core Competencies, while also aligning with UWSMPH core competencies, the analysis identified curricular gaps and opportunities to strengthen integration of foundational principles of integrative medicine.

Results : Among 335 preclinical lectures containing integrative health-related terms, 8 (2.4%) focused primarily on integrative medicine, while 327 (97.6%) referenced secondary or peripheral topics such as chronic disease. Major content gaps were identified in whole-person health, mindfulness, meditation, spirituality, traditional and Indigenous healing practices, botanical medicine, and group medical visits. Overall, integrative health content was limited in depth and distribution across the preclinical curriculum, indicating a need for greater alignment with core integrative medicine competencies.

Conclusions : This review reveals significant underrepresentation of integrative medicine within the UWSMPH preclinical curriculum. Addressing these deficiencies through intentional integration of core competencies could enhance students’ ability to deliver holistic, patient-centered care and foster greater engagement with integrative medicine principles. Future curriculum development should prioritize sustained, longitudinal incorporation of integrative health topics—particularly those identified as major content gaps. Further studies may assess how enhanced integrative health education influences medical students’ knowledge, attitudes, and clinical application of whole-person care principles.

P 04.02

Evidence-informed practice as a bioethical imperative: a novel training program for complementary and integrative healthcare providers

Margaret D Whitley 1 , Ian D Coulter 1 , Joshua Z Goldenberg 2 , Daryl Nault 3 , Kieran Cooley 4,5,6 , Katherine A Pohlman 7

1 RAND, Santa Monica, CA, United States

2 National University of Natural Medicine, Portland, OR, United States

3 Notre Dame of Maryland University, School of Integrative Health, Baltimore, MD, United States

4 Canadian College of Naturopathic Medicine, Toronto, ON, Canada

5 University of Toronto, Toronto, ON, Canada

6 Southern Cross University, Lismore, New South Wales, Australia

7 Parker University, Dallas, TX, United States

Purpose : Complementary and integrative healthcare (CIH) education includes both bioethics and evidence-informed practice (EIP), yet these domains are rarely taught together. Practicing EIP aligns with bioethical principles of beneficence, non-maleficence, veracity, autonomy, fidelity, and justice. Competence in EIP better enables clinicians to deliver safe, effective, and bioethically-sound care. This project will develop a free, online training program integrating bioethics and EIP to strengthen CIH practitioners’ research literacy.

Method(s): We will design ten virtual modules linking bioethics and EIP, each with defined learning objectives. A Bioethics and EIP working group, comprising CIH institution faculty who are members of RAND REACH, will refine content and ensure relevance to CIH practice. The curriculum will emphasize evaluating evidence across scientific methods and clinically applying evidence. The program will be distributed through CIH institutions’ to promote widespread adoption.

Results : This 12-month project, funded 9/2025, has established a working group of scholars from CIH institutions across North America. Topics will include balancing patient autonomy with evidence-based recommendations and evaluating traditional therapies with limited published evidence. To create the modules, we are collaborating with methods and bioethics instructors and with leaders of Process of Integrating Evidence-a multi-institution collaboration led by Parker University. Our program will be freely available to CIH institutions, with CE accreditation through professional bodies to facilitate integration into curricula and re-licensure pathways.

Conclusions : CIH professions prioritize EIP, but framing EIP as a bioethical imperative is a novel approach. This virtual program will better equip practitioners to navigate ethical complexities inherent in evidence application and patient-centered care. As CIH research expands, the need for ethically grounded, evidence-informed training grows. Applying EIP in clinical practice presents unique challenges, more so now with the introduction of artificial intelligence tools. By integrating bioethics and EIP, this initiative will strengthen the ethical foundation of CIH practice.

P 04.03

Building an International Exchange Platform for Medical Students Interested in Integrative Medicine

Weijun Zhang DrPH 1 , Edward Hui MD 1 , Haoyue Li PhD 2 , Anna Yang MS 1 , Traci Wells PhD 1 , Jing Shu MD, PhD 3 , Dong Shang MD, PhD 4 , Min Li MD, PhD 5 , Xin Chen PhD 6 , Hung-Rong Yen MD, PhD 7 , Xiaqiu Wu PhD 8 , Andrew Jang MPH 9 , Dhave Setabutr MD 10 , Pravit Akarasereenont MD, PhD 11 , Ka-Kit Hui MD 1

1 UCLA, Los Angeles, CA, United States

2 China Academy of Chinese Medical Sciences, Beijing, Beijing, China

3 Shanghai University of Traditional Chinese Medicine, Shanghai, Shanghai, China

4 Dalian Medical University, Dalian, Liaoning, China

5 Hong Kong Baptist University, Hong Kong, Hong Kong, Hong Kong

6 University of Macau, Macau, Macau, China

7 China Medical University, Taichung, Taiwan, Taiwan

8 Zhejiang Chinese Medical University, Hangzhou, Zhejaing, China

9 Jaseng Medical Academy, Seoul, Seoul, Korea, Republic of

10 Thammasat University, Bangkok, Bangkok, Thailand

11 Mahidol University, Bangkok, Bangkok, Thailand

Purpose : As integrative medicine (IM) gains global recognition, medical education remains largely siloed, limiting opportunities for cross-cultural learning and collaboration. To address this gap, we established an international exchange platform connecting medical students across universities in the U.S. and East Asia who share interests in evidence-based integrative health. The initiative aims to cultivate future physician-leaders capable of bridging biomedical and traditional health paradigms through shared education, research, and community engagement.

Method(s): Supported by the UCLA Global Advisory Council, the platform unites faculty and medical students from ten partner institutions—including UCLA and academic universities across East Asia (Hong Kong, Macau, Mainland China, Taiwan, Thailand, and South Korea). A Faculty Advisory Committee guides program development. Core components include (1) a virtual webinar series on integrative medicine topics; (2) a web portal to link resources and facilitate discussion; (3) faculty-mentored student research exchanges; (4) short clinical rotations in integrative health settings; and (5) a student-led society to promote peer learning and leadership.

Results : In its pilot year (2025–2026), the program will engage approximately 50 medical students and 30 faculty members across partner institutions. The inaugural cohort will participate in an eight-session monthly webinar series highlighting each partner’s integrative medicine education and research programs and will co-develop frameworks for future research mentorship and exchange activities. Preliminary feedback from student focus groups indicates strong interest in experiential and culturally grounded IM learning opportunities.

Conclusions : This international exchange platform represents a scalable model for global IM education. By linking universities with shared missions and diverse medical systems, it fosters cross-cultural competence, collaborative scholarship, and a transnational community of early-career physicians committed to advancing integrative, person-centered care.

P 04.04

Why Physicians Avoid Taking Complementary Alternative Medicine Course Content When Earning Continuing Medical Education Credits

Dr. MARK A PETERSON Ed.D.

St. Mary's University of Minnesota, Minneapolis, MN, United States

Purpose : Purpose of this qualitative grounded theory study was to reveal key reasons why medical doctors chose specific CME courses to earn their required 75 credits of continuing education units (CEU’s). The study aimed to reveal themes on why Internal Medicine physicians had diverse attitudes toward CAM topics, and how that provided valuable insights into why physicians chose the CME they earned credits for, and why they did not choose CAM/IM topics for CME credit.

Method(s): Methods of this Qualitative Grounded Theory study used Braun & Clarke's 6-phase Thematic Analysis. 12 Zoom meeting interviews with Internal Medicine physicians licensed in Minnesota. Data analyzed utilizing NVivo-12 software. Respondents were asked ten open-ended questions in a semi-structured interview that took approximately 30 - 45 minutes. Each interview was audio and video recorded by Zoom meeting technology. Interviews were transcribed in both digital and hard-copy paper format using Otter.ai for coding later in the research process.

Results : Results found 8 distinct themes: 1) Physicians had diverse attitudes towards CAM. 2) Need for more scientific evidence supporting CAM effectiveness. 3) CAM needs to be integrated into existing patient-care models. 4) MDs experience multiple pragmatic constraints when choosing CME. 5) Individualized needs and specific practice requirements. 6) CAM needs to be integrated into medical schools. 7) Reputations of CME providers are important selection factors. 8) Technology/electronic patient records systems need to integrate CAM.

Conclusions : Study conclusions revealed that physicians avoid CAM course topics because CAM is not currently integrated into existing CME delivery structures, electronic medical records systems or patient care models. All respondents expressed pragmatic motivations for their current CME choices, individualized needs specific to their medical practice requirements, lack of familiarization with CAM in medical school, and the need for CAM subject matter experts to be included into the CME offerings and venues they do attend.

P 04.05

Design and Implementation of an Integrative Internal Medicine Teaching Clinic at a FQHC: Advancing the Learning and Practice of Whole Person Care

Arlene Betancourt MD, Dip ABOIM

Texas Health Presbyterian Hospital, Dallas, TX, United States. UT Southwestern, Dallas, TX, United States

Purpose : To describe the design and implementation of an integrative internal medicine teaching clinic within a Federally Qualified Health Center.

Method(s): The competency-based goals and objectives for the clinic were designed to promote interprofessional collaboration and whole-person care. Educational resources include the Johns Hopkins Internal Medicine Ambulatory Care Curriculum and experiential learning on integrative medicine. Select residents and faculty participate in the Integrative Medicine in Residency program. Each resident sees patients at the continuity clinic an average of one half-day per week, supervised by faculty with expertise in integrative, internal, and family medicine, medicine-psychiatry, and nephrology. Additionally, residents complete a dedicated ambulatory month, incorporating experiences with psychiatry, 340B pharmacy, nutrition, optometry, community health workers, mammography and bone densitometry. The FQHC provides dental, women’s health, and pediatric services, and offers a robust language program, including interpreters and a language line to support patients with limited English proficiency.

Results : The clinic opened in November 2025 through collaboration between hospital, GME, and FQHC leadership. Key milestones included recruitment of physician leaders, faculty identification and development, and workflow design. The clinic launched with 18 residents and 6 faculty members. Extended visits, EMR templates, and quality metrics support whole-person care. PHQ-9, GAD-7 and SDOH screenings are performed at every visit. In the first month, residents saw 136 patients across 13 sessions, primarily Hispanic, Black, and refugee populations speaking 68 languages. Operational outcomes included an 83% show rate (vs. 72% for other departments) and 87 internal referrals. Patient satisfaction was 89%, with residents and faculty reporting improved ability to deliver quality care.

Conclusions : This initiative demonstrates the feasibility of embedding integrative internal medicine teaching clinics into FQHCs - offering a replicable and scalable model for advancing integrative health equity, enhancing resident competency in culturally responsive care, and preparing physicians to deliver whole person care to underserved populations.

P 04.06

Comparing Interactive vs Traditional Teaching Formats for Integrative Medicine Topics in a Family Medicine Residency at a Federally Qualified Health Center

Dr. Ariadna Mercouffer MD

Institute for Family Health, New York, FL, United States

Purpose : Integrative Medicine (IM) training is increasingly recognized as essential in Family Medicine practice due to its emphasis on patient-centered care and the use of holistic options that expand therapeutic choices. This study aimed to compare knowledge gain between an interactive Kahoot-based session and a traditional slide-based lecture on IM topics. Secondary objectives were to assess resident confidence, perceived usefulness, and engagement across teaching methods to inform optimal IM education strategies within a time-limited residency curriculum.

Method(s): Twenty residents and faculty completed one pre-intervention survey and two post-session surveys following two 15-minute IM sessions: an interactive Kahoot session on probiotics and fiber and a traditional lecture on common dietary supplements. Surveys assessed confidence, understanding, perceived usefulness, and engagement using 5-point Likert scales. Paired t-tests compared pre/post lecture changes and between-session differences. Quantitative data were analyzed for mean change, statistical significance, and effect size.

Results : The traditional lecture significantly improved in comfort (t = -3.33, p = .002, d = 1.07) and understanding (t = -2.89, p = .007, d = 0.93), while perceived usefulness remained unchanged. The interactive Kahoot session showed no significant change in pre/post scores (p > .30, |d| < 0.35). Engagement and enjoyment scores were high for both (4.35 ± 0.93 vs. 4.75 ± 0.44). The Kahoot group gave uniformly perfect engagement scores (5/5), suggesting very high engagement, though statistical testing was not possible due to zero variance.

Conclusions : These findings suggest that IM education is both feasible and well-perceived in residency curriculum, supporting its inclusion to enhance knowledge, comfort, and appreciation for holistic care in family medicine practice. Although knowledge gains differed, both methods promoted positive learning experiences within a brief timeframe. These findings support incorporating varied teaching modalities in Integrative education and demonstrate that gamified learning can sustain attention and enjoyment in resident didactic environments.

P 04.07

Building the Neurotrauma Evidence Synthesis Training (NEST) Program: A Process Evaluation of a Virtual Systematic Review Training Center for Complementary and Integrative Healthcare Trainees

Dr Joshua Z Goldenberg ND 1 , Dr Monique Aucoin ND 2 , Dr Richard D Batson ND, MS 1 , Dr Alisha Bruton ND, MS, MS 1,3 , Dr Ryan Wexler ND, MS 1 , Dr Lita Buttolph PhD, LAc 1 , Michelle Berg 1 , Tammy Mazure 1 , Dr Heather Zwickey PhD 1

1 National University of Natural Medicine, Portland, OR, United States

2 Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada

3 Oregon Health Sciences University, Portland, OR, United States

Purpose : Traumatic brain injury (TBI) affects millions globally, and Complementary and Integrative Health (CIH) interventions are increasingly being used to address TBI sequelae. Systematic reviews are the foundation of evidence-based guidelines, yet most systematic reviews in CIH and neurotrauma are of critically low quality. The Neurotrauma Evidence Synthesis Training (NEST) program was developed as a virtual, mentorship-driven training center that explicitly includes CIH institutions.

Method(s): Data sources included program records, administrative documents, financial reports, mentee and mentor interviews, participant surveys, and outputs from systematic review projects. Review quality was assessed using the AMSTAR-2 tool. Funding and sustainability strategies were examined via grant submissions, peer review feedback, and institutional commitments, with special attention to capacity-building for CIH institutions.

Results : Thirty-five trainees enrolled. Most were students from CIH institution or early-stage clinician-researchers with limited prior access to high-level systematic review training. Retention was high, with only two attritions (6%). Educational activities included biweekly Evidence Synthesis Labs, neurotrauma-focused seminars, asynchronous training modules, and multi-level mentorship. Within two years, NEST registered 16 systematic reviews, published two protocols, and submitted two full reviews, both rated “high quality” on AMSTAR-2. Active projects span CIH-relevant areas including dietary interventions for metabolic outcomes, botanical medicine, and mind-body practices for neurological conditions. Funding has included a pilot grant from the RAND REACH Center, a NIDDK R25 grant, and in-kind faculty contributions.

Conclusions : NEST demonstrates that a virtual, mentorship-driven, program can train CIH healthcare trainees, producing high-quality systematic reviews in neurotrauma, as well as other topics. Early results suggest that NEST is both feasible and replicable. Outputs already exceed expectations, with reviews addressing CIH-relevant interventions poised to inform whole-person care. However, adequate funding remains a significant concern two years into the program with most of the faculty effort being provided as in-kind contributions.

P 04.08

Seeding the next generation of CIH research: the RAND REACH pilot grant program

Michele J Maiers DC, MPH, PhD 1 , Patricia M Herman ND, PhD 2 , Heather Zwickey PhD 3 , Ian Coulter PhD 2

1 Northwestern Health Sciences University, Bloomington, MN, United States

2 RAND, Santa Monica, CA, United States

3 National University of Natural Medicine, Portland, OR, United States

Purpose : Preliminary research and pilot studies are essential precursors to full-scale projects and provide valuable real-world experience for early-career researchers. However, securing pilot funding can be challenging—particularly for clinician scientists at complementary and integrative health (CIH) institutions, which often lack internal funding support.

Method(s): The NIH-funded RAND Research Across Complementary and Integrative Health Institutions (REACH) Center addresses this gap through its Pilot Research Grants program. Funded by the NCMIC Foundation, this program offers up to $15,000 for 1–2 year pilot studies aimed at generating data for larger research proposals, fostering cross-institutional collaboration, and developing early-career investigators. Grant applications are submitted via the RAND REACH members-only portal in response to semiannual funding announcements. Proposals are structured like NIH grants and must include research aims, background, methods, human subjects and data safety plans, budget, biosketches, and letters of support. Applicants must also explain how the pilot will support future research. Each submission is reviewed by a three-person panel—one Center leader, one institutional research director, and one junior Center member—using the NIH 9-point scoring rubric. Proposals demonstrating collaboration or led by early-career investigators receive priority. Funded researchers engage in monthly meetings for mentorship, troubleshooting, and peer learning.

Results : To date, 21 proposals have been submitted and nine pilot grants awarded. Nearly all involve multi-institution collaboration; seven are led by early-career investigators. All funded projects have either published findings, submitted papers, or are ongoing, with initial pilots informing subsequent large-scale proposals.

Conclusions : This pilot grant model has successfully seeded impactful research and supported development of emerging CIH investigators through hands-on experience, mentorship, and structured project leadership. While the funding amount for individual grants is small, distributing funding in this manner has created a broad range of projects and allowed RAND REACH to provide real-world support for early career CIH researchers.

P 04.09

Measuring What Matters in Surgical Education: Mentorship, Institutional Culture, and Equitable Development in Orthopedic Residency Training

Research Fellow Cordero L McCall MBA, MPH

Rothman Orthopaedic, Philadelphia, Pennsylvania, United States

Purpose : Orthopedic surgery continues to be one of the most competitive specialties in medicine, and research productivity has become a common way to evaluate applicants. First-author publications prior to residency are often used as a proxy for academic curiosity and long-term commitment to scholarly work. However, it is still uncertain whether these early markers actually predict continued academic engagement once training begins. This project explores patterns of research activity among orthopedic residents to better understand what program and trainee factors contribute to sustained productivity and professional growth.

Method(s): Data from U.S. orthopedic surgery residents during the 2024–2025 academic year, representing match cycles from 2019 to 2024, were analyzed. A total of 3,809 residents across 213 accredited programs were included. Publication data were collected through PubMed and separated into prematch and postmatch categories. Additional information about residency program characteristics was obtained from national databases and ranking systems. Multivariate models are being developed to examine how prematch first-author publications and program rank relate to ongoing research productivity during residency, while accounting for gender, degree type, and advanced degrees.

Results : Early analysis shows that overall publication output tends to increase as residents advance through training, with those in top 25 programs demonstrating greater growth compared with peers in other programs. Prior first-author experience appears to relate to higher ongoing productivity, especially in programs with strong mentorship structures. Further analysis is underway to confirm these trends.

Conclusions : Preliminary results point to the importance of mentorship, institutional environment, and access to research infrastructure in supporting long-term scholarly development. Understanding these influences may help programs design more equitable and integrative approaches to residency education that foster curiosity and professional growth.

P 04.10

Impact of Integrative Health Education on Pediatric Resident Awareness and Clinical Behavior: A Two-Survey Analysis

Lisa Squires BSN , Dr Maria Mascarenhas MBBS, Mya King MD, Andrea Szabo MD

University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Purpose : Integrative health (IH) approaches are increasingly being incorporated into pediatric care settings. Despite this trend, medical training in IH remains variable. Resident physicians play a pivotal role in initiating consultations and influencing family openness to complementary interventions. Limited IH education during residency often translates to underutilization and knowledge deficits. To address these gaps, a targeted educational intervention (noon lecture) was implemented to increase resident awareness and engagement.

Method(s): Baseline survey (n=52) and follow-up survey (n=25,) 3 months after an in-person noon lecture on IH was completed. Both surveys included items on PGY level, IH modality awareness and consult details. The follow-up survey additionally recorded attendance at the lecture and post-intervention knowledge.

Results : Residents demonstrated marked changes in IH awareness and consult behavior after the educational intervention with attendance at the IH noon conference in 40% of follow-up respondents. The proportion of PGY1 respondents (N=14) was unchanged for both surveys, suggesting early engagement of new trainees. Number of residents unaware that nurses could provide aromatherapy sniffers decreased from 40% to 28%. Consult behavior remained high (90% to 92%); number of residents placing multiple IH consults increased from 46% to 60%, indicating lecture exposure may have prompted more active and confident integration of IH into patient care plans. Consults were distributed across more teams, with notable increases in General Pediatrics, Hematology and Adolescent teams, suggesting more team-level dissemination of IH practices. 77% of respondents wanted to learn more.

Conclusions : Brief, structured educational intervention such as noon lecture can significantly enhance pediatric resident awareness of and engagement with integrative health services. Following a single educational session, residents demonstrated improved knowledge, increased consult frequency, and broader dissemination across clinical teams. These findings support the inclusion of integrative health topics within residency didactics and suggest that even limited exposures can create meaningful change in behavior and care delivery

P 04.11

Training, knowledge, and attitudes of medical and dental students toward integrative medicine

Kayla Kendall 1 , Dr. Adam Perrin MD 1,2 , Dr. Mary Guerrera MD 1

1 University of Connecticut School of Medicine, Farmington, CT, United States

2 St. Francis Hospital and Medical Center, Hartford, CT, United States

Purpose : This study evaluated knowledge, attitudes, and exposure to integrative medicine (IM) among 92 medical and dental students at a single institution to assess how current curricular offerings influence readiness to discuss IM with patients. The goal was to identify strengths and gaps in IM education to inform future curriculum development that better prepares graduates to provide evidence-based, whole-person care.

Method(s): Attitudes toward IM were measured using the Complementary and Holistic Beliefs Questionnaire (CHBQ) and items adapted from validated IM survey instruments assessing exposure, training, and factors influencing attitudes. Descriptive statistics were used to summarize familiarity with IM modalities, exposure sources, and willingness to discuss IM with patients. CHBQ scores were compared across year of training to identify patterns in attitudes.

Results : Among respondents, the mean CHBQ score was 32.8 ± 6.2 (n = 92), indicating overall neutral attitudes toward IM on a 10-item, 5-point scale (maximum = 50). Approximately 65% reported prior IM exposure through one or more sources. Students were most familiar with yoga, meditation, acupuncture, massage, and tai chi, with mean familiarity scores ranging from 2.8–3.5. Willingness to discuss IM with future patients increased with greater exposure; nearly 70% of students reporting multiple IM experiences expressed moderate to high willingness to do so. CHBQ scores were highest among first-year students (34.8) compared to second-year (29.6) and third- to fourth-year (32.0–32.5) students.

Conclusions : Findings reveal declining IM attitudes among upper-level students, suggesting potential influence of the hidden curriculum during clinical training. Greater exposure was associated with increased confidence and willingness to discuss IM with patients, underscoring the importance of early experiential learning. Inclusion of both medical and dental students highlights the cross-disciplinary relevance of IM in preparing future clinicians for collaborative, patient-centered care. As public interest in integrative health continues to grow, strengthening IM education and normalizing these discussions in training are essential for meeting patient needs through evidence-based, whole-person approaches.

Topic Area 05: Integrative Medicine Implementation

P 05.01

Be I.N.F.O.R.M.E.D. (Individuals Necessary for Research Making Educated Decisions) Community Wellness Project

Regime Willis B.S. 1 , Katherine Dignan M.S. 2

1 University Hospitals, Cleveland, Ohio, United States

2 U.S. Department of Veterans Affairs, Cleveland, Ohio, United States

Purpose : The purpose of this project was to provide a series of interactive educational sessions paired with wellness activities to improve the knowledge and awareness of clinical trial participation among the target populations of Veterans and African Americans.

Method(s): Participants engaged in 4, 75 minute education and skill development sessions. Participants were educated on health disparities, research, ethics, how to get involved and participate in research studies. In addition participants experienced wellness sessions at every class which included a 15-30 minute experience on mindfulness, cooking, yoga and creative expression. This program was a community-based initiative, providing services directly in the neighborhoods that participants lived. Data collection of this program ran from January 2025-March 2025. During this time period 3 cohorts were completed (1 virtual and 2 in person at 2 separate community wellness centers). A post-implementation data review included 23 unique participants.

Results : Results indicate participants improved knowledge at each of the 4 sessions. Knowledge of health disparities in session one, pre verse post programming, changed from fair knowledge 2.5 (SD 1.2) to good knowledge 3.1 (SD 0.8). In session 2 knowledge improved on how to be an advocate for yourself when considering research, moving from fair knowledge 3 (SD 1.3) to good knowledge 3 (SD 1.1). In session 3 knowledge of how to find a research study improved from poor knowledge 3.6 (SD 1) to good knowledge 2.1 (SD 0.9). In general no improvements were noted in physical or mental health when measured at session 1 and 4. In addition, participants had a very high interest in engaging in wellness activities at the start and end of the program with a rating of 4 (S.D 1) out of a possible 5.

Conclusions : In conclusion these results indicate improvements in research knowledge after attending these sessions. This community-based initiative helped to bring healthcare professionals directly into neighborhoods, making it easier for individuals to learn about and use available services.

P 05.02

Implementation of a Pediatric Integrative Medicine Program at a Children's Hospital

Dr. Natalia Jaramillo PhD, Saloni Dangoria BA, Elena Gareau BS , Carly Wold, Jay Taimish, Dr. Jeffrey Gold PhD

Children's Hospital of Los Angeles, Los Angeles, CA, United States

Purpose : Integrative health practices such as acupuncture, massage, mindfulness, and yoga are increasingly being implemented in pediatric medical settings to support comprehensive care and improve outcomes. These practices have shown promise in enhancing symptom management, reducing pain, and improving emotional well-being among pediatric populations. This study examines the implementation of a Pediatric Integrative Medicine (PIM) program at Children’s Hospital Los Angeles, designed to enhance patient comfort and pain management.

Method(s): The Exploration, Preparation, Implementation, Sustainment (EPIS) model was utilized as an implementation framework for this evaluation. This study sample (N = 103; ages 8-19) reflects a diverse population across ethnicity (40.8% Latino/Hispanic, 25.2% Caucasian, 34.0% Other), gender (63.1% female, 34.0% male, 1.9% nonbinary/third gender), and insurance coverage (61.2% Medi-Cal, 37.9% PPO/HMO). The PIM program delivers a range of integrative services – including acupuncture, massage, mindfulness, yoga, and biofeedback – through a multidisciplinary model. A structured referral system connects specialty teams in pain management, palliative care, rheumatology, rehabilitation medicine, and hematology-oncology.

Results : Preliminary findings show that acupuncture participants experienced, on average, a statistically significant 49.5% reduction in pain within individual sessions, with pain intensity scores on the Faces Pain Scale – Revised (FPS-R) decreasing from 4.57 to 2.31. In addition to these outcomes, participant feedback reflects high satisfaction: A 16-year-old patient receiving acupuncture shared, “Very good service. Helps me feel less pain and stress.” A 17-year-old engaged in mindfulness sessions remarked, “Very helpful, learned new things/tools.” A parent of an 11-year-old massage recipient noted, “This service makes such a difference in the hospital setting.”

Conclusions : These preliminary findings emphasize the value of integrative approaches in enhancing pediatric care. The PIM program reflects a promising model for delivering holistic support in medical settings. Future directions include expanding the program through multi-center research collaborations and identifying strategies for long-term sustainability and integration into standard pediatric care pathways.

P 05.03

Sustainable Academic–Community Partnership to Expand Integrative Medicine in Underserved Communities

Edward Hui MD 1 , Weijun Zhang DrPH 1 , Gene Hui MPH, MBA 2 , Annie Law MA 1 , Jack Cheng JD 2 , Nina Yuen-Loc MA 2 , Ka-Kit Hui MD 1

1 UCLA, Los Angeles, CA, United States

2 Chinatown Service Center, Los Angeles, CA, United States

Purpose : Integrative medicine development in community health typically follows one of three pathways: evolving an existing integrative medicine program into a community health center; embedding integrative medicine components into existing community clinics; or building academic-community partnerships to deliver comprehensive services. This project illustrates how an academic-community partnership with the Chinatown Service Center (CSC) facilitated the integration of integrative health services into underserved communities in Los Angeles.

Method(s): Guided by implementation science and community-engaged principles, the UCLA–CSC partnership seeks to: (1) expand access to integrative medicine for immigrant and low-income patients through a clinical service agreement, (2) establish CSC as a medical education platform for culturally responsive care, and (3) develop a research infrastructure for health equity and non-drug mental health innovation.

Results : Since 2021, the UCLA Center for East-West Medicine (CEWM) has established a partnership with CSC - a Federally Qualified Health Center serving over 20,000 primarily Chinese and Latinx patients annually - to integrate person-centered, East-West care into community practice. • Medical Education: Established community-based training pathways including the Early Authentic Clinical Experience for first-year medical students, Discovery Area of Concentration for third-year students, and fellowship rotations in integrative community care, cultivating a pipeline of culturally competent clinicians. • Clinical Integration: The integrative medicine teaching clinic delivers approximately 300 visits per month, expanding to behavioral health through non-drug therapies such as Tai chi, qigong, meditation, and music therapy, and includes an oral health integration initiative. • Research Application: Focuses on workforce development through community-based teaching health centers, and studies addressing health disparities among Asian and Latinx populations.

Conclusions : The CEWM–CSC partnership exemplifies a sustainable academic–community model advancing equitable, culturally grounded integrative health. By aligning education, clinical care, and research, this model bridges academic innovation and community needs - offering a replicable framework for implementing person-centered, non-drug, and culturally responsive care in immigrant and underserved populations.

P 05.04

Moving from Grant Support to Non-Profit Status: A Case Study in Financial Independence for a Patient-Focused Program

Clinical Assistant Professor Sarah Ingersoll MS, MBA 1 , Louis Castro DPT 2 , Kenneth Hayashida MD 3 , Kris Mendenhall JD 4

1 University of Southern California, Los Angeles, CA, United States

2 T.R.O. Physio + Wellness, Los Angeles, CA, United States

3 retired, Los Angeles, CA, United States

4 Nossaman LLP, Los Angeles, CA, United States

Purpose : To describe a practical approach by which a small, patient-centered exercise program operating within a university setting achieved financial independence and organizational stability by transitioning from grant reliance to non-profit status. For many years, a free community exercise program serving individuals with neurological conditions depended on institutional grant support to cover personnel and operational costs. Increasing competition for grant funding and growing administrative constraints within the university environment prompted exploration of alternative funding models to ensure program continuity.

Method(s): Options considered included partnering with an existing non-profit organization. However, logistical, administrative, and cultural-fit challenges made this path impractical. As payroll deadlines approached, the program launched a GoFundMe campaign, rebranded its relationship with the university as “collaboration,” and—using generative AI resources—navigated the process of establishing an independent 501(c)(3). Liability coverage appropriate for a community exercise program was secured through research into local nonprofit insurers.

Results : AI-enabled research streamlined the incorporation process, allowing state registration as a public benefit corporation, liability coverage, and IRS recognition of non-profit status within weeks. Donor enthusiasm was strong, with patient contributions readily directed toward sustaining the program’s mission. Transitioning to nonprofit status provided financial stability, operational flexibility, and a more direct relationship with the program’s community of supporters.

Conclusions : Establishing a dedicated nonprofit proved to be an efficient and replicable strategy for sustaining a small, mission-driven health program. This approach reduces dependency on uncertain grant funding, strengthens community engagement, and supports continuity of care. It offers a viable model for similar initiatives seeking long-term stability and independence.

P 05.05

Scaling Integrative Healthcare: Practical Approaches for Health Systems

Katrina Vigo MSN, RNC-MNN, HNB-BC , Parvita Bhoodai MSN, RN, AMB-BC, Julia Smith MSN, RN, MEDSURG-BC, Amelia DeWitt BSN, RN, Dr. Kathleen DeMarco PhD, NE-BC, CPHQ,RN

NYU Langone Health, New York, NY, United States

Purpose : Integrative health interventions have shown benefits for patient outcomes and staff wellbeing. However, implementing sustainable interventions can sometimes be challenging. While many initiatives begin as pilots, scaling them across health systems requires structured implementation strategies to ensure sustainability and measurable impact.

Method(s): Two quality improvement pilot projects from a Holistic Nursing and Integrative Health Fellowship, one focused on staff grief and loss support and the other on perioperative wellness education, demonstrate processes used to successfully implement integrative health interventions across a health system. Strategies utilized include engaging stakeholders, aligning initiatives with staff-identified needs, integration into existing workflows, fostering interdisciplinary partnerships, and selecting outcome metrics that capture barriers, opportunities, and effectiveness.

Results : The 2025 fellows projects reached 3,955 patients over their 3-month pilot phases, a 471% increase since 2024. Successful implementation of projects can be attributed to the implementation of needs assessments systematically evaluating wellness priorities and areas of opportunity, integrating evidence-based practices into standard workflows, working collaboratively with teams, and establishing evaluation frameworks to demonstrate effectiveness. Key lessons include the importance of leadership support and collaboration to sustain programs.

Conclusions : Scaling integrative health interventions requires intentional implementation strategies such as stakeholder engagement, workflow integration, interdisciplinary collaboration, and meaningful outcome measurement. These fellowship projects demonstrate that pilot initiatives can be expanded system-wide to enhance staff wellbeing and advance whole-person care. The lessons learned offer practical guidance for healthcare organizations seeking sustainable, evidence-based integrative practices.

P 05.06

ARE THERE UNIVERSALS SHARED BY ALL MEDICINES? WHAT ARE SOME IMPLICATIONS FOR INTEGRATION, A CASE FOR PLURALITY?

Dr. Claire M Cassidy PhD, LAc 1,2 , Dr. Lisa A Conboy Ma, MS,ScD 3 , Founder Tanuja Prasad BA engineering 4

1 Georgetown University, Washington, District of Columbia, United States

2 Windpath Healing Works Consulting, Bethesda, MD, United States

3 Harvard University, Cambridge, MA, United States

4 ApplyComplexity, New York, NY, United States

Purpose : When comparing medical systems people often seek differences. We wish to shift the gaze toward starting with what is the same among Medicines. When the resulting knowledge is applied, it becomes easier to accept plurality and apply it in education, clinical care, research, and in policymaking.

Method(s): Evidence is drawn from sources including social sciences, history, clinical trials, colleague researchers, journalism, and from interviewing practitioners of different Medicines. This work is being developed as a book called Six Medicines, Six Gifts, Steps to a Plural Medicine. This combined information offers insight into the complexity of the concept of a medical system. It is developed into discussions that can shift Readers’ perceptions toward open-mindedness and plurality.

Results : Three Universals undergird all medical systems. All societies recognize suffering, and some in each society choose to help by offering medical care. All answer the same set of five Fundamental Questions. But they answer them differently, hence multiple medical systems (and their technologies). Trained persons develop a ‘medical gaze’ that reflects the medical model of their system, and these are sufficiently different that they can explain many of the miscommunications that occur as the dominant biomedicine tries to ‘make sense’ of Other Medicines.

Conclusions : Knowing that all Medicines start from the same concerns and diversify as they answer the Fundamental Questions makes it easier to do well-grounded comparative study. Were this knowledge put to work, it would change how students are educated, how the patient-practitioner relationship is played out, how research is done, and could guide public policy. The mechanisms are available. What is needed is both comparative knowledge and a structure to implement the ideas and gifts of multiple medical systems.

P 05.07

Short-Term Changes in Patient-Reported Emotional Well-Being and Function After Integrative Medicine Consultations

Marcus Grewal BS 1,2 , Aaditya Pallerla BS 1,2 , Ria Jindal BS 1,2 , Sanjana Katiyar 2 , Harini Pallerla MS 2 , Dr. Sian Cotton PhD 1,2 , Dr. Mladen Golubic MD, PhD 1,2

1 University of Cincinnati College of Medicine, Cincinnati, OH, United States

2 University of Cincinnati Osher Center for Integrative Health, Cincinnati, OH, United States

Purpose : Integrative medicine (IM) offers a patient-centered approach that combines conventional medical care with evidence-informed therapies to promote optimal healing. IM providers play a pivotal role in facilitating lifestyle modification and connecting patients to therapies such as yoga, acupuncture, tai chi, and more. We aim to evaluate longitudinal changes in emotional well-being, mood, perceived stress, flourishing, and health-related functioning in patients receiving IM care at an urban academic health system.

Method(s): Patients scheduled with IM providers completed an online survey prior to their consultation, and follow-up surveys were administered after 3 months, with future 6- and 12-month surveys to be collected. Participants may have received a range of IM therapies via referral during the survey period. Validated survey instruments include the Perceived Stress Scale (PSS), Flourishing Measure, and PROMIS-29 Profile, which measures domains including Anxiety, Depression, Fatigue, Pain Interference, Physical Function, Sleep Disturbance, and Participation in Social Roles. Data was analyzed via paired t-tests with SPSS-29 software.

Results : 242 patients completed a pre-survey of which 75% were female with a mean age of 53. Currently, 25 patients have completed a 3-month post-survey. Preliminary analysis shows no significant changes in PSS, Flourishing Measure, or PROMIS-29 Profile, except for the Physical Function domain, in which a slight decrease was observed (Mpre=44.23, Mpost=41.57, p=0.012). Sub-group analyses were not performed at this time due to sample size.

Conclusions : Despite the lack of significant changes observed in all except one PROMIS-29 domain, this data provides valuable demographic insight into the patients receiving IM care. The future goal of this project is to collect additional post-survey data to better analyze changes across measured domains. 6- and 12-month data may reveal longitudinal changes in patients receiving a longer duration of IM care. These findings can inform the design of IM therapies and support continued implementation of whole-person approaches in clinical practice.

P 05.08

Analysis of Electronic Health Records Data from U.S. Naturopathic Clinics

Nini Callan ND, MS 1 , Carlo Calabrese ND, MPH 1 , Ryan Bradley ND, MPH 2 , Michelle Simon PhD, ND 3 , Steve Chamberlin ND, LAc, MS 4

1 National University of Natural Medicine, Portland, OR, United States

2 University of California, San Diego, La Jolla, California, United States

3 Institute for Natural Medicine, Seattle, Washington, United States

4 Oregon Health & Science University, Portland, Oregon, United States

Purpose : This pilot study aims to construct a HIPAA-compliant, de-identified database using CharmHealth EHR data from primary care naturopathic clinics. Aims include: 1. To assess the feasibility of data extraction and de-identification; 2. To evaluate database utility through two test questions: (a) trends in HbA1c among patients with Type 2 diabetes (structured data), and (b) documentation of lifestyle counseling (unstructured data); 3. To establish protocols for secure, long-term data storage, governance, and reuse for future research.

Method(s): EHR data from 5-10 naturopathic clinics will be securely exported, de-identified, and transformed into standardized flat-file tables. Structured data (e.g., labs, diagnoses) and unstructured data (e.g., narrative fields) will be integrated with the EMERSE text-search platform to identify and quantify clinical documentation trends. Workflow metrics include extraction success, PHI removal accuracy, and regulatory compliance. HIPAA Safe Harbor and NIST SP 800-88 standards guide de-identification, storage, and destruction to ensure data security and reproducibility.

Results : To date, 7 naturopathic clinics have agreed to participate, and data use agreements, institutional approvals, and system access procedures are underway. The technical architecture for secure CharmHealth API data transfer, encryption, and de-identification has been designed. Early implementation confirms logistical and technical feasibility while highlighting the need for iterative coordination across sites and vendors. Data extraction, de-identification, and EMERSE-based query testing will commence following completion of onboarding and compliance milestones.

Conclusions : Establishing a secure, de-identified multi-site naturopathic EHR database is feasible yet methodologically complex. This pilot provides critical groundwork for future large-scale analyses of naturopathic care and outcomes. The resulting infrastructure will support both quantitative and qualitative investigations, integrating structured and unstructured data for practice-based research. Sustainable database storage and governance will enable long-term data reuse and comparative effectiveness studies, advancing the visibility, rigor, and collaborative potential of naturopathic and integrative health research.

P 05.09

Project P.A.T.H. (Parkinson’s Access to Technology & Health): A Community-Driven Initiative to Address Disparities in Parkinson’s Disease Care in Los Angeles County

Tiffany Y. Chen B.S. 1,2 , Weijun Zhang Ph.D., MS 3,4

1 UCLA David Geffen School of Medicine, Los Angeles, CA, United States

2 UCLA Center for East-West Medicine, Los Angeles, CA, United States

3 UCLA Center For East-West Medicine, Los Angeles, CA, United States

4 UCLA David Geffen School of Medicine, Los Ángeles, CA, United States

Purpose : Parkinson’s disease (PD) disproportionately impacts underserved populations who face barriers to neurologic and integrative care. Project P.A.T.H. (Parkinson’s Access to Technology & Health) was developed to advance equitable, whole-person PD care through a digital-community hybrid model that connects patients and caregivers to integrative resources such as tai chi, mindfulness, nutrition, and support groups. Grounded in the principles of integrative and community medicine, the project aims to address the social determinants of health influencing access and engagement, while empowering patients with culturally responsive, linguistically accessible wellness education.

Method(s): Using a community-based participatory research framework, surveys (n = 110) were conducted across Los Angeles County to assess barriers to integrative and neurologic care, technology access, and wellness engagement. Findings informed development of a multilingual mobile platform aggregating educational content including affordable medication options, transportation guides, and wellness modules. A community ambassador program is being designed to enhance digital literacy and care navigation. Planned evaluation metrics include patient uptake of integrative health services. Ongoing stakeholder input from neurologists, integrative medicine specialists, and community partners guides refinement.

Results : Survey findings highlight significant unmet needs. 62% of respondents reported medication costs as a major obstacle, while 72% identified transportation challenges in accessing specialty clinics. Importantly, 70% of respondents expressed strong interest in a mobile platform offering patient education, cost transparency, and accessible navigation features. These insights guided the platform’s design, emphasizing multilingual accessibility and community-grounded integrative health education.

Conclusions : Project P.A.T.H. bridges digital innovation with the principles of integrative and community medicine to make whole-person Parkinson’s care more accessible and inclusive. By combining technology, multilingual education, and culturally grounded wellness resources, it reimagines how integrative health can meet patients where they are. As Project P.A.T.H. moves toward pilot implementation, future evaluation will assess its impact on access, engagement, and quality of life among underserved populations. Ultimately, this work illustrates how integrative and digital health approaches can advance equitable, person-centered care for individuals living with chronic neurological disease. Acknowledgement: This research is partly supported by the Cyrus Tang Foundation.

P 05.10

Midwives of Color as Catalysts for Change in Postpartum Care: “Celebrating birthing experiences is how we do it”

Paige L Prater MPH 1 , Dr. Chanda Williams 2,3,4,5

1 University of California San Francisco, San Francisco, CA, United States

2 PhD, Pacifica Graduate Institute California, Santa Barbara, California, United States

3 MA, Pacifica Graduate Institute California, Santa Barbara, California, United States

4 MA, Integrative Health Studies, California Institute of Integral Studies, San Francisco, California, United States

5 BA, Mechanical Engineering, Kettering University, Flint, Michigan, United States

Purpose : Amid mounting threats to reproductive health and equity, community midwives of color provide essential perinatal care while remaining marginalized within US health care. This study centers the experiences of community midwives of color and explores how they conceptualize and provide comprehensive postpartum care.

Method(s): We conducted in-depth, semi-structured interviews with community midwives practicing in freestanding birth centers and home-based settings across California. Using reflexive thematic analysis, an interdisciplinary team identified key themes related to care for diverse families. We refined findings through two member-checking events with midwives.

Results : Among midwife participants of color (n=23) 57% identified as multiracial. More than half (52%) spoke multiple languages. We identified three interconnected themes in midwives’ approach to postpartum care: (1) Promoting healing, justice, & joy beyond survival; (2) Advocating for families through wraparound support; and (3) Integrating cultural traditions & ancestral wisdom. Midwives described providing expansive postpartum care, including home visits, emotional support, and intergenerational healing, rooted in cultural affirmation.

Conclusions : Midwives of color are essential to reimagining postpartum care through integrative health equity and reproductive justice. Their perspectives highlight how community-based postpartum care can address inequities and promote healing, joy, and improved health. Integrating their voices into research, policy, and practice is vital for achieving equity in perinatal health. This study affirms that birth justice begins in community and that transformative change is possible when those most impacted lead the way.

P 05.11LB

Economic evaluations of nonpharmacological treatments for chronic pain in the United States: A scoping review

Hannah Cheng MS , Molly Beestrum MLIS, AHIP, Lucy Bilaver PhD, Christine Rini PhD, David Victorson PhD, Rinad S Beidas PhD

Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Purpose : Approximately 1 in 5 people in the United States (US) live with chronic pain. Although pharmacological treatments are widely adopted, they often carry risks. Nonpharmacological pain treatments (NPTs) are noninvasive interventions that target behaviors and brain processes underlying the experience of pain. Despite effectiveness, uptake of NPTs remains low, with affordability as a major barrier. Understanding the economic value of NPTs is essential for guiding uptake across health systems.

Method(s): Guided by the PRISMA-ScR, this scoping review examined studies of NPTs for individuals with chronic pain that reported both costs and outcomes. Eligible studies were original research published between 2000 and 2025 that conducted economic evaluations of NPTs in US health care settings. Search strategies were developed with a medical librarian using keywords on chronic pain, nonpharmacological treatments, and economic evaluations. Searches were conducted in Medline (PubMed), Embase, Cochrane Library, and Scopus.

Results : A total of 1,785 nonduplicated studies were identified for title and abstract screening. Of these, 199 (11.1%) underwent full-text screening, and 30 (1.7%) were included for data extraction. Two-thirds of included studies were published in the past decade. Many studies employed cost-effectiveness analysis; few examined long-term economic outcomes. Across NPTs, interdisciplinary and integrative care models were associated with reductions in downstream healthcare utilization, yielding net cost savings. Psychosocial interventions such as cognitive behavioral therapy and mindfulness-based stress reduction consistently demonstrated cost-effectiveness. Spinal manipulative therapy demonstrated mixed cost-effectiveness across pain conditions. Physical therapy incurred higher costs but shared similar benefits to chiropractic care and exercise-based interventions.

Conclusions : Despite being cost-saving and cost-effective, integrative care models and psychosocial interventions remain underutilized for chronic pain management compared to physical therapy. Policies that facilitate the scaling of these NPTs may improve their accessibility and transform chronic pain care.

P 05.12LB

Activating Hidden Clinical Capacity: A Workforce-Based Hybrid Integrative Medicine Model in an Academic Hospital

Professor Kengo Nakata MS, MA, LAcMx 1,2,3 , Professor Keiko OGAWA-OCHIAI MD, PhD, 1,2,3

1 Hiroshima University Hospital, Hiroshima, Hiroshima, Japan

2 Hiroshima University, Hiroshima, Hiroshima, Japan

3 Kampo Medicine Promotion Organization Inc., Minato, Tokyo, Japan

Purpose : Healthcare systems worldwide face critical workforce shortages and escalating costs, yet substantial therapeutic resources remain underutilized. In Japan, Kampo medicine is insurance-covered while acupuncture is predominantly self-pay, limiting institutional integration despite increasing demand for multidisciplinary care. Following completion and validation of the full 2024 operational dataset, a previously unrecognized systems-level pattern emerged. This study presents a late-breaking workforce-capacity analysis evaluating how a hybrid integrative medicine model can activate hidden clinical capacity within an academic hospital.

Method(s): We implemented a physician-led referral pathway in which Kampo physicians conducted initial evaluations and collaborated with licensed acupuncturists for ongoing management. Electronic medical records supported cross-disciplinary information sharing, reinforced by reciprocal clinical education to ensure safe hospital-based integration. During final data integration in December 2025, we performed the first comprehensive system-level analysis incorporating longitudinal referral growth, workforce utilization, productivity impact, and financial sustainability.

Results : New acupuncture referrals increased from 12 in 2021 to 67 in 2024 (ANOVA p<0.001), totaling 150 patients. Across four years, 1,552 acupuncture sessions were delivered. Introduction of acupuncturists doubled the number of patients managed per Kampo physician while reducing outpatient burden. Despite representing a minimal proportion of national healthcare expenditure, the licensed acupuncture workforce functioned as a scalable clinical capacity extender. Hybrid financing generated approximately ¥9.72 million (∼USD 65,000) in self-pay revenue without increasing physician staffing. Referrals spanned multiple departments including palliative care, internal medicine, and surgery.

Conclusions : This late-breaking reinterpretation demonstrates that redistributing underutilized therapeutic professionals can expand care capacity without increasing physician workload. By reframing integrative medicine as a workforce-extending strategy rather than a supplementary service, the Hiroshima model offers a scalable framework for academic health systems confronting global staffing constraints. Timely dissemination is warranted because delayed presentation would diminish the relevance of these findings for institutions actively redesigning care delivery.

P 05.13LB

Expanding Access to Whole Health through a Community-Engaged Research Framework: Outcomes from TakeCare’s 9-Week Peer Group Pilot Well-Being Program

Melissa H Abadi Ph.D. 1,2 , Kirsten T. Thompson M.A. 1 , Stephen R Shamblen Ph.D. 3 , Bonnie O. Richard Ph.D. 1 , Ruth Q. Wolever Ph.D. 4,5,6

1 Pacific Institute for Research and Evaluation (PIRE), Louisville, KY, United States

2 University of Kentucky, College of Nursing, Lexington, KY, United States

3 Pacific Institute for Research and Evaluation (PIRE), Louisville, Kentucky, United States

4 Osher Center for Integrative Health, Vanderbilt University Medical Center, nashville, TN, United States

5 Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, nashville, TN, United States

6 Vanderbilt University School of Nursing, nashville, TN, United States

Purpose : Scaling Whole Health requires community access beyond conventional healthcare. We adapted a nine-week healthcare-based group program to a community-led program to assess feasibility and obtain preliminary outcomes.

Method(s): Using a community-engaged framework, we recruited and trained 38 community members to facilitate TakeCare’s nine-week program within their communities. Twenty-two community facilitators led 28 groups. We collected pre- and post-surveys online.

Results : Our diverse sample (n=143) comprised 20-78 year olds (mean 44) from Hispanic/Latino (38%), Black (38%) and White (21%) backgrounds. Most participants were female (87%) and employed (72%). Education ranged from some high school (9%), to high school or some college (39%), to bachelor’s degree or higher (52%). Over half (63%) reported at least one diagnosed chronic condition. Participants completed 143 pre- and 134 post-surveys (94% response rate). Using mixed model linear regression, models regressed dependent measures on contrast representing waves. We assumed random intercepts, adjusting for variability among groups and repeated measurements. Participants reported improvement in health and well-being following the 9-week program, with statistically significant changes in the following: (a) WHO-5 Well-Being Index (p<.001), (b) PROMIS Global Physical Health (p=.016) and Mental Health (p=.020), and (c) NIH Meaning and Purpose (p=.022). Participants also significantly improved on tailored measures, including (a) Knowledge about Whole Health (p <.001), (b) Attitudes about Importance of Areas of Health and Well-being (p <.001) and Behavior Change Strategies (p=.023), and (c) Self-Care Practices (e.g., movement, nutrition, etc.) (p <.001).

Conclusions : Pilot results show promising impact on individual-level Whole Health and Well-being. This is particularly noteworthy due to our diverse sample and community-engaged model, wherein the facilitators as well as the participants were members of the community who self-selected to participate. Future studies will examine the program’s impact on long-term outcomes, as well as against a comparison group. Our goal is to scale programming to enhance access.

Topic Area 06: Physical Activity/Lifestyle Medicine

P 06.01

BE-WEHL 22q: Developing and Implementing a Wellness Education Program for Children with 22q11.2 Deletion Syndrome

Mr. Luc A Santilli BA, BS 1 , Dr. Alain J Benitez MD, MSTR 1,2 , Ms. Donna M McDonald-McGinn MS, CGC 1,2 , Dr. Lauren K White PhD 1 , Ms. Robin Miccio MS, LMT 1 , Dr. Maria R Mascarenhas MBBS 1,2

1 the Children's Hospital of Philadelphia, Philadelphia, PA, United States

2 the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Purpose : 22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion, occurring in ∼1 in 1,000 pregnancies and 1 in 2,000 live births. Anxiety is highly prevalent in 22q11.2DS and frequently precedes the onset of psychosis. There is a need for accessible, systems-based interventions tailored to this population. Integrative wellness practices have shown promise in reducing anxiety and promoting well-being. We developed and piloted “BE-WEHL-22q,” an 8-week virtual wellness education program specifically adapted for children with 22q11.2DS and their families, incorporating mindfulness, yoga, sleep, nutrition education, and novel biomarkers examining the brain-gut axis. We hypothesized that BE-WEHL-22q would positively impact anxiety, resilience, and potentially alter gut microbiome composition.

Method(s): Children 7–14 years with a confirmed 22q11.2 deletion and at least one caregiver participated in this IRB-approved study. The virtual 8-week BE-WEHL-22q curriculum covered Coping and Resilience, Pause and Reflect, Caring Touch, Activity and Rest, Mindful Movement Yoga, Healthy Eating, Fresh Mindset, and Navigating the Journey, a session specific to parenting children with 22q11.2DS. Psychosocial measures, dietary intake, stool, and urine samples were collected at baseline, post-intervention, and at 1-, 3-, and 6-month follow-ups. Observational data, family feedback, and practice logs were also collected.

Results : Thirty-three participants were enrolled; 10 completed the full program to date (median age 10.8 years; 57% female; 76% white). Mothers represented 97% of caregivers. All reported the program was helpful and would recommend it. Families frequently engaged additional members, despite home-based challenges such as noise and limited space. Biological samples (23 total) from 17 participants were collected for future analysis.

Conclusions : BE-WEHL-22q is a novel, feasible, well-received virtual wellness program for families affected by 22q11.2DS. Next steps include evaluating its impact on anxiety and behavior and analyzing microbiome-related biomarkers. If effective, BE-WEHL-22q may offer a scalable, home-based intervention for children with genetic and behavioral vulnerabilities.

P 06.02

Analysis of the Reach of the American Medical Women’s Association Healthy Lifestyle Revolution Campaign: A Pilot Study

Alayna Ritter BS 1 , Paul Kang MS 1 , Dr. Dolapo Babalola MD 2 , Dr. Manasi Kekan MD, MMM 3 , Dr. Beatriz Olson MD 4 , Dr. Eliza Chin MD, MPH 5 , Dr. Bisi Alli DO 6,1

1 Creighton University, Phoenix, AZ, United States

2 American Medical Women's Association, Atlanta, GA, United States

3 American Medical Women's Association, Houston, TX, United States

4 American Medical Women's Association, Middlebury, CT, United States

5 American Medical Women's Association, San Francisco, CA, United States

6 American Medical Women's Association, Phoenix, AZ, United States

Purpose : The American Medical Women’s Association Healthy Lifestyle Revolution is a campaign that encourages physicians to share evidence-based lifestyle tips on social media, with a goal of making credible wellness information more accessible. This pilot study analyzed videos posted by physicians for the campaign to gain a better understanding of the engagement and reach of these videos on YouTube and LinkedIn.

Method(s): Videos using the hashtag #AMWASTEPSTOWELLNESS were reviewed for length, theme, narration style, visual quality, visual content, content strategy, credentialing, and how long they had been posted. Engagement outcomes included total likes and views on YouTube, as well as total comments, reactions, and shares on LinkedIn. In total, 33 videos were analyzed (YouTube: 16; LinkedIn: 17).

Results : YouTube consistently had more views and responses than LinkedIn. Videos with more than one theme had the highest engagement (β = 52.8; 95% CI: 25.8–79.9; p < 0.001), while stress management content trended toward lower engagement. Exercise-themed LinkedIn posts generated more comments and reposts (p = 0.06). Including credentials increased responses (+22.4; p = 0.042), and videos posted longer gained more engagement over time (0.28 additional responses per day; p = 0.015). Videos that used both selfie and visual elements with a conversational tone tended to get more views (p = 0.017). Video length itself wasn’t a major factor, but longer videos were generally tied to fewer responses.

Conclusions : Across both platforms, narrative style, visual format and theme impacted trends regarding viewer engagement. This pilot study highlights how strategic use of social media by physicians can enhance access to evidence-based health information and contribute to more effective public health communication.

P 06.03

The Perceived Importance of Health Behaviors in US Adults

Yuktha Shanavas , Melany Taranto, Dr. Kaushal Nanavati Medical Degree, Dr. Jamie Romeiser Romeiser Ph.d, MPH

Upstate Medical University, Syracuse, New York, United States

Purpose : Chronic diseases are incredibly prevalent in US adults. Complex management needs and rising healthcare costs contribute to individual and community burdens. While adopting healthy lifestyle behaviors can help mitigate chronic conditions, many adults do not meet the recommended lifestyle guidelines. As beliefs often drive and shape actions, understanding how individuals value healthy behaviors is critical. This study examined perceptions of lifestyle behaviors and identified sociodemographic factors associated with differing levels of importance for overall well-being.

Method(s): We used nationally representative survey data from the Pew Research Center's American Trends Panel (2024, n = 10,133). Participants were asked, “How important are each of the following for your overall well-being?” Items included “Eating healthy”, “Exercise”, “Managing stress and anxiety”, “Sleeping well”, “Keeping up with friends and family” and “Being involved in your community”. Responses were dichotomized into high/very vs. neutral/low importance. Prevalence of high importance was examined across sociodemographic characteristics. Separate multivariable logistic regression models identified factors associated with high perceived importance for each item. All analyses were conducted at the 0.05 significance level.

Results : Most responders reported sleep (82%), managing stress and anxiety (79.9%), eating healthy (69.6%), and socialization with friends and family (66%) as highly important to well-being. Fewer valued exercise (59.2%) or community involvement (21.8%). After adjustment, higher odds of rating these behaviors as important were most commonly observed among older adults, women, those with higher education and higher income.

Conclusions : Uneven value was placed on different lifestyle pillars, with younger individuals and men most consistently viewing them as less essential to well-being. Understanding these perceptions can provide insight into behavior and barriers to adherence. This in turn informs the creation of comprehensive treatment plans and calls for a broader collaboration across clinicians and public health platforms to promote the importance of all health behaviors.

P 06.04

Targeting Anxiety Sensitivity in College Students: Dance Course Curricula and Protective/Risk Factors

Ms. Malena M Price MSc 1,2,3 , Dr. Amishi Jha PhD 1

1 University of Miami, Coral Gables, FL, United States

2 Harvard Medical School, Cambridge, MA, United States

3 Massachusetts General Hospital (MGH), Boston, MA, United States

Purpose : College students face heightened risk for psychological health challenges. One factor that can increase vulnerability to these issues is anxiety sensitivity (AS), or the fear of anxiety-related sensations. Despite the importance of AS in college students' impairment, little is known about psychological processes that may heighten or protect against this vulnerability, or how existing college courses may reduce it. This study investigated dispositional mindfulness and decentering as potential protective factors and mind wandering as a potential risk factor. In addition, we examined whether participation in dance courses, relative to Psychology courses, benefits AS.

Method(s): We recruited college students (N = 271) across three course conditions: mindfulness-infused dance movement therapy (DT-M), traditional dance (TD), and Psychology. Students completed two remote testing sessions at the beginning and end of the semester. AS was measured using the Anxiety Sensitivity Index-3 (ASI-3). Dispositional mindfulness and decentering were measured using the Five Facet Mindfulness Questionnaire (FFMQ) and the Experiences Questionnaire (EQ-D), respectively. Mind wandering was measured using the Spontaneous and Deliberate Mind Wandering Scale (SDMWS).

Results : Taking an individual differences approach, higher dispositional mindfulness and decentering were associated with lower AS, while higher spontaneous mind wandering was associated with higher AS. Multilevel model results showed that students in dance classes (DT-M + TD) experienced significantly greater reductions in AS-physical concerns over the semester than students in non-dance, Psychology courses, even after accounting for exercise variables.

Conclusions : These findings reveal the potential protective nature of dispositional mindfulness and decentering for AS, and the risk-imposing nature of mind wandering. Moreover, results suggest that existing curricular dance offerings, including those embedding mindfulness, may be beneficial for reducing AS and anxiety-related vulnerabilities in college students. Such dance offerings may serve as a pragmatic and scalable solution for protecting students’ psychological health.

P 06.05

Maternal Early Life Stress and Physical Activity during Pregnancy

Dr. Laura E Laumann PhD 1,2 , Dr. Destiny Printz Pereira PhD 1,2 , Dr. Gina Erato Garza PhD 1,2 , Janet O Joseph BS 3,2 , Dr. Laura R Stroud PhD 1,2

1 The Warren Alpert Medical School of Brown University, Providence, RI, United States

2 The Miriam Hospital, Providence, RI, United States

3 Brown University, Providence, RI, United States

Purpose : Research suggests that individuals with a history of early life stress (ELS) are more likely to engage in high-risk behaviors during pregnancy. Physical activity (PA), specifically moderate-vigorous physical activity (MVPA), may buffer against negative health outcomes. Little research has examined how PA during pregnancy may differ by ELS exposure. Thus, the aim of this exploratory analysis was to explore differences in PA during pregnancy by ELS exposure in a sample of pregnant women oversampled for smoking behaviors (22% smoking).

Method(s): 94 pregnant women (Mage=26.9; 54.3% White; 31.9% low SES) completed a modified, 20-item version of the Adverse Childhood Experiences Scale and the Pregnancy Physical Activity Questionnaire (PPAQ) in their second trimester as part of their participation in a larger study. Listwise deletion was applied to missing data. Participants were categorized into groups by ELS exposure: Low (0-1; n=32), moderate (2-3; n=29), and high (4+; n= 33). PA was measured in MET (metabolic equivalent of task) hours/week. We hypothesized that greater ELS exposure would be associated with less MVPA.

Results : Participants engaged in Mdn=63.1 MET hours/week of MVPA. Results of a Kruskal-Wallis test demonstrated no significant differences in MVPA across levels of ELS exposure, p >.05. Further analyses were conducted to probe the reason for high levels of MVPA in the present sample. Approximately 38% of the sample's MVPA MET hours/week consisted of occupational activity and 32% consisted of household activity. MVPA did not significantly differ by smoking status, SES, or occupation.

Conclusions : A during pregnancy did not differ by ELS exposure in the present sample. Compared to validation samples for the PPAQ, women in the present sample engaged in relatively high levels of MVPA, not accounted for by SES or smoking status. Further analyses will assess factors related to high MVPA during pregnancy.

P 06.06

Facilitate Physical Activity Engagement and Psychosocial Support in Prostate Cancer Survivors with a Golf-based Multimodal Activity Program

Associate Professor Jacek Pinski MD, PhD 1,2 , Guanrong Cai 3 , Professor George Salem PhD 3

1 USC/Norris Comprehensive Cancer Center, Los Angeles, CA, United States

2 USC/Division of Biokinesiology & Physical Therapy, Los Angeles, CA, United States

3 University of Southern California, Los Angeles, CA, United States

Purpose : Prostate cancer and its treatments can impair physical function and quality of life, highlighting the importance of physical activity and psychosocial support in survivorship care. Group-based multimodal recreational activity (MRA) programs foster activity engagement and social connection. Golf offers physical and psychosocial benefits and can be integrated into structured MRA programs. The Golf Recreational Exercise for Enhanced Survivorship (GREENS) program is a 10-week supervised group-based MRA intervention combining exercise, golf skill instruction, on-course play, and social support. This stage I behavioral study examined feasibility (safety, adherence, acceptance) and preliminary efficacy on physical function and quality of life in prostate cancer survivors receiving hormone therapy.

Method(s): Fifteen survivors (mean age 73.1±5.7) were recruited from a comprehensive cancer center and electronic medical record registry. The 18-week design included three assessment timepoints (baseline [T0], pre-intervention [T1], post-intervention [T2]), a 5-week delayed-entry control period, and a 10-week intervention (20 sessions). Feasibility outcomes included adverse events (CTCAE), attendance, session adherence, and thematic analysis of exit interviews. Physical function (Short Physical Performance Battery [SPPB]) and quality of life (FACT-P and Physical Component Summary [PCS]) were analyzed using linear mixed-effects models.

Results : Ten participants completed all procedures; dropouts were unrelated to the intervention. No CTCAE grade ≥2 adverse events occurred. Attendance averaged 90%, and within-session adherence was 98.9%. Qualitative findings demonstrated high satisfaction, perceived value, strong motivation, and positive peer engagement. SPPB scores improved significantly over time (p=0.012), with a 0.9-point increase from T0 to T2 (p=0.003). FACT-P total scores did not change significantly; however, PCS improved (p=0.04), with a 1.8-point increase at T2 (p=0.04).

Conclusions : The GREENS program was safe, well accepted, and showed promising improvements in physical function and prostate cancer–specific quality of life, supporting further evaluation in larger and more diverse populations.

P 06.07

The Role of Table Tennis in Integrative Management of Parkinson’s Disease: Early Results from the NeuroPong™ Program

Antonio Barbera MD 1,2,3 , Joel Edman DSc 4

1 Movement Disorders Center, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, United States

2 Rocky Mountain Multiple Sclerosis Center, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, United States

3 International Parkinson and Movement Disorder Society, Milwaukee, Wisconsin, United States

4 Metropolitan State University of Denver, Denver, Colorado, United States

Purpose : Parkinson’s disease (PD) is a progressive neurodegenerative disorder with motor and non-motor symptoms that reduce quality of life. Medications alleviate some symptoms but do not fully address functional, cognitive, or psychosocial needs. Integrative approaches that combine movement, cognitive engagement, and social interaction may offer broader benefits. Table tennis incorporates aerobic activity, motor learning, balance, coordination, attention, and adaptability across ability levels. The NeuroPong™ Program formalizes table tennis into a therapeutic framework aimed at improving motor control, cognition, and emotional well-being in people with PD.

Method(s): Twenty-six individuals with PD completed a 12-week table tennis-based intervention held twice weekly for 120 minutes. Sessions included warm-ups, skill training, structured game play, and cool-downs. This report presents four representative cases, supported by video documentation, illustrating functional changes observed during participation.

Results : Case 1: A 59-year-old man with deep brain stimulation and significant dyskinesia improved upper-limb control, depth perception, hand–eye coordination, and daily functioning, reporting enhanced quality of life. Case 2: A 65-year-old man with dyskinesia and impaired movement regulation successfully switched playing dominance, achieving smoother motor control and reduced anxiety, with marked improvement in daily function. Case 3: A 66-year-old woman with upper-limb dyskinesia and multitasking difficulty demonstrated smoother arm movements, improved directional control, and enhanced ability to follow instructions, with substantial anxiety reduction. Case 4: A 64-year-old woman with tremor, trunk stiffness, and poor rhythm perception showed improvements in timing, trunk mobility, hand control, and emotional comfort during play.

Conclusions : These early findings demonstrate the feasibility, safety, and therapeutic promise of the NeuroPong™ Program. Participants experienced motor improvements, such as better upper-limb control, coordination, and reaction time, as well as psychosocial gains including reduced anxiety and increased confidence. Table tennis uniquely blends repetitive motor learning, cognitive engagement, and social interaction, offering multidimensional benefits not typically achieved through conventional rehabilitation.

P 06.08

The Role of Table Tennis in Integrative Management of Multiple Sclerosis: Early Results from the NeuroPong™ Program

Antonio Barbera MD 1,2,3 , Joel Edman DCs 4

1 Movement Disorders Center, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, Aurora, CO, United States

2 Rocky Mountain Multiple Sclerosis Center, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States

3 International Parkinson and Movement Disorder Society, Milwaukee, WI, United States

4 Metropolitan State University of Denver, Denver, CO, United States

Purpose : Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system characterized by fluctuating motor, cognitive, and emotional symptoms. While traditional therapies manage disease progression, many individuals continue to experience unmet physical and psychosocial needs. Integrative approaches such as the NeuroPong™ program offer a complementary strategy. Table tennis, a low-impact, adaptable activity, supports balance, coordination, cognition, stamina, and well-being, with flexible modifications for fatigue, heat sensitivity, and mobility limitations.

Method(s): The NeuroPong™ Program is a table tennis–based prehabilitation and neurorehabilitation intervention for neurodegenerative conditions. Fourteen participants completed a 12-week course consisting of twice-weekly 120-minute sessions incorporating warm-ups, skill training, game play, and cool-downs. This report highlights four MS cases, supplemented by video documentation, to illustrate functional changes observed during the program.

Results : Case 1: A 60-year-old woman with relapsing-remitting MS entered with cane-assisted gait, left-sided weakness, foot drop, and dysarthria. By week 12, she demonstrated improved balance, left-leg flexion, coordinated strokes, and reduced fatigue. Case 2: A 58-year-old man with relapsing-remitting MS and stick-assisted gait gained the ability to bend his knees, play independently, and maintain balance, with notable fatigue improvement. Case 3: A 72-year-old woman with primary progressive MS using a wheelchair showed enhanced upper-limb strength, coordination, dexterity, and endurance after switching to left-hand play. Case 4: A 57-year-old woman with secondary progressive MS improved left-leg flexion, gait quality, and balance, progressing to play without walking sticks.

Conclusions : Across MS subtypes and disability levels, all four individuals demonstrated functional gains in mobility, coordination, strength, or balance, with no falls recorded. Tailored adaptations supported success, and participants reported meaningful psychosocial benefits. Although preliminary and based on a small sample, these findings support further investigation of table tennis as a safe, flexible, and engaging integrative intervention for people with MS.

P 06.09

Gerofit Program Outcomes at the Columbus Chalmers P. Wylie VA

Adam Judd RT, Heather Bierbaugh PTA, Deborah Wilson LISW-S, Heather Seymour MSW, LISW, Lora Cunningham RN, Reversa Joseph MD

Chalmers P Wylie Veterans Administration, Columbus, Ohio, United States

Purpose : Physical inactivity in older adults contributes to functional decline, increased fall risk, and reduced quality of life. The Gerofit program, a supervised exercise and health promotion intervention offered through the Whole Health program at the Chalmers P. Wylie VA, aims to improve physical function, mobility, and overall well-being among Veterans aged 65 and older through personalized, progressive group exercise. The program launched at the Columbus site in April 2023 and has continued to expand participation.

Method(s): Veterans aged ≥65 enrolled in Gerofit completed standardized functional assessments at baseline, 3, 6, and 12 months, including Sit-to-Stand, Arm Curl, 6-Minute Walk, 2-Minute Step Test, 8-Foot Get-Up-and-Go, and Balance testing. Participants also completed a satisfaction survey (Likert scale 1–6) assessing mood, meaning, and perceived life benefits. A total of 168 assessments were completed since program initiation, reflecting strong engagement and retention.

Results : Significant improvements were observed across all domains. Sit-to-Stand repetitions increased by ∼63% and completion time decreased by ∼36%. Arm Curl repetitions increased by ∼46%. Six-Minute Walk distance improved by ∼24%, and 2-Minute Step Test counts increased by ∼56%. Get-Up-and-Go time decreased by ∼36%, and balance duration improved by 100%. Satisfaction scores were consistently high (mean 5.3–5.5/6), with over 90% of Veterans reporting improved mood, 88% reporting greater daily function, and 95% expressing pride and meaning in program participation.

Conclusions : Gerofit participation was associated with meaningful improvements in strength, endurance, mobility, balance, and psychosocial well-being among older Veterans. Given these outcomes and sustained engagement, the Columbus VA plans to expand this model to younger Veterans (<60 years) through VetFit, extending the benefits of structured, Whole Health–aligned exercise to broader Veteran populations.

Topic Area 07: Manual Therapies

P 07.01

A Pilot Study on the Use of Massage Therapy and Healing Touch to Enhance the Overall Well-Being of Patients with Cancer

Ria Jindal BS 1,2 , Marcus Grewal BS 1,2 , Aaditya Pallerla BS 1,2 , Shannon McKnight MS, LMT, BCTMB 2 , Angela Johnson LMT 2 , Harini Pallerla MS 2 , Dr. Mladen Golubic MD, PhD 1,2 , Dr. Sian Cotton PhD 1,2

1 University of Cincinnati College of Medicine, Cincinnati, OH, United States

2 University of Cincinnati Osher Center for Integrative Health, Cincinnati, OH, United States

Purpose : Prior research has demonstrated that massage therapy and healing touch can improve pain and anxiety in patients undergoing cancer treatment. The objective of this pilot study was to evaluate how these interventions affect the overall well-being of patients with cancer in both an inpatient and outpatient setting.

Method(s): Patients receiving inpatient or outpatient cancer treatment were offered massage therapy and/or healing touch by two licensed therapists. Participants completed a pre- and post-intervention mixed-methods iPad survey with three validated measures: the Perceived Stress Scale (PSS-4), the Pain, Enjoyment of Life, and General Activity (PEG-3) scale, and the Edmonton Symptom Assessment Scale (ESAS). Paired statistical analysis of pre- and post-intervention scores was conducted using SPSS-29, and thematic analysis was applied to open-ended questions.

Results : Fifty-one unique participants were enrolled (55% female, 88% White; mean age, 60 years), and 64 paired pre- and post-evaluations were completed. The most common diagnoses were blood cancer (58%), pancreatic cancer (14%), and colorectal cancer (12%). Patients requested massage therapy (81%), healing touch (28%), or both (9%). The primary reasons for requesting care were stress (30%), pain (28%), and anxiety (17%). Before the intervention, 44% of patients rated their health as “fair” or “poor.” Post intervention, participants reported significant reductions in pain, tiredness, nausea, depression, anxiety, drowsiness, and shortness of breath (p<0.05). Well-being increased significantly (p<0.05), and appetite trended upwards (p=0.06). On open-ended responses, 98% of participants indicated the therapy was beneficial, and 100% would recommend the service to others.

Conclusions : This study demonstrates the short-term benefits of massage therapy and healing touch on the well-being of patients with cancer. Limitations include potential self-selection bias and the absence of a control group. Future directions include reproducing the study as a randomized controlled trial (RCT) and expanding to broader oncology populations.

P 07.02

Establishing Priorities to Advance Patient Safety Culture in the Chiropractic Profession: A Mixed Methods Study with Global Chiropractic Leaders

Dr Stacie A Salsbury PhD, RN 1 , Dr Kent Stuber DC, MSc, PhD 2,3 , Dr Maranda Kleppe DC 1 , Dr Sidney Rubinstein PhD 4 , Prof Richard Brown DC, LLM, FRCC 5 , Dr Katherine A Pohlman DC, MS, PhD 2

1 Palmer College of Chiropractic, Davenport, IA, United States

2 Parker University, Dallas, TX, United States

3 Canadian Memorial Chiropractic College, Toronto, Ontario, Canada

4 Vrije Universiteit, Amsterdam, North Holland Province, Netherlands

5 Richard Brown Chiropractic Consultancy, Stroud, Cotswolds, United Kingdom

Purpose : Establishing and sustaining a robust patient safety culture in chiropractic necessitates growth from our current focus on minimizing adverse events to implementing strategic objectives aligned with global initiatives. Our objective was to examine chiropractic leaders' perspectives on global priorities to enhance patient safety culture within the profession.

Method(s): We recruited chiropractic leaders associated with the World Federation of Chiropractic (WFC) for a multi-phased study designed to establish organizational priorities for patient safety initiatives. Respondents completed online surveys via REDCap, video-conferencing interviews for a remote adaptive nominal group process and ranking exercises with open-ended items. Descriptive statistics and qualitative thematic analysis collated findings to identify priorities, strengths, and barriers to improving patient safety culture.

Results : Fifty respondents completed the initial survey, including 47 chiropractors, of which 36 have active practices. Respondents represented all WFC regions and the majority participated in subsequent phases. Top patient safety priorities included: 1) reporting and monitoring adverse events and safety incidents, 2) adopting professional standards and healthcare worker safety protocols, 3) training chiropractors to engage in safety conversations with patients, 4) incorporating patient safety into clinical education, licensing, regulatory, and accreditation requirements, 5) encouraging chiropractors to participant in patient safety initiatives within chiropractic and collaborate across healthcare professions, 6) disseminating patient educational materials and evidence-based resources for chiropractors on clinical processes to reduce patient risk, 7) implementing safety-related clinical pathways and health record documentation in chiropractic settings, 8) committing to using Safety I (reactive safety management) and Safety II (proactive safety management) frameworks to build resilience, 9) developing and collecting meaningful outcome measures of patient safety experiences, and 10) establishing professional competences in patient safety.

Conclusions : Global leaders ranked their priorities for patient safety culture initiatives, establishing a needs assessment and action agenda for an international chiropractic organization.

P 07.03

A Survey of Chiropractic Trainees and Program Directors: Insights into Postdoctoral Training in Clinical Research and Health Policy

Dr. Maranda Kleppe DC 1 , Dr. Wren Burton DC, MPH 2 , Dr. Victoria Bensel DC, MS, MPH 3,4 , Dr. Macy Randolph DC 2 , Dr. Robert Vining DC, DHSc 1

1 Palmer College of Chiropractic, Center for Chiropractic Research, Davenport, IA, United States

2 Osher Center for Integrative Health, Harvard Medical School & Brigham and Women’s Hospital, Boston, MA, United States

3 Department of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States

4 VA Connecticut Healthcare System, New Haven, CT, United States

Purpose : Few postgraduate programs exist for chiropractors in clinical research and health policy. This study describes available programs and examines trainee experiences.

Method(s): We conducted an electronic survey of 18 postdoctoral trainees and program directors from 13 known U.S.-based clinical research and health policy programs affiliated with academic institutions or healthcare systems. Trainees surveyed completed an eligible program within the past 5 years (after June 2020) or were enrolled in a program as of June 2025. Surveys included questions on program resources and career development. Directors provided program characteristics and funding details. Quantitative data were analyzed descriptively while qualitative data were analyzed thematically.

Results : Sixteen trainees and 7 directors participated, with response rates of 89% and 54%, respectively. Two directors did not participate due to discontinuation of program funding. Trainees identified formal mentorship (94%), academic coursework (88%), and research skill training (69%) as the most valuable resources. Qualitative analysis further revealed that trainees valued dedicated mentors who were responsive, invested, and fostered professional growth. Trainees also recognized the complementary roles of formal coursework and practical program activities, mentioning research methodology, scientific writing, and biostatistics as the most beneficial skill areas developed. Trainees also reported that participation in their mentored training programs enhanced their understanding of varied career paths and influenced decisions to remain involved in research or health policy-related fields. Trainees reported co-authoring a combined total of 38 peer-reviewed publications directly related to participating in training programs. Directors highlighted challenges in securing or sustaining funding for their postdoctoral training program.

Conclusions : Current programs facilitate key skill development, provide a foundation for careers in research and health policy, and demonstrate productivity through scholarly output. However, stable funding to support the few available programs that develop a pipeline of research and health policy professionals remains extremely limited.

P 07.04

A Survey of U.S. Chiropractors Assessing the Importance and Feasibility of Quality Measures for Chiropractic Care: Exploring Differences Across Healthcare Settings

Dr. Maranda Kleppe DC , Jacob McCarey MS, Sujatha Kedilaya, Robert Vining DC, DHSc

Palmer College of Chiropractic, Center for Chiropractic Research, Davenport, Iowa, United States

Purpose : A recently developed set of quality measures (QMs) for chiropractic care was provisionally validated by chiropractors and administrators in U.S. integrated care settings and chiropractic educational institutions. This study examined U.S. licensed chiropractors’ perceptions of the importance and feasibility of implementing QMs in varied practice settings to support further refinement and prioritization for pilot implementation.

Method(s): We conducted an electronic survey of U.S. licensed chiropractors from March-May 2025 on the importance and feasibility of implementing QMs in respondent settings. We targeted recruitment efforts to ensure respondent perspectives from 1) Multidisciplinary and single discipline practices; 2) Referral and portal-of-entry access settings; 3) Low and high population density areas; and 4) primary care Health Professional Shortage Areas. Respondents rated each QM on a 5-point Likert scale (low to high) for both importance and feasibility. Measures were ranked by mean ratings and rank orders were compared across subgroups defined by the settings described above. Kendall’s Tau correlation coefficient (range: -1 to 1) was used to assess rank-order correlation between subgroups.

Results : Respondents (n=869) were 69% male, with a mean of 23.8 years of experience. Sixteen percent (n=141) reported working in multidisciplinary settings, of whom 66% (n=93) reported familiarity with QMs. QM rankings differed little across respondent settings demonstrated by high (≥0.75) rank-order correlations for importance and moderate or higher (≥0.55) for feasibility. ‘Documenting adverse events’ was the highest rated measure for importance and ‘Performing an exam for a presenting problem’ was the highest rated measure for feasibility with means of 4.79 and 4.65, respectively. Of the 10 highest-rated clinical process measures, eight relate to supporting patient safety.

Conclusions : Provider setting had minimal influence on measure ratings. QMs supporting safe care were consistently rated highest, suggesting pilot implementation should prioritize safety-related measures independent of practice setting characteristics.

P 07.05

Cultivating MassageNet, the World’s Largest Massage-Therapy Focused Practice-Based Research Network: May 2022 – April 2025

Niki Munk PhD, LMT 1,2 , Samantha Zabel PhD(c) 1

1 Indiana University Indianapolis, School of Health & Human Sciences, Indianapolis, IN, United States

2 Massage Therapy Foundation, Evansville, Illinois, United States

Purpose : Practice-Based Research Networks (PBRNs) are vital for applied clinical health disciplines to facilitate real-world evidence generation, foster practitioner-driven inquiry, and support research translation into practice. MassageNet is the largest PBRN focused exclusively on therapeutic massage and was initially established in 2009. After an enthusiastic initial start, MassageNet became essentially dormant after 2016 and establishing N=513 massage clinician members. The Massage Therapy Foundation (MTF) acquired and updated the PBRN starting in 2019 and officially relaunched MassageNet during the International Massage Therapy Research Conference (IMTRC) in May2022.

Method(s): Enrollment and practice descriptor surveys via SurveyMonkey were designed to collect demographics, professional characteristics, and PBRN-related interests and needs from self-identified massage therapy clinicians. Original MassageNet members piloted the surveys and re-enrolled if interested Feb-April 2022 with open access and invitation to enroll launching May 12, 2022. Research collaborators were able to inquire and launch approved research studies within MassageNet beginning in late 2022/early 2023, respectively, through the MTF Research Committee.

Results : By IMTRC 2025 (April 29, 2025), MassageNet had collected N=876 enrollment surveys and N=320 practice descriptor surveys from 49 US States and over 19 countries across 6 continents. Most were currently practicing (90%) and with licensure/credentials (92%), female (77%), and White (80%) with ∼15yrs in practice on average and 46.2 (±11.8) years old. Additionally, multiple research projects had completed the MassageNet inquiry process (n=6), successfully launched (n=4), and completed (n=3) within MassageNet; topics:mental health, practitioner-client perspective alignment, terminology, ergonomics.

Conclusions : MassageNet’s successful relaunch and expansion demonstrate the feasibility and value of a large-scale, profession-specific PBRN within the therapeutic massage field. MassageNet addresses longstanding challenges in massage therapy research by fostering practitioner engagement, generating real-world data, and supporting evidence-informed practice. As MassageNet enters its growth phase (2026-2029), it is poised to further integrate therapeutic massage into broader healthcare research and delivery systems.

P 07.06

“Neck pain …a part of me”: A Qualitative Study of Combined Chiropractic Care and Tai Chi for Chronic Neck Pain

Emma Dubinsky MS 1,2 , Jacqueline Guzman 1 , Wren M Burton 1,2 , Matthew H Kowalski 1 , Cynthia R Long 3 , Jacob McCarey 3 , Daniel Litrownik 1,2 , Kristina Twaalfhoven 1,2 , Viviane Nguyen 1,2 , Thomas J Hagen 4 , Pamela M Rist 1,2 , Robert Vining 3 , Karen Kilgore 1 , Peter M Wayne 1,2

1 Osher Center for Integrative Health, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States

2 Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States

3 Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States

4 Khalsa Chiropractic, Cambridge, MA, United States

Purpose : Chronic neck pain (CNP) is a significant public health concern. While individual complementary and integrative health (CIH) therapies show promise in reducing CNP-related disability and pain, little is known about participant perspectives of acceptability, effectiveness and safety of combining manual and mind-body CIH therapies.

Method(s): Forty-eight individuals with CNP were enrolled in a pilot three-arm RCT investigating validated community-based multimodal chiropractic care (CC, arm 1), chiropractic care and virtual Tai Chi instruction (CC+TC, arm 2), and enhanced usual care (EUC, arm 3). Participants completed qualitative interviews at baseline and 16 weeks. This qualitative sub-study aims to provide insights into participants’ perspectives.

Results : Patients viewed both CC and TC as effective in reducing stress and CNP-related disability and pain. Participants described their chiropractors as perceptive regarding their pain, responsive to their needs, and capable of providing clear explanations. They learned about the complexity of their neck pain and its relationship to musculoskeletal issues. Participants began the study hesitant about CC. By their final interview, participants were surprised by the extent of chiropractic work beyond spinal manipulation. TC was viewed as effective for reducing stress throughout the body and increasing somatic awareness. While participants noted that CC and TC were qualitatively different interventions, they described a potential synergistic effect between CC and TC, noting that both interventions encouraged them to think about how changes in their body can shape their experience of pain

Conclusions : TC and CC both show promise to help patients with CNP-related disability and pain. Participants viewed both CC and TC as helpful in changing how they thought about and experienced pain in their bodies. Further study of combined TC and CC for CNP-related disability and pain is warranted

P 07.07

Designing and implementing an immersive, experiential osteopathic manipulative medicine elective course in allopathic medical education

Dr. Selim Sheikh DO, MBA

University of Utah, Salt Lake City, Utah, United States

Purpose : Interest in integrative medicine disciplines, including osteopathic manipulative medicine (OMM), is growing among U.S. allopathic (MD) medical students. However, manual medicine is absent from MD curricula, and fewer than half of practicing doctors of osteopathic medicine (DOs) utilize osteopathic manipulative treatment (OMT) in medical practice. This gap highlights the need for an introductory elective for MD students. An immersive, practical OMM course can offer MD students a foundational understanding of OMM in patient care and a basis for further study and skill development.

Method(s): An elective course was designed and implemented at the University of Utah School of Medicine. It consisted of three, four-hour in-person sessions over two days, balancing brief didactic content with extensive small-group, hands-on practice. Objectives focused on OMT principles, palpatory experience, screening examinations, diagnostic approach, practice of a range of OMT techniques, and integration into clinical practice. The curriculum progressed from core principles to specific techniques for various body regions. Assessment included in-class practice and a reflective write-up.

Results : Reflection papers and course evaluations reported a highly positive learning experience. All twelve students who completed the course (with representation of all class years) reported deeper understanding of osteopathic principles and practice. The average overall course satisfaction rating was 4.8/5. Qualitative analysis showed recurring themes, including increased appreciation for a whole-person health approach and the practical utility of hands-on medical treatment. Students achieved greater confidence in basic palpatory diagnosis and introductory OMT applications. Four students pursued optional clinical shadowing after the course.

Conclusions : The OMM elective successfully met its objectives, demonstrating enhancement in students’ understanding of osteopathic principles and whole-health patient care. The positive outcomes provide a compelling case for integrating OMM exposure into allopathic medical education to enrich students' understanding of diverse healthcare approaches, foster interprofessional understanding, and improve comprehensive patient assessment and management.

P 07.08

A Sustainable Model for Implementing Massage Therapy in a Comprehensive Cancer Center

Benjamin P Smith B.S Psychology 1 , Shelley White PhD 1,2,3

1 Huntsman Cancer Institute, Salt Lake City, Utah, United States

2 Huntsman Mental Health Institute, Salt Lake City, Utah, United States

3 University of Utah, Salt Lake City, Utah, United States

Purpose : Integrating massage therapy into comprehensive cancer centers faces significant funding and sustainability hurdles. This presentation describes the successful, replicable model of the Huntsman Cancer Institute (HCI) Massage Therapy Program. Established in 2012 within an NCI-designated center, it serves as a framework for institutions building integrative services. By detailing solutions to operational challenges, we provide a roadmap addressing the theme “Scaling What Works” in a complex academic environment.

Method(s): Presented as an organizational case study, the HCI program is a core service staffed by 11 therapists (∼6.0 FTEs). Key components include a hybrid funding model (nursing budget, philanthropy, patient revenue) and a clinical delivery model spanning the care continuum: no-cost inpatient sessions, fee-based outpatient appointments, and staff support. The program operates from a purpose-built space using standardized safety protocols, including the Tracy Walton Pressure Scale, for risk management.

Results : After over a decade, the program is deeply embedded, delivering thousands of encounters annually. Its long-term sustainability is achieved through the hybrid funding model, ensuring stability and growth. Clinical integration is evidenced by provider referrals, EHR documentation, and participation in NIH-funded trials. Success includes a stable, specialized team and infrastructure optimized for integrative care, demonstrating a viable financial and operational structure.

Conclusions : The HCI program provides a proven, sustainable model for integrative oncology. Success hinges on diversified funding, strong institutional support, and a multi-faceted delivery model. Looking ahead, we aim to evolve beyond a multidisciplinary approach toward enhanced interdisciplinary care, exploring shared medical appointments and groups empowering patients with self-massage and mindful body awareness. This framework offers a practical roadmap, “scaling what works” to improve accessibility and quality of care nationwide.

P 07.09

Massage Therapy and Pain Outcomes within a Patient-Centered Medical Home

Tracy L Rupp PhD., MAc

Defense and Veterans Center for Integrative Pain Management (DVCIPM), Department of Anesthesiology, Uniformed Services University (USU), Bethesda, MD, United States. Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States

Purpose : Massage therapy is effective for reducing short- and long-term pain, yet its implementation and impact in real-world clinical settings remain understudied. Patient-Centered Medical Homes (PCMHs) offer coordinated, accessible, team-based care associated with improved outcomes and represent a key setting for evaluation. To assess the value of integrating massage therapy into a PCMH model, we examined outcomes for patients who received massage therapy at a U.S. military treatment facility via specialty referral from PCMH clinicians.

Method(s): This project occurred at the Kimbrough Army Medical Center PCMH, where a licensed massage therapist provided specialty care (January 2023–January 2025). Patients completed PASTOR questionnaires within one week of scheduling. This retrospective observational study used Military Health System Data Repository records for patients who received massage therapy. Variables included demographics, diagnoses, and patient-reported outcomes from DVPRS pain intensity/interference items and PROMIS domains. Generalized linear models evaluated changes between pre-treatment and 60–90-day post-massage assessments.

Results : A total of 217 patients received massage therapy during the observation period, and fifteen patients had complete patient-reported outcomes for analysis. This subsample received a median of 2 sessions (IQR: 1–3.5). Generalized linear models demonstrated significant pre- to post-massage improvements in three outcomes: Worst 7-Day Pain (6.5 ± 1.5 to 5.8 ± 1.6), Average 7-Day Pain (4.5 ± 1.5 to 3.8 ± 1.3), and PROMIS Neuropathic Pain Quality (52.0 ± 6.4 to 49.3 ± 8.6).

Conclusions : This evaluation provides preliminary evidence that integrating massage therapy into a military PCMH referral pathway may be associated with improved patient-reported outcomes. Adjusted analyses showed significant reductions in worst and average weekly pain and in neuropathic pain symptoms, though mean changes may be of limited clinical magnitude. Future research should examine larger PCMH populations and assess effectiveness and scalability. Findings support continued integration and evaluation of PCMH-linked massage therapy services within team-based primary care.

P 07.10

System Redesign for Integrating Chiropractic Care into Safety-Net Primary Care for Low Back Pain: Identifying and Prioritizing Referral Barriers

Anna Natrakul 1 , Julia Bozkurtian 1 , Asifa Rahim MPH 1 , Katherine Gergen-Barnett MD 2 , Richard Printon DC 3 , Susan Haddow MD 3 , Michael LaValley PhD 4 , Lance Laird ThD 2 , Michael A Fischer MD, MS 1 , Robert B Saper MD, MPH 5 , André Bussières DC, PhD 6,7 , Roni Evans DC, PhD 8 , Natalia E Morone MD, MS 1 , Eric J Roseen DC, PhD 1

1 Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States

2 Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States

3 Division of Integrative Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, United States

4 Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States

5 Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, United States

6 Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada

7 School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Québec, Canada

8 Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN, United States

Purpose : Few patients with low back pain (LBP) access guideline-recommended nonpharmacologic treatments after visiting a primary care provider (PCP), especially in underserved communities. We examined barriers to accessing chiropractic care following a PCP consult for LBP at safety net hospitals.

Method(s): We conducted a two-phase sequential mixed methods study involving process mapping with failure modes and effects analyses (FMEA) at four primary care clinics in Minnesota (MN) and Massachusetts (MA). PCPs, clinic staff, and onsite or community-based chiropractors were invited to interviews. Each participant created a process map outlining steps for a patient with LBP to see their PCP and then a chiropractor, as well as barriers to each step. Deductive thematic analysis informed by the Consolidated Framework for Implementation Research was used to combine maps. An online survey was administered to participants to prioritize barriers through FMEA by assigning each barrier a risk priority number (RPN, 1–1000), with higher scores denoting greater importance.

Results : Thirty-three interviewees (8-9 per clinic) created process maps, and 71 distinct barriers were identified. One interviewee per clinic site helped select 32 important potentially modifiable barriers for FMEA evaluation. Ninety-three participants (mean age=45; 74% female; 45 PCPs, 32 staff, 11 chiropractors) completed the FMEA survey. Barriers with high RPN scores included “Insurance Uncertainty” (mean RPN: 193.6) and “Patient Knowledge Gap” (186.6). Barriers scoring high in MN but not MA clinics: “Lost Hope” (165.2) and “Weak Recommendation” (162.8). Barriers scoring high in MA but not MN clinics were: “Patient Scheduling Burden” (201.4) and “Insurance Search Burden” (193.9).

Conclusions : Uncertainty about insurance coverage and patient knowledge gaps were identified as key barriers to receiving chiropractic care across health systems. Other barriers varied across sites, reflecting local organizational and contextual differences. Addressing these barriers will require tailored multi-level implementation strategies to improve access to chiropractic care in underserved primary care settings.

P 07.11LB

The Impact of Massage therapy on Pain and Anxiety in patients with gynecologic cancer receiving Cancer Treatment (IMPACT): A Feasibility Study Protocol

Jill S. Cole MA, LMT, BCTMB 1,2 , Niki Munk PhD, LMT 3,4 , Frederick R. Ueland MD 5 , Amanda M. Biddle M.Ed. 1 , Stacey Slone MS 6 , Kyle Kosik PhD, ATC 7 , Esther E. Dupont-Versteegden PhD 2

1 University of Kentucky Integrative Medicine and Health, Lexington, KY, United States

2 University of Kentucky Rehabilitation and Health Sciences PhD Program, Lexington, KY, United States

3 University of Indiana, School of Health and Human Sciences, Indianapolis, IN, United States

4 Massage Therapy Foundation, Evanston, IL, United States

5 University of Kentucky Markey Cancer Center Department of Gynecologic Oncology, Lexington, KY, United States

6 University of Kentucky Dr. Bing Zhang Department of Statistics, Lexington, KY, United States

7 University of Kentucky Department of Athletic Training and Clinical Nutrition., Lexington, KY, United States

Purpose : Patients with gynecologic cancers often experience multifactorial pain and anxiety. Massage therapy is an efficacious non-pharmacological treatment for pain and anxiety in people living with cancer, but the feasibility of performing clinical trials for massage outcomes in a practice-based setting of an infusion center is not clear. The goal of this study is to determine the feasibility of studying massage therapy in patients with gynecologic cancers

Method(s): This protocol describes a single-site, randomized-control, mixed-methods feasibility study in patients with gynecologic cancers receiving infusion therapy. We will randomize 24 patients upon screening and enrollment to massage therapy or an attention-control group. Participants randomized to either the massage or attention control group will receive 3 treatment-sessions during their regularly scheduled infusions. Primary outcomes of recruitment, retention, randomization, blinding, control, data collection, and adherence will be measured using the traffic light system. Secondary outcomes of pain will be measured at enrollment/baseline and pre/post-intervention using the Defense and Veterans Pain Rating Scale and Temporal Summation with von Frey filaments. We will measure anxiety using the Stait-Trait 6-question anxiety scale at enrollment/baseline and pre-post intervention. Post-study patient surveys on acceptability, appropriateness, and feasibility will be collected, as will qualitative data from a focus group of massage therapists.

Results : Feasibility metrics will be reported as counts, percentages, and 95% CIs and evaluated using the traffic light method. Longitudinal data will be presented with visualizations and analyzed with mixed-effects models to estimate variability for future trial design.

Conclusions : This study aims to show whether it is feasible to conduct future clinical intervention trials in patients with gynecologic cancers in an infusion center. Results from this study are important for identifying, improving, and utilizing appropriate research methods to investigate the efficacy of massage in alleviating pain and anxiety.

Topic Area 08: Measurement

P 08.01

Measurement Applicable to All: Validating an Invariant Multidimensional Assessment of Interoceptive Awareness Short Form (MAIA–SF) Across Health and Healing Contexts

Maria F Carriel MPH, Dr Janell L Mensinger PhD

Nova Southeastern University, Davie, 33314, United States

Purpose : Ensuring psychological measures function equivalently across populations is foundational to rigorous research and clinical practice. Measurement invariance (MI) provides a method for testing whether item meaning is comparable across groups, yet MI is often overlooked. Interoception—the adaptive integration of bodily signals—supports self-regulation and homeostatic balance. The Multidimensional Assessment of Interoceptive Awareness (MAIA) is widely used in integrative health research, but its length and evidence of bias across background characteristics have raised concerns about its utility. Prior efforts to develop a brief MAIA were made in an Eastern European sample; preliminary data suggests presence of noninvariance in US samples. To address these challenges, we validated an invariant MAIA Short Form (MAIA-SF).

Method(s): Data were collected in July 2025 using CloudResearch Connect, employing US Census-matched quotas on sex, age, and racial/ethnic identity. Two independent samples of adults (N=2000) completed the original MAIA-2 plus nine pilot items. Exploratory factor analysis supported retention of seven pilot items, yielding 44 items for invariance testing. Multi-group confirmatory factor analyses with robust maximum likelihood estimation assessed configural, metric, and scalar invariance across characteristics relevant to interoceptive functioning: gender, age, eating disorder status, BMI, childhood trauma exposure, and weight stigma. Twenty-four items demonstrating strong factorial validity, local fit, and parameter stability were retained.

Results : The final eight-factor model showed excellent global fit (χ 2 [224]=689.4; RMSEA=.032; CFI=.977; SRMR=.027) and strong MI across all variables (ΔCFI ≤ .003). A subsample (N=298) completed the MAIA-SF for validation and test–retest reliability. Internal consistency was adequate across subscales (ω=.71–.92), and test–retest reliability was moderate to strong (ICC=.60–.81) for seven factors. Lower ICC for Not Distracting (ICC=.44) may reflect fluctuations in behavioral responses to pain.

Conclusions : The MAIA-SF provides a concise, unbiased, and psychometrically robust tool suitable for evaluating interoceptive sensibility in clinical practice and mind–body intervention research.

P 08.02

Assessing Well-being among Older Adults: Acceptability, Feasibility, and Utility of a Modified Well-Being Signs Measure

Dr. Sophia M. Bartels 1 , Dr. Claire E. Grant 1 , Aileen Mcgrory 1 , Dr. Catherine Dawson 2 , Dr. Eileen Dryden 1

1 Center for Health Optimization and Implementation Research, Bedford VA, Bedford, MA, United States

2 VA Bedford Healthcare, Bedford, MA, United States

Purpose : Evaluating patient well-being can assist clinicians in anchoring healthcare recommendations to what matters most to their patients; however, measuring well-being is challenging. In 2021, Veterans Health Administration (VHA) researchers developed a 3-item measure called the Well-Being Signs (WBS). To optimize use of the WBS among Geriatric populations, our team identified a need to administer the WBS to caregivers and to add open-ended questions to the measure, rather than relying on the numeric scores alone. We then sought to understand the feasibility, acceptability, and utility of implementing the modified WBS within Geriatrics clinics.

Method(s): In 2025, we piloted the modified WBS within two VHA Geriatrics clinics and conducted interviews with Veterans, caregivers, and clinic staff about their experiences being administered and implementing the WBS, respectively. We used rapid qualitative analysis to analyze interview transcripts.

Results : The modified WBS was administered to 151 older Veterans and caregivers, with 17 agreeing to interviews about their experience. Overall, Veterans and their caregivers were able to complete the WBS and liked talking to providers about what matters most to them. However, some had challenges providing numeric responses on a 0-10 scale. Most of the 8 clinicians we interviewed thought it was feasible to incorporate the WBS into clinic flow. Additionally, they perceived that the modified WBS added value by starting a conversation with Veterans about their well-being and tracking well-being over time. However, some struggled to see its advantage over other efforts to understand what matters most to the Veteran and with knowing what to do for patients with low WBS scores; consequently, only one clinic planned to continue using the WBS beyond the pilot.

Conclusions : The modified WBS holds promise in improving understanding and intervention around Geriatrics patients’ well-being; however, implementation tools are likely needed to support its clinical use and broader spread.

P 08.03

Measuring What Matters and Leveraging What Works: Implementation of the Well-Being Signs Across the Veterans Health Administration

Jamila S. Miah LCSW, Sara M. Bozeman PhD, Amy S. Collings PhD , Natalie J. Cross PhD, Tosha Ellis PhD, Jessica Hennessey MBA, RRT

VHA Office of Patient Centered Care and Cultural Transformation, Washington, DC, United States

Purpose : The Veterans Health Administration is enhancing the Whole Health System by focusing on outcomes that prioritize Veteran well-being. The Well-Being Signs (WBS), a validated tool, measures personal well-being across critical domains1,2. This project aimed to implement and scale WBS usage across diverse settings, guided by the Office of Patient-Centered Care and Cultural Transformation’s Field Implementation Team (FIT). The objective was to make WBS a standard metric for Veteran-centered care, ensuring effective and widespread adoption3.

Method(s): FIT employed a multi-component, iterative strategy, including educational resources and consultative guidance for various programs. Collaborative learning structures including huddles and community calls were used to gather insights and adapt materials. A communication plan across Veterans Integrated Service Networks (VISNs) raised awareness. WBS was integrated into technology platforms like Behavioral Health Lab (BHL) and Mental Health Assistant (MHA), and workflow templates were developed for Computerized Patient Record System (CPRS) to streamline data capture and documentation.

Results : Between FY23 and FY25, WBS utilization grew significantly. From May to August 2025, WBS administrations doubled from 33,219 to 65,622. The number of sites capturing ≥100 WBS instances increased from 40 to 86, with active sites rising from 115 to 132. WBS was incorporated into various clinical settings, reflecting broader adoption beyond Whole Health clinics. Qualitative feedback indicated increased clinician engagement and the tool's alignment with Veteran-centered care, enhancing both individual planning and program evaluation.

Conclusions : The WBS implementation demonstrates how a large health system can effectively scale well-being measurements. FIT’s adaptive strategies ensured the tool's integration into workflows and technologies. Key lessons include aligning tools with organizational priorities, iterative field-informed tactics, leveraging existing systems, and continuous feedback. This initiative not only advances Whole Health implementation but also offers a model for other systems to prioritize well-being, shifting focus from disease metrics to meaningful life activities.

P 08.04

Checklist Development of Whole Health Practices by Complementary and Integrative Healthcare Providers within Federally Funded Community Health Clinics

Dr. Andrea K Albertson DC 1 , Dr. Jocelyn Faydenko ND, DC, MS 2 , Dr. Maya Roth ND 3 , Dr. Chris Hanson DC 1 , Dr. Ian Coulter PhD 4

1 Northwestern Health Sciences University, Bloomington, MN, United States

2 National University of Health Sciences, Lombard, IL, United States

3 Bastyr University, San Diego, CA, United States

4 RAND Corporation, Santa Monica, CA, United States

Purpose : In preparation for a larger project, the purpose of this study is to develop a standardized checklist of whole health practices common among three licensed complementary and integrative health (CIH) professions (acupuncture, chiropractic, and naturopathy) that work in federally funded community health clinics.

Method(s): The investigative team, comprised of CIH professionals, conducted a literature search to identify whole health practices from indexed and grey literature. The team reviewed and extracted whole health themes applicable to CIH scopes of practice, clinical experience, and familiarity within CIH professions. These themes informed categorical domains for the checklist, expanded to include definitions and examples for clinical use. The checklist was reviewed for face validity by one team member with intimate knowledge of federally funded community health clinics.

Results : The one-page checklist consists of six domains: physical, spiritual/philosophical/psychosocial, behavioral/lifestyle, socioeconomic, multidisciplinary care, and trust/ethical treatment. Each domain contains related subdomains and can be categorized as a discussion, provider recommendation, or intervention. Subdomains can be ranked from most to least emphasized in the treatment encounter by the observer. Additional data includes total time the provider spent with the patient, primary purpose of visit (e.g., physical medicine, internal medicine, mental/emotional medicine), initial or returning patient, discussion of patient goals and values, and provider goals for the patient.

Conclusions : The objective of this checklist is to standardize data collection of whole health practices among three licensed CIH professions during a treatment encounter within federally funded community health clinics.

Topic Area 09: Mental Health

P 09.01

Interoceptive Awareness as a Mechanism of Change in Touch-Based Therapies for Generalized Anxiety Disorder

Benjamin P Smith B.S Psychology 1 , Becky Kinkead PhD 1,2,3

1 Huntsman Cancer Institute, Salt Lake City, Utah, United States

2 University of Utah, Salt Lake City, Utah, United States

3 Huntsman Mental Health Institute, Salt Lake City, Utah, United States

Purpose : While touch-based interventions like Swedish Massage Therapy (SMT) reduce symptoms of Generalized Anxiety Disorder (GAD), the neurobiological mechanisms remain unclear. Interoception—perceiving internal bodily signals—is critical for emotional regulation and often disrupted in GAD. Addressing the theme “measure what matters,” this study investigates interoceptive awareness as a mechanism explaining therapeutic efficacy. The primary aim is to determine if baseline interoceptive awareness moderates clinical outcomes in GAD patients receiving SMT versus Light Touch (LT). Secondarily, we identify neural and autonomic correlates of changes in interoceptive awareness to provide a multi-level understanding of therapeutic effects.

Method(s): Leveraging two ongoing randomized clinical trials, we recruited 80 participants (40 GAD, 40 non-psychiatric controls). Participants were randomized to six weeks of twice-weekly, 45-minute sessions of either SMT (engaging affective C-tactile pathways) or LT (engaging discriminative Aß-fibers). Interoceptive awareness was measured pre- and post-intervention via the Multidimensional Assessment of Interoceptive Awareness (MAIA-2). Anxiety severity was assessed weekly (HAM-A). Neurobiological mechanisms were explored via pre- and post-intervention resting-state fMRI and autonomic measures, including heart rate variability (HRV) and galvanic skin response.

Results : With final results anticipated by the conference, we hypothesize baseline MAIA-2 profiles will moderate treatment response. Specifically, higher Body Trusting and Self-Regulation scores should predict greater symptom reduction in the SMT group, whereas LT responsiveness may hinge on different interoceptive facets. Furthermore, we expect longitudinal improvements in interoceptive awareness will correlate with functional connectivity changes in emotional regulation regions (e.g., insula, ACC) and improved autonomic balance.

Conclusions : This research elucidates how touch-based therapies ameliorate GAD symptoms. Identifying distinct neurophysiological pathways moves the field beyond one-size-fits-all approaches toward personalized, evidence-based treatments. Findings will help clinicians “scale what works” by targeting interventions based on individual interoceptive profiles. This approach enhances the efficacy of integrative care, contributing to a nuanced model of whole-person health.

P 09.02

Measuring What Matters Most to Veterans: Quality of Life, Hope, and Self-Efficacy through VIP Boot Camp

Dr Carolyn Davidson PhD 1 , Dr Meghan Rooney PsyD 1 , Dr Jessica Walsh PhD 2 , Dr. Julianna Hogan PhD 2,3 , Ms. Gina Foltz MS, RD, LDN 4 , Dr Kaki York PhD 2

1 VA VISN 9 Clinical Resource Hub, Louisville, KY, United States

2 Michael E. DeBakey VA Medical Center, Houston, TX, United States

3 Southcentral MIRECC, Houston, TX, United States

4 Office of Patient Centered Care and Cultural Transformation (OPCC&CT)., Washington DC, DC, United States

Purpose : Access to mental health (MH) is a challenge in VA. VIP Boot Camp is an evidence-informed, group psychotherapy program within Primary Care MH Integration (PCMHI) that provides timely, brief, comprehensive treatment to address mood, pain, and sleep—common, interconnected, core concerns for Veterans. Applying an integrative Whole Health approach to care, VIP Boot Camp reduces reliance on more intensive, specialty settings by empowering and equipping Veterans to actively manage their health and well-being. This effort evaluates its impact on quality of life, self-efficacy, and Veteran satisfaction.

Method(s): Real-time satisfaction data from 46 Veterans who completed VIP Boot Camp from September 2023 to September 2025 were obtained from VA’s VSignals, a customer experience platform, and anonymous Veteran feedback surveys were analyzed.

Results : Improvements in quality of life, a key Whole Health metric, were reported by 91.3% of participants. Over 93.5% practiced evidence-based strategies to improve sleep, citing greater understanding of stimulus control (bed is for sleep, sleep is for the bed). The chronic pain module was valued for pain education and daily BOMB (Breathe, go Outside, Move Body) exercises. Veterans reported increased cognitive flexibility via stress reduction tools, with 60.9% using the CBT mantra “Catch it, Check it, Change it.” Over 90% of respondents recommend the program, highlighting leader empathy, clarity, and care. All 100% of respondents said that VIP Boot Camp leaders explained things in a way that held their interest. Most importantly, over 80% of respondents expressed greater hopefulness and personal efficacy after participation.

Conclusions : VIP Boot Camp provides an accessible, scalable group MH intervention to address mood, pain, and sleep through a whole-health approach. High Veteran satisfaction and improved health behaviors support its effectiveness and engagement. A proactive, “upstream” solution, VIP Boot Camp plays a pivotal role in supporting Veterans’ sense of purpose, which has been shown to have positive implications on physical health, enhanced mental and emotional well-being, improved health behaviors and engagement. Future efforts will examine region-specific outcomes and further tailor care to what matters most to Veterans.

P 09.03

Integrated and Integrative: Implementing Integrative Health Services to Support Pediatric Mental Health in an Underserved Primary Care Clinic

Bridget S Garmisa MSN , Maria Mascarenhas MBBS

Children's Hospital of Philadelphia, Philadelphia, PA, United States

Purpose : In 2023, more than 5.3 million adolescents aged 12-17 years (20.3%) had a current, diagnosed mental or behavioral health condition. This is particularly concerning when considering health disparities as adolescent depression and anxiety forecast adverse health and socioeconomic consequences throughout the lifespan. This pilot program aims to increase access and availability of integrative health services for children and adolescents with anxiety, depression and/or ADHD in an urban, underserved primary care clinic where demand for mental health support far exceeds the availability of providers.

Method(s): Patients aged 8-18 years are offered 6 individual sessions with an IH trained nurse practitioner in their medical home. Patients 14-18 years can choose to join a series of group medical visits (GMVs) focused on evidence-based supportive techniques for anxiety and depression. Metrics being collected will assess for improvements in mental health screening (PHQ-9, GAD-7, SCARED, Vanderbilt questionnaires, Clinician Global Impressions Scale), financial billing and reimbursement as well as participant satisfaction and patient reported health outcomes (PROMIS-7).

Results : Clinician feedback demonstrates enthusiastic support for integrative health consultation to help manage behavioral health conditions. Patient and family experience feedback is being used to tailor GMV frequency and content. Our program launched in fall of 2025, and we anticipate several months of enrollment data will be available by conference date to begin assessing impact and financial sustainability.

Conclusions : Embedding integrative health services into a primary care practice with co-located behavioral health services conceptually meets the needs of patients in need of whole health support for common mental health conditions. Quality metrics being obtained will allow for both clinical and self-reported improvements in mental health. Financial review of generated RVUs and reimbursement will determine long term viability of this program. A successful pilot would allow for expansion to other primary care practices in the CHOP Primary Care network.

P 09.04

Growing through Adversity: Prosocial Behaviors' Correlation with Psychological Outcomes in Marginalized Youth

Saloni Dangoria BA , Elena Gareau BS, Dr. Natalia Jaramillo PhD, Dr. Jeffrey I. Gold PhD

Children's Hospital of Los Angeles, Los Angeles, CA, United States

Purpose : Adverse Childhood Events (ACEs) have a statistically significant correlation with internalizing and externalizing behaviors; however, possible moderators for this relationship are yet to be identified in marginalized youth. Previous literature has revealed that engaging in prosocial behaviors can diminish the clinical risk of developing internalizing and externalizing problems. This study examines the moderating role of prosocial behaviors on the relationship of ACEs on internalizing and externalizing factors.

Method(s): 89 patients (ages 9-19) represent a diverse adolescent population (62.9% female, 36.0% male, 1.1% nonbinary), ethnicities (38.2% Hispanic/Latinx, 32.6% White, 7.9% Black, 7.9% Mixed, 5.6% Asian, 7.8% Unknown), and insurance types (61.8% Medi-Cal, 37.1% PPO/HMO, 1.1.% Self-Pay). Patients' caregivers completed the Pediatric ACEs Related Life Events Screener (PEARLS) and Behavior Assessment System for Children 3rd Edition (BASC-3). To investigate prosocial behaviors, the study examined BASC-3 parent-report outcomes for Adaptive Skills and each of its sub-scales (Adaptability, Social Skills, Leadership, Functional Communication, and Activities of Daily Living).

Results : Pearson correlations revealed statistically significant associations between patient’s total number of ACEs and adaptive skills (p < .01), externalizing factors (p < .001) and internalizing factors (p < .001). Pearson correlations revealed statistically significant correlations (p < .001) between adaptive skills and externalizing factors and all its respective sub-domains as well as internalizing factors and all its respective sub-domains, except for somatization. Testing a model of moderation, adaptive functioning did not weaken the relations between ACEs and a) externalizing or b) internalizing behaviors.

Conclusions : Despite ACES being highly correlated with behavioral problems and prosocial behaviors, adaptive skills did not moderate the impact of ACEs on externalizing and internalizing factors. Although results were insignificant, it is important to continue investigating methods to reduce the impact of ACEs on the psychological and behavioral profile of marginalized children.

P 09.05

Better Dead Than Diagnosed? The Deadly Impact of Culturally Intertwined Stigmas on Mental Health Help-Seeking Behaviors and the Suicide Rate in India

Rifa Sipai High School

Las Positas College, Livermore, CA, United States

Purpose : India faces a worsening mental health crisis, with suicide rates rising despite global advances in psychological care. This study investigates how culturally embedded stigma in India shapes help-seeking behaviors and contributes to suicidality. Addressing gaps in cross-cultural psychological research, it examines public, self, gendered, and structural stigma, as well as cultural beliefs and mental health literacy.

Method(s): Using a qualitative design, the study combined a review of peer-reviewed literature with semi-structured interviews conducted with ten participants of Indian background (five male, five female; ages 16–40) selected through purposive sampling. Interviews explored cultural identity, perceptions of mental health, stigma experiences, help-seeking barriers, and views on suicide. Audio-recorded interviews were transcribed verbatim and analyzed using inductive thematic analysis with constant comparison and peer debriefing to enhance credibility.

Results : Findings revealed four interconnected forms of stigma. Public stigma was rooted in collectivist values, framing mental illness as a source of family shame and a threat to social standing, particularly regarding marriage. Self-stigma emerged as internalized guilt and perceived weakness, leading to emotional suppression and denial. Gendered stigma disproportionately affected women, who described pressure to conceal distress to protect marital prospects. Structural stigma appeared in dismissive healthcare encounters, limited culturally sensitive care, and provider bias that discouraged psychiatric referral. Suicide was commonly interpreted as a moral or familial failure rather than a mental health outcome, reinforcing secrecy and avoidance. Together, these stigmas create multilayered barriers to care, sustaining untreated psychological distress and suicide risk.

Conclusions : Effective prevention must extend beyond expanding services to include culturally informed education, anti-stigma initiatives, and systemic reform. Transforming cultural narratives and institutional practices is essential to improving equitable access to mental health care and reducing suicide vulnerability.

Topic Area 10: Mind-Body & Mindfulness

P 10.01

Integrative Health Nursing Fellows Translate Practice to Research: Qualitative Insights to Shape Mind-Body Care in Gender-Affirming Surgery

Mr. Patrick J Treacy MS, BSN, CMSRN 1 , Christen Boardman BS, RN, RNC-OB, C-EFM 1 , Dr. Andrea Shang PhD 1 , Giselle Pena 1 , Mason Ballingoff 1 , Kevin Moore 1 , Devynn Emory 1 , Benjamin Bass 1 , Dr. Rachel Bluebond-Langer 1 , Dr. Lee Zhao 1 , Dr. Moriah E. Thomason PhD 2 , Kathleen A. DeMarco 1 , Dr. Emma M Millon PhD 1,2

1 NYU Langone Health, New York, NY, United States

2 Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, United States

Purpose : Transfeminine patients undergoing vaginoplasty face a demanding perioperative course and protracted recovery period. Integrative health (IH) interventions such as breathing practices, guided imagery, and mindfulness may improve coping, pain management, sleep, and patient autonomy during surgical transition. The field lacks evidence on the most feasible and efficacious interventions to offer, when to deliver them, and how to integrate them into routine care. This study utilized patient interviews and narratives to identify gaps in perioperative support, and to determine recommendations for timing, content, and delivery of IH interventions to guide future clinical applications.

Method(s): 18 transfeminine adults undergoing vaginoplasty at an academic medical center have been recruited prior to surgery for this study. Purposive sampling aimed to capture diverse perspectives. Standard IH care for surgical patients consists of a pre-surgical workshop and bedside consultative visits from an IH nurse during hospitalization. Workshops and consults include a combination of breathwork, guided imagery, meditation, and/or aromatherapy. Study data collection is ongoing;18 pre-surgical and 9 post-surgical qualitative interviews have been completed; data were analyzed for themes.

Results : Preliminary findings indicate mixed participation in IH services. Four of nine participants opted to engage in a bedside intervention with an IH nurse, and 1 attended the pre-surgical workshop, due to scheduling conflicts or lack of interest. 2-3 months post-surgery, those who participated expressed positive feedback on IH offerings, with techniques such as guided meditation and visualization aiding stress reduction during dilation and recovery. Identified barriers include lack of knowledge and timing of intervention delivery.

Conclusions : Patients were open to using IH interventions to navigate the emotionally taxing recovery process of vaginoplasty but require improved education and availability of services. Participant insights suggest bundling IH interventions with clinical appointments may enhance access and facilitate participation. Further study is needed to optimize the delivery and timing of IH in perioperative care.

P 10.02

A Sustainable Reiki Program at an Acute Care Hospital

Robert J Crandall BS

Upstate medical university hospital, Syracuse, New York, United States

Purpose : To provide an example of integrative therapy provided at the bedside for patients with high levels of pain in addition to showing the level of improvement in pain, anxiety and sleep.

Method(s): The presentation will provide how the Reiki Program was integrative at the Upstate facility from the inside out. It will show how the program grew as the results were assimilated into the patient charts. It will show how it gradually educated physicians, nurses as well as administrators on the benefit to patients, family care-givers and staff of adding an integrative therapy (Reiki) with zero negative impact to the traditional medical care for patients and in many cases enhanced it while still ensuring that the patients remained in full control of the primary staff. They did not need to me moved at all from their beds.

Results : The presentation will show the following result: Pain - 60 % reduction (including clearing the phantom pain due to an amputation) Anxiety -70 % reduction Sleep - 70 % improvement Physical changes, such as clearing bowel obstruction, enhancing body movement limitations. Stimulation of leg paralysis with some recovery.

Conclusions : The audience will be able to not only understand the process to assure a hospital will except therapy by developing it from the inside out but also how it can be done while educating the staff on its benefit. The Reiki team now receives an average of 10 consults for Reiki for a 640 bed facility - from Physicians, Physician Assistants, and Nurse Practitioners. This being done while being embedded in the Spiritual Care Department to ensure healing the whole body.

P 10.03

Interoceptive Mechanisms of a Mobile Heart Rate Variability Biofeedback App for Disordered Eating in Healthcare Workers: Proof-of-Concept Findings

Dr. Janell L Mensinger PhD , Maria Fernanda Carriel MPH

Nova Southeastern University, Fort Lauderdale, FL, United States

Purpose : Recent US-based datasets (Ns>1000) show over 1-in-4 adults suffer from clinically significant disordered eating. Methods for preventing subthreshold problems from becoming full-blown eating disorders are needed. Healthcare professionals suffer from high levels of burnout and stress. Chronic stress often results in maladaptive eating patterns, and research shows this was particularly pronounced during the COVID-19 pandemic. An 8-week, single-arm feasibility trial of a mobile heart rate variability biofeedback (HRVB) app supported strong acceptability and preliminary efficacy for reducing disordered eating in this population. The present study investigated potential mechanisms of change from pre- to post-intervention.

Method(s): Participants were 24 healthcare workers recruited during the COVID-19 pandemic who scored in the clinically significant range on the Loss of Control Eating Scale-Brief (LOCES-Brief) (92% female, 83% non-Hispanic white, 79% nurses, Mean age=42 years; SD=11.8). Measures included the eight subscales from the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2), the Eating Disorder Examination-Questionnaire 7-item Short form (EDE-Q7) and the LOCES-Brief. We conducted mediation analyses using the MEMORE macro for repeated measures; indirect effects were evaluated via 95% Monte Carlo confidence intervals.

Results : For EDEQ-7 scores, significant indirect effects were found for MAIA-2 ‘noticing’, ‘attention-regulation’, ‘emotional-awareness’, ‘self-regulation’, and ‘body-listening’ subscales. The percent of the intervention’s effects mediated by each factor were: 45%—‘noticing’, 62%—‘attention regulation’, 22%—‘emotional awareness’, 67%—'self-regulation’, and 54%—‘body listening.’ ‘Not-worrying’, ‘not-distracting’, and ‘trusting’ did not significantly mediate EDE-Q7 changes. For LOCES-Brief, significant indirect effects were found only for the MAIA-2 ‘trusting’ factor, with 29% of the HRVB effect mediated.

Conclusions : Findings suggest HRV biofeedback may reduce disordered eating by enhancing interoceptive skills. These results support further investigation into biofeedback as a low-cost, scalable intervention for populations at risk for dysregulated eating. Future studies should evaluate fully powered controlled efficacy trials of mobile HRVB as a preventive strategy for eating and body-related mental health concerns.

P 10.04

Beyond Alignment: Fascial Dynamics and Biotensegrity in Transient Scoliosis – A Case Report

Physiotherapist, Somatic Educator, and PhD Candidate in Health Sciences Bruna Petito Physiotherapist, PhD Candidate

Inner Balance Somatic Education Institute, Westfield, Indiana, United States

Purpose : The purpose of this case report is to explore whether functional and structural changes in transient idiopathic scoliosis can emerge through fascial and somatic integrative processes based on biotensegrity principles. This study aims to illustrate how neurofascial communication, proprioceptive refinement, and embodied perception, applied through the Inner Balance Somatic Education Method, may promote systemic reorganization and postural adaptation without mechanical correction, highlighting the body’s intrinsic capacity for self-organization.

Method(s): A 12-year-old girl (L.B.S.) presented with transient idiopathic scoliosis following a spinal injury during physical education class. She completed twenty 45-minute sessions of the Inner Balance Somatic Education Method, emphasizing proprioceptive refinement, neurofascial communication, and embodied perception rather than mechanical correction. Somatic-fascial dialogue and imagery-based movement inquiry were applied to restore tensional balance. Clinical observation, pain scale (VAS), and radiographic analysis were used to assess postural alignment, curvature, and functional outcomes.

Results : Radiographs demonstrated a reduction in thoracic curvature from 15.8° to 6.4°, with improved balance of lumbar lordosis and thoracic kyphosis. The patient reported complete resolution of pain (VAS: 9→0), improved postural confidence, and emotional well-being. The findings suggest that restoring fascial coherence and interoceptive fluency may foster systemic reorganization and functional alignment without external fixation.

Conclusions : This case illustrates the potential of fascia-informed somatic education as a complementary approach to conservative scoliosis management. The results support a paradigm shift from correction to communication—recognizing the body as an active, adaptive system capable of reorganizing from within, under principles of biotensegrity and integrative embodiment.

P 10.05

HEAL-SLE Holistic Energy for Alleviating Lupus Symptoms : A Pilot Study Evaluating the Effect and Feasibility of Virtual Reiki Therapy as a Complementary Treatment for Patients with Systemic Lupus Erythematosus

Monica Gamez-Perez BSN, RN 1 , Katrina Vigo MSN, RNC-MNN, HNB-BC 2 , Kathleen Zavotsky PhD, RN, CCRN, FAEN, FCNS 2

1 NYU Langone Health/ NYU Grossman School of Medicine, New York, New York, United States

2 NYU Langone Health, New York, New York, United States

Purpose : Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease marked by pain, fatigue, inflammation, and unpredictable flares that impair quality of life. Stress, a major trigger of symptoms and inflammation, is often under-addressed in lupus care. Research on Reiki, an energy-based healing modality, demonstrates benefits in reducing pain and stress, while improving relaxation and quality of life in other chronic illnesses, but has not been studied in SLE. This pilot study will evaluate the feasibility, acceptability, and efficacy of Virtual Reiki therapy for adults with SLE.

Method(s): This single-site, pre/post pilot study will enroll 20 adults with SLE from a rheumatology practice in an academic medical center. Participants will receive eight weekly, 20-minute Virtual Reiki sessions delivered by certified Reiki practitioners. Participants will complete surveys at Baseline, Week 4, and Week 8. Primary outcomes will assess pain using the Visual Analog Scale (VAS) and quality of life using the Lupus Quality of Life (L-QoL) questionnaire. Secondary outcomes will evaluate feasibility and acceptability through retention rates, pre/post patient-reported surveys, and weekly Reiki session logs.

Results : The HEAL-SLE study received IRB approval August 2025, with recruitment beginning in Fall 2025. Expected outcomes include patient acceptability and feasibility of Virtual Reiki and reported improvements in pain and quality of life.

Conclusions : The HEAL-SLE pilot study addresses a critical gap in lupus and integrative health research. Virtual Reiki therapy may offer a safe, low cost, non-pharmacologic adjunct to standard lupus care, improving quality of life and addressing unmet psychosocial needs. The virtual delivery model aligns with current trends in telemedicine, while supporting broader goals in health equity, accessibility, and holistic patient-centered care. Anticipated findings will provide a foundation for larger randomized controlled trials. Moreover, this study underscores the vital role of nursing-led research in advancing holistic interventions, expanding treatment options, and centering whole person care.

P 10.06

Abbreviated Mindfulness-Based Cognitive Therapy: Enhancing Accessibility Without Compromising Efficacy

Dr. Pallavi D. Visvanathan PhD 1 , Dr. Tanya M. Spruill PhD 2 , Dr. Amanda J. Shallcross ND, MPH 3

1 Manhattan Center for Mindfulness-Based Therapy, New York, NY, United States

2 NYU Grossman School of Medicine, New York, NY, United States

3 Cleveland Clinic, Cleveland, OH, United States

Purpose : Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based intervention with robust support from rigorous randomized controlled trials demonstrating efficacy for preventing depression relapse and reducing depressive symptoms. However, the standard 8-week protocol requiring 2-2.5 hours per week (16-20 total contact hours) presents a significant barrier to participation and limits scalability. Time burden, scheduling conflicts, and logistical challenges consistently emerge as primary reasons for non-enrollment and attrition, particularly among working adults, caregivers, and individuals with limited resources.

Method(s): In response to these accessibility challenges, our team developed MBCT-Brief, an abbreviated protocol requiring 8 contact hours—approximately 50% of the time required for the full-length protocol—while intentionally preserving core therapeutic components including mindfulness meditation practices, cognitive and behavioral exercises, participant inquiry, and home practice.

Results : We leveraged principles from several evidence-based adaptation frameworks for reducing intervention length while maintaining therapeutic integrity and fidelity to MBCT's theoretical foundations. Four independent studies have evaluated MBCT-Brief across diverse populations and settings. Findings consistently demonstrate high satisfaction ratings and improved engagement (average session = 7/8 sessions) and retention (86%) compared to standard-length MBCT. Preliminary clinical outcomes show promising effects for reducing depressive symptoms and stress, with medium to large effect sizes (Cohen’s d = 0.62 - 1.2), comparable to full-length MBCT.

Conclusions : These converging findings suggest that MBCT-Brief offers a viable solution to scalability challenges limiting widespread implementation of mindfulness-based interventions. By reducing time burden by half without sacrificing therapeutic integrity, this approach can reach populations previously unable to access MBCT. Importantly, this systematic abbreviation framework may be applied to other mindfulness-based interventions—such as Mindfulness-Based Stress Reduction (MBSR)—that face similar participation barriers. This approach represents a promising pathway toward maximizing the public health impact of evidence-based mindfulness interventions.

P 10.07

Mechanisms of Online Mindfulness Through the Lens of Patients with Migraine: A Qualitative Study

Dr Paige Marie Estave MD, PHD 1 , Junelyn Floyd MPH 1 , Hannah O'Brien MHA 1 , Nicole Tamol 1 , Mila Naidu 1 , David Hendrix 1 , Caroline Oliver 1 , Julia Byrnes 2 , Caitlyn Margol 3 , Summerlyn Beeghly 4 , Mariam Shakir 5 , Camden Nelson 6 , Derek Pyland MD 1 , Nathaniel O'Connell PhD 1 , Joshua Phillips 7 , Zev Schuman-Olivier MD 7 , Scott Powers PhD 8 , Justin B Moore PhD 1 , Paula Gardiner MD, MPH 7 , Rebecca Erwin Wells MD, MPH 1

1 Wake Forest University School of Medicine, Winston-Salem, NC, United States

2 Emory University School of Medicine, Atlanta, GA, United States

3 Medical College of Georgia, Augusta, GA, United States

4 George Washington School of Medicine and Health Sciences, Washington, DC, United States

5 Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, TN, United States

6 Temple University-Lewis Katz School of Medicine, Philadelphia, PA, United States

7 Cambridge Health Alliance, Boston, MA, United States

8 Cincinnati Children’s Hospital, Cincinnati, OH, United States

Purpose : The mechanisms underlying the benefits of group-based online mindfulness for migraine are complex and not fully understood. The purpose of this research is to utilize patient voices and experiences to better understand the impact of mindfulness on migraine and capture what matters most to patients.

Method(s): We conducted five rounds of online semi-structured focus group interviews on participants with migraine who had completed either online Mindfulness-Based Stress Reduction (MBSR) or online Headache Education as part of the randomized phase 3 clinical trial of BE WELL (Brain Education and Wellness) with Migraine. Using an interview guide, discussions explored participant views on benefits, challenges, and implementation recommendations of group-based online mindfulness and headache education. Zoom recorded and transcribed the interviews.

Results : Of 85 participants who were randomized and completed the interventions, n=60 completed focus groups (n=29 MBSR; n=31 Headache Education). Participants had an average age of 47.4 years (SD 13.2), 77% White, 10% Black, 5% Asian, 6% Hispanic, with baseline headache frequency of 12.7 (4.9) days/month. Themes emerged to be discussed include benefits and challenges: of an online intervention (accessibility, feasibility, technology); and of group-based interventions in patients with migraine (accountability, decreased isolation, disease validation, increased sense of community, unexpected migraine attacks). Participants in both groups reported impact on stigma and empowerment. Additionally, specific benefits of MBSR intervention include acute symptom management, body awareness, reduced stress reactivity, and greater self-compassion. Other factors reported that may mediate effects include impact on sleep, family, and relationships. Most participants reported overall improved disease burden and would recommend online mindfulness to others.

Conclusions : The mechanisms of mindfulness may be multi-faceted, and the additional benefit of an online intervention taught in group format may provide synergistic benefits. Both mindfulness and headache education help target overall disease burden and strengthen whole-person health. Patient voices can help illuminate the rich learning of mindfulness from the lived experiences of those with significant disease burden.

P 10.08

Decreased MMP-9 Gene Expression following Mindfulness-Based Stress Reduction

Jeffrey Greeson Ph.D.

Rowan University, Glassboro, NJ, United States

Purpose : A growing number of studies are now investigating changes in gene expression associated with mindfulness meditation as a plausible biological mechanism that could mediate effects on health. Whereas previous studies have mainly focused on changes in gene expression associated with the Conserved Transcriptional Response to Adversity (CTRA) or similar stress- and inflammation-related signaling pathways, no studies to our knowledge have examined specific changes in matrix-metalloproteinase 9 (MMP-9) gene expression following Mindfulness-Based Stress Reduction (MBSR).

Method(s): Given the role of chronic stress in activating MMP-9 and the key functional role of MMP-9 in contributing to coronary heart disease risk and depression, this pilot study explored whether MBSR may impact MMP-9 gene expression in healthy, stressed adults (n=30, F=63%, White=70%, mean age=40). Whole blood samples were collected at rest and in response to acute stress in the lab, both before and after a standard, 8-week MBSR program.

Results : MMP-9 gene expression was significantly lower post-MBSR both at rest (p<.05) and immediately following acute stress (p<.01), but not at 1-hr post-stress.

Conclusions : Building on prior work, these findings reveal another plausible molecular pathway through which 8-weeks of mindfulness meditation training can potentially lower MMP-9 activity, a known biomarker implicated in regulating stress physiology and associated stress-related chronic disease. Based on these significant preliminary findings from a single-arm trial, larger controlled trials are needed to replicate this effect and extend observed changes in gene expression following mindfulness training to clinically meaningful health metrics.

P 10.10

Breast Cancer Survivors’ Experiences with Daily Surveys and Perspectives on a Digital, Daily Mindfulness Intervention: Insights from a Qualitative Analysis

Dr Chelsea J Siwik PhD 1 , Eleni Stogianni BA 2 , Shilpa Jujjavarapu MSc 3 , Dr Patricia J Moran PhD 4 , Dr Ashley Mason PhD 4 , Dr Frederick M Hecht MD 4

1 Cleveland Clinic, Cleveland, OH, United States

2 VA Palo Alto Health Care System, Palo Alto, CA, United States

3 Palo Alto University, Palo Alto, CA, United States

4 University of California, San Francisco, San Francisco, CA, United States

Purpose : Mindfulness-based interventions (MBIs) can reduce cancer-related distress. However, most MBIs are time-intensive and group-based, posing barriers to engagement, especially for cancer survivors recently post-treatment. As part of a larger initiative to evaluate digital approaches for delivering MBIs in this population, we pilot tested daily text-based surveys for 10 days and then conducted individual interviews to assess participants’ experiences and gather feedback on a daily, digital MBI.

Method(s): We conducted ten 60-minute individual interviews with breast cancer survivors (stage 0-3) who completed treatment within 6 months - 3 years. Interviews were conducted virtually after participants (N=34) completed 10-minute surveys assessing emotional wellbeing and health behaviors delivered via text twice daily for 10 days. To capture a range of experiences, participants with high (n=5) or low (n=5) survey completion were invited to participate in an interview (n=10). During the interview, we explored participants’ experiences and gathered feedback on a digital MBI. We used thematic content analysis to identify patterns across transcribed interviews.

Results : The following themes emerged: (1) completing daily surveys promoted accountability to healthy behaviors (diet and exercise) and increased awareness of thoughts, feelings, and actions; (2) the brief, digital, daily format of the surveys was well-received, though participants valued an initial face-to-face interaction with study staff for a sense of connection; (3) a daily, digital MBI was appealing to most participants, with high interest in a 10-minute per day commitment, but participants noted concern for potential overuse of mobile devices and limited interpersonal connection.

Conclusions : Delivering MBIs in a digital, daily format via text offers a promising way to reduce access barriers and appears to be acceptable to cancer survivors. However, balancing digital convenience with the connection that is typically fostered in groups warrants further study. Future research should identify strategies to preserve interpersonal connection within digital delivery models.

P 10.11

Exploring the Perspectives of Older Black Breast Cancer Survivors on an Abbreviated Mindfulness-Based Intervention for Depression and Reducing Barriers to Clinical Trial Participation

Dr. Jacob D. Hill ND, MS, FABNO 1 , Amrita Bonthu MS 2 , Sydney Roberts MA, NCC, LPC, CPPN 3 , Sylvia Wise 1 , Dr. Pallavi Visvanathan PhD 4 , Dr. Amanda J. Shallcross ND, MPH 1 , Dr. Nora L. Nock PhD, PE 2

1 Cleveland Clinic, Cleveland, Ohio, United States

2 Case Western Reserve University, Cleveland, Ohio, United States

3 The Gathering Place, Cleveland, Ohio, United States

4 Manhattan Center for Mindfulness-Based Therapy, New York, New York, United States

Purpose : Older Black breast cancer survivors (BCS) experience disproportionately high rates of depression yet remain underrepresented in mental health research. This limits the development of culturally tailored interventions that address their psychosocial needs. Mindfulness-Based Cognitive Therapy-Brief (MBCT-Brief) is an evidence-based treatment for depression, but it has not been tailored to reflect the lived experiences of older Black BCS. This study seeks to identify barriers to research participation and collaboratively co-develop a culturally grounded adaptation of MBCT-Brief designed to better serve this population.

Method(s): We conducted five focus groups (n=21) with older Black breast cancer survivors aged ≥65 who completed treatment for stage I-III breast cancer and report elevated depressive symptoms. Participants were recruited through the Cleveland Clinic and The Gathering Place, a community partner providing free supportive cancer care in Cleveland, Ohio. Focus groups were audio-recorded, transcribed verbatim, and will be analyzed using thematic analysis. The focus group guide explored cancer-related stressors, perceptions of mindfulness and depression, cultural considerations for intervention design, and barriers to clinical trial participation.

Results : Emerging themes indicate participants experience ongoing physical and psychological symptoms well into survivorship. Depression was often reframed as fatigue or low energy due to cultural expectations of exhibiting strength. Spiritual practices like prayer were considered similar to mindfulness. There was strong interest in a culturally relevant, structured mindfulness intervention with peer support, in-person and hybrid delivery options, and a cultically sensitive facilitator. Participants emphasized the importance of Black representation on research teams, and suggested study recruitment through clinician offices and via personal phone calls.

Conclusions : These valuable insights will actively shape the adaptation of MBCT-Brief to better reflect the needs and realities of older Black BCS. This study will inform the development of a culturally relevant intervention tailored to address the drivers of depression in older Black BCS for use in future clinical trials.

P 10.12LB

Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) Combined with Passive Body Heating (PBH) for Insomnia Disorder: Feasibility, Acceptability, and Preliminary Outcomes

Mingzhuo Pei 1 , Wendy Hartogensis 1 , Sarah Fisher 1 , Anoushka Chowdhary 2 , Erika Jung 1 , Leena Pandya 1 , Rick Hecht 1 , Jennifer Felder 1 , Ashley Mason 1

1 University of California, San Francisco, San Francisco, CA, United States

2 The University of Arizona, Tucson, AZ, United States

Purpose : Insomnia disorder is common, with a point prevalence of 10% among adults. The American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment, but some individuals remain undertreated after completing CBT-I. We hypothesized that individuals with difficulty falling asleep might experience thermoregulatory dysfunction not addressed by CBT-I; we thus tested whether combining CBT-I with a body-based, non-pharmacologic intervention, passive body heating (PBH), could improve treatment outcomes. We evaluated the feasibility and acceptability of a remote intervention combining online CBT-I with PBH and explored preliminary changes in insomnia symptoms.

Method(s): Ten participants with insomnia disorder completed a six-module online CBT-I program and used an infrared sauna blanket ∼2 hours bedtime for 15 minutes over nine weeks. Procedures included baseline and post-treatment clinical interviews and self-report assessments, weekly online screening surveys, daily sleep diaries, and daily objective sleep monitoring using an off-the-shelf wearable device (Oura Ring) with user feedback turned off.

Results : After treatment, 9/10 participants no longer met DSM-5 criteria for insomnia disorder assessed via clinical interview. Insomnia Severity Index (ISI) scores decreased from baseline to post-intervention (M diff= -13.6 points [95%CI: -16.5, -10.7; p< .0001] and to 6-month follow up (M diff= -13.7 points [95%CI: -16.2, -11.2, p<0.0001], representing maintenance of improvement in insomnia symptoms. Sleep diary outcomes showed improved sleep parameters at post-intervention: Sleep onset latency decreased by 32.57 minutes (p = .0004); wake after sleep onset decreased by 18.03 minutes (p = .0023); sleep efficiency increased by 12.31% (p = .0001); and subjective sleep quality increased by 37.4% (p = .0002). Participants reported high acceptability of both interventions, with no serious adverse events.

Conclusions : A combined digital CBT-I and PBH intervention was feasible, acceptable, and associated with preliminary improvements in insomnia. These findings support further investigation in a larger randomized trial.

P 10.13LB

An Evaluation of a Reiki Program for Healthcare Workers at Multiple Cancer Infusion Centers

Dr. Natalie L Dyer PhD 1,2 , Dr. Lucas Jones PhD 1 , Karen Fink BSc, RN 1

1 Connor Whole Health, University Hospitals, Cleveland, OH, United States

2 The Center for Reiki Research, Southfield, MI, United States

Purpose : Reiki is a type of biofield therapy provided in many US hospitals for both patient and staff symptom relief and wellbeing. However, no study to date has evaluated Reiki for healthcare staff working in multiple infusion clinics. Therefore, purpose of this study was to evaluate the real-world effectiveness of Reiki for symptom improvement and wellbeing in hospital staff at several infusion centers.

Method(s): Participants were healthcare staff that received Reiki during their shift in an infusion clinic at University Hospitals in Ohio between April 2022 and December 2025. Before and after receiving the 15-20-minute Reiki session, participants completed measures of pain, fatigue, anxiety, nausea, and wellbeing from the Edmonton Symptom Assessment System (ESAS). Means and 95% confidence intervals (CI) were used and a linear mixed model examined Reiki’s effect on ESAS measures where the pre-session score was ≥1. Clinical significance was met by an improvement of >1 point for each symptom on the ESAS and statistical significance was set to p < .05.

Results : Between April 2022 and December 2025, 951 Reiki sessions were provided to infusion staff, most of which were female nurses. Of those, 930 provided pre scores and 669 provided post scores. Participants reported clinically significant adjusted mean [95% CI] improvements (≥1 unit) in pain (-1.58 [1.96, -1.21]), fatigue (-1.76 [-2.08, -1.44]), anxiety (-2.16 [-2.56, -1.77]), nausea (-1.58 [-2.08. -1.08), and wellbeing (1.62 [1.34, 1.90]) (all p values < .001). Participants commented that the Reiki was an overwhelmingly positive experience, promoting relaxation, wellbeing, and reducing various symptoms.

Conclusions : This is the largest study to date of hospital staff receiving Reiki. Participants reported clinically and statistically significant improvements in all symptoms, high levels of satisfaction, and a qualitatively positive healing experience. More research is needed, with inclusion of an appropriate control group and long-term assessments following Reiki.

P 10.14LB

Effects of MBSR on Generalized Anxiety Disorder Symptoms: A Systematic Review and Meta-Analysis

Vinicius Vieira Neves MD, MSc 1 , Blair T Johnson PhD 2 , Nana Amma Larbi MD 1 , Rebecca Acabchuck PhD 1 , Laura Haygood 1 , Shufang Sun PhD, LP 1 , Simon Goldberg PhD 3 , Elizabeth A Hoge MD 4 , Judson Brewer MD, PhD 1 , Chen Li PhD 2 , Eric B Loucks PhD 1

1 Brown University, Providence, RI, United States

2 University of Connecticut, Storrs, CT, United States

3 University of Wisconsin-Madison, Madison, WI, United States

4 Georgetown University., Washington, DC, United States

Purpose : The efficacy of mindfulness-based interventions for treating anxiety disorders has shown mixed effects in systematic reviews, but there has been little evidence synthesis of randomized controlled trials (RCTs) in the past decade. The purpose of this study was to evaluate the effects of Mindfulness-Based Stress Reduction (MBSR) on the most common form of anxiety, Generalized Anxiety Disorder (GAD).

Method(s): Systematic searches of eight databases identified RCTs of MBSR for adults with GAD, diagnosed via clinical interview or validated scales. We calculated standardized mean differences (Hedges’ g) for between-group comparisons, synthesizing effect sizes using random-effects models. The study protocol was preregistered (PROSPERO CRD420251140213).

Results : Across 8 RCTs (n=1,012), there was a statistically significant, moderate effect of MBSR on GAD symptoms, pooling across all control conditions (Hedges’ g=-0.46; 95%CI [-0.81,-0.11]; p=.01). Heterogeneity was substantial (I2=86.8%) but largely explained by comparison type. In comparisons against waitlist and treatment-as-usual (k=5, n=547), MBSR effects were large and statistically significant (Hedges’ g=-0.71; 95%CI [-1.12,-0.30]; p<.001). Conversely, trials employing active comparison conditions (pharmacotherapy or attention control; k=3; n=464) showed no significant difference (Hedges’ g=-0.03; 95%CI [-0.28,0.22]; p=.80). This finding was driven by two large non-inferiority trials (k=2; n=375) comparing MBSR to first-line pharmacotherapy (escitalopram) (Hedges’ g=0.07; 95%CI [-0.13,0.27]; p=.52), confirming equivalent efficacy. Heterogeneity was moderate within active comparisons (I2=44.8%) but remained high within waitlist/TAU (I2=81.6%), reflecting variability in minimal-treatment benchmarks.

Conclusions : These findings indicate that MBSR is clearly superior to usual care or waitlist conditions and performs similarly to first-line pharmacotherapy. Consequently, these 'null' findings support the hypothesis of clinical non-inferiority rather than ineffectiveness, establishing MBSR as a viable, non-pharmacologic treatment option. This is particularly critical for patients who prefer non-drug interventions or discontinue medication due to adverse effects, justifying MBSR’s consideration within reimbursement and referral frameworks.

Topic Area 11: Natural Products

P 11.01

Study of the Mechanism of Action of Rabdosia rubescens in Inhibiting Breast Cancer Drug Resistance Based on Network Pharmacology

Dr Ningyi Guo DAOM, MM

Lake Baldwin VA Clinic, Orlando, FL, United States. Chengdu First People's hospital, Chengdu, Sichuan, China

Purpose : To investigate the effect of Rabdosia rubescens on drug resistance in breast cancer and explore its possible mechanism of action using a network pharmacology approach.

Method(s): Network pharmacology was used to predict potential drug targets of Rabdosia rubescens in overcoming breast cancer drug resistance. Protein-protein interaction (PPI) networks were constructed using the STRING database and Cytoscape 3.9.1 software to identify the key drug targets. Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were conducted via the DAVID database.

Results : Network pharmacology analysis identified 149 potential targets of Rabdosia rubescens related to breast cancer resistance. The key targets included BCL2, SRC, EGFR, ESR1, MMP9, STAT3, CASP3, CCND1, which were primarily involved in the estrogen signaling pathway, proteoglycans in cancer, signaling pathway in cancer pathogenesis, and lipid and atherosclerosis signaling pathways.

Conclusions : Rabdosia rubescens may inhibit breast cancer drug resistance by targeting key genes such as BCL2, SRC, EGFR, ESR1, MMP9, STAT3, CASP3 and CCND1, providing new insights into integrated treatment strategies for breast cancer.

P 11.02

Exploring Herb–Drug Interactions between Chinese Herbal Medicines and Anti-Inflammatory Drugs

Miss Faiza Azhar

NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia

Purpose : The concurrent use of Chinese herbal medicines (CHMs) and anti-inflammatory drugs is common for managing chronic inflammation, yet potential herb-drug interactions (HDIs) remain underexplored and may alter therapeutic outcomes. This study focuses on investigating interactions between widely used CHMs and conventional drugs through in vitro assay, evaluating nitric oxide inhibition and cytotoxicity. The findings aim to identify synergistic or antagonistic effects, supporting safer and more effective co-administration in chronic inflammatory conditions.

Method(s): Four commonly used anti-inflammatory Chinese herbs i.e., Curcuma longa L., Gingko biloba L., Panax notoginseng (Burk.), and Allium sativum L. were selected based on their pharmacological relevance and combined with anti-inflammatory drugs (aspirin, diclofenac sodium, ibuprofen and prednisolone). A total of 16 combinations were screened for nitric oxide inhibition and cytotoxicity in RAW 264.7 macrophages. Combination index (CI) analysis was employed to determine interactions. Moreover, the AI-based predictive algorithms were applied for improved interaction prediction.

Results : Preliminary findings revealed synergistic interactions between Allium sativum L. and anti-inflammatory drugs, with the strongest synergy observed with prednisolone (IC 50 = 185 µg/mL), followed by ibuprofen (190 µg/mL) and aspirin (100 µg/mL), showing potent nitric oxide inhibition and cytoprotective effects (CI < 1). In contrast, diclofenac combinations were antagonistic, with A. sativum (>1000 µg/mL), Curcuma longa (342 µg/mL), Panax notoginseng (259 µg/mL), and Ginkgo biloba (150 µg/mL) all exceeding the synergy threshold (CI > 1).

Conclusions : These findings demonstrated that Allium sativum L. exhibited the most promising synergistic anti-inflammatory effects when combined with prednisolone, ibuprofen, and aspirin, showing strong nitric oxide inhibition and cytoprotective potential without cytotoxicity. In contrast, diclofenac-based combinations showed clear antagonism across all tested herbal extracts. These preliminary results highlight A. sativum as a key candidate for further investigation into its underlying mechanisms using in vivo zebrafish models.

P 11.03

The Effects of Supplemental Curcumin on Anxiety Symptoms in Adults: A Systematic Review and Meta-Analysis

Dr. Monique Aucoin ND MSc 1,2 , Katherine Kartusch MSc 2 , Zoel Beal Msc 3 , Alisha Bruton 4 , Laura LaChance 1 , Joshua Goldenberg 5

1 Canadian College of Naturopathic Medicine, Toronto, ON, Canada

2 University of Guelph, Guelph, ON, Canada

3 University of Guelph, Guelph, On, Canada

4 Oregon Health & Science University, Portland, Oregon, United States

5 National University of Natural Medicine, Portland, Oregon, United States

Purpose : Anxiety disorders are growing in prevalence. Evidence suggests that curcumin, the primary polyphenol in turmeric, may aid in the alleviation of depression symptoms, due to its anti-inflammatory and neuroprotective properties; however, less is known about its impact on anxiety symptoms. The objective of this study was to conduct a systematic review and meta-analysis of human experimental studies assessing curcumin's impact on anxiety symptoms.

Method(s): PubMed/MEDLINE and Web of Science were searched using a comprehensive search string. Eligible studies were human experimental studies that provided curcumin supplementation to adult participants and reported an anxiety symptom outcome. Studies using combination products were excluded. Article screening, data extraction, and risk of bias assessment were completed independently in duplicate. Pooled standardized mean differences (SMD) with corresponding 95% confidence intervals (CI) were calculated using random effects meta-analysis. Additionally, we converted study results to the instrument most familiar to clinicians and conducted meta-analysis. Heterogeneity was measured using the I2 statistic.

Results : Of the 382 articles identified, 23 met the inclusion criteria in the systematic review; 19 randomized controlled trials were included in the meta-analysis. At the end of the intervention, compared with the control arm, participants in the curcumin treatment arm reported significantly lower anxiety symptom severity scores (SMD=-0.41; 95% CI: -0.62, -0.20; I2 =71%). When the outcome data was converted to the Beck Anxiety Inventory scale, the pooled mean difference was -2.92 (95% CI: -5.11, -0.73). Seventeen of the 22 randomized trials had a low risk of bias.

Conclusions : Curcumin supplementation probably improves anxiety symptoms slightly.

P 11.04

Clinical Outcomes from Traditional East Asian Herbal Medicine in Patients with Pancreatic Cancer: a Systematic Review

Milo Jackson DAHM 1 , Kailey Brennan DAHM 1 , Emery Olson MSEAM 2 , Blake Langley ND, MSEAM 3,4 , Teresa Jewell MLIS 4 , Lisa Conboy ScD 5,1 , Katherine Taromina DACM 1,3

1 Seattle Institute of East Asian Medicine, Seattle, WA, United States

2 Five Branches University, San Jose, CA, United States

3 Fred Hutchinson Cancer Center, Seattle, WA, United States

4 University of Washington, Seattle, WA, United States

5 Harvard Medical School, Boston, MA, United States

Purpose : Pancreatic cancer (PC) remains one of the most aggressive malignancies despite advances in therapies. Emerging clinical and preclinical research suggest Chinese Herbal Medicine (CHM) may reduce some treatment-related symptoms, improve quality of life, and extend survival time. However, evidence on clinical application of these treatments remains heterogeneous and methodologically limited. This systematic review aims to critically evaluate and update the current evidence on the efficacy of CHM as an adjunctive therapy in PC.

Method(s): The protocol for this review is registered on Open Science Framework ( https://osf.io/ufm7k/ ). The search strategy was developed to retrieve records of clinical studies, reviews, and trial protocols using combined English and transliterated terms for PC and whole herb CHM products in humans. Studies must have at least one clinical outcome. Records were reviewed independently and in duplicate and inter-rater reliability was assessed using Cohen’s K. Methodological quality will be assessed using risk of bias tools.

Results : The literature search returned 2,554 deduplicated records from 10 databases. Moderate agreement was achieved at initial review (K = 0.52, overall agreement = 96%), and 76 records were moved forward for full text review. To date, 23 records have been included for final analysis and 10 articles are under final full-text review.

Conclusions : This ongoing systematic review represents the most up-to-date synthesis of evidence on the use of CHM in PC since 2022, and indicates a steady increase in the volume and interest of TCM research in the field. Final extraction and synthesis of data will include study quality, intervention design, clinical outcomes including survival, symptom control, and quality of life. At the time of the 2026 Congress, we will complete evidence synthesis to convey the trends and therapeutic scope of CHM research in PC.

P 11.05

American Ginseng Slices (AG Slices) in Clinical Practice: A Scoping Review of Randomized Controlled Trials

Dr. Yike Song Bachelor of Arts in English , Dr. Lihong Han master degree, Dr. Tingxiu Liu master degree, Dr. Kai Liu master degree, Dr. Xiaohan Zhang master degree, Dr. Zeyang Shi bachelor degree, Dr. Yaqian Wen bachelor degree, Dr. Rihe Liu bachelor degree, Prof. Zhaolan Liu PhD

Beijng University of Chinese medicine, Beijing, Beijing, China

Purpose : American ginseng slices(AG slices) hold a significant position in Complementary and Alternative Medicine, traditionally used to address fatigue, cognitive decline, and metabolic disorders. Despite their widespread application, clinical evidence supporting their efficacy remains fragmented across different health conditions. This scoping review systematically examines randomized controlled trial (RCT) evidence to identify researched health conditions, summarize outcome measures, and highlight knowledge gaps, thereby providing guidance for future research and clinical practice.

Method(s): This review followed established methodological frameworks for scoping studies.We systematically searched seven databases including CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, and Embase. Literature management software was used for deduplication. Two researchers independently conducted preliminary screening and data extraction, with disagreements resolved by a third researcher. The analysis focused on three dimensions: health conditions and population characteristics, dosage forms and administration methods of AG slices, and primary clinical outcome measures.

Results : This review included 27 randomized controlled trials with a total sample size of 1,429 participants.The studies originated from multiple countries, including China (15 studies) and Canada (7 studies). Analysis revealed that the top five disease areas by number of studies were hypertension (3 studies), type 2 diabetes (3 studies), cancer-related fatigue (2 studies), chronic fatigue syndrome (2 studies), and acute myocardial infarction complicated by arrhythmia (2 studies). The primary outcome measures encompassed multiple dimensions including glycemic parameters, symptom scores, physiological indicators, and laboratory tests. In terms of administration forms, capsules (12 studies) were the most common, and daily doses primarily ranged from 3-6 g (16 studies). The safety profile was generally favorable across the included studies.

Conclusions : This scoping review demonstrates that American ginseng slices show the most consistent efficacy in the management of type 2 diabetes,while evidence quality in other disease areas requires further validation. Future high-quality studies are needed to further elucidate the therapeutic value of American ginseng slices.

P 11.06

A Community Pharmacy Role Model for Herbal Medicine in Thailand

Ms. Siwaphorn Peecharoensap M.Sc. 1 , Dr. Mayuree Tangkiatkumjai PhD 2

1 Siwaphorn Pharmacy, Angthong, -, Thailand

2 Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, -, Thailand

Purpose : This study aimed to develop and propose practical roles for community pharmacists in Thailand.

Method(s): This action research examined the pharmacist’s role in herbal medicines in a pharmacy to develop pharmacy roles in this field. A pilot project was conducted at Siwaporn Pharmacy from 2024 to 2025, in which the pharmacist developed a standard operating procedure (SOP) to ensure the efficacy and safety of using herbal medicines, either alone or in combination with conventional medication.

Results : Siwaporn Pharmacy was the first pharmacy in Thailand to develop an SOP for prescribing herbal medicines. The owner was concerned about the rational use of herbal medicines. The SOP consisted of: (1) a checklist and recommendations for the rational use of Andrographis in mild COVID-19, (2) a checklist to prevent acute kidney injury from herbal medicines in patients with renal insufficiency, (3) a checklist sticker was placed at the product counter to guide customers before purchasing over-the counter herbal medicine, with a focus on high-risk groups susceptible to adverse effects, such as the elderly and patients with liver or kidney insufficiency, and (4) a screening process for potential herbal-drug interactions before prescribing herbal medicines or conventional medicines, particularly for medications at high risk of interactions, such as warfarin. The pharmacists used the mobile application Herbal Expert by Mayuree to access reliable information on herbal medicines before prescribing or recommending them.

Conclusions : This practical model focuses on the safe and rational use of herbal medicines, including risk management strategies, providing patient guidance, and aiming to prevent serious herbal adverse effects and herb-drug interactions. Further studies should implement this model in pharmacies nationwide and evaluate its impact on clinical outcomes and patient satisfaction.

P 11.07

Combating Infectious Diseases with Herbal Medicine - The Anti-Viral Potential of Ganoderma lingzhi and Panax ginseng ’s Bioactive Compounds

Ms LingLing Deng

University of Toronto, Toronto, ON, Canada

Purpose : Global infectious diseases are on the rise. Current anti-viral therapies fall short to drug resistance and often have high toxicity, a narrow spectrum of activity, and substantial treatment costs. Our goal is to establish a functional health-food product that fills current gaps in anti-viral therapeutic approaches and poses no hazards to consumers’ health and wellness.

Method(s): Using contemporary scientific methods, we have extracted the pharmaceutically active compounds from Ganoderma lingzhi (triterpenoids) and Panax ginseng (ginsenoside) and created a buccal tablet that can function as an anti-viral, anti-microbial, and anti-inflammatory against various viral and bacterial diseases. Both ingredients offer different pharmaceutical functions that can potentially increase the bioactivity of the product altogether.

Results : We are currently testing our product with consumers and potential collaborators. Informal feedback has demonstrated the effectiveness of the buccal tablet in alleviating upper respiratory tract infection-related symptoms associated with various diseases, including influenza.

Conclusions : The development of more innovative therapeutic approaches is urgently needed to combat the spread of infectious diseases worldwide. Combining the bioactive compounds of G. lingzhi and P. ginseng can function as agents against various viral and bacterial pathogens. We are currently seeking product feedback on our prototype buccal tablet and would welcome your insights. If there is an alignment, we would be excited to explore opportunities for collaboration.

P 11.08

Brain Health & the Microbiome (bMicrobiome Study): A Proof-of-Concept Study Integrating Shotgun Metagenomics, Metrology, and Multidisciplinary Analysis in Cognitive Health

Dr. Leigh A. Frame PhD, MHS

George Washington University, Washington, DC, United States

Purpose : The gut-brain axis plays a key role in neurodegenerative disease, connecting microbial dysbiosis with inflammation, metabolism, and cognitive decline. This feasibility study investigated how gut microbiome composition and function relate to cognition and behavior across healthy controls (HC), mild cognitive impairment (MCI), and early Alzheimer’s disease (eAD). The study integrates comprehensive clinical, dietary, and psychosocial assessments with advanced microbiome sequencing to explore modifiable targets for early intervention.

Method(s): Seventeen participants (aged 50–95) completed baseline, 3-month, and 6-month visits including Boston Cognitive Assessment (BoCA), Alzheimer's Disease Cooperative Study–Activities of Daily Living (ADCS-ADL), PROMIS-29, DietID™, and a Readiness for Change Survey developed by the study team. In partnership with the National Institute for Standards and Technology (NIST), stool samples were processed using NIST metrology standards and analyzed by shotgun metagenomics (CosmosID), providing quantitative taxonomic and functional microbiome profiles. Statistical/bioinformatic analyses examined associations between key microbial features (taxa, pathways, etc.) and health indicators (cognitive and nutritional).

Results : Despite a smaller cohort (n=17) due to withdrawals/exclusions, distinct microbial trends were observed. Participants with MCI exhibited reduced abundance of butyrate-producing and enrichment of proinflammatory taxa. Functional pathway analysis revealed lower short-chain fatty acid metabolism and higher lipopolysaccharide (LPS) biosynthesis. Exploratory correlations linked higher dietary quality and greater readiness for change with higher microbial diversity and improved cognitive performance–consistent with our scoping review.

Conclusions : We demonstrated the feasibility of integrating quantitative metrology-based metagenomics with comprehensive behavioral and nutritional assessments in cognitive research. The NIST partnership enhanced analytical rigor and reproducibility of human microbiome analyses. Findings support growing evidence linking gut microbial composition and function to early cognitive decline. This integration of metrology and advanced sequencing enhances microbiome data interpretability, enabling its translation into precision nutrition and integrative care models for brain health promotion and dementia prevention.

P 11.09

Life Force Treatment Induces Reprogramming of Genomic and Metabolomic Responses in an Organ-specific Manner in a Plant Model

Dr. Sanjay Swarup MSc, PhD (Genetics), PhD (Plant Pathology) , Dr. Glenn Mendoza MD, MPH

Pranic Healing Research Institute, Lyndhurst, NJ, United States

Purpose : Cells and organs respond to a wide range of frequencies in the electromagnetic spectrum. This study was aimed to understand the responses of cells and organs to the highly subtle form of energy, the universal life force, also known as qi or prana. This is the first study to address the cellular and organ-specific responses at a multi-systems biology level. We aimed to uncover signaling, and gene regulatory network of the responses to life force.

Method(s): A plant model was adopted due to its suitability for rapid life cycle, easy success to organs and ability to conduct a randomized trial with a replicated design of 25 plants each for treatment and control, respectively, for statistical robustness. Life force was applied in a standardized manner by certified pranic energy practitioners at six times during growth. Biomass, 3D phenotyping of organs, transcriptome and metabolome were measured for two organs, roots and shoots.

Results : Energy treatment increased growth by 60% and opened architecture by 13°. Of the 42,188 transcripts sequenced, 1,244 were differentially affected in the leaf organ and 2,442 in the root organs. Novel receptor candidates, MAP kinase signaling and transduction, health, defense, and secondary metabolism genes were affected at p< 0.05. Untargeted metabolomics analysis revealed changes at p<0.05 in 290 metabolites including vitamins, gamma-tocopherol, beta-carotene, and phylloquinone, and phenylpropanoid polyphenols.

Conclusions : These responses to life force treatment reveal coordinated regulation via a hierarchical network of signaling, growth, defense and architecture of gene expression and metabolic pathways in an organ-specific manner. Hypotheses is signalling responses could be generated but causality remains to be tested in future studies. This study paves the way to better understand the reception and transduction of subtle energy by cells and organs.

P 11.10

Association Between Chinese Herbal Medicine Use and Reduced Prevalence of Metabolic Syndrome: A Secondary Analysis of a Large Taiwanese Cohort

Professor Chien-Yeh Hsu PhD 1 , Professor Jia-Wen Guo PhD 2

1 National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Taiwan

2 University of Utah, Salt lake city, Utah, United States

Purpose : This study examined whether self-reported Chinese Herbal Medicine (CHM) use is associated with metabolic syndrome (MetS) prevalence using data from a large Taiwanese health check-up database. MetS, characterized by abdominal obesity, hypertension, dyslipidemia, and impaired glucose metabolism, is a major public health issue in Taiwan and East Asia. While CHM is widely used as complementary therapy and may improve metabolic parameters, population-based studies on CHM use and MetS prevalence are limited.

Method(s): Cross-sectional data from the Mei Jau Health Management Institution, a large network of private health screening centers in Taiwan, included 38,697 adults aged ≥18 years with complete demographic, lifestyle, and clinical information. CHM use was assessed through self-administered questionnaires asking whether participants were currently using CHM. MetS was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria for Asian populations. Multivariable logistic regression tested the association between CHM use and MetS after adjusting for age, sex, education, marital status, exercise, alcohol consumption, and smoking.

Results : The mean participant age was 40 years (SD = 13.4), and 7% (n = 2,677) reported current CHM use. MetS prevalence was 12% (n = 4,785). CHM users were more likely to be female and slightly older than non-users. Importantly, MetS prevalence was lower among CHM users (11%) compared with non-users (12%; p = 0.02). After adjusting for confounders, CHM use remained significantly associated with reduced odds of MetS (adjusted OR = 0.78; 95% CI: 0.68–0.89; p < 0.001), indicating approximately 22% lower odds of MetS.

Conclusions : This study provides real-world evidence that CHM users were significantly less likely to have MetS after adjusting for demographic and lifestyle factors, suggesting a protective association with metabolic health. Future research should identify which specific CHM types are most beneficial for metabolic outcomes.

P 11.11

Antitumor Activity of Diosgenin Combined with Chemotherapy in KRAS-mutant and EGFR-mutant Non-Small Cell Lung Carcinoma Cells

Dr. Clara Santiago ND 1 , Edwin Figueroa 2 , Juan Figueroa 2 , Keisy Rodríguez BS 3 , Ricardo Colón MS 4 , Dr. Yamixa Delgado PhD 4

1 Universidad Ana G. Méndez Gurabo Campus, Gurabo, PR, United States

2 Biology Department, University of Puerto Rico, Cayey, PR, United States

3 Pharmaceutical Sciences Doctoral Program, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, United States

4 Biochemistry & Pharmacology Department, San Juan Bautista School of Medicine, Caguas, PR, United States

Purpose : Non-small cell lung carcinoma (NSCLC) accounts for 85 % of lung cancers and remains the leading cause of cancer mortality. Standard chemotherapies such as cisplatin and doxorubicin suffer from acquired resistance, metastasis, and toxicities, particularly in KRAS mutant (∼28 %) or EGFR mutant (∼15 %) tumors. Consequently, innovative adjuvant strategies are needed. Plant derived compounds are promising sources of novel anticancer agents. Diosgenin, a steroidal sapogenin with established bioactivity, has demonstrated antitumor properties across various cancer types. Here, we investigated the potential of diosgenin to enhance the efficacy of cisplatin and doxorubicin in KRAS mutant (A549) and EGFR mutant (H1975) NSCLC cell lines.

Method(s): A549 and H1975 cells were treated for 24 hours with diosgenin, cisplatin, and doxorubicin as single agents and in dual drug combinations (diosgenin with cisplatin or doxorubicin). Cell viability was measured by MTS assay, and IC 50 values were determined by non linear regression. Drug interactions were assessed as synergistic, additive, or antagonistic using SynergyFinder 4.0.

Results : As a single agent, diosgenin induced dose dependent cytotoxicity in both A549 and H1975 cell lines, with IC 50 values in the micromolar range. Importantly, combinations of diosgenin with either cisplatin or doxorubicin exhibited significant synergistic and additive effects across both cell lines, indicating enhanced cell killing compared to single-agent treatments.

Conclusions : These in vitro findings demonstrate that diosgenin potentiates cisplatin and doxorubicin cytotoxicity in KRAS-mutant NSCLC models. The synergism suggests that diosgenin may modulate apoptosis and DNA repair mechanisms. These findings support the further preclinical investigation of diosgenin as an adjuvant therapeutic to enhance conventional oncologic regimens.

P 11.12

A multicenter, randomized, double-blind, positive drug parallel- controlled clinical trial to evaluate the efficacy and safety of Xiao'er Fengreqing Oral Liquid in the treatment of Acute Pharyngitis/tonsillitis in Children

Kai Liu 1 , Yu Du 2 , Lei Shi 1 , TingXiu Liu 1 , Hui-lan Liu 3 , Zhao-Lan Liu 1

1 Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Chaoyang District, Beijing, China

2 University of Colorado Denver, Business School, Denver, Colorado, United States

3 The Third Affiliated Hospital of Beijing University of Chinese Medicine, Chaoyang District, Beijing, China

Purpose : Pediatric acute pharyngitis/tonsillitis (PAPT) is common and largely viral, but frequently leads to unnecessary antibiotic use. Xiao’er Fengreqing Oral Liquid (XFOL), a 20-herb traditional Chinese medicine (TCM) formulation with anti-inflammatory and antiviral activity, is widely used, yet controlled evidence remains limited.

Method(s): In this three-center, randomized, double-blind, parallel-group, non-inferiority trial, children aged 3–12 years with PAPT (onset ≤48 h) were allocated 1:1 to XFOL plus placebo Xiao’er Yanbian Granules (XYG) or XYG plus placebo XFOL for 5±1 days. Co-primary endpoints at Day 5 were: (1) sore-throat resolution (Wong–Baker Faces Pain Rating Scale [WBS] = 0) and (2) response rate (≥50% WBS reduction). The non-inferiority margin was 10%. Secondary outcomes included time to onset and disappearance of sore throat (WBS and TCM scores), fever resolution time, and TCM syndrome response. Safety was assessed in all treated participants.

Results : All 120 randomized participants completed follow-up. Day-5 WBS response rates were 100% in both groups. Sore-throat disappearance at Day 5 was 98.3% with XFOL vs 90.0% with XYG; non-inferiority was met and the risk-difference 97.5% CI was entirely above zero, indicating superiority for this endpoint. Median time to sore-throat disappearance was shorter with XFOL (3.8 vs 4.2 days; P=0.014), and several secondary TCM throat-pain measures similarly favored XFOL. Fever resolution did not differ significantly. No XFOL-related adverse events occurred; transient mild proteinuria (1 vs 3 cases) resolved spontaneously.

Conclusions : XFOL was effective and well tolerated for PAPT within an integrative-medicine framework, providing clinically meaningful symptom relief with a favorable safety profile and potential to support antibiotic-sparing care. Further larger and longer positive-controlled trials are warranted.

P 11.13

Efficacy and safety of American Ginseng for Diseases Interventions: A Large-Scale Systematic Review and Meta-analyses of Randomized Controlled Trials

Ms Tingxiu Liu Master of Medicine 1 , Ms Yike Song Bachelor of Arts in English 1 , Mr Kai Liu Master of Public Health 1 , Mr Zeyang Shi Bachelor of Computer Science 1 , Prof Zhaolan Liu Ph.D. in Epidemiology and Biostatistics 1 , Prof Yu Du 2

1 Center of Evidence-based Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

2 University of Colorado Denver, Denver, Colorado, United States

Purpose : American ginseng (AG), also known as Panax quinquefolius, is a prized herb originating from North America that has long been used in food and medicine. Its indications may cover diseases of the cardiovascular and endocrine systems. However, the quantity and quality of existing clinical evidence for its applications, as well as the outcomes used to evaluate its efficacy, have yet to be systematically established. This study aims to provide a comprehensive overview of AG by employing systematic review and meta-analysis methods.

Method(s): The full protocol was registered on PROSPERO (CRD420251147209) and adheres to the PRISMA statement. This study will systematically search 7 bibliographic databases, including PubMed, the Cochrane Library, Embase, CNKI, Wanfang, CQVIP, and SinoMed, for articles published before December 3rd, 2025. Only randomized controlled trials will be included in the analysis. Multiple researchers will independently perform study screening and data extraction. The search results will be imported into NoteExpress for deduplication and data extraction, and the meta-analysis will be performed in RStudio. All RCTs will be categorized according to the disease of the study population, followed by subgroup analyses based on the specific type of AG interventions. The quality of included studies will be rigorously assessed using the RoB-2 tool, and the certainty of evidence will be rated using the GRADE framework.

Results : The study will be created to illustrate the current state of clinical research on AG across different diseases. Specific outcomes for different diseases will be analyzed. If substantial heterogeneity exists, its potential sources will be explored through sensitivity analyses such as leave-one-out analysis or meta-regression.

Conclusions : This study will systematically review the evidence for the clinical use of American ginseng. It will summarize the efficacy and safety of American ginseng in treating various diseases, providing guidance for clinicians, researchers, and policymakers on its rational use and future research directions.

P 11.14LB

Herbal Decoction and Lumbar Spine Surgery in Patients With Lumbar Disc Herniation: A Real-World Study Using Linked Electronic Health Record and Claims Data

Dr Yoon Jae Lee KMD, PhD 1 , Ye-Rim Yun KMD 2 , Jaeyoung Youn KMD 2

1 Jaseng Medical Foundation, Seoul, Seoul, Korea, Republic of

2 Jaseng Korean Medicine Hospital, Seoul, Seoul, Korea, Republic of

Purpose : Lumbar disc herniation (LDH) is a major cause of low back pain and may require surgery when conservative treatment fails. In Korea, herbal medicine is widely used as part of non-surgical integrative care; however, its long-term association with lumbar surgery risk has not been evaluated because herbal decoctions were historically not captured in insurance claims data.

Method(s): We conducted a retrospective cohort study linking electronic health records (EHRs) from four Korean medicine hospitals with National Health Insurance claims data. Patients newly diagnosed with LDH (ICD-10 M51) between 2016 and 2017 were included. The index date was defined as one year after the first hospital visit, and patients were followed until July 31, 2021. Exposure was defined as receiving herbal decoction for ≥30 days versus <30 days before the index date. Patients with red-flag conditions or prior lumbar surgery were excluded. Propensity score matching (1:1) was performed using age, sex, insurance type, Charlson Comorbidity Index, and baseline leg pain numeric rating scale. Lumbar surgery was identified using procedure codes. Kaplan–Meier analysis and Cox proportional hazards models were applied.

Results : Among 6,669 eligible patients, 2,504 received herbal decoction for ≥30 days. After matching, 2,473 patients remained in each group with good covariate balance. The ≥30-day group showed a significantly lower cumulative incidence of lumbar surgery than the <30-day group (log-rank P=0.033). Across sequential Cox models, longer herbal decoction use was consistently associated with a reduced risk of surgery (hazard ratio range, 0.60–0.74) after adjustment for demographics, comorbidity, healthcare utilization, and baseline pain severity.

Conclusions : In this real-world linked EHR–claims study, herbal decoction use for ≥30 days was associated with a lower risk of subsequent lumbar spine surgery in patients with LDH. These findings support herbal medicine as a potential non-surgical treatment option and warrant confirmation in prospective randomized studies.

P 11.15LB

Withania somnifera (Ashwagandha) Extracts Promote Resilience to Age-Related Changes in Neurological Function in Drosophila

Rudo Duri M.S. 1,2,3 , Ellala Limoico 2,3,4 , Alexander Law B.S. 2,5 , Jesus Martínez B.S. 2,3 , Dr. Amala Soumyanath Ph.D. 2,3 , Dr. Doris Kretzschmar Ph.D. 2,5

1 Helfgott Research Institute, National University of Natural Medicine, Portland, OR, United States

2 BENFRA Botanical Dietary Supplements Research Center, Oregon Health & Science University, Portland, OR, United States

3 Department of Neurology, Oregon Health & Science University, Portland, OR, United States

4 Department of Chemistry, Portland State University, Portland, OR, United States

5 Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States

Purpose : Aging-related neurological decline often manifests as impaired locomotion and cognitive function. Withania somnifera (ashwagandha) is traditionally used to support healthy aging, yet relative contributions of root- and leaf-derived constituents to functional outcomes remain incompletely understood. This study evaluated effects of W. somnifera root extracts, derived fractions, and leaf extracts on age-associated locomotor decline in a Drosophila melanogaster model.

Method(s): Wild-type Canton-S Drosophila melanogaster flies aged 28–42 days were used to assess locomotor and sensorimotor function via fast phototaxis assays, with males and females analyzed separately. Aqueous (WSAq) and hydroalcoholic (WSE) leaf extracts were administered for 14 days. The aqueous root extract (WSAq-20) was fractionated into ethanol-insoluble, aqueous alkaline–soluble, aqueous acidic–soluble, and chloroform-soluble fractions. Fractions were tested at concentrations equivalent to their proportion in the parent extract. Withanolide content in extracts and fractions was measured using liquid chromatography–mass spectrometry (LC–MS).

Results : Leaf extracts produced sex- and dose-dependent effects: aqueous leaf extract modestly improved phototaxis in males at 0.5 mg/g (p = 0.030) but not in females. The hydroalcoholic leaf extract significantly enhanced phototaxis in females at 2 mg/g (p = 0.019) but reduced performance in males at 0.5 mg/g (p < 0.001). WSAq-20 significantly improved phototaxis in aging flies of both sexes (p<0.05). Withanolides were enriched in the chloroform-soluble fraction; however, neither this fraction nor the ethanol-insoluble fraction improved phototaxis. However, aqueous alkaline and acidic fractions significantly enhanced performance, suggesting activity driven by water-soluble constituents.

Conclusions : These findings demonstrate that W. somnifera root and leaf extracts modulate locomotor function in aging Drosophila in a sex- and extract-specific manner. Non-withanolide, water-soluble compounds of the root contribute to functional benefits, warranting further investigation of active compounds underlying these effects.

P 11.16LB

Antimicrobial Action Of Cannabidiol Oil In Oral Spray And Systemic Use

Mrs Cynthia De Carlo Post graduate

UNG, Sao Paulo, Sao Paulo, Brazil

Purpose : Cannabinoids have demonstrated therapeutic potential in treating various diseases due to their immunological, infectious, and anti-inflammatory properties. Cannabidiol (CBD), a non-psychoactive compound, is increasingly studied for its antimicrobial effects, particularly in oral health. Objectives: To evaluate the in vitro antimicrobial action of full-spectrum cannabidiol (CBD) oil in oral spray and systemic forms against multispecies subgingival biofilm.

Method(s): Two experiments were conducted. In Experiment A (mouthwash), groups included: Volcanic Oral Spray® (0.625 mg CBG/CBD per spray), 0.12% chlorhexidine (CLX), 0.075% cetylpyridinium chloride (CPC), and a negative control (BHI medium + bacteria). In Experiment B (systemic use), test groups received CBD oil at 250 mg, 500 mg, and 750 mg. Controls included metronidazole (270 µg/ml), amoxicillin (108 µg/ml), their combination, and a negative control. Metabolic activity was assessed using TTC, and bacterial quantification was performed via Checkerboard DNA-DNA hybridization.

Results : In Experiment A, no statistically significant differences were observed among the four groups regarding metabolic activity. In Experiment B, CBD oil demonstrated antimicrobial potential, with reduced metabolic activity and bacterial counts across various complexes, especially at higher concentrations.

Conclusions : CBD oil, both as oral spray and systemic formulation, exhibits promising antimicrobial activity against multispecies subgingival biofilm in vitro. These findings suggest potential applications in oral health therapies, warranting further clinical investigation. Keywords: Cannabidiol, CBD Oil, Antimicrobial Activity, Oral Spray, Subgingival Biofilm, In Vitro Study

Topic Area 12: Nature Therapy/Planetary Health

P 12.01

Making Nature RX More Accessible Through Virtual, Video Conference-Delivered Prescription Consultations: A Qualitative Interview Study with Nature “RXperts”

Varsha Ganesh 1,2,3 , Alexandra Haney 2,3 , Timothy Chen 2,3 , Bruriah Horowitz MEd 2,3 , Christina Sauer MS 2,3 , Dr. David Victorson PhD 2,3

1 New York University, New York, New York, United States

2 Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

3 Osher Center for Integrative Health at Northwestern University, Chicago, Illinois, United States

Purpose : Growing public health research supports the positive relationship between nature contact and improvements in human health. While nature prescriptions (Nature RX) have been shown to be a viable strategy to increase meaningful experiences in nature, many health professionals have limited time and resources for this. The purpose of this study is to learn from experienced nature prescribers about key considerations in developing and implementing a virtual, videoconference-delivered nature prescription consultation by a trained prescriber.

Method(s): Experienced nature RX providers participated in a 45-minute recorded Zoom interview about their insights and opinions about a virtual Nature RX program. Following transcript review, research team members engaged in a Grounded Theory analysis (e.g., open, axial, selective coding) in which codes were systematically grouped into higher order categories, and subsequent themes. Dedoose qualitative analysis software was used.

Results : Interviews with 15 participants generated 55 unique codes related to a videoconference-delivered Nature RX consultation. Axial and selective coding yielded 14 categories and five overarching themes: “Accessibility and Equity in a Virtual Nature RX,” “Communication and Education in Patient Engagement,” “Practitioner Role and Implementation Quality,” “‘Virtual’ as a Source of Misunderstanding,” and “Program Design, Promotion, and Engagement Strategies.” Themes emphasized equitable access, practitioner competency, clear articulation, and thoughtful design to optimize patient engagement.

Conclusions : This study offers expert perspectives that successful videoconference-delivered Nature RX consultations depend on ensuring accessibility, fostering rapport, and clarifying the program’s “virtual” nature to avoid misunderstanding. Findings suggest qualified, culturally competent practitioners and diverse engagement strategies are essential for maintaining authenticity and connection in a virtual setting. Addressing logistical and promotional challenges will enhance program feasibility, while integrating education and equity considerations can strengthen the platform’s capacity to deliver meaningful, inclusive nature-based health benefits.

P 12.02

Integrative Health Care as a Pathway to Planetary Health: Insights from the Osher Collaborative

Aterah Nusrat MSc, DIC 1 , Brenda Loew DAOM 2 , Ann Vertovec MD, FACEP, ABOIM 3 , Barbara Walker PhD 4 , Tiff Young 5 , Geeda Searfoorce MFA 6 , Christine Vatovec PhD 6

1 Harvard, Boston, MA, United States

2 University of Washington, Seattle, WA, United States

3 Northwestern, Chicago, IL, United States

4 University of Cincinnati, Cincinnati, OH, United States

5 Vanderbilt, Nashville, TN, United States

6 University of Vermont, Burlington, VT, United States

Purpose : Integrative medicine supports individual, community, and planetary health through holistic frameworks. Yet, its role in advancing planetary health remains underrecognized. The Osher Collaborative, a global network of 11 academic institutions, prioritizes planetary health and has developed programming linking it to integrative care. This poster aims to raise awareness, showcase Osher’s efforts, engage the global community in sharing models and successes, and assess attendees’ understanding of integrative healthcare’s impact on planetary health.

Method(s): In response to strong interest in planetary health, the Osher Collaborative formed a Planetary Health Task Force with 45+ members across 11 centers. Monthly meetings fostered collaboration, resulting in joint publications, presentations, a symposium, speaker series, and educational resources for various audiences. This poster shares key learnings, data, and case studies, and invites attendees to contribute insights via an interactive wordcloud and survey to establish a baseline of planetary health work across the integrative health community.

Results : This poster will present educational content on planetary health in relation to integrative health, showcase case studies from Osher Centers, and share live survey data from Congress attendees on their understanding and engagement with the intersection of integrative health and planetary health. Results will establish a baseline for future comparison. QR codes will link to interactive tools for engagement. The Osher Collaborative will use findings to foster continued dialogue and support action across the integrative health community.

Conclusions : A summary of the key drivers, lessons learned, and success stories that have supported planetary health initiatives across the Collaborative will be offered, along with conventional and holistic frameworks for measuring progress. Opportunities for future engagement with the ongoing data collection and analysis process will be offered. Learning resources and organizations that can support individuals and organizations in planetary health work will be offered.

Topic Area 13: Nutrition

P 13.01

Community Gardens Improve Social Isolation...Community Perspective

Terrah Keck-Kester MD 1,2 , Laurie Crawford MPM 2 , Susan Veldheer DEd, RD, LDN 1 , Kayla Rutt DPH 1

1 Penn State College of Medicine, Hershey, PA, United States

2 Penn State Health, Hershey, PA, United States

Purpose : Over a billion people worldwide suffer from mental health conditions. The world health organization emphasizes that investing in mental health benefits people, communities, and economies. Social isolation and loneliness are strongly linked to mental health conditions. Community gardens (CG) have been associated with improvements in mental health, but less is known about community perceptions of the benefits of CG on social isolation and loneliness. This study explores community perceptions of CG impact on social isolation.

Method(s): Two hundred and nine surveys were distributed at 18 CG in Central Pennsylvania. Survey items included questions about personal feelings of isolation reported as none (never/occasionally) vs any (some of the time/often). Dichotomous survey items included questions about sense of community, the garden as a welcoming and inclusive place, and the garden’s effect on isolation. These surveys were uploaded into Redcap and descriptive statistics were utilized to analyze the data.

Results : We received 152/209 (73%) completed surveys. Of the CM that were surveyed at the CG, 40% (61/152) say that they some of the time or often feel isolated from others; 93% (141/152) of CM think that coming to the garden helps them feel less isolated from others, 99% (151/152) of CM find that the gardens are an inclusive environment, and 100% (152/152) of CM feel that the gardens give them a sense of community.

Conclusions : Isolation and loneliness negatively impact health. CG have long been recognized as spaces that promote connection, purpose, and well-being. These surveys contribute to the growing body of evidence by capturing the perspectives of CM themselves. Their responses affirm that gardening is not only therapeutic, but also a powerful tool for reducing isolation and fostering social cohesion. By integrating community perceptions into our understanding of health interventions, we strengthen our ability to deliver whole-person care.

P 13.02

SHOP WITH THE DOC: FEASIBILITY AND IMPACT OF CULTURAL GROCERY TOURS ON NUTRITION EDUCATION

Dr. Michelle Loy MD 1 , Ellie Hsu 2 , Lianna Levine Reisner MSOD 3

1 Weill Cornell Medicine/ New York Presbyterian, New York, NY, United States

2 New York University, New York, NY, United States

3 Plant Powered Metro New York, New York, NY, United States

Purpose : Grocery store tours are increasingly used for nutrition education, yet evidence on their effectiveness and outcomes remains limited. This pilot evaluated the feasibility and impact of culturally tailored grocery tours on participants’ knowledge and behaviors.

Method(s): “Shop with the Doc” was piloted between February 2023 and August 2024 by a board-certified lifestyle medicine physician in collaboration with Plant Powered Metro New York, a nonprofit promoting plant-based nutrition. Four no-cost tours were conducted at Chinese and Indian markets (Ranch 99, Jmart, Patel Brothers), highlighting health benefits of culturally relevant foods. Participants were invited to complete a survey assessing experience and changes in shopping and eating habits. Metrics included attendance, demographics, and survey responses; descriptive statistics were applied.

Results : Attendance ranged from 5–15 per session. Of 68 registrants, 11 completed surveys (9 attended a tour). Respondents were predominantly female (89%) and aged ≥65 (56%). Ethnic diversity included White (33%), Black/African American (22%), Asian/Pacific Islander (22%), and Declined (23%). Participants reported discovering new foods (e.g., mushrooms, bok choy, noodles) and learning benefits of vegetables, beans, ginger, and turmeric. Seventy-eight percent reported changes in purchasing behavior, increasing intake of unprocessed plant foods. Challenges included information recall and limited organic options. Most felt confident making healthier choices (67%) and were very likely to recommend the tour (89%). Suggestions included providing handouts, adding cooking demonstrations, scheduling at less busy times, offering thematic tours, and managing group size. Limitations included low response rate and potential responder bias.

Conclusions : This pilot was feasible and well-received, suggesting potential for positive changes in purchasing behaviors and dietary variety. Further research is needed to confirm findings, assess long-term impact, and explore scalability of culturally tailored grocery tours as a strategy to enhance nutrition education in diverse communities.

P 13.03

Educational Integration of Continuous Glucose Monitoring for Nutritional Self-Regulation Training

Yulia Yusipova

European University of Longevity, Hollywood, florida, United States

Purpose : To evaluate the effectiveness of using continuous glucose monitoring (CGM) as an educational tool for improving self-awareness, nutritional regulation, and metabolic literacy among participants in an integrative medicine curriculum. The study aimed to explore how real-time glucose feedback can enhance learning outcomes and foster behavioral change in dietary decision-making.

Method(s): The educational intervention was implemented as part of an eight-week training module within a certified program on integrative and longevity medicine. Participants (n = 62, including healthcare professionals and nutrition students) were equipped with CGM devices and instructed to record dietary patterns, mood, energy levels, and lifestyle factors through a digital journal. Weekly group sessions focused on interpreting glucose curves, identifying glycemic triggers, and personalizing meal timing and composition. Pre- and post-intervention surveys assessed participants nutritional awareness, self-efficacy, and perceived control over eating behaviors. Quantitative CGM metrics (mean glucose, time in range, glycemic variability) were analyzed alongside qualitative self-reports.

Results : Following the intervention, 87% of participants demonstrated increased awareness of postprandial responses, and 73% modified at least one major dietary habit (meal timing, macronutrient composition, or snack frequency). Average glycemic variability (CV%) decreased by 12%, and “time in range” improved from 78% ± 9% to 86% ± 8% (p < 0.05). Qualitative analysis indicated enhanced emotional stability and reduced reactive eating episodes. The integration of CGM feedback into the learning process also improved engagement and comprehension of metabolic principles, with 94% of participants rating the module as “transformative” for personal or professional use.

Conclusions : Integrating CGM-based biofeedback into nutrition education represents a promising method to bridge theory and behavior in integrative medicine. Real-time metabolic data enhance self-regulation, deepen understanding of individual variability, and promote lasting lifestyle changes. The results support expanding CGM-supported educational models to broader health-professional training and public metabolic health initiatives.

P 13.04

Designing Nutrition Studies for Long COVID: Qualitative Insights from a Patient-Reported Evaluations of a Ketogenic Metabolic Therapy

Dr. Dana Dharmakaya Colgan MA, MS, PhD 1,2 , Dr. Lita . Buttolph PhD, DSOM, MS 1 , Dr. Diane Stadler PhD 2 , Tabitha Grow BS 1 , Dr. Heather Zwickey PhD 1 , Mary Ruddick MS,MS 3 , Dr. Todd E. Davenport DPT, PhD, MPH 4

1 National University of Natural Medicine, Portland, OR, United States

2 Oregon Health & Science University, Portland, OR, United States

3 Enable Your Healing, Houston, Texas, United States

4 University of the Pacific, Stockton, California, United States

Purpose : Long COVID affects over 400 million people worldwide and has no FDA-approved treatments. Patients often rely on self-directed strategies, making their lived experiences an essential, yet underutilized, source of evidence. Ketogenic metabolic therapy (KMT) has demonstrated mechanisms relevant to Long COVID, including improved mitochondrial energy production, reduced oxidative stress, and modulation of inflammation, but remains underexplored in this population. Our goal was to engage stakeholders who had completed a community-based, virtually delivered KMT plus lifestyle (KMT-LS) program to increase our understanding of key elements necessary to conduct a future clinical trial.

Method(s): We conducted a cross-sectional, mixed-methods study of adults who completed, Enable Your Healing, a 12-week virtual program integrating KMT with lifestyle components. Recruitment emails were sent to 194 participants; 41 completed the online REDCap survey (21% response). Quantitative data were summarized descriptively. Qualitative data were analyzed using conventional content analysis.

Results : Participants (mean age 41; 90% female) reported diagnoses including dysautonomia (71%) and ME/CFS (60%). Five themes emerged: Program benefits, program challenges, recommendations for optimization, and scientific considerations for future clinical trials. Key insights included the value of multicomponent synergy, extended duration, and the balance of functional and biological outcomes.

Conclusions : This study explored patient-reported experiences with a virtually delivered, multicomponent KMT-LS for individuals with Long COVID, ME/CFS, and dysautonomia. Findings suggest nutrition trials for Long COVID should incorporate longer intervention periods, multicomponent design, patient-centered outcomes, lived-experience integration, and tailored supports to optimize feasibility and impact. By integrating these lessons, nutritional research in Long COVID can move toward interventions that are not only mechanistically grounded, but also acceptable, feasible, and impactful in the lives of patients.

P 13.05

Patients’ Experiences with a Virtually Delivered Ketogenic Metabolic Therapy for Post-infectious Dysautonomia, Myalgia encephalomyelitis/chronic fatigue syndrome, and Long COVID Indicate Feasibility, Acceptability, and Symptom Improvements: A Cross-Sectional Study

Dr. Dana Dharmakaya Colgan MA, MS, PhD 1,2 , Dr Diane Stadler PhD, RD 2 , Tabitha Grow MS 1 , Dr. Heather Zwickey PhD 1 , Mary Ruddick MS,MS 3 , Dr. Todd E Davenport DPT, PhD, MPH 4

1 National University of Natural Medicine, Portland, OR, United States

2 Oregon Health & Science University, Portland, OR, United States

3 Enable Your Healing, Houston, Texas, United States

4 University of the Pacific, Stockton, California, United States

Purpose : Over 400 million people worldwide are living with Long COVID, yet there are currently no FDA-approved treatments. Ketogenic metabolic therapy (KMT) has been shown to modulate several of the proposed mechanisms underlying Long COVID, including mitochondrial dysfunction, neuroinflammation, and autonomic dysregulation. This study examined the feasibility, acceptability, and patient-reported benefits of a virtually delivered ketogenic metabolic therapy and lifestyle (KMT-LS) program developed for individuals with post-infectious dysautonomia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Method(s): A cross-sectional study was conducted to analyze quantitative data obtained from online surveys completed by individuals with post-infectious dysautonomia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and Long COVID who participated in a 12-week, remotely delivered ketogenic metabolic therapy and lifestyle (KMT-LS) intervention. Data were collected using the Research Electronic Data Capture (REDCap) platform. Descriptive statistics were used to summarize sample characteristics and outcome distributions. To calculate the Impression of Change variable, paired sample t-tests were used to determine significance of mean differences between symptom severity at the beginning of program and at the time of survey completion.

Results : Among an international sample (n=41), participants reported the KMT-LS intervention was acceptable, feasible, and safe. Approximately, 96% of participants reported the intervention was helpful; 96% recommended the program; and 75% reported feeling, “A lot better,” following the intervention. Participants reported substantial improvement in symptoms across multiple domains, including fatigue, pain, and autonomic symptoms.

Conclusions : Participants found a ketogenic metabolic therapy to be a feasible and acceptable, with reported benefits across multiple symptom domains. Capturing and integrating patient perspectives is essential to guide the development of safe, acceptable, and effective treatments.

P 13.06

Ketogenic Metabolic Therapy for Long COVID: A Single-Arm, Open-Label Pilot Study Assessing Feasibility, Acceptability, and Preliminary Efficacy

Dr Dana Dharmakaya Colgan MA, MS, PhD 1,2 , Dr. Diane E. Stadler PhD 3 , Tabitha Grow BS 1 , Dr Heather Zwickey PhD 1 , Mary Ruddick MS, MS 4 , Dr. Todd E. Davenport DPT, PhD, MPH 5

1 National University of Natural Medicine, Portland, OR, United States

2 Oregon Health & Science University, Portland, Or, United States

3 Oregon Health & Science University, Portland, OR, United States

4 Enable Your Healing, Houston, Texas, United States

5 University of the Pacific, Stockton, California, United States

Purpose : Approximately 400 million individuals are estimated to suffer from Long COVID. Ketogenic metabolic therapy (KMT) is hypothesized to modulate key mechanisms underlying Long COVID, including metabolic dysfunction, inflammation, oxidative stress, and autonomic dysregulation. This small proof of concept study aimed to explore the feasibility and acceptability of a KMT paired with lifestyle interventions (KMT-LS) for individuals with Long COVID.

Method(s): We conducted a mixed-methods, single-arm pilot study to evaluate a community-based, 12-week, remotely delivered KMT-LS intervention. Eligible adults met criteria for Long COVID with post-infectious dysautonomia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Feasibility and acceptability were assessed using predefined metrics of enrollment, retention, adherence, satisfaction, and safety. Exploratory outcomes at post-intervention and 6-month follow-up examined changes in symptoms and functioning using minimal clinically important difference (MCID) thresholds and non-parametric paired-sample t-tests (Wilcoxon). All data were collected and managed using the Research Electronic Data Capture (REDCap) platform.

Results : A total of 11 participants completed the study, meeting benchmarks for feasibility and acceptability. All achieved and maintained nutritional ketosis (β-hydroxybutyrate > 0.5 mmol/L). MCID were observed in fatigue, mood, social and physical function, sleep, and pain (PROMIS-29; Duke Activity Scale), autonomic regulation (Malmo POTS Symptom Scale), breathlessness (Modified MRC Dyspnea Scale), and life satisfaction (Satisfaction with Life). Statistically significant improvements at postintervention were reported in fatigue (p=.03), sleep (p=.04), life satisfaction (p=.01), and autonomic regulation (p=.04), and at 6-month follow-up in fatigue (p=.05), social function (p=.03), sleep (p=.03), autonomic regulation (p=.02), pain interference (p=.04), and physical functioning (p=.008).

Conclusions : This pilot study demonstrates that a virtually delivered 12-week KMT-LS is feasible, acceptable, and safe for individuals with Long COVID presenting with ME/CFS and post-viral dysautonomia. High adherence and participant satisfaction, coupled with preliminary signals of clinical improvement, support the rationale for larger controlled trials to investigate efficacy and mechanistic pathways of KMT-LS in post-infectious chronic illness.

P 13.07

Broad-Spectrum Micronutrient Supplementation in Childhood ADHD: Two Independent RCTs

Mr. Dallin Hardy M.Sc

Hardy Nutritionals, Raymond, Alberta, Canada

Purpose : Academic publishing often fragments data from a single study across multiple papers, obscuring the full research narrative. Readers may also miss connections between an original RCT and replication studies. Furthermore, meta-analyses rarely narrow their scope to two or three studies of an identical intervention. This poster consolidates results from two similar RCTs using the same intervention in comparable populations into a single cohesive narrative.

Method(s): The Methods section of this poster consolidates the methodological approaches employed across the two double-blind, placebo-controlled trials and their associated ancillary publications, providing a unified overview of study designs, procedures, and analytical frameworks.

Results : The Results section of this poster presents the key findings from the two double-blind, placebo-controlled trials and their associated ancillary publications, presenting outcome measures, statistical and safety data including one-year follow-up after each RCT.

Conclusions : These two independent RCTs demonstrate that broad-spectrum micronutrient supplementation effectively improves global functioning, emotional dysregulation, aggression, and anxiety in children with ADHD. The micronutrients were safe and well-tolerated, with no significant side effects compared to placebo, even at high doses (9-12 capsules daily). About 50% of children showed significant improvement within 2 months, increasing to 66% by 4 months, and ongoing benefits were sustained for at least a year in responders with no emergence of adverse effects long-term. discontinuation often led to regression, indicating the need for continued use. Global measures were more sensitive to micronutrient effects than core ADHD symptom scales, suggesting that the micronutrients are not a targeted treatment but rather improve ADHD impairment indirectly by conveying pervasive holistic benefit. In addition to improving symptomatology to a clinically significant degree for a majority of participants, including full remission in the long term, micronutrients enhanced physical growth. Meanwhile, medications showed no better ADHD management but were associated with significantly worsened anxiety in addition to the risk of stunting. These high quality, replicated studies confirm the safety and efficacy of broad-spectrum micronutrients for ADHD populations highly representative of clinical practice.

P 13.08

RCT of Broad-Spectrum Micronutrient Supplementation: Outcomes for Maternal Depression and Infant Neurodevelopment

Mr. Dallin Hardy M.Sc

Hardy Nutritionals, Raymond, Alberta, Canada

Purpose : Academic publishing often fragments data from a single study across multiple papers, obscuring the full research narrative. This poster compiles the significant findings from the NUTRIMUM trial and its subsequent observational follow-up studies, investigating the efficacy and safety of broad-spectrum micronutrients (BSM) for antenatal depression and their impact on maternal and infant outcomes. The RCT phase focused on maternal depression, global functioning, and the predictors of a positive response to BSM during pregnancy. Exploration of potential mechanisms included both blood and stool analysis. Subsequent analyses explored both maternal and infant birth outcomes as well as infant development, and postnatal maternal mood.

Method(s): The Methods section of this poster consolidates the methodological approaches employed in the double-blind, placebo-controlled trial and seven associated ancillary publications, providing a unified overview of study designs, procedures, and analytical frameworks.

Results : The Results section of this poster presents the key findings from double-blind, placebo-controlled trial and the associated ancillary publications, presenting outcome measures, statistical and safety data including one-year follow-up for mother and infant.

Conclusions : The NUTRIMUM RCT and follow-up studies highlight the significant benefits of broad-spectrum micronutrient supplementation for mothers with antenatal depression and their infants. The NUTRIMUM trial showed that micronutrients outperformed standard recommendations in improving maternal functioning and self-perceived health, with no observed harm. Follow-up studies confirmed that micronutrient exposure reduced risks linked to maternal depression, and yielded better infant outcomes such as improved gestational age, birth length, and neurobehavioral performance compared to antidepressant exposure. Infants exposed to micronutrients exhibited temperament similar to those from typical pregnancies, with no adverse effects in the first year. Notably, mothers receiving micronutrients had significantly lower post-partum depression rates, indicating a lasting restorative effect. These findings emphasize the critical role of nutrition in pregnancy for optimal maternal and infant brain health. Broad-spectrum micronutrients may offer a safe and effective alternative, potentially surpassing antidepressants. This research sets a strong foundation for larger, more diverse studies to establish nutritional supplementation as a primary option, enhancing choice and outcomes for families.

P 13.09

AI-Assisted, Culturally Inclusive Nutrition Education to Support a Whole Food, Plant-Based Dietary Pattern: A Pilot Study at a Cancer Residential Facility

Dr Laura D Rhaney MD, MPH 1 , Anjali Yedavalli 2 , Eva Reineck 2 , Shreeya Yarlagadda 2 , Kara Morelock 2 , Maggie Bauwens 2 , Chrys Yates 2 , Liz Mattson 2 , Kim Barbel Johnson 2 , Dawn Mussallem 2

1 Mayo Clinic, Rochester, MN, United States

2 Mayo Clinic, Jacksonville, FL, United States

Purpose : Whole food, plant-based (WFPB) dietary patterns are linked to improved health outcomes, yet U.S. dietary guidance often falls short in cultural inclusivity and accessibility. Emerging technologies, such as artificial intelligence (AI), offer novel opportunities to advance culturally relevant nutrition education and support sustainable dietary change.

Method(s): This pilot study recruited participants from the American Cancer Society’s Hope Lodge in Jacksonville, Florida. The participants completed a pre-intervention survey and brief interview to assess baseline perceptions of a whole food plant-based dietary pattern, artificial intelligence, and cultural belonging. Following a digital educational seminar on nutrition and culture, the participants were guided to use Open AI’s ChatGPT to generate whole food plant-based adaptations of culturally significant recipes. A post-intervention survey was administered to evaluate perceived changes.

Results : Participants presented a highly statistically significant increase in openness toward AI technology and sense of belonging (p < 0.001), as well as a significant change in openness to a whole food plant-based dietary pattern (p < 0.005). Participants engaged meaningfully in discussions of food heritage and identity, though cultural belonging was difficult to quantify. Thematic analysis revealed several key themes which included community engagement, education, transition in dietary habits, cultural heritage, and spiritual motivations.

Conclusions : AI-assisted, culturally inclusive nutrition education may positively influence perceptions of a whole food plant-based dietary pattern. Future research should employ longer-term study designs with larger samples to evaluate whether these perceptual changes can translate into sustained dietary behavior changes.

P 13.10

Pilot testing of a diet cost calculation process for dietary counselling studies

Monique Aucoin ND MSc 1,2 , Hainan Yu 3,4 , Melissa Murphy 5,6 , Nicole Yoannou 1 , Laura LaChance 7 , Kieran Cooley 7,8,9 , Patricia Herman 10

1 Canadian College of Naturopathic Medicine, Toronto, ON, Canada

2 University fo Guelph, Guleph, ON, Canada

3 Ontario Tech University, Oshawa, On, Canada

4 Canadian Memorial Chiropractic College, Toronto, ON, Canada

5 California State University San Bernardino, San Bernardino, CA, United States

6 Bastyr University, San Diego, CA, United States

7 Canadian College of Naturopathic Medicine, Toronto, On, Canada

8 Southern Cross University, East Lismore, NSW, Australia

9 University of Toronto, Toronto, ON, Canada

10 RAND Corporation, Santa Monica, CA, United States

Purpose : Nutrition is a significant modifiable risk factor for the development and progression of many illnesses; however, it is recognized that adherence to dietary recommendations can be poor. One often-cited barrier to adherence is the perceived cost of healthy food. While many diet diary templates exist, none have been developed to capture the data needed for calculating the cost of a diet consumed during a diet intervention study.

Method(s): The objective of the present project was to develop and pilot test 1) a novel diet diary template with instructions, and 2) alternative approaches for calculating diet cost, which can be used in clinical trials to measure the difference in cost between baseline and intervention diets. We created a draft diet diary and instructions which were used by participants for one week. We used the data to test the feasibility of calculating weekly diet cost. Two methods were used: calculation of the cost based on the actual price of the items purchased (Method 1), calculation using standardized prices (Method 2). Acceptability of the diet diary and instructions was assessed by conducting participant interviews. The methods to calculate costs were compared in terms of feasibility of cost calculation and researcher time needed.

Results : Of 15 participants enrolled, 14 completed the interview and 12 submitted a complete diet diary. All participants reported that the process was acceptable or highly acceptable. Participant feedback was used to guide changes to the diet diary and instructions. Costs were calculated for 85.3% and 96.3% of food items using Method 1 and 2, respectively. The time to complete each method per participant, per week was 6.5 and 5 hours, respectively. Participants who gave feedback confirmed that the edits addressed their previous concerns.

Conclusions : The diet diary and instructions were acceptable to participants and feasible for the collection and costing of diet data.

P 13.11

Dietitian led Food as Medicine programming for Veteran adults

Katherine Dignan

VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States

Purpose : The purpose of this project was to determine the effectiveness of a Food as Medicine program within the Veteran population led by a Certified Functional Dietitian Nutritionist. The program focused on providing functional nutrition education and a holistic approach to health.

Method(s): Participants were educated on anti-inflammatory eating plans, elimination diets, gut health, toxins and vitamins/supplements during the 10 week program. Participants engaged in 10, 60 minute education and skill development sessions during each cohort. Individuals were also given the opportunity to continue with education by attending bi-monthly education sessions after graduation of the program with a Psychologist and Dietitian. Data collection of this program ran from January 2023-October 2025. During this time period 8 cohorts were completed. A post-implementation data review included 66 unique Veterans.

Results : Results indicate participants improved pre verse post programming in physical health with a change from 3.4 (SD 0.9) to 2.7 (SD 0.7) and mental health from 3.1 (SD 0.9) to 2.6 (SD 0.8). A lower rating indicating excellent and a higher number indicating poor. In addition participants reported living a more meaningful and purposeful life with a change from 2.8 (SD 1.6) to 2.3 (SD 1.0). Participants represented were 56% male and 44% female. In addition participants reported significantly decreasing overeating, improvement in hunger and fullness cues, portion size knowledge and improvements in noticing subtle flavors in food.

Conclusions : In conclusion these results indicate improvements in physical health, mental health and improvements in overall mindful eating. Food as Medicine classes may empower Veterans to make better long term changes and sustainable habits.

P 13.12

Cystic Fibrosis Healthy Eating Series: A Program series developed to provide practical skills to patients and their families

Mr. Luc A Santilli BA, BS 1 , Ms. Robin Miccio MS, LMT 1 , Dr. Maria R Mascarenhas MBBS 1,2

1 The Children's Hospital of Philadelphia, Philadelphia, PA, United States

2 the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Purpose : Nutritional management is central to Cystic Fibrosis (CF) care. Historically, CF diets emphasized high-calorie, high-fat, and high-salt foods due to their association with improved lung function. However, emerging evidence highlights the importance of nutrient-dense foods for longevity, mood, and overall well-being. Despite receiving nutrition support, families with CF often struggle to apply dietary guidance in daily life due to time constraints and lack of practical cooking education. To promote sustainable behavior change, it is critical to engage the entire family in learning how to prepare simple, nutritious, and enjoyable meals that align with CF dietary needs.

Method(s): In partnership with the CHOP CF Family Partner Group, CF specialists, nutritionists, and a medical chef educator, we developed a pilot virtual interactive culinary medicine series for CF families. One-hour classes were delivered via a secure web platform, featuring culturally diverse, affordable, easy-to-prepare recipes suitable for all life stages and adaptable for allergies. Families were encouraged to cook along, and all recipes and class recordings were shared online. Attendance, number of recipes per class, and satisfaction survey responses were collected.

Results : Two seasons of monthly classes were created, totaling eighteen sessions, eleven of which have been completed to date. Promotion occurred through flyers, email, social media, newsletters, and QR-coded posters. Attendance ranged from 6–13 participants (parents and children), and multiple recipes were demonstrated per session. Recorded sessions received 8–261 views. Average recipe cost was $30/session, and development cost was $50/class. Survey findings showed strong results (measured by % satisfaction): recipe relevance 83.5%, class duration 90%, virtual format 91%, likelihood of recipe adoption 92%, and prior recipe reuse 38%.

Conclusions : A virtual culinary medicine program for CF families was feasible and well-received. Future sessions will focus on increasing participation and incorporating more budget-friendly, family-oriented recipes that balance nutrition, simplicity, and flavor.

P 13.13

Cooking up Competence-The State of Food as Medicine Curricula in Family Medicine Residencies: A CERA Survey

Dr Alex J Kipp MD 1 , Dr Anna Shannahan MD 2 , Dr Mari Ricker MD 3

1 Valley Family Medicine, Renton, WA, United States

2 Northwestern Feinberg School of Medicine, Chicago, IL, United States

3 Andrew Weill Center of Integrative Medicine, Tucson, AZ, United States

Purpose : Despite the growing recognition of the importance of the power of food in treating and preventing disease, little is known about the status of Food as Medicine curriculum within Family Medicine residency programs, and its impact on graduates' competence and comfort in delivering nutrition guidance. We surveyed Program Directors across the country to study their FaM offerings and its impact on graduate readiness to provide competence nutritional advice to patients on graduating.

Method(s): The CAFM Educational Research Alliance (CERA) regularly releases surveys to all Family Medicine Program Directors and allows researchers to apply to ask 10 questions along a research topic. We used descriptive analyses to summarize data on FaM presence and scope across demographic features. We then used comparative statistics, such as chi-square test, to test for independence between categorical variables with existence and scope of FaM curriculum. We then studied the relationship between these variables and PD beliefs on graduate readiness to provide nutritional information

Results : We had 320 PDs respond to our survey. Of those, 175 programs did have some form of FaM in their curriculum. Most of the curriculum was didactic, with about half of the programs including experiential aspects as well. 77% of PDs felt their graduates were somewhat or very comfortable with providing nutritional guidance. In our bi-variate analysis, we found having FaM curriculum and having a faculty trained in Lifestyle Medicine was associated with higher rates of comfort in providing nutritional guidance

Conclusions : We are not surprised that having FaM curriculum makes graduates more likely to be comfortable providing nutritional guidance. As the first nationwide study of this nature, it is somewhat disheartening that over 40% of surveyed programs do not have this essential curriculum. As the ACGME considers competencies in nutrition, it behooves programs across the country to implement. Additionally, we will explore further the implications for internal medicine and pediatric residencies.

P 13.14

Reevaluating the Role of Dietary patterns in Depression Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ms. Rahele Tavakoly PhD (Doctorate) 1,2 , Ms. Alina Moosburner Master 1,2 , Mr. Dennis Anheyer PhD (Doctorate) 1,2,3 , Mr. Holger Cramer PhD (Doctorate) 1,2

1 Institute of General Practice and Interprofessional Care, Tübingen, Baden-Württemberg, Germany

2 Robert Bosch Center for Integrative Medicine and Health, Stuttgart, Baden-Württemberg, Germany

3 Department of Psychology and Psychotherapy, Witten, North Rhine-Westphalia, Germany

Purpose : Background: Emerging interest in nutritional psychiatry has spurred numerous clinical investigations into the potential of dietary interventions for managing depressive disorders. However, the efficacy of specific dietary patterns remains unclear. Objective: To critically assess and synthesize current evidence from randomized controlled trials (RCTs) evaluating the effects of structured dietary patterns interventions on clinical outcomes in adults diagnosed with depressive disorders.

Method(s): A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, Scopus, and ProQuest from inception to April 30, 2024. Eligible studies were RCTs comparing the effects of defined dietary patterns with active or passive control conditions on depressive symptoms in clinically diagnosed adults. Secondary outcomes included remission rates, health-related quality of life (HRQoL), and adverse events. Data were pooled using a random-effects model, and results were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane RoB-2 tool, and the certainty of evidence was evaluated via the GRADE framework.

Results : Five RCTs (n = 952) focusing exclusively on the Mediterranean diet (MD) were identified. Participants consisted solely of individuals with major depressive disorder or subclinical depression. Meta-analysis revealed no statistically significant short-term benefit of MD over active controls (SMD = −1.25; 95% CI: −5.11 to 2.61) or passive controls (SMD = −0.22; 95% CI: −0.74 to 0.29) in reducing depression severity. Similarly, short-term MD showed no significant impact on HRQoL when compared with active controls (SMD = 0.71; 95% CI: −3.38 to 4.79). Intermediate and long-term data were consistent with these findings. The overall risk of bias for the included studies was rated “some concerns”, and most of the outcome’s results showed “very low” certainty of evidence.

Conclusions : Current evidence from RCTs does not support a clinically meaningful benefit of Mediterranean diet interventions for treating depressive disorders. These results highlight the need for rigorously designed trials exploring diverse dietary patterns frameworks, and longer follow-up durations. Registration: This review was prospectively registered in PROSPERO (CRD42024541885).

P 13.15

Demystifying Nutritional Requirements: A Dietary Reference Intakes Deep Dive

Mr. Taron Fletcher B.Sc

Hardy Nutritionals, Raymond, Alberta, Canada

Purpose : This presentation outlines the reference values that form the foundation of the Dietary Reference Intakes (DRIs). It explores the definitions, and methodologies used to establish these nutrient intake guidelines and provides critical evaluations of their applicability including conditions where the RDA may be insufficient and where the UL does not apply. The presentation will also include illustrative metabolic maps to demonstrate vitamin and mineral cofactor utilization in critical pathways. It will provide new insights for the role of nutrition-based triage principles that govern enzyme function and efficiency.

Method(s): This presentation employs a structured review of the Dietary Reference Intake framework in a way that will help attendees understand the definition, relationship, rationale and methodology for setting nutrient reference values; EAR, RDA, UL, NOAEL, and LOAEL. Pathway maps illustrate vitamin and mineral cofactor influence on metabolic processes and enzyme efficiency.

Results : The objective of this presentation is to achieve the following results: 1. Attendees will understand the definition, relationship, rationale and methodology for setting nutrient reference values; EAR, RDA, UL, NOAEL, and LOAEL. 2. Attendees will learn additional sources of credible nutritional information and the guidelines afforded to them for clinical applications. 3. Attendees will learn how essential vitamin and mineral cofactors influence metabolic processes and enzyme efficiency.

Conclusions : This material reaffirms the centrality of nutrient reference values in public health and clinical nutrition while emphasizing the necessity of nuanced interpretation helping to improve nutritional evaluation and intervention strategies. In summary, this presentation provides a forward-looking framework that bridges established dietary reference values with evolving concepts of metabolic regulation, thereby guiding more precise, evidence-based approaches to nutrition science and practice.

P 13.16

Five Osher Centers, One Mission: A Multi-Institutional Programmatic Comparison of Culinary Medicine Health Professional Training

Dr. Stephanie M White EdD 1 , Dr. Melinda Ring MD 2 , Dr. Karen C Westervelt PhD, PT, ATC, NBC-HW 3 , Traci Thompson MS 4 , Dr Anna B Shannnahan MD, ABOIM, FAWM 2 , Dr Lori A Walsh MD 2 , Chef R. Leah Pryor 5 , Theresa Dvorak RDN, MS 4 , Kelly Lyle MS, MHA 1 , Dr. Teresa K. Glynn PT, DPT, MBA 6 , Dr. Laura S Redwine PhD 6 , Dr Iman Majd MD, MS, LAc 7 , Dr. Debra G Bell MD 7

1 Osher Center for Integrative Health at the University of Cincinnati, Cincinnati, Ohio, United States

2 Osher Center for Integrative Health at Northwestern University, Chicago, IL, United States

3 Osher Center for Integrative Health at the University of Vermont, Burlington, VT, United States

4 Osher Center for Integrative Health at the University of Utah, Salt Lake City, Utah, United States

5 University of Vermont Health, Burlington, VT, United States

6 Osher Center for Integrative Health at the University of Miami, Coral Gables, FL, United States

7 Osher Center for Integrative Health at the University of Washington, Seattle, WA, United States

Purpose : Transforming the health care system to a whole health model is a critical mission of the Osher Collaborative. This transformation will take a multifaceted approach, including changes to the education of the next generation of health care providers. One of these changes is the inclusion of culinary medicine in the curriculum. By exploring and comparing culinary medicine education programs for health professionals across five Osher Centers with a shared philosophy concerning integrative health, this research highlights common themes and practical innovations that can inform the development and scalability of culinary medicine and nutrition education models for health professionals.

Method(s): A structured 19-item survey was generated to gain a holistic perspective of the culinary medicine programming offered within health professional education at each Osher Center. The authors compiled the responses to explore commonalities and distinctions across the Osher Centers. The quantitative data were analyzed using descriptive statistics, and a subset of authors thematically grouped the open-ended qualitative responses. The authors reviewed these findings as a committee to critique findings and collectively determine results.

Results : Preliminary data show culinary medicine programs across the five Osher Centers target numerous academic audiences within health professions, indicating a need for curricula that expose health professionals along their academic journey. While program duration and modalities vary, all emphasize experiential learning, interprofessional teaching teams, and translation of nutrition knowledge into practical, patient-centered skills focused on whole health.

Conclusions : The Osher Center culinary medicine programs align with key elements identified in recent scoping reviews of culinary medicine education within medical schools. Their integration within the Osher Collaborative’s mission for whole health transformation offers a distinctive, scalable model that prioritizes measurable outcomes in nutrition and lifestyle education. This approach equips future health professionals with evidence-based skills to advance prevention and whole-person care while expanding effective, sustainable practices across clinical and community settings.

P 13.17

Bridging the Nutrition Education Gap: A Trainee-Led Food as Medicine Elective in Medical Training

Seema Sajjan Bachelor of Science , Zephelline Huerta Bachelor of Arts, Dr. Alia Badawi Doctor of Medicine, Dr. Osha Osha Chesnutt-Perry Doctor of Medicine, Dr. Tanya Datta Doctor of Medicine

Icahn School of Medicine at Mount Sinai, New York, NY, United States

Purpose : Chronic noncommunicable diseases (NCDs) account for 74% of global deaths, many of which are diet-sensitive and preventable. Yet, nutrition education in U.S. medical schools remains insufficient, with only 26% offering the recommended 25 hours of training. This gap limits physicians’ ability to provide culturally responsive dietary counseling. To address this, we are developing a trainee-led, six-week elective at the Icahn School of Medicine integrating nutrition, food-as-medicine principles, and culturally informed counseling for diverse patient populations in New York City.

Method(s): This six-week elective introduces medical students to “food as medicine” and its application in chronic disease prevention and management. Weekly modules cover conditions such as diabetes, hypertension, cancer, and mental health through short lectures, case discussions, and reflective exercises. Sessions feature clinicians experienced in culturally diverse care, patient perspectives, and a collaborative cooking activity. Pre- and post-course surveys using the validated General Nutrition Knowledge Questionnaire (GNKQ) and written reflections assess nutrition knowledge and culturally responsive counseling confidence.

Results : Primary outcomes include changes in nutrition knowledge (GNKQ) and self-efficacy in culturally responsive counseling. We anticipate that participation will enhance medical students’ understanding of nutrition’s role in chronic disease prevention and their ability to integrate culturally relevant dietary practices into care. Findings will inform refinement of the elective and provide evidence for incorporating structured food-as-medicine training into the medical curriculum at the Icahn School of Medicine at Mount Sinai.

Conclusions : Integrating food-as-medicine and cultural competency into medical education addresses critical gaps in chronic disease prevention training. This trainee-led initiative demonstrates how embedding nutrition science and cultural awareness can prepare future clinicians to deliver patient-centered, evidence-based counseling. Broader implementation may improve health equity, foster trust among diverse communities, and strengthen the role of nutrition in clinical care. This framework serves as a model for advancing integrative, preventive medicine education across medical institutions.

Topic Area 14: Pain

P 14.01

From Referral to Relief: Mapping Patient Demographics, Referral Patterns, and Treatment Outcomes at an Integrative Pain Clinic

Dr. Rasha Kakati MD 1 , Dr. Thu Tran MD 1 , Dr. Hanna Keller PharmD, BCPS 2 , Dr. Zubair Syed MD 1

1 University of Texas Southwestern, Dallas, TX, United States

2 Parkland Health and Hospital System, Dallas, TX, United States

Purpose : The primary objective of this study is to determine the therapeutic potential of specific interventions on the various patients with different chronic non-cancer pain (CNCP) diagnoses seen at the Parkland Integrated Pain and Healing Center (IPHC). We aim to elicit patterns of patient profiles and their respective treatment strategies of most benefit with the aims of developing an algorithmic approach to CNCP and a predictive model for patient outcomes. Secondary objectives include evaluating the patterns of external referrals to our IPHC, treatment utilization, and provider-patient continuity.

Method(s): Retrospective observational study of electronic health record data from January 2023 to May 2025 for approximately 200 adults referred to the IPC for CNCP. The study aims to assess follow-through with baseline treatment plan and continuity of care via descriptive statistics, evaluate changes in patient-reported outcomes over time via repeated measures analyses, and delineate links between observed improvements and specific interventions while accounting for patient characteristics via exploratory multilevel modeling. Patient reported health outcome measures (1) Pain, Enjoyment of Life, and General Activity (PEG), (2) Patient Health Questionnaire (PHQ-9), (3) Generalized Anxiety Disorder-7 (GAD-7) measured at each encounter.

Results : The number of referrals per month to IPC have ranged from 28 (January 2023) to 98 (May 2025), with median of 65. Average age of patient referred is 55. The most common reasons for referral include lumbar pain and radiculopathy, fibromyalgia, rheumatoid arthritis, paresthesias, discogenic thoracic back pain, polyarthralgia, chronic bilateral knee pain, and central pain syndrome.

Conclusions : We hypothesize a reduction in at least one patient health outcome measures for patients engaged in at least one intervention over time (i.e. 2 or more patient visits). We hope to elucidate which interventions (medications, behavioral therapy, acupuncture, etc.) might result in significant change.

P 14.02

MULTIsite feasibility of MUSIc therapy to address Quality Of Life in Sickle cell disease (MULTI-MUSIQOLS): Protocol for a Mixed-Methods Randomized Controlled Trial

Dr. Samuel N Rodgers-Melnick PhD, MPH, LPMT, MT-BC 1,2,3 , Dr. Coretta Jenerette PhD, RN, AOCN, ANEF, FAAN 4 , Viraj Gorthi MPH 1,5 , Angelique Foss MS, CHES®, NBC-HWC, LPMT, MT-BC 1,6 , Ashwini Erande MPH, M.Sc 7 , Dr. Amma Owusu-Ansah MD 8,9 , Dr. Samuel Anim MD 10 , Slate Bretz BA 1 , Priscilla Ketter BS 11 , Tranaka Fuqua MBA, CCRP®, BSN, RN 11 , Dr. Alan R Anderson MD 11 , Dr. Alison Karasz PhD 12 , Dr. Jeffery A Dusek PhD 7,13

1 Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States

2 Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States

3 Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, United States

4 University of California San Francisco School of Nursing, San Francisco, CA, United States

5 Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States

6 Department of Music, University of Rhode Island, Cleveland, OH, United States

7 Susan Samueli Integrative Health Institute, University of California – Irvine, Irvine, CA, United States

8 Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, United States

9 Department of Pediatrics, Division of Hematology and Oncology, Cleveland, OH, United States

10 Department of Medicine, Division of Hematology and Oncology, Cleveland, OH, United States

11 Department of Pediatric Hematology-Oncology, PRISMA Health Comprehensive SCD Program, University of South Carolina School of Medicine, Greenville, SC, United States

12 Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States

13 Department of Medicine, University of California – Irvine, Irvine, CA, United States

Purpose : Accessible, person-centered, nonpharmacologic modalities are needed to address chronic pain and health-related quality of life (HRQoL) among individuals with sickle cell disease (SCD). Building off prior single-site pilot studies of music therapy (MT) with this population, the purpose of this study is to (1) examine the data collection processes and intervention implementation overall and across two sites; and (2) evaluate the implementation of the MT and health education interventions using quantitative and qualitative data.

Method(s): This 3-arm, 2-site, feasibility randomized controlled trial (RCT) will include 90 individuals ≥14 years who have SCD, chronic pain, and access to a mobile device who are not currently engaged in mind-body pain management interventions under the supervision of a healthcare professional. Participants will be randomized to 6 patient-centered sessions over 8 weeks of either: (1) in-person MT, (2) hybrid (1 in-person, 5 virtual) MT, or (3) hybrid health education. Patient-reported outcome measures of HRQoL and self-efficacy will be assessed at baseline, post-intervention, and 6 weeks post-intervention. Twenty-four participants (8 per arm) and 20 stakeholders (e.g., hematologists, music therapists, nurses) will be invited to complete semi-structured interviews to further examine intervention acceptability, perceived benefits, and implementation. Sessions will be monitored for fidelity, and participants lacking access to home internet or videoconferencing technology will be provided tablets to engage in virtual sessions. Feasibility will be determined by rates of data completion, recruitment, retention, session attendance, and home practice.

Results : As of September 29, 2025, we have enrolled 26 participants. If accepted for presentation, the investigators will share preliminary feasibility data as well as best practices for (1) adapting MT interventions for virtual delivery and (2) facilitating intervention accessibility through technology and partnering with community health centers.

Conclusions : Successful conduct of this trial will provide the necessary framework for conducting a future, multi-site, definitive RCT.

P 14.03

Comparing Reiki and Mindfulness for Chronic Knee Pain: Results from a Placebo-Controlled Randomized Clinical Trial

Kennedi Childs , Dr. Adam Hanley PhD

Florida State University, Tallahassee, FL, United States

Purpose : Knee osteoarthritis (KOA) is a leading cause of chronic pain and disability. Pharmacologic options provide temporary relief and carry risks, highlighting the need for scalable nonpharmacological interventions. Reiki, a biofield therapy, and mindfulness meditation show promise for pain management but lack rigorous evaluation. This trial evaluated the efficacy of Reiki compared to sham Reiki (placebo), mindfulness meditation, and waitlist control for reducing KOA symptom severity.

Method(s): In a four-arm, randomized controlled trial ( NCT05541718 ), 164 adults with physician-confirmed KOA were randomized (1:1:1:1) to Reiki, sham Reiki (Feiki), mindfulness meditation, or waitlist control. Active interventions consisted of four weekly 30-minute sessions. Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, assessed at baseline, 1-month, and 2-month follow-up. Analyses included mixed-effects models and responder analyses (≥30% reduction in symptoms).

Results : A significant Condition × Time interaction emerged (p < .05). At 2-month follow-up, Reiki (d = 0.29, p = .023) and mindfulness (d = 0.46, p < .001) participants reported significantly greater symptom reduction than waitlist, with effects persisting through follow-up. Reiki reduced KOA symptoms by 32% (clinically meaningful), comparable to mindfulness (38%) and greater than Feiki (20%) or waitlist (13%). Responder rates (≥30% symptom reduction) were 55% for Reiki and mindfulness, compared to 33% for Feiki and 36% for waitlist. Retention was excellent (96%). No adverse events were reported.

Conclusions : Reiki and mindfulness significantly reduced KOA symptoms over two months, with effects exceeding placebo and waitlist. Reiki demonstrated strong feasibility and acceptability, supporting its potential as a complementary pain management approach for chronic knee pain.

P 14.04

Reaching Rural Veterans: Applying Mind-Body Skills for Pain: The RAMP Pilot

Dr. Diana J Burgess PhD 1,2 , Katherine Hadlandsmyth PhD 3 , Brent D. Leininger 4 , Brent C. Taylor 1,2 , Lee J. S. Cross 1 , Ann Bangerter 1 , Emily M. Hagel Campbell 1 , Alexander C. Haley 4 , Mallory Mahaffey 1 , Marianne S. Matthias 5 , Stephanie L. Taylor 6,7,8 , Roni Evans 4

1 Minneapolis Veterans Affairs Health Care System (VAHCS), Minneapolis, MN, United States

2 University of Minnesota Medical School, Minneapolis, MN, United States

3 University of Iowa, Iowa City, IA, United States

4 Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, School of Nursing, University of Minnesota, Minneapolis, MN, United States

5 University of Arizona, Tucson, AZ, United States

6 VA Greater Los Angeles Health Care System (VAGLACS), Los Angeles, CA, United States

7 Fielding School of Public Health and Department of Medicine, Los Angeles, CA, United States

8 David Geffen School of Medicine, University of California (UCLA), Los Angeles, CA, United States

Purpose : Rural-dwelling Veterans experience unique challenges in accessing multidisciplinary biopsychosocial pain care. The current study piloted a telehealth, multicomponent intervention for rural Veterans to increase access to complementary and integrative health (CIH) approaches to managing chronic pain: the Reaching Rural Veterans: Applying Mind-Body Skills for Pain Using a Whole Telehealth Intervention (RAMP).

Method(s): This single arm pilot study examined the feasibility of trialing the RAMP intervention. To facilitate community engaged research and enhance the likelihood of future implementation, we assembled a Veteran Engagement Panel and a Community Advisory Panel who we partnered with throughout the study. The RAMP intervention integrated multiple CIH self-management components (pain education, mindfulness, pain-specific exercises, and cognitive behavioral strategies, all delivered using expert-led videos) to address Veterans’ capability-, opportunity-, and motivation-related needs for supporting adaptive pain self-management behaviors. The RAMP intervention included an initial 1-to-1 session followed by 11 facilitated group sessions (90-minutes each). Feasibility was assessed using pre-specified milestones for recruitment and enrollment (N = 40), satisfaction (75%), fidelity (90%), intervention engagement (75%), and data collection (surveys of pain and health outcomes at 14 weeks, 80%).

Results : Among the N = 40 enrolled rural VA patients with chronic pain, 90% were satisfied with the intervention, fidelity was 100%, intervention engagement was 68%, and data collection reached 75% survey completion at 14 weeks.

Conclusions : In summary, our results indicate that RAMP is feasible and acceptable to rural Veterans highly impacted by chronic pain. Such scalable, telehealth CIH self-management interventions for rural VA patients with chronic pain could help accelerate and improve the implementation of nonpharmacological pain treatment for rural Veterans. Findings support the need for a hybrid randomized pragmatic clinical trial of the RAMP intervention to determine effectiveness and lay the groundwork for future implementation.

P 14.05

Building a National Headache Medicine Research Network: The BE WELL with Migraine Champion Providers Network™

Rebecca Erwin Wells MD, MPH 1 , Mila Naidu 1 , David Hendrix 1 , Junelyn Floyd MPH 1 , Hannah O'Brien MHA 1 , Nicole Tamol 1 , Caroline Oliver 1 , Camden Nelson 2 , Joshua Phillips 3 , Paige M Estave MD, PhD 1 , Shivani Vaidya DO 1 , Brian Moore MS 1 , Katherine Hamilton MD 4 , Ellie Adam 1 , Nathaniel O'Connell PhD 1 , Justin B Moore PhD 1 , Richard B Lipton MD 5 , Timothy T Houle PhD 6 , Zev Schuman-Olivier MD 3 , Paula Gardiner MD, MPH 3 , Scott W Powers PhD 7

1 Wake Forest University School of Medicine, Winston-Salem, NC, United States

2 Lewis Katz School of Medicine, Philadelpha, PA, United States

3 Cambridge Health Alliance, Boston, MA, United States

4 Medstar Georgetown University Hospital, Washington, DC, United States

5 Albert Einstein College of Medicine, New York, NY, United States

6 Massachusetts General Hospital, Boston, MA, United States

7 Cincinnati Children’s Hospital, Cincinnati, OH, United States

Purpose : Our purpose: to develop and assess the effectiveness of a national network of clinicians referring adults with migraine for a remotely delivered clinical trial.

Method(s): The BE WELL with Migraine Champion Providers Network™ supports clinician referrals across the United States into a remotely conducted mindfulness clinical trial.. Participant trial recruitment includes community outreach and clinician referrals. The primary study team obtains informed consent and collects all study outcomes. Clinicians interested in referring patients register for the Network via a REDCap survey. The ongoing clinical trial allows for recruitment of trial participants and Network members through 2026. We analyzed Network survey results through February 2025. We compared participant progression through eligibility assessment between clinician referral and community outreach.

Results : The BE WELL with Migraine Champion Providers Network™ includes 46 clinicians across the United States through February 2025 , most (89%) are headache specialists. To date, 905 participants completed the initial online screener, with 5% (n=41) from clinician referrals and 95% (n=864) from community recruitment. Of those, 12.3% (n=107) were eligible to continue and consented and completed the virtual interview. After the interview, 65 participants progressed to the headache log run-in period and then were randomized/eligible for randomization (6 from referrals, 59 from community). Of the original participants from clinician referrals who completed the online screener, 14.6% (6/41) were randomized/eligible for randomization, compared to 6.8% (59/864) recruited via community. Once consented, 100% (6/6) of Network-referred patients progressed to randomization/eligibility for randomization, versus only 58% (59/101) from community recruitment.

Conclusions : The BE WELL with Migraine Champion Providers Network™ models the development and implementation of a national clinician referring network.. While growth and implementation of a national network takes time, our results demonstrate the yield of appropriate referrals eligible for randomization was more than double community recruitment.

P 14.06

A Patient Headache Educational Program to serve as a Control Intervention for Non-pharmacological Studies in Migraine

Ms. Kristina Twaalfhoven BA 1,2 , Ruth Wolever PhD 3 , Pamela Rist ScD 1,2 , Peter Wayne Ph.D. 1,2 , Carolyn A Bernstein MD 1 , Karen Kilgore PhD 1 , Kena McDermott DC 4,5 , Meredith Beaton-Starr MS, OTR/L 1 , Dennis Munoz Vergara DVM, MSc, PhD 1,2 , Robert Vining DC, DHSc 6 , Matthew H Kowalski DC 1 , Jason Sico MD, MHS 4,5 , Cynthia Long PhD 6 , Viviane Nguyen BS 1,2 , Macy Randolph DC 1,2

1 Osher Center for Integrative Health, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States

2 Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States

3 Vanderbilt University Medical Center, Nashville, TN, United States

4 Veterans Affairs Medical Center, West Haven, CT, United States

5 Yale University, New Haven, CT, United States

6 Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States

Purpose : As interest in non-pharmacologic treatments for migraine prevention increases, there is an urgent need to evaluate if these treatments are well-designed randomized trials. However, designing a “control” for non-pharmacologic treatments is complex. One solution is to design credible educational programs to use as comparators that partially control for natural history and patient engagement, attention and positive expectancy. Purpose: to develop and validate through a modified Delphi process a “Headache Health Education” (HHE) program to be used as the control arm in a pilot study of multi-modal chiropractic care for episodic migraine.

Method(s): Leveraging existing patient educational materials, we drafted an initial HHE program with 14 modules covering migraine-related topics. Designed to be delivered by research assistants in a one-to-one video conference, modules provide education using a slide deck and guided conversation, grounded in adult learning theory. The script-based sessions are informed by tenets of polyvagal theory and motivational interviewing. The initial program was validated using a Delphi process. A panel of subject matter experts provided ratings and qualitative feedback regarding key elements of the control intervention. A second round of the Delphi process was used following refinement of the HHE program.

Results : Initial endorsement of the HHE program was strong but included considerable variability. While agreement with most statements on the Delphi survey averaged greater than 6 (out of 7), there was a wide range of scores. After refinement of the program, endorsement improved with lower variability during the second round of the Delphi process. Improvements included two new topics, new videos, and training for research assistants in skills to engage participants.

Conclusions : Development of an HHE program to use as a comparator in a randomized control trial of a non-pharmacological treatment for migraine is feasible. Studies underway will examine the fidelity and acceptability of program delivery and elicit feedback from study participants.

P 14.07

Engagement in mindfulness-based psychotherapy among migraine patients with comorbid trauma and depression: Implications for integrative care

Dr. Hallie Tankha PhD 1,2 , Ms. Narissa P. McCarty MS 2 , Dr. Jacob Hill ND, MS 1,2 , Dr. Amanda J Shallcross ND, MPH 1,2

1 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States

2 Cleveland Clinic, Cleveland, Ohio, United States

Purpose : Posttraumatic stress disorder (PTSD) and depression are highly prevalent among individuals with migraine and significantly worsen migraine-related outcomes. However, first-line migraine treatments do not address comorbid mental health symptoms, representing a critical gap in clinical care. Mindfulness-based psychotherapy offers a promising integrative approach to address migraine and mental health symptoms simultaneously. Understanding treatment-engagement patterns in patients with complex symptom presentations can inform patient-centered care.

Method(s): Adults with migraine (n=854) completed screening measures for a “skills-based psychological treatment study:” PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-8), and a single item assessing current engagement in mindfulness-based psychotherapy. We examined the prevalence of comorbid PTSD-depression symptoms and their relationship to mindfulness-based psychotherapy engagement.

Results : Overall, 32.1% (n=274) met criteria for probable PTSD (PCL-5≥31) and 50.4% (n=430) endorsed moderate to severe depression (PHQ-8≥10), with 28.2% (n=241) endorsing both. Across the entire sample, 16.3% (n=139) reported mindfulness-based psychotherapy engagement. Findings showed increased engagement as mental health symptoms increased: 10.2% (n=40/391) among those with neither symptom elevation, 17.5% (n=33/189) with elevated depression only, 21.2% (n=7/33) with elevated PTSD only, and 24.5% (n=59/241) with both elevated symptoms. Participants with both PTSD and depression elevations were 2.84 times more likely to engage in mindfulness-based psychotherapy than those with neither.

Conclusions : Individuals with migraine showed graded engagement in mindfulness-based psychotherapy based on symptom severity, with highest engagement among those with comorbid PTSD and depression. This suggests that mindfulness-based approaches may be particularly attractive to individuals with complex mind-body presentations. Mindfulness-based approaches offer integrated treatment that aligns with patients’ lived experience of migraine as impacting both physical and mental wellbeing. These findings also highlight a critical gap in current migraine care: trauma and depression must be addressed within migraine treatment rather than as separate concerns. Mindfulness-based psychotherapy offers an accessible patient-centered and trauma-informed approach for this integrated care model.

P 14.08

Feeling Seen: Sense of Community, Pain Catastrophizing, and Self-Efficacy in a Digital Mindfulness Trial for Chronic Pain

Laura J Orozco-Segura MS

Cambridge Health Alliance, Boston, MA, United States

Purpose : Social connection is increasingly recognized as a key factor in integrative and mind–body approaches to chronic pain. Digital mindfulness programs may foster belonging and resilience, yet the social mechanisms underlying these benefits remain understudied. This study aims to examine baseline associations between sense of community, pain catastrophizing, and pain self-efficacy among adults enrolled in the Our Whole Lives (OWL) mindfulness trial, exploring whether greater social connectedness relates to more adaptive pain-related beliefs and coping.

Method(s): Baseline data from adults with chronic pain participating in the OWL randomized digital mindfulness trial will be analyzed cross-sectionally. Measures include the Sense of Community Scale, Pain Catastrophizing Scale (PCS), and Pain Self-Efficacy Questionnaire (PSEQ). Descriptive statistics, Pearson correlations, and multiple linear regression models will examine associations between sense of community, catastrophizing, and self-efficacy, adjusting for age and gender. An exploratory mediation model will test whether self-efficacy mediates the relationship between community and catastrophizing.

Results : Analyses of baseline data will identify associations between sense of community, pain catastrophizing, and pain self-efficacy among adults with chronic pain. Results will summarize correlations and regression models examining whether participants with higher perceived community show lower catastrophizing and greater self-efficacy. Findings will be reported in detail at the conference to highlight the potential role of social connectedness as a psychological resilience factor within digital mindfulness interventions.

Conclusions : This study will provide an initial look at the social mechanisms that may support integrative healing among individuals with chronic pain. By identifying how a sense of community relates to adaptive pain beliefs and coping capacity, findings will contribute to a growing understanding of the mind–body–social dimensions of chronic pain. Results will inform the design of future interventions that intentionally cultivate belonging and empowerment in digital mindfulness-based programs.

P 14.09LB

The relative contributions of pain distribution, intensity, and psychological factors to physical function in multisite pain: an exploratory cross-sectional analysis

Wren Burton DC, MPH 1 , Cynthia Long 2 , Jacob McCarey 2 , Robert Vining 2 , Brad Manor 3 , Jeffrey Hausdorff 4,5 , Matthew Kowalski 1 , Yan Ma 1 , Peter Wayne PhD 1

1 Osher Center for Integrative Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States

2 Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States

3 Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, United States

4 Sagol School of Neuroscience and Department of Physical Therapy, Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, NA, Israel

5 Department of Orthopedic Surgery, Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States

Purpose : Multisite musculoskeletal pain is highly prevalent, and several pathways may explain its impact on physical function. This study explored associations of multisite pain, global pain intensity, pain intensity, catastrophizing, kinesiophobia, pain interference, and physical function in individuals with multisite pain.

Method(s): This exploratory cross-sectional analysis included 101 participants aged 18-85 years. Multisite pain was assessed across eight anatomic regions, using binary questions, with scores based on total affected sites. A composite function score was derived via principal component analysis from self-reported physical function, objective gait speed, and clinician-assessed dynamic balance. Hierarchical multivariable linear regression models examined the associations between number of pain regions and composite function, adjusting for age, sex and BMI, with sequential addition of global pain intensity, catastrophizing, kinesiophobia, and pain interference.

Results : Participants had a mean age of 40.2 years and were predominantly female (69%). Median number of pain regions was 2 (IQR 1- 3). After adjusting for demographics, higher number of pain regions was associated with lower composite function (ß: -0.16; 95% CI (-0.31 to -0.01); R 2 = 0.520, ΔR 2 = 0.205). Global pain intensity further contributed to the explained variance (ß: -0.20; 95% CI -0.30 to -0.10);R 2 = 0.589, ΔR 2 = 0.069), while pain interference and psychological factors contributed minimally.

Conclusions : Greater global pain intensity was associated with worse composite function, with number of pain regions contributing somewhat to this relationship. Psychological factors and pain interference contributed minimally. These findings call for further longitudinal research exploring potential mediating relationships and exploring multimodal and multidisciplinary approaches which address pain, functional outcomes, and other related elements of biopsychosocial health.

P 14.10LB

Changes to Pain, Functioning, Pain Catastrophizing, and Posttraumatic Stress Disorder of Life Following a 5-Session Pain-Sensitive Teleyoga Class for Veterans with Chronic Pain

Dr. Belle Zaccari PsyD

VA Portland Health Care System, Portland, OR, United States. Oregon Health & Science University, Portland, OR, United States

Purpose : Yoga has emerged as a desirable, evidenced-based nonpharmacologic intervention for patients with chronic pain This project pilot tested a 5-session pain sensitive teleyoga class and its impact on subsequent teleyoga practice delivered either synchronously or asynchronously among a sample of predominantly rural veteran patients. The current study presents pre-post clinical outcomes of patients receiving the 5-session pain sensitive teleyoga class.

Method(s): This sample (N=37) comprised veterans receiving care at a Pacific Northwest VA Health Care Facility who were diagnosed with chronic musculoskeletal pain. Following enrollment, participants attended up to 5 sessions of a closed group, synchronous pain-sensitive teleyoga class. Each teleyoga session included 30-45 minutes of pain management education and 30 minutes of guided yoga practice. Generalized estimating equations evaluated changes from baseline to post-intervention follow-up using validated and reliable measures for (1) pain intensity and (2) pain interference, (3) physical functioning , (4) pain catastrophizing, and (5) trauma symptoms.

Results : Patients in this sample were primarily male (62%), white (65%), non-Hispanic (84%) and had a mean age of 56.1 years (SD=14.0 years). Following participation in the teleyoga class, patients reported significantly less pain interference, pain catastrophizing, and trauma symptoms. Pain intensity (and physical functioning did not significantly improve from baseline to post-intervention follow-up.

Conclusions : These results show promise for the preliminary effectiveness of a brief yoga intervention delivered virtually to reduce pain interference and catastrophic thinking associated with physical and emotional traumas.

P 14.11LB

Central Sensitization and Embodied Connection as Mechanistic Targets Linking Fibromyalgia and Complex PTSD Symptoms: Somatic and Affective Pathways

Ms Shalynn M Murphy MS , Dr. Janell L Mensinger PhD

Nova Southeastern University, Fort Lauderdale, FL, United States

Purpose : Fibromyalgia and complex posttraumatic stress disorder (CPTSD) frequently co-occur, yet the mechanistic pathways linking chronic pain conditions to trauma-related symptom severity remain poorly understood. Integrative health models suggest that central sensitization, positive embodied experiences (e.g., connection, safety, agency), and emotion regulation may represent modifiable intervention targets across pain and trauma contexts.

Method(s): Using a large U.S. census-matched sample (N=2000), we examined whether fibromyalgia diagnosis was associated with greater CPTSD symptom severity (International Trauma Questionnaire) and tested a theoretically driven serial mediation model. Central sensitization (Central Sensitization Inventory), embodied connection (Brief Experiences of Embodiment Scale), and difficulties with accepting emotions (DERS-Non-acceptance) were specified as sequential mediators using PROCESS (v4.2), controlling for age, gender, race, and BMI. Indirect effects were estimated with percentile bootstrapped (5000 samples) 95% confidence intervals.

Results : Individuals reporting a fibromyalgia diagnosis (N=89, 4.5%) reported higher CPTSD symptom severity (B=4.09, SE=1.10, p<.001), independent of age, gender, race, and BMI. Central sensitization emerged as the primary and most robust upstream mediator (explaining ∼80% of the total indirect effect), with additional significant indirect effects through reduced embodied connection and emotion acceptance as downstream mediators of CPTSD symptoms. The full serial pathway—fibromyalgia → central sensitization → (dis)embodiment → emotion (non)acceptance → CPTSD—was significant. Sensitivity analyses demonstrated identical mediation structures when migraine, TMJ, or pain intensity ratings were substituted for fibromyalgia diagnosis. Given that bidirectional effects between trauma history and pain are well established, we also examined alternative pathway specifications to evaluate the robustness of the hypothesized ordering.

Conclusions : Although cross-sectional, these findings identify statistically robust, theoretically coherent pathways linking pain-related conditions to CPTSD symptom severity. Results support central sensitization, embodied connection, and emotion acceptance as promising, intervention-relevant targets for integrative, trauma-informed approaches to chronic pain and CPTSD. Longitudinal interventional studies using mind-body strategies (e.g., biofeedback, yoga) to target somatic experiences and embodied processes are needed.

Topic Area 15: Provider Well-Being

P 15.01

The Compassion Champion Model: A Peer- Led Framework for Cultivating and Sustaining Compassion in Organizations

Sivaranjani Penna MD 1,2 , Melanie Bateman RN, BSN 1,2

1 Welugu, Narberth, PA, United States

2 Bryn Mawr Hospital, Bryn Mawr, PA, United States

Purpose : Despite strong evidence linking compassionate healthcare to improved clinical outcomes, enhanced patient experience, clinician well-being, reduced burnout, lower costs, and decreased medicolegal risk, compassion remains underprioritized across healthcare organizations. There is a pressing need for models that embed compassion into daily practice, transforming it from an aspirational ideal into a normative component of healthcare culture. We propose the Compassion Champion Intervention, an integrative model that harnesses healthcare professionals’ innate capacity for humanitarian care. Through structured training, peer reflection, and brief compassion practices embedded in daily workflow, this model seeks to cultivate and sustain compassion as a foundation of clinician well-being, patient connection, and organizational culture.

Method(s): To evaluate feasibility and impact, a nine-month mixed-methods framework is proposed. Primary outcomes include compassion, burnout, feasibility, and acceptability; secondary outcomes include patient experience and organizational engagement. The intervention comprises three phases: (1) identifying professionals who exemplify compassionate care (top quartile on a compassion scale (2) training them as Compassion Champions through six weekly 60-minute sessions on compassion, reflection, and communication (3) empowering them to lead daily huddles and monthly Compassion Circles for four months, fostering reflection, barrier-solving, and peer support, before transitioning to unit-led compassion circles and weekly huddles. Quantitative data will be analyzed using mixed-effects modeling, and qualitative reflections through thematic analysis.

Results : The intervention is expected to enhance compassion, reduce burnout, and improve patient experience. Qualitative findings are anticipated to reveal increased self-awareness, emotional regulation, and confidence in integrating compassion into clinical practice. Integration analysis will map behavioral and cultural changes, and highlight mechanisms of sustained compassion. within organizations.

Conclusions : The Compassion Champion Intervention offers a pragmatic, scalable framework for embedding compassion within healthcare systems. By transforming compassion from an individual virtue into a shared practice, it aligns clinician well-being with patient-centered care and organizational culture, supporting sustainable, system-wide compassion.

P 15.02

The Micro Self-Reflection Initiative: A Feasible, Low-Burden Approach to Cultivate Compassion and Well-Being in Healthcare Professionals

Sivaranjani Penna 1,2 , Melanie Bateman 1,2

1 Welugu, Narberth, PA, United States

2 Bryn Mawr Hospital, Bryn Mawr, PA, United States

Purpose : Compassionate healthcare enhances patient outcomes, adherence, and clinician well-being while reducing burnout. Yet, structured compassion training is rarely implemented and often unsustainable due to workload and time constraints. There is a need to move from didactic teaching to brief, reflective practices that integrate compassion into daily routines. The Micro Self-Reflection Initiative addresses this gap by leveraging clinicians’ inherent compassion and natural pauses in workflow to cultivate real-time reflection.

Method(s): Grounded in self-compassion and mindfulness, the initiative introduces one-minute micro-reflections within daily routines to strengthen emotional awareness, compassion for self and others, and overall well-being. Healthcare professionals aged 18 and older will complete baseline, post-intervention, and three-month follow-up surveys assessing reflection habits, self-compassion (Self-Compassion Scale), compassion toward others (Healthcare Provider Compassion Scale) and burnout (Maslach Burnout Inventory-Human Services Survey).. Following a 30-minute virtual orientation, participants engage in four one-minute reflections daily for eight weeks, supported by personalized reminders and guided prompts. Change in self compassion, compassion to others, well-being, burnout, feasibility, acceptability, perceived benefits, and sustained impact will be evaluated using mixed methods. A preliminary survey was conducted to assess early feasibility and acceptability.

Results : Among 32 respondents, feasibility was strongly supported (56.3% agree; 15.6% strongly agree) with moderate acceptability (46.9% agree; 9.4% strongly agree). Neutral responses (25% feasibility; 37.5% acceptability) indicate opportunities to enhance engagement and understanding. Positive effects are anticipated across self- and other-directed compassion. Broader studies are needed to assess long-term impact.

Conclusions : This conceptual framework suggests that brief, structured micro-reflections are feasible and may enhance compassion and emotional regulation in demanding clinical environments. While acceptance requires further strengthening, integrating one-minute reflections into daily routines offers a low-burden, sustainable model to foster compassion, reduce burnout, and support well-being across healthcare settings.

P 15.03

Integrative Medicine in Orientation Week: Preparing Students for the Demands of Medical Training

David Pogosyan

University of Arizona College of Medicine - Tucson, Tucson, AZ, United States

Purpose : The transition to medical school introduces considerable academic and personal demands, yet early curricula often lack structured opportunities for cultivating well-being skills. To address this gap, we implemented a Wellness Retreat during orientation week for first-year medical students, providing experiential instruction in self-care. The retreat aimed to introduce practical wellness strategies and protected time for students to explore individualized approaches to maintaining well-being.

Method(s): A total of 121 first-year medical students participated in an in-person retreat featuring four experiential stations: nutrition and culinary medicine, purpose and meaning, wellness inventory and goal setting, and mind–body skills for stress management. Students completed anonymous pre- and post-retreat surveys analyzed using independent-samples t-tests.

Results : Of the participants, 118 completed the pre-survey and 116 completed the post-survey. Across all domains, mean self-reported scores increased significantly. Gains were observed in nutrition (6.64 to 7.95, p<.01), purpose and meaning (6.76 to 8.07, p<.01), goal setting (6.69 to 8.35, p<.01), and mind–body practices (6.21 to 7.96, p<.01). Students also reported stronger intentions to revisit wellness goals within six months (7.97 to 8.79, p<.01) and increased interest in exploring purpose and meaning during training (7.42 to 8.41, p<.01). Post-event feedback indicated that the wellness inventory and goal-setting session was the most impactful (37%), while mindfulness emerged as the most valued domain (43%). Qualitative responses emphasized renewed motivation and confidence in sustaining positive lifestyle changes.

Conclusions : Introducing structured, experiential wellness programming at matriculation was associated with significant improvements in self-reported wellness skills and intentions. This model provides a feasible, replicable approach to fostering early self-care habits, establishing a shared language of well-being, and addressing modifiable risk factors for burnout. Future research should include comparison groups and longitudinal assessment of stress, burnout, and academic outcomes.

P 15.04

Medical Intern and Resident experiences in Employee Whole Health

Katherine Dignan MS, RD,LD, CDCES

VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States

Purpose : The objective of this review is to determine the impact of the VA Paid Employee Whole Health program implemented to promote well-being of the students and trainees at VA Northeast Ohio Healthcare System. This review includes students and trainees working as medical doctors, dietetic interns, pharmacy interns, nurse trainees and mental health professional trainees.

Method(s): Each of the 146 unique participants could attend unlimited employee activities on a voluntary basis provided by Employee Whole Health and all completed 4 hours of mandatory employee experiences. The mandatory Whole Health experiences included education on stress and Whole Health and experiences of Mindfulness, Tai Chi/Qigong, Yoga and creative expression.

Results : At the start of their internship/residency 86% of participants reported exercising on a regular basis, 77% reported sitting for most of their duties at work and 26% reported practices of Mindfulness, Yoga or Tai Chi regularly. 38% of trainees were male and 62% were female. Participants were asked to self-report daily stress at work before Employee Whole Health activities. The average rating before the activity was 5.5 (SD 1.9) with 1 being no stress and 10 being high stress. After participation results indicate a drop in stress level to 3.7 (SD 2.1). Using the brief resilient coping scale, participants had noted improvement over the 1 year period. Perceived daily stress and good quality sleep were negatively impacted during the one year trainee program. Participants reported their general health was at a rating of 2.4 (SD 2) at the beginning of the program moving to post program at 2.6 (SD 0.9) with 0 indicating excellent health.

Conclusions : In conclusion this review helps to support the growing body of evidence that Employee Whole Health interventions can support the health and well-being of our interns and residents.

P 15.05

Expanding Therapeutic Impact: Inclusion of Caregivers in a Community-Based Parkinson’s Disease Program

Clinical Assistant Professor, University of Southern California Sarah Ingersoll MS, MBA 1 , Kris Mendenhall JD 2 , Kenneth Hayashida MD 3 , Louis Castro DPT 4

1 University of Southern California, Los Angeles, CA, United States

2 Nossaman, Los Angeles, CA, United States

3 retired, Los Angeles, CA, United States

4 T.R.O. Physio+Wellness, Los Angeles, CA, United States

Purpose : To describe a successful model for actively engaging caregivers in an exercise program originally designed for individuals with Parkinson’s disease. Physical therapy and exercise programs for people with Parkinson’s disease are available in both community and clinical settings, but they rarely address the needs of caregivers. The caregiver is most often the chauffeur and escort rather than a co-beneficiary. Because exercise interventions are inherently adaptable and socially oriented, they offer an underutilized opportunity to include caregivers in meaningful ways. The program described here is led by a licensed physical therapist with expertise in leading groups, and intentionally incorporates caregivers as participants.

Method(s): Caregiver involvement began informally but quickly proved beneficial, enhancing the group’s cohesion and overall experience. Recruitment messaging was revised to emphasize inclusivity (“Everyone welcome”), reframing the program as a shared activity. Participation trends and caregiver feedback were tracked over several years, providing qualitative and quantitative data on engagement. While the participant pool is self-selected and attrition is not systematically monitored, longitudinal surveys offer insights into evolving participant priorities.

Results : The program has demonstrated consistent growth and strong engagement among patients, caregivers, and volunteers, with participation increasing prior to the pandemic, and then, more steadily, from 2021 to 2025. Survey responses reveal a shift in priorities: social connection has become the primary perceived benefit, surpassing the exercise itself. Notably, some caregivers continue their involvement with the program even after the death of their partner with Parkinson’s disease, underscoring the program’s broader social value.

Conclusions : An exercise program designed for patients can be effectively adapted to engage caregivers as co-participants. This inclusive approach enhances program sustainability, fosters meaningful social networks, and provides mutual benefits beyond the original therapeutic goals.

P 15.06

An Integrative, Community-Engaged Approach to Improving Caregiver Sleep in Pediatric Inpatient Settings

Gabrielle D Davis MS, RN, PMHNP, PED-BC 1 , Patenne Mathews MPH 1 , Stephanie Caldas PhD 1 , John Sy PhD 2 , Emma M. Millon PhD 1 , Isabela Loeff Goldsztein 3 , Kathleen DeMarco PhD, NE-BC, CPHQ, RN 1 , Shari Esquenazi-Karonika PhD 1

1 NYU Langone Health, New York, NY, United States

2 University of Arizona, Tuscon, arizona, United States

3 NYU, New York, NY, United States

Purpose : Caring for a hospitalized child places significant emotional, physical, and psychological demands on caregivers, often compromising their overall wellbeing. Within an integrative health framework, sleep is viewed as essential for physical restoration, emotional balance, and connection. In hospital settings, caregivers frequently experience fragmented sleep averaging less than six hours per night, leading to fatigue and reduced resilience. Despite its importance, few interventions address caregiver sleep as a core aspect of holistic health. This project identified barriers to restorative sleep and evaluated the feasibility, acceptability, and effectiveness of an integrative education and skill-building intervention to enhance caregiver wellbeing.

Method(s): This mixed-methods study examined sleep support for caregivers within the inpatient setting. A literature review established the current evidence base, followed by surveys of Family Advisory Council caregiver representatives to identify barriers experienced during overnight stays. Qualitative interviews with bedside nurses explored logistical considerations for implementing a structured sleep education and wellbeing intervention. Pre- and post-intervention surveys evaluated the feasibility, acceptability, and impact of the integrative sleep education and kit on caregiver sleep and holistic wellbeing.

Results : Barriers to caregiver sleep in hospitals are multifactorial, including environmental disruptions (light, noise, rounding, furniture) and personal factors (stress, responsibilities, screen use). Findings highlight the interconnected physical, emotional, and environmental influences on wellbeing and support the need for integrative, whole-person interventions. Both caregivers and nurses endorsed inpatient sleep and wellbeing promotion programming.

Conclusions : By recognizing sleep as an essential yet often overlooked pillar of integrative health, this project highlights opportunities to strengthen caregiver resilience, reduce stress and anxiety, and enhance caregiving capacity for hospitalized children. Aligned with the principles of integrative medicine, these findings emphasize caregiver and family wellbeing as foundational to high-quality, patient-centered care. Lessons from this pilot can inform hospital policies and routines that promote rest and recovery through environmental modifications, staff education, and caregiver-centered resources.

P 15.07

Development of a Whole Health, Lifestyle Medicine Course for Medical Students

Dr Emily M Godfrey MD, MPH 1 , Ms Grace Guenther MPA 1 , Sarah Lill PA 2 , Reyna Houston MPHc 2 , Kayla Kenyon MPHc 2

1 University of Washington, Seattle, WA, United States

2 University of Washington School of Public Health, Seattle, WA, United States

Purpose : Noncommunicable chronic diseases (NCDs) such as heart disease, diabetes, obesity, and cancer represent the predominant health burden in the US with significant health disparities. Working with patients on their dietary patterns and lifestyle behaviors is an essential, first-line step in preventing and managing these diseases. The Association of American Medical Colleges (AAMC) recognizes whole-health, lifestyle medicine (LM) approaches to prevent and treat NCDs and have called for more LM-trained physicians. Few medical schools have responded to this call.

Method(s): We are conducting a needs assessment to identify the gaps in knowledge, skills and behaviors of LM’s six pillars for UW School of Medicine (UWSOM) students using Kern’s 6-step approach to curriculum development. Among the UWSOM, we are interviewing students and faculty to understand whether the current curriculum meets LM competencies. We are interviewing practicing primary care physicians to assess what their training should have included to prepare them to meet LM competencies in practice.

Results : We will report on the findings from 3 focus groups of 6-10 UWSOM medical students, both in the pre-clinical and clinical clerkship years, 10 pre-clinical and clinical faculty, and up to 30 interviews with early career primary care clinicians. Transcripts will be analyzed using thematic analysis, following Braun and Clarke’s six-phase approach. Two independent researchers will code the data, with discrepancies resolved through discussion. Emergent themes will be mapped to LM competencies, educational experiences, instructional preferences and whether current curriculum aligns with needs of underserved communities served by UWSOM primary care clinicians.

Conclusions : The findings from this needs assessment stage will be used to develop the equity-grounded course goals and objectives and inform optimal educational strategies to help reinforce the concepts and skills among learners. The study can serve as a feasible approach for whole-health, lifestyle medicine curriculum development at other medical schools nationally.

P 15.08

Care for the Caregiver Program: Scaling a peer-based, integrative, evidence-informed approach to healthcare workforce well-being

Dr. Viktoriya Karakcheyeva MD. MS, Dr. Leigh Frame , Dr. Patrick Corr

George Wshington University, Washington, DC, United States

Purpose : Healthcare workers around the world face chronic exposure to distress, burnout, and compassion fatigue, with adverse consequences for their mental health, patient safety, and healthcare system sustainability. The objective of this study is to evaluate the effectiveness of the Care for the Caregiver (CFC) Program at GW Medicine - a peer-delivered, integrative model based on Psychological First Aid (PFA) and the “Hope Module” designed to strengthen resilience, reduce emotional strain, and cultivate a culture of well-being within healthcare organizations.

Method(s): A convergent mixed methods design was used. Quantitative data (n = 35 pre-test; n = 13 post-test; n = 7 matched) were collected using the ProQOL-5 instrument. Qualitative data from two focus groups and eight individual interviews were analyzed thematically. The study was guided by the Knowledge–Attitudes–Behaviors (KAB) framework.

Results : Quantitative analyses revealed meaningful improvements across indicators of secondary traumatic stress and burnout, such as reductions of more than half a scale point in feelings of being preoccupied with those they help (Δ = –0.80), being easily startled by unexpected sounds (Δ = –0.77), difficulty separating personal and professional life (Δ = –0.73), feeling personally affected by others’ traumatic stress (Δ = –0.62), and feeling worn out from their role as a helper (Δ = –0.70). Thematic analysis identified enhanced understanding of PFA, increased confidence in using helping skills in both professional and personal contexts, and fostered a sense of community through monthly check-ins.

Conclusions : The CFC Program represents a scalable, evidence-informed integrative model that merges peer support, PFA, and hope building practices. It addresses critical gaps in healthcare workforce well-being by promoting proactive, accessible, and relational well-being strategies. Findings support expansion of this model to other healthcare settings as a cost-effective, culturally adaptive solution, aligned with whole-person care.

P 15.09

Coast to Coast Nursing Wellbeing Challenge

Candace McNulty MSN, Ashley Rush LCSW-QS

Orlando VA, Orlando, FL, United States

Purpose : Nurses are frequently exposed to occupational stressors that can negatively influence their well-being and, in turn, patient care quality and safety. Nurse well-being in hospital settings is closely linked to job satisfaction, organizational commitment, and key patient outcomes. This project reports on a four-week interfacility Nursing Wellbeing Challenge conducted at the Orlando VA and San Francisco VA (October 6–November 1, 2025) designed to promote nurses’ engagement in structured well-being activities and to evaluate change in self-reported well-being.

Method(s): The intervention was grounded in the VHA Whole Health model, which includes eight dimensions of well-being. Two dimensions were highlighted each week, with participants selecting and logging evidence-based well-being practices via a standardized electronic form. Pre- and post-intervention surveys assessed three domains—physical well-being, mental/emotional well-being, and day-to-day life—on a 1–5 Likert scale.

Results : More than 250 nurses across the two sites enrolled in the challenge. In the Orlando cohort, mean pre- and post-scores demonstrated improvement across all domains: physical well-being increased from 3.29 to 3.84, mental/emotional well-being from 3.51 to 4.00, and day-to-day life from 3.60 to 3.96. Participants additionally submitted photographs and brief narratives illustrating “what matters most” in their well-being journeys, and weekly videos from Orlando VA nursing staff modeled practical self-care strategies and reinforced social norms around well-being engagement.

Conclusions : These preliminary findings suggest that a brief, structured, Whole Health–aligned wellbeing challenge is feasible at scale and may positively influence nurses’ perceived well-being. Given the established associations between nurse well-being, retention, and patient outcomes, such interventions may represent a pragmatic approach to supporting a healthier and more sustainable nursing workforce. Planned next steps include expansion of the Nursing Wellbeing Challenge to additional VHA sites in 2026 and the incorporation of longitudinal outcome measures, including well-being scores, participation patterns, and workforce indicators.

P 15.10

Implementation of an Integrative Health Promotion Innovation Award Program at NYU Langone Health

Shari Esquenazi-Karonika PhD , Darah K Salmaggi MS, Fariza Alendy MSW, MPH, Emma Millon PhD, Kathleen DeMarco PhD, NE-BC, CPHW, RN

Department of Integrative Health, New York, NY, United States

Purpose : Integrative approaches to workplace wellness that address mental and physical well-being are increasingly essential for reducing burnout and improving care quality among healthcare workers. Yet many systems lack accessible, staff-driven programs. To address this gap, NYU Langone Health launched the Lerner Health Promotion Innovation Award to incubate wellness initiatives. The 2025 cycle partners with The Monday Campaigns, using Monday as a reset to support sustainable behavior change as awardees design, implement, and evaluate workforce-driven programming.

Method(s): The 2025 Innovation Award program was promoted across the NYULH workforce through the intranet and targeted outreach emails. Applicants completed a two-phase application, beginning with a Letter of Intent and then a full proposal detailing implementation, evaluation, and sustainability plans. Submissions were assessed for feasibility, scalability, and alignment with whole-person wellbeing, while ensuring diversity in populations, settings, and behaviors targeted. Projects span 12–18 months and include mentorship, development checklists, publication templates, and regular consultations.

Results : The 2025 program awarded six seed grants, funding four research studies and two quality improvement projects focused on sleep hygiene, stress reduction, mindfulness, physical activity, nutrition, and more. Target populations include first-year medical students, caregivers of acute pediatric patients, and healthcare worker groups such as emergency department staff, cardiac electrophysiology teams, overnight nurses, and rehabilitation clinicians. Four principal investigators were nurses, with one physician and one social worker. Awardees translated their ideas into scalable initiatives.

Conclusions : This Innovation Award program demonstrated the power of integrative health as a cornerstone of sustainable workforce wellness. By equipping internal changemakers with funding, mentorship, and visibility, it supported tailored, scalable projects that embed integrative practices into workplace culture. Beyond outcomes, the model strengthens workforce capacity by empowering staff to lead, collaborate, and apply integrative principles for resilience. Adaptable to varying funding levels, future cycles aim to expand participation, advancing a replicable model for holistic wellness.

P 15.11

Addressing Gaps in Holistic Healthcare: The Role of Provider Wellness

Abigail K. Todd MA

Colorado Christian University, Lakewood, Colorado, United States. The Sanctuary Therapy Center, PLLC, Crawford, CO, United States

Purpose : As healers, helpers, and providers, it's easy to prioritize others over yourself. However, engaging in your own holistic healing practices is essential in your journey of effectively supporting others. This session will be an opportunity to explore research on how providers like you are experiencing the benefits of holistic healthcare. Examine what research has found related to holistic healthcare, provider burnout, job satisfaction, and mental wellness. Discover practical strategies for resilience and identify areas to improve your own wellness plan.

Method(s): The method for this presentation will consist of two components. The first component involves a comprehensive literature review addressing holism's effects on providers, with particular attention to burnout, job satisfaction, and overall wellness. In the second component, the presenter will facilitate participant engagement through reflective and interactive exercises designed to identify current gaps in holistic practices among providers, followed by collaborative discussions on effective strategies to address these gaps, including considerations of how, when, and why such improvements might be implemented.

Results : This research is presented as a literature review and posits that holistic health practices may offer benefits to providers, particularly in terms of burnout, job satisfaction, and mental wellness. As this work synthesizes existing studies rather than conducting original research, it does not include specific qualitative or quantitative results sections.

Conclusions : Clinicians and healthcare providers function as essential frontline personnel, requiring targeted initiatives in provider education, implementation, and active participation in holistic practices that protect their well-being and strengthen workplace resilience. Although self-care remains an important consideration, research indicates that adopting holistic health strategies offers a more balanced method to effectively mitigate burnout and improve both job satisfaction and mental health among healthcare professionals. This presentation encouraged meaningful self-assessment on integrating the five domains of holistic care at the individual level and offered actionable methods for incorporating each domain into daily routines, thereby supporting lifestyle modifications that emphasize comprehensive preventive health measures.

P 15.12

A Dose of Wellness: Weekly Self-Care at the University of Colorado Skaggs School of Pharmacy

Dr Monika Nuffer PharmD, NCCA

University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO, United States

Purpose : Chronic health conditions continue to represent a major burden within the United States (US) healthcare system, representing 90% of total healthcare expenditures annually. Unhealthy lifestyles and behaviors can significantly contribute to chronic disease. Pharmacy schools’ primary focus is on medications and their interactions with the body and diseases, with limited instruction in areas of wellness. Pharmacy programs should adopt a holistic curricular approach, promoting healthy lifestyles and disease prevention, including integrative medicine and wellness.

Method(s): The University of Colorado Skaggs School of Pharmacy offers a 2-credit Integrated Health and Medicine (IHM) elective. Topics within this elective include mindfulness and biofeedback, aromatherapy, and culinary herbs for “food as medicine”. Student pharmacists are tasked with identifying and trying various wellness techniques and strategies to decrease stress, journaling their activities and perceptions about them. They pretend to be a consumer with an ailment at a vitamin store to evaluate potential treatments offered. They apply breathing techniques, sample new culinary herb recipes, and prepare aromatherapy products, reflecting on each experience, with the goal of building healthy stress-reducing behaviors.

Results : Approximately 750 students completed this elective course with 20 course offerings across the past 14 years. The course fills to capacity every year, and student feedback is strongly positive, averaging 4.7 to 4.9 on a 5-point scale. Examples of wellness practices performed by students include walking outside, building Legos, puzzling, getting nails done, FaceTime with family, movies, yoga, reading, and cooking. Qualitative feedback examples include “This course was very interesting and informative” “Amazing job having assignments that got us engaged.” “Will definitely recommend this course to others!” “I love this class! The emphasize for IHM was fantastic!” “Loved the weekly wellness.”

Conclusions : This course has successfully demonstrated the role of various IHM modalities within pharmacy and the importance of healthy behaviors to build resilience and prevent burn-out.

P 15.13

A Brief Mindfulness Skills Course for University Employees is Feasible and Effective: Changes in Perceived Stress, Mindfulness, Relational Well-being, and Workplace Performance

Jeffrey Greeson Ph.D.

Rowan University, Glassboro, NJ, United States

Purpose : There is surging interest in workplace mindfulness programs to address employee stress, resilience, and performance, however, significant gaps in knowledge remain around feasibility, acceptability, effectiveness, and predictors of therapeutic change. This study evaluated whether a brief, 4-session Mindfulness Skills Course (MSC) for university employees, covered by the institution’s wellness benefits, was effective in reducing stress, increasing mindfulness, improving feelings toward oneself and others, and increasing work performance.

Method(s): Prospective observational cohort study design. Participants completed self-report surveys before and after the MSC. Class attendance and home mindfulness practice were recorded to assess feasibility and adherence. Paired t-tests and Pearson correlations were used to evaluate program effectiveness and predictors of change.

Results : 190 employees enrolled during the first year of roll-out. Of those, 164 (86%) completed pre-course surveys, 134 (82%) attended at least three class sessions, and 123 (75%) completed the post-course surveys and program evaluation. Paired samples t-tests showed improvements for perceived stress, mindfulness, and relational wellbeing with moderate to large effect sizes (d=.44 - .78; p’s< .001). Self-perceived work performance increased with a small effect (d=.33; p< .001). More frequent home meditation practice was positively correlated with a larger increase in mindfulness (r=.20; p< .05). Increased mindfulness correlated with reduced stress (r=-.55), greater positive emotions towards self (r=.38), and reduced negative emotions towards self (r=-.40) and others (r=-.42) (all p’s< .001). Reduced stress was correlated with increased perceived work performance (r=-.22; p< .05). Higher baseline stress levels predicted greater increases in mindfulness (β= .37, R2= .14, p<.001), while lower baseline mindfulness predicted greater reduction in stress (β= .27, R2= .07, p<.01).

Conclusions : Taken together, these results support the feasibility, effectiveness, and scalability of a brief, 4-week, employer-sponsored mindfulness skills course, which may be most helpful for individuals with higher stress and lower trait mindfulness.

P 15.14

From Simulation to Stillness: A Contemplative Medicine Program for Cultivating Presence in the Clinical Encounter

Momotaz Begum MD , Ronald A Miller MD, PhD, Madeline Lee, Kaushal B Nanavati MD, Leslie Kohman MD, FACS, Hesham Masoud MD, MSc

SUNY Upstate Medical University, Syracuse, NY, United States

Purpose : Incorporating mindfulness in medicine has consistently demonstrated benefits toward patients and practitioners. However, learning how to effectively implement contemplative practices in a busy clinical workflow remains a challenge. Here we demonstrate how simulation can play a fundamental role in educating resident physicians on the practice of contemplative medicine. Integrating simulation-based training and contemplative retreat structure to cultivate presence, communication skill, and mindful clinical practice among healthcare professionals. The enfolded micro-retreat introduces participants to the concepts of contemplative medicine and establishes the basis of an annual offering for healthcare practitioners working together. The program design is aimed at fostering a shared commitment to contemplative practice as a means of enriching personal, professional culture and counteracting practitioner burnout. Ultimately the goal of the program is to enhance patient care through improvement in wellness.

Method(s): The study involves an immersive clinical simulation to mirror inward contemplative practice. Study activities were completed in a high fidelity clinical simulation center at SUNY Upstate Medical University. Participants engaged in realistic patient scenarios that emphasized the importance of tempering a task focused approach with awareness and reflection. The total duration of the program for each participant is approximately 1.5 hours. A pre-program and post-program survey were administered to all participants. Information being collected includes sentiment analysis of self-reflection text, and data from pre/post surveys including the attitude toward contemplative medicine, WHO-Five Well-Being Index, and a burnout survey.

Results : Pre- and post-intervention survey data were collected during the study. Preliminary data analysis indicate participants reported increased capacity for integrating mindful presence and reflection into both their clinical practice and daily life. These findings support the program's effectiveness in cultivating mindful clinical practice through its integrated simulation and retreat model.

Conclusions : This program effectively cultivated mindful clinical practice, presence, and enhanced communication skills among healthcare professionals through its unique integration of immersive simulation and contemplative medicine elements. Thus far the findings support the hypothesis that this approach fosters a greater understanding and integration of contemplative practices into both professional and personal life.

P 15.15

Burnout and Mindfulness Among Medical Researchers: Findings from a Large-Scale, Global Cross-Sectional Survey

Dr. Jeremy Y Ng PhD 1,2,3,4 , Ms. Niveen Syed BSc 1,2 , Ms. Gabriela Melendez BSc 1,2 , Dr. Anna K Koch PhD 5 , Prof. Dr. Holger Cramer PhD 1,2

1 Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany

2 Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Baden-Württemberg, Germany

3 Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

4 School of Public Health, Faculty of Health, University of Technology Sydney, Syndey, New South Wales, Australia

5 Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humbold-Universität zu Berlin, Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Berlin, Berlin, Germany

Purpose : Burnout, characterized by emotional exhaustion, cognitive and emotional dysregulation, and psychological distancing, is a growing concern across professions and contributes to reduced well-being. Medical researchers often operate in high-pressure environments and play a critical role in advancing scientific and clinical knowledge but remain an understudied group. Consequently, this study assessed burnout risk and trait mindfulness, a protective factor, among medical researchers worldwide.

Method(s): Published authors in MEDLINE-indexed journals between December 13, 2023, and January 25, 2024, were identified using a search strategy. Eligible participants (medical researchers with a terminal degree or ≥5 years in a research role) completed an anonymous online survey that included sociodemographic questions, the Burnout Assessment Tool-12 (BAT-12), and the Freiburg Mindfulness Inventory-14 (FMI-14). Sociodemographic characteristics were summarized as frequencies, while BAT-12 scores were categorized as no risk, at risk, or very high risk, and FMI-14 scores (ranging from 14 to 56, with higher scores indicating greater trait mindfulness) were organized using descriptive statistics.

Results : A total of 1,732 participants completed the survey. Most were senior researchers (60.10%) and employed full-time (88.11%). Nearly half were faculty members (48.43%), followed by clinician-researchers (16.80%) and academic research staff (14.79%). Participants worked primarily in Europe (35.85%) and the Americas (34.70%) and were aged 36-55 (61.72%). Common research areas included clinical (31.49%), preclinical (23.73%), and health services and systems (18.25%), with Public Health (12.98%), Biochemistry/Genetics (8.22%), and Nervous System (5.92%) as popular disciplines. Overall, 38.8% of respondents were at risk or very high risk of burnout. Mental distancing was most affected (52.2%), followed by exhaustion (36.9%), emotional impairment (29.7%), and cognitive impairment (15.6%). Participants had a mean mindfulness score of 37.51 (SD = 7.64).

Conclusions : These findings show substantial burnout risk among medical researchers and highlight the prevalence of trait mindfulness, supporting future work on targeted interventions to improve researcher well-being globally.

P 15.16

Occupational Well-being of Advanced Practice Providers Comparative to Physicians in US Academic Medical Centers

Bridget S Garmisa MSN, MS

Children's Hospital of Philadelphia, Philadelphia, PA, United States

Purpose : To describe prevalence of burnout, professional fulfillment (PF) and intention to leave (ITL) among advanced practice providers at academic-affiliated health care systems and compare these well-being markers to physicians.

Method(s): Cross-sectional analysis of survey administered to physicians and APPs at academic medical centers affiliated with the Healthcare Professional Well-being Academic Consortium.

Results : Survey respondents included 19,532 physicians and 6,873 APPs (response rate 52.1% physicians, 49.5% APPs). Among APPs, 73.6% identified as women while 42% of physicians identified as women. Among APPs, 33.6% met criteria for PF, 38.1% met criteria for burnout, and 35.3% reported moderate or higher ITL. APPs have an equal likelihood of PF and are less likely to experience burnout (OR 0.8, 95% CI 0.7-0.9, p<0.001) compared to physicians when adjusting for demographics. APPs are more likely to experience ITL compared to physicians (OR 1.3, 95% CI 1.2-1.5, p<0.01) when adjusting for demographics, PF, and burnout.

Conclusions : Demographic findings reveal higher proportions of APPs identify as women and are younger comparative to physician colleagues. Age and gender influence occupational well-being parameters for both physicians and APPs. Despite demographic differences, APPs were less likely to experience burnout than physicians, while having an equal likelihood of PF. Understanding key drivers of APP PF and burnout may inform beneficial learnings for healthcare teams given the favorable occupational well-being profile. More research is needed on drivers of APP ITL to inform interventions to reduce APP turnover.

P 15.17LB

Bridging the Gap: Analyzing Clinician Engagement with an Interactive Decision-Support Tool for Integrative Oncology

Ms. Melissa Zappa Dac , Ben Smith BS, Shelley White PhD

Huntsman Cancer Institute, Salt Lake City, UT, United States

Purpose : Integrative health services in oncology face persistent challenges in educating providers regarding the clinical benefits and safety of integrative therapies. The Wellness and Integrative Health Center (WIHC) at Huntsman Cancer Institute is a multidisciplinary center offering a wide range of integrative health services, including acupuncture, osteopathic manual medicine, massage, nutrition, personalized exercise prescriptions, music therapy, expressive arts therapies, and more. This wide range of service offerings can be daunting to allopathic medical providers and can present as a barrier to referrals when physicians and nursing staff don’t fully understand the benefits of these services or when to appropriately recommend or refer to integrative offerings. To address this, the WIHC launched the ‘Thrive with Wellness’ educational campaign, a multifaceted approach featuring an innovative interactive referral tool designed for real-time clinical use.

Method(s): The interactive tool, built via a customizable Qualtrics interface, allows clinicians to select a patient’s top three symptoms and receive tailored, evidence-based recommendations. The interface captures granular data on user roles, frequent symptom clusters, and the specific services recommended most often.

Results : Analysis reveals that integrative medicine is increasingly utilized to fill specific care gaps. Pain was a primary concern in 61% of physician-reported issues, followed by fatigue (42%) and musculoskeletal complaints (34%). High-prevalence symptom clusters identified include: Pain/Fatigue/Musculoskeletal complaints. Pain/Fatigue/Neuropathy. Mental health facets (e.g., mood disturbances, depression, or anxiety) were consistently present in all of the third most common cluster combinations.

Conclusions : Quantifying these trends provides essential insights into the educational needs of oncology providers. Identifying where care teams repeatedly seek guidance allows researchers to target interventions that move the needle toward truly interdisciplinary care and improved patient outcomes.

P 15.18LB

Caring for Our Future Healers: Adverse Childhood Experiences and Well-Being Among Healthcare Professional Students

Dr Michelle E Clausen PHD, MSN, CNM, Dr Patrick G Corr Ed.D., MPH, AFAMEE

The George Washington University, Washington, DC, United States

Purpose : Adverse Childhood Experiences (ACEs) are strongly associated with long-term mental and physical health outcomes through their effects on stress physiology, emotional regulation, and mind-body functioning. Amid escalating concern regarding burnout and distress within the healthcare workforce, attention is increasingly turning to the formative years of professional training. Healthcare professional students enter high-demand learning environments, and individuals drawn to caregiving professions may carry elevated rates of early adversity. Yet ACE prevalence and its relationship to well-being remain underexplored in healthcare education. This mixed-methods study examined the prevalence of ACEs and their association with well-being among healthcare professional students to inform trauma-informed, integrative educational strategies.

Method(s): A cross-sectional mixed-methods study was conducted among healthcare professional students at a large private university on the U.S. East Coast. Participants from medicine, nursing, occupational therapy, physician assistant studies, and physical therapy completed the Adverse Childhood Experiences Questionnaire and the WHO-5 Well-Being Index. A subset participated in semi-structured interviews exploring experiences of early adversity, coping, and perceptions of support within training environments. Quantitative analyses examined ACE prevalence, associations with well-being, and disciplinary differences. Qualitative thematic analysis was conducted and integrated.

Results : A total of 150 students completed the survey (mean age 27). The mean ACE score was 2.8, with 26.6% reporting high-risk exposure (≥4 ACEs). The mean WHO-5 score was 14.29. Higher ACE scores were significantly associated with lower well-being. Nursing students reported the highest ACE scores (M=4.0). Qualitative themes highlighted early emotion regulation strategies, meaning-making, and motivations to enter caregiving professions, alongside unmet needs for trauma-informed, mind-body, and relational supports

Conclusions : ACEs are prevalent among healthcare professional students and are meaningfully associated with reduced well-being during training. Integrated findings underscore the urgency of embedding trauma-informed, mind-body–oriented, and relationally supportive approaches within healthcare education to promote resilience, protect learner well-being, and strengthen the future healthcare workforce.

Topic Area 16: Traditional Medicine

P 16.01

Knowledge, Experience and Interest in Traditional, Complementary and Alternative Medicine among Veterans attending a Neurology Clinic

Rahul Chauhan BS 1 , Varsha Vasu BBA 2 , Dr. Archana Purushotham MD, PhD 3,2

1 University of Texas, Galveston, TX, United States

2 Baylor College of Medicine, Houston, TX, United States

3 Michael E. DeBakey VA Medical Center, Houston, Texas, United States

Purpose : There is broad interest in Traditional, Complementary and Alternative Medicine (TCAM) among US veterans, but they experience several barriers to receiving TCAM care. Usage and interest in TCAM have been found to vary both by the specific modality, and by demographic characteristics including race, gender, age and geographical location. We conducted this study to ascertain the preferences of veterans attending a Neurology clinic, to inform the development of an integrative Headache Clinic.

Method(s): A cross-sectional survey of veterans attending the Houston VA Neurology out-patient clinic was conducted in 2019. Veterans willing to participate rated their knowledge in, prior experience, and interest in trying eight TCAM modalities: acupuncture, yoga, meditation, Ayurveda, biofeedback, Tai Chi, massage, and naturopathy. Descriptive statistics were used to summarize the results. Analysis included correlation with demographic characteristics and statistical significance testing of differences between groups.

Results : A total of 885 veterans were surveyed. Barring Ayurveda, biofeedback and naturopathy, most reported good knowledge of other modalities. On average, a veteran had used 1.89 (± 1.70) of the modalities; 0.49 (± 0.86) of them had provided benefit. Massage therapy was the most commonly used (51.85%), while acupuncture was the most beneficial (43.83% of users). Interest was very high across all modalities –79% (massage therapy) to 60% (Ayurveda). Female and college educated veterans reported significantly greater knowledge and interest in TCAM.

Conclusions : Veterans in a neurology clinic demonstrated modest knowledge, minimal experience, but substantial interest in TCAM therapies across all demographic categories. This mismatch points to an unmet demand for information and access to TCAM therapies among veterans. Providing evidence-based TCAM education to primary care providers, and providing information about and expanded access to TCAM services to veterans, are essential to align health care to veterans’ preferences and reduce health care disparities.

P 16.02

Determinants of Traditional Korean Medicine Utilization among Frail Older Adults: Using the 2022 Korean Longitudinal Study of Aging

Boyoung Shin KMD, MPH , Prof Bo-Hyoung Jang KMD, PhD

Kyung Hee University, Seoul, Seoul, Korea, Republic of

Purpose : South Korea is rapidly becoming a super-aged society, and frailty is a key determinant of health care utilization among older adults. Frailty, characterized by reduced physiological reserve and vulnerability to stressors, increases medical needs and barriers to care. Traditional Korean Medicine (TKM), covered by public insurance, is widely used to manage chronic conditions, yet determinants of its use among frail older adults remain unclear. This study examined these factors using Andersen’s Behavioral Model and national data.

Method(s): Data were drawn from the 9th wave (2022) of the Korean Longitudinal Study of Aging. A total of 736 individuals aged 65 years or older who met frailty criteria were included. Frailty was measured using the Frailty Index based on exhaustion, social isolation, and weak grip strength. TKM utilization was defined as at least one visit in the past two years. Logistic regression identified factors associated with TKM use. Analyses applied survey weights and STATA 16.

Results : Among 736 frail older adults, 19% had used TKM at least once in the past two years. Women were more likely to use TKM than men (OR=3.23, p<0.001). Education showed an inverse association, with lower use among middle school (OR=0.49, p=0.051) and high school or higher groups (OR=0.47, p=0.015). Income demonstrated a clear gradient: the second (OR=2.30), third (OR=2.42), and fourth quintiles (OR=2.23) were significant, while the highest quintile was not (OR=1.66, p=0.212).

Conclusions : Female gender, lower education, and income levels were significant determinants of TKM utilization among frail older adults. Although previous studies showed mixed income effects in the general population, this study identified a clear income gradient. Given frail older adults’ high health care needs, economic disparities may limit access to traditional care. Reducing financial barriers and integrating TKM into geriatric care may promote equitable access. Further research should examine causal mechanisms and health outcomes.

P 16.03

Integrative Use of Suan Zao Ren Tang for Sleep Disturbance in a Patient with Recurrent Metastatic Breast Cancer - A Case Report

Dr. Michelle Loy MD

Weill Cornell Medicine/ New York Presbyterian, New York, NY, United States

Purpose : Traditional Chinese Medicine (TCM) herbal therapy has long supported cancer care in Asia, emphasizing balance, nourishment, and quality of life. In Western oncology, TCM is increasingly integrated to manage side effects and enhance well-being. This case describes the use of Suan Zao Ren Tang (SZRT) for sleep disturbance in a patient with recurrent metastatic breast cancer on endocrine therapy.

Method(s): A 65-year-old woman with iron deficiency anemia, hypothyroidism, SIBO, and chronic insomnia was diagnosed with ER+/PR+ breast cancer in 2014, treated with lumpectomy, chemotherapy, radiation, and multiple endocrine therapies. In 2024, she developed metastatic recurrence and received chemotherapy, axillary node dissection, radiation, and was started on letrozole, abemaciclib, and zoledronic acid. Persistent insomnia, worsened by endocrine therapy, prompted referral to integrative medicine. She expressed interest in SZRT, a calming formula containing Suan Zao Ren (Ziziphus), Fu Ling, Chuan Xiong, Zhi Mu, and Gan Cao. After confirming safety, she began a 7:1 water extract (500 mg/tablet) twice daily. A comprehensive sleep plan included yoga nidra, meditation, circadian rhythm regulation, cooling strategies for night sweats, acupuncture, CBT-I apps, and magnesium glycinate.

Results : Following implementation, the patient reported improved sleep quality, fewer awakenings, and greater restfulness. Hot flashes decreased, and SZRT was discontinued after several months without recurrence of insomnia. Six months later, she remained on letrozole and abemaciclib with stable sleep. March 2025 imaging showed no evidence of disease.

Conclusions : This case highlights SZRT as a potential adjunct for endocrine therapy-related insomnia in breast cancer patients. When combined with lifestyle and mind-body interventions, TCM herbal therapy was well tolerated and contributed to improved quality of life and treatment adherence. Integrative approaches incorporating evidence-based TCM may support symptom relief and survivorship outcomes. The patient reported doing well in June 2025, seeking further integrative strategies for medication-related fatigue.

P 16.04

Tongue Tooth Marks and Stress: Links to Norepinephrine and Kampo Patterns

Dr. Hongyang Li

Hiroshima University Hospital, Hiroshima, Hiroshima, Japan

Purpose : In Kampo medicine, stress-related changes are evaluated through the four diagnostic methods. Tongue appearance, pulse, and abdominal findings are key indicators of both physical and psychological states. Psychological stress may induce teeth clenching and tension in the tongue and jaw muscles, affecting autonomic and endocrine functions. This study investigated the physiological basis of Kampo diagnostic findings of stress, focusing on tongue tooth marks as indicators of sympathetic activation and comparing stress-related markers across Kampo patterns.

Method(s): Healthy women aged 40–59 years (BMI 18–27) with subjective physical discomfort were recruited. Assessments included tongue imaging for tooth marks, ultrasonography of masseter muscle thickness and stiffness, and Kampo diagnostic examinations. Stress-related markers—plasma catecholamines, salivary cortisol, and autonomic balance (LF/HF ratio)—and psychological stress (STAI) were evaluated. Statistical analyses were performed using SPSS software Version 28.

Results : A total of 66 participants were recruited. Among them, 72% scored above the STAI cutoff, indicating susceptibility to psychological stress. Participants with tooth marks(n=30) had significantly higher plasma norepinephrine levels compared to those without tooth marks. These findings align with our previous presentation at the Japanese Society of Fatigue Science, showing positive correlation between tooth marks and norepinephrine, and weaker associations with cortisol variation and LF/HF ratio. Analysis based on Kampo pattern classification showed that 13 participants were categorized as liver deficiency, 32 as spleen deficiency, 20 as kidney deficiency, and 1 as lung deficiency. Norepinephrine was higher in liver deficiency than kidney deficiency, though not significant.

Conclusions : Participants with tongue tooth marks showed higher norepinephrine levels, suggesting tongue diagnosis may indicate stress-related sympathetic activation. Norepinephrine was also higher in liver-deficiency patterns, supporting the Kampo view that the liver governs emotion and is sensitive to stress, reflecting underlying autonomic differences.

P 16.05

Unfreezing the Future: TCM Perspectives on Cold Influence and Long-Term Health in Frozen Embryo Offspring. A Qualitative Study

Dr Ioana D Panduru, Dr Lisa Conboy

Seattle Institute of East Asian Medicine, Seattle, WA, United States

Purpose : This qualitative study explores the long-term health effects on offspring from frozen embryo transfer (FET) from the perspective of Traditional Chinese Medicine (TCM), with a focus on cold as a pathogenic factor. While assisted reproductive technology (ART) has improved pregnancy and birth outcomes, the potential constitutional effects of cryopreservation remain underexplored. Drawing on the holistic diagnostic framework of TCM, this research investigates how experienced practitioners conceptualize the impact of cryopreservation on the development of the human body, from the embryonic stage to adult life.

Method(s): Using a phenomenological research design, semi-structured interviews were conducted with ten licensed TCM practitioners specializing in fertility, pediatrics, Shang Han Lun, and Traditional Chinese Medicine. Thematic analysis revealed six key themes: awareness and inquiry into the method of conception; perception of cryopreservation and cold; developmental and systemic impacts of FET; interpretations of Jing, Shen, Hun, and Po in FET offspring; clinical strategies and preventive recommendations; and research and integration perspectives.

Results : The practitioners interviewed identified potential risks, including Yang deficiency, digestive weakness, impaired transformation and transportation of fluids, and subtle emotional or behavioral patterns associated with constitutional imbalance. Warming therapies, dietary modifications, and life-cycle approaches were suggested to support long-term health. However, most emphasized the need for individualized treatment guided by pattern differentiation rather than assumptions based solely on conception history.

Conclusions : By offering insight into how TCM clinicians interpret potential constitutional patterns in FET offspring, this study not only deepens the understanding of TCM’s diagnostic relevance in modern contexts but also creates a platform for dialogue with emerging biomedical findings. In doing so, it contributes to the limited knowledge of FET offspring health and underscores the importance of interdisciplinary research to better understand how early cryopreservation may influence health trajectories across the lifespan.

P 16.06

A Case of Improvement in Facial Nerve Paralysis Associated with External Auditory Canal Carcinoma through Kampo Medicine and Acupuncture Therapy

ms KEIKO HROSE

Kampo Clinical Center, Hiroshima University Hospital, hiroshima, hiroshima, Japan

Purpose : Introduction Facial nerve paralysis affects 30–50 per 100,000 people annually, with 40,000–50,000 new cases in Japan. Symptoms such as facial asymmetry, incomplete eye closure, and impaired speech greatly reduce quality of life. Standard treatments include corticosteroids, antivirals, and surgery, but 20% of cases remain unresolved. Tumor-related paralysis, such as from external auditory canal carcinoma, is exceedingly rare and refractory. This report describes successful Kampo and acupuncture treatment in a patient with paralysis secondary to such carcinoma.

Method(s): Case Presentation A 59-year-old woman with chronic otorrhea developed right facial paralysis, later diagnosed as external auditory canal carcinoma. After TPF chemotherapy and radiotherapy, severe paralysis persisted. She began Kampo therapy (Ninjin-yoei-to) and weekly acupuncture targeting qi and blood circulation. Gradual improvement followed: reduced edema, better lip movement, clearer pronunciation, and regained facial recognition (Face ID) by the 20th session, demonstrating objective functional recovery.

Results : Discussion International guidelines differ regarding acupuncture’s role in facial paralysis. Evidence remains limited, though recent studies show neuroplastic and neurotrophic effects, reduced inflammation, and improved circulation. Ninjin-yoei-to may promote nerve regeneration and restore vitality diminished by cancer therapy. Objective measures—including the Yanagihara score, House–Brackmann scale, and Face ID—validated recovery, emphasizing the potential of integrative approaches combining Kampo and acupuncture for refractory tumor-related facial paralysis.

Conclusions : Conclusion This rare case of tumor-related facial paralysis improved with combined Kampo herbal medicine and acupuncture. The patient achieved meaningful recovery in facial symmetry and function despite prior oncologic therapy. This integrative approach suggests potential benefits for similar refractory cases. Accumulating rigorously documented reports and conducting collaborative studies are essential to establish evidence-based strategies and clarify therapeutic mechanisms in managing facial nerve paralysis associated with malignancy.

P 16.07

A Whole-Person Ayurvedic Approach to Osteoarthritis: Integrating Evidence and Tradition

Dr. Anupama Kizhakkeveettil BAMS (Ayu), MAOM, L.Ac., C-IAYT, FAIHM, PhD

Southern California University Of Health Sciences, Whittier, CA, United States

Purpose : The purpose of this study is to present an evidence-based Ayurvedic framework for the management of osteoarthritis (OA) through a whole-person approach. This work aims to bridge traditional Ayurvedic principles with modern clinical understanding, emphasizing personalized, preventive, and holistic strategies that address both symptom relief and the underlying causes of joint degeneration based on Ayurvedic approach.

Method(s): This presentation integrates insights from classical Ayurvedic literature describing Sandhigata Vata, contemporary clinical research, and a detailed case example. A personalized treatment protocol was developed, primarily based on Vata-pacifying principles, combining external and detoxification therapies with internal herbal formulations, dietary guidance, yoga, breathing exercises, and lifestyle adjustments. The approach was contextualized with current evidence from clinical trials evaluating Ayurvedic and integrative care models for osteoarthritis.

Results : Review of Ayurvedic literature and current evidence shows that osteoarthritis (Sandhigata Vata) can be effectively managed through Vata-pacifying and tissue-nourishing therapies. Key treatments include Abhyanga (oil massage) and Swedana (fomentation) such as Churna Pinda Sweda (herbal powder bolus), Patra Pinda Sweda (leaf bolus), and Shashtika Shali Pinda Sweda (medicated rice bolus). Internal detoxification procedures like Basti (medicated enema), along with herbal formulations, dietary adjustments, lifestyle regulation, and yoga practices, improve pain, stiffness, and mobility while supporting balance, joint health, and overall well-being.

Conclusions : Findings from classical texts and modern research suggest that Ayurveda provides a viable complementary framework for osteoarthritis management. By addressing the root causes of joint degeneration through individualized, Vata-balancing and regenerative strategies, Ayurveda supports long-term musculoskeletal health. Integrating Ayurvedic principles such as personalized care, lifestyle modification, and mind-body balance into mainstream practice may enhance patient outcomes and promote a more preventive, whole-person model of care.

P 16.08

Gut-Mind Interactions in Psychedelic Healing: A Case Study Assessing the Microbiome and Psychological Effects of Huachuma and Ayahuasca

Payton A Follestad ND/MSCR Candidate 1,2 , Patricia Filbin ND/MSCR Candidate 1,2 , Brice Thompson ND/MS 1,2 , Piper Dobner NMD/MS 3 , Atara Jaffe ND 4 , Austin Perlmutter MD 2 , Heather Zwickey PhD 1,2

1 National University of Natural Medicine, Portland, Oregon, United States

2 Helfgott Research Institute, Portland, Oregon, United States

3 Biome-Basics, Nampa, Idaho, United States

4 Stowe Natural Family Wellness, Stowe, VT, United States

Purpose : Depression and disconnection affect a growing number of adults in the United States, underscoring the need for innovative and integrative treatment approaches. While conventional lifestyle interventions such as sleep, nutrition, and exercise contribute to physical and mental well-being, they may not be sufficient to address underlying biological and psychospiritual contributors to depression. Two ancient serotonergic psychedelics, Ayahuasca, containing dimethyltryptamine (DMT), and Huachuma, containing mescaline, have been used for centuries in ceremonial and healing contexts to promote connection and emotional and spiritual restoration. This single-participant case study investigates the distinct subjective and biological effects of Ayahuasca and Huachuma.

Method(s): In this case study, psychological and microbiome outcomes were assessed following Ayahuasca and Huachuma ceremonies. Stool samples were self-collected pre- and post-ceremony using validated microbiome test kits to evaluate gut microbial composition. Standardized surveys assessed depression severity and connectedness, while semi-structured interviews captured subjective experiences and perceived psychospiritual effects. Qualitative data were analyzed thematically to identify recurring patterns, enabling an integrated view of the biological and experiential effects of each traditional psychedelic medicine.

Results : Findings indicate that both Ayahuasca and Huachuma ceremonies were associated with improvements in depressive symptoms, increased feelings of connectedness, and pre- to post-ceremony shifts in gut microbial composition, with qualitative interviews revealing distinct experiential patterns for each medicine. Together, these unique experiential and microbiome patterns offer preliminary insight into possible psychospiritual and gut-mediated mechanisms of healing and add to the emerging evidence on the multidimensional mental and physical health effects of traditional psychedelics.

Conclusions : This hypothesis generating case study illustrates a potential link between psychedelic-induced microbiome changes and improvements in mental health which may contribute to reduced inflammation, a known driver of depression, and sustained antidepressant effects via modulation of the microbiota-gut-brain axis.

P 16.09

Quantitative Analysis of Plantar Pressure in Taijiquan Standing Meditation

Dr. Scott Yam 1 , Dr. T Julian Chu 2

1 Queen's University, Kingston, ON, Canada

2 CMC Taichi Academy DC & NC, Cary, NC, United States

Purpose : Low-impact, balanced-based, meditative-aerobic trainings (LBMAT) are gaining popularity in an aging demographic. LBMAT can benefit from a more quantitative translation approach to reach a broader audience. We propose foot pressure measurement for ground reaction force (GRF) characterization during practice.

Method(s): Measured the foot pressure variations of 23 Taijiquan/ Taichi practitioners (2 advanced, 18 intermediate, 2 novice) in a dynamic, upright stance. Taijiquan/ Taichi practitioners are asked to: (1) maintain an upright posture, (2) keep their legs straight, (3) have feet flat and stationary on the pressure mat, (4) keep their socks on, (5) and maximize GRF on mat.

Results : The GRF variation in advanced practitioners is observed to be significantly higher in magnitude and frequency compared with the novice group. This could imply significant differences in the activation and synchronization of the underlying muscle groups that maximize the GRF measurement by the advanced practitioners. Similar distinctive signatures in left and right foot GRF are also observed between other advanced and beginning practitioners.

Conclusions : There is a significant qualitative difference in the GRF foot pressure between beginning and seasoned Taijiquan/ Taichi practitioners. While this is well known in the LBMAT community of seasoned practitioners, it is not widely known in the beginner circle. It is likely the first time this has been recorded by a pressure mat in this setting. Given the small sample size (23), a larger data set from a more diverse group will provide a higher confidence over the preliminary results to the general public. The preliminary results provide a potentially new approach to foot GRF monitoring during LBMAT practice. Together with other appropriate non-invasive wearable sensors, this could lead to a novel platform that enables the efficient translation of LBMAT training among an aging demography. This could lead to a more quantitative and repeatable approach to LBMAT related healthcare studies.

P 16.10

The Effects of Liu Zi Jue (Six Healing Sounds) Qigong Compared to Mindful Awareness on Depression and Quality of Life in Adults: a Pilot Feasibility Randomized Controlled Trial

Marcus Tenaglia BSiHS 1,2 , Heather Zwickey PhD 1,2

1 Helfgott Research Institute, Portland, OR, United States

2 National University of Natural Medicine, Portland, OR, United States

Purpose : Depression affects over 8% of U.S. adults annually and significantly reduces quality of life (QOL). While psychological and pharmaceutical therapies are effective for symptom reduction, improvements in QOL are often limited. This pilot feasibility randomized controlled trial examines the acceptability and preliminary efficacy of Liu Zi Jue (Six Healing Sounds) Qigong compared to mindful internal awareness and no-intervention control for improving depression symptoms and QOL in adults with moderate depression.

Method(s): Thirty adults aged 18–70 with PHQ-9 ≥ 10 were randomized to: (1) Liu Zi Jue Qigong, (2) mindful internal awareness, or (3) control. Intervention participants received two 2-hour trainings and practiced 15–20 minutes daily, five days per week for eight weeks. Depression (BDI-II, PHQ-9), QOL (SF-36), anxiety (GAD-7), mindfulness (MAAS), and Chinese pulse diagnosis were assessed at baseline, biweekly, and 2- and 6-month follow-ups.

Results : Feasibility outcomes include recruitment within six weeks, ≥70% retention, ≥60% adherence, <20% missing data, and ≥70% participant satisfaction. Preliminary efficacy analyses will estimate within- and between-group effect sizes (Cohen’s d) for depression and QOL outcomes and correlations between Chinese diagnostic pulse changes and symptom severity changes. Exploratory analyses will evaluate moderators such as baseline severity and previous mind-body experience.

Conclusions : This pilot will illuminate the feasibility of implementing Liu Zi Jue in a Western research setting and provide preliminary efficacy data to inform a future fully-powered RCT. Findings will clarify whether Liu Zi Jue offers superior benefit to mindful awareness alone for depressive symptoms and QOL, and will identify culturally adaptive refinements for integrative mental health research.

P 16.11

Determinants of Qigong, Tai Chi, and Yoga Use for Health Conditions: A Systematic Review

Dr. Ryan S Wexler ND, MS 1 , Dr. Christopher T Joyce 2 , Cora Pereira 3 , Dr. Emily Hurstak 4 , Jacob Halpern 2 , Grace Naylor 2 , Dr. Lance Laird 3 , Dr. Helen Lavretsky 5 , Dr. Chenchen Wang 6 , Dr. Rob Saper 7 , Karen S Alcorn 8 , Dr. Brian S Mittman 9 , Dr. Eric J Roseen 4

1 National University of Natural Medicine, Portland, OR, United States

2 Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, United States

3 Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States

4 Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, United States

5 University of California, Los Angeles, Los Angeles, California, United States

6 Tufts Medical Center, Boston, Massachusetts, United States

7 Cleveland Clinic, Cleveland, Ohio, United States

8 Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts, United States

9 Kaiser Permanente Southern California, Pasadena, California, United States

Purpose : Qi gong, tai chi, and yoga are increasingly recommended in clinical practice guidelines as interventions for health conditions such as low back pain and osteoarthritis. However, adoption of these interventions in healthcare settings remains limited. Furthermore, determinants of implementation success (i.e., barriers and facilitators) may vary across contexts. Thus, this systematic review aims to summarize literature on implementation determinants to examine how barriers and facilitators vary by intervention type, health condition, healthcare setting, and implementation outcome. In doing so, tailored implementation strategies can be developed and tested to optimize intervention uptake into clinical practice.

Method(s): We searched electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, PsycInfo) through May 2024 and grey literature through March 2025. We included original research that identified determinants of qi gong, tai chi, and yoga for adults with health conditions. Two reviewers independently screened titles, abstracts, full-texts, and extracted study characteristics. Currently, we are extracting and coding determinants using the Consolidated Framework for Implementation Research (CFIR) and its five domains (intervention characteristics, outer setting, inner setting, characteristics of individuals, implementation process) to synthesize factors influencing implementation.

Results : We screened 8,478 titles/abstracts, reviewed 302 full-texts and included 114 articles. Most studies examined determinants of yoga or tai chi (71% and 26%, respectively) for various health conditions including musculoskeletal pain, mental health, fall-prevention and cancer-symptoms. Across 114 included articles, data from 5,919 informants (e.g., patients, healthcare providers, intervention instructors, caregivers, trial staff) was collected. Themes related to implementation barriers and facilitators will be presented.

Conclusions : Qi gong, tai chi, and yoga have been implemented in diverse ways across healthcare systems and clinical populations, leading to considerable variability in their implementation. Future mind-body research should proactively address implementation determinants throughout study design and intervention delivery to improve effectiveness and sustainability.

P 16.12

Comparison of Mind-Body Movement Styles and Their Impact on Physical Activity, Connection, and Well-Being in the Veteran Population

Dr. Rosalie Diaz PsyD

VA Northeast Ohio Healthcare System, Cleveland, OH, United States

Purpose : Tai Chi and Qigong are complementary mind-body practices rooted in traditional Chinese medicine and philosophy. Both cultivate Qi, or vital life energy, through the integration of breath, gentle movement, and focused awareness. Initial Whole Health data revealed low engagement in physical activity among Veterans, highlighting the need for accessible, gentle movement options. In response, VA Northeast Ohio Healthcare System's Whole Health offered multiple styles—including Tai Chi Easy, Tai Chi 24, Tai Chi Chuan, and Qigong— across sites to promote movement, stress reduction, and community connection. Comparing outcomes across these modalities offers insight into their shared and unique benefits for Veterans’ well-being.

Method(s): Veterans participated in one of four distinct mind-body movement programs. Pre- and post-program self-report surveys assessed changes in physical activity, mood, sense of connection, meaning, and perceived well-being.

Results : Across all modalities, Veterans demonstrated different areas of improvement. Specifically, Tai Chi Easy noted benefits in increased physical activity, improved mood, and significant improvement in stability and ability to balance pre versus post programming, moving from 3.4 (SD 1.0) to 2.8 (SD 0.9), indicating a move from Fair to Good balance. Tai Chi Chaun noted most benefit in stability and balance, moving from 3.2 (SD 1.1) to 1.7 (SD 0.5), indicating very good self-reported balance. Tai Chi 24 showed significant improvements in mental health, with a positive change from 2.3 to 2.9, with 0 indicating excellent mental health. Qigong noted improvements in physical and mental health, with a change in mental health rating from 2.7 (SD 1.0) to 2.0 (SD 1.1), indicating good overall mental health.

Conclusions : Mind-body movement, regardless of style, supports the Whole Health mission of empowering Veterans to take charge of their health and well-being. The inclusion of multiple Tai Chi and Qigong styles provides flexibility to meet varying abilities while improving movement, mood, and connection.

P 16.13

Balancing Fidelity and Flexibility in a Pragmatic Trial: Monitoring Remote Tai Chi for Knee Osteoarthritis (TAICHIKNEE)

Weijun Zhang DrPH 1 , Eric Roseen DC, PhD 2 , Brian S. Mittman PhD 3 , Robert Saper MD, MPH 4 , Sherwood Alexis 5 , Pilar M Sanjuan PhD 6 , Emily Hurstak MD, MPH 2 , Andrew Sussman PhD, MCRP 6 , Lance Laird ThD 7 , Narissa McCarty MS 4 , Chenchen Wang MS, MSc 5

1 UCLA, Los Angeles, CA, United States

2 Boston Medical Center, Boston, MA, United States

3 Kaiser Permanente, Pasadena, CA, United States

4 Cleveland Clinic, Cleveland, Ohio, United States

5 Tufts Medical Center, Boston, MA, United States

6 University of New Mexico, Albuquerque, NM, United States

7 Boston University, Boston, MA, United States

Purpose : Ensuring intervention fidelity is critical for maintaining rigor and internal validity in complex health interventions delivered across diverse settings. Pragmatic trials must uphold fidelity to core components while allowing flexibility for real-world adaptations. Despite increasing adoption of telehealth, few studies have systematically evaluated fidelity monitoring strategies for remotely delivered mind-body interventions like Tai Chi.

Method(s): The TAICHIKNEE pragmatic trial evaluates feasibility and effectiveness of remotely delivered Tai Chi for patients with knee osteoarthritis across five U.S health systems. A comprehensive fidelity monitoring plan was implemented with three key components: (1) standardized intervention manuals for both instructors and patients; (2) structured instructor training, including manual review, didactic sessions, supervised practice, and pilot teaching; and (3) iterative refinement through ongoing supervision and retraining for instructors who did not meet 80% fidelity threshold. Fidelity data from the first two of six planned cohorts (200 classes in total 20 sessions) were collected through fidelity checklist forms (randomly sampling 10% of sessions), instructor process notes, and supervision meeting summaries. Quantitative checklist data were summarized descriptively, while qualitative data were analyzed thematically.

Results : Preliminary analyses with 20 fidelity checklists indicate high adherence to core Tai Chi structure, sequence, and pacing across instructors. This has been supported by approximately 30-hour of combined didactic training, supervision, and retraining. Common implementation challenges included technology barriers, variability in participants’ physical abilities, and instructor pacing differences. Ongoing supervision and feedback facilitated rapid correction, reinforced adherence to core elements, and supported context-sensitive adaptations. Iterative revisions to manuals and training protocols improved clarity and usability, and alignment with pragmatic trial principles.

Conclusions : Systematic fidelity monitoring for remote Tai Chi is both feasible and essential for ensuring scientific rigor and reproducibility in pragmatic trials. The combination of structured observation, instructor self-reported process documentation, and iterative supervision offers a scalable framework for balancing fidelity with flexibility.

P 16.14

Neural Effects of Core Shamanic Drumming Music on Chronic Pain

Brock Pluimer 1,2 , Alessandra Anzolin 3 , Apeksha Sridhar 1,2 , Richard E Harris 1,2

1 Susan Samueli Integrative Health Institute, Irvine, CA, United States

2 Department of Anesthesiology and Perioperative Care, Irvine, CA, United States

3 Spaulding Rehabilitation Hospital, Harvard University, Massachusetts General Hospital, Boston, MA, United States

Purpose : This study evaluated the feasibility of using EEG hyperscanning to monitor neurophysiological responses during shamanic drumming in fibromyalgia patients. Building on evidence that shamanic healing induces altered consciousness and reduces pain in temporomandibular disorder, we investigated whether shamanic journeying produces measurable pain relief in fibromyalgia and identified neural correlates. This addresses gaps in understanding neurophysiological mechanisms underlying shamanic healing for chronic pain management.

Method(s): Eight female fibromyalgia patients were randomly matched with one of three shamanic practitioners for five treatment sessions over eight weeks. During V1 and V5, simultaneous EEG recordings were collected from both patient and practitioner using Brain Products 32-channel water-based nets. Each session included classical music (CL) as an active comparator followed by shamanic drumming (SH). EEG data were sampled at 500Hz, bandpass filtered (1-45Hz), and re-referenced to the average. Pain outcomes were assessed using validated measures (Fibromyalgia Impact Questionnaire-Revised, Brief Pain Inventory, Pain Catastrophizing Scale) at baseline and one-month follow-up.

Results : Shamanic drumming significantly reduced fibromyalgia pain across multiple validated measures, p < 0.05, Fibromyalgia Impact Questionnaire Revised and Brief Pain Inventory, with effects lasting one month post-treatment. At V5, compared to V1, patients showed a 10.91% increase in alpha relative power during shamanic sessions (p=0.21), indicating relaxed, internalized focus, while classical music decreased alpha by 4.73%. Notably, alpha coherence between patient and practitioner increased globally from V1 to V5, suggesting enhanced inter-brain synchronization between the patient and practitioner.

Conclusions : This pilot study demonstrates the feasibility of using EEG hyperscanning to investigate shamanic healing practices and reveals task-specific neurophysiological signatures associated with therapeutic outcomes in FM. The pronounced divergence in alpha activity between SH and CL conditions, coupled with sustained pain reduction, provides preliminary objective neurophysiological evidence supporting shamanic drumming as a chronic pain intervention. Larger sample studies are warranted to confirm these findings with adequate statistical power.

P 16.15

Traditional Asian Mind-body Exercises for Vasomotor Symptoms and Other Menopausal Symptoms in Women Experiencing Peri- and Post-Menopause: A Scoping Review

Wen Tu Ph.D. Candidate 1 , Caroline Sariah Howell BS 1 , Lydia A Howes MSI 2 , Lisa Taylor-Swanson Ph.D 1

1 College of Nursing, University of Utah, Salt Lake City, Utah, United States

2 Eccles Health Sciences Library, University of Utah, Salt Lake City, Utah, United States

Purpose : This scoping review aims to systematically map the current literature on the effects of Asian mind-body exercises on vasomotor symptoms (VMS) and other menopausal symptoms in peri- and postmenopausal women. The goal is to address existing knowledge gaps and provide insights to inform healthcare interventions and future research.

Method(s): Guided by the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Arksey and O'Malley framework, this review adhered to PRISMA-ScR guidelines to ensure methodological transparency and reproducibility. Literature screening and data extraction were conducted using Covidence (Veritas Health Innovation), with citation management and duplicate removal performed via EndNote (Clarivate Analytics). Comprehensive searches including peer-reviewed studies and grey literature were conducted in both English and Chinese databases during two time points (November 2024 and August 2025).

Results: The review screened 2,555 papers, excluding 26 duplicates and 2,080 irrelevant studies. After full-text assessment of 449 papers, 403 were excluded for inappropriate population, outcomes, or interventions, or lack of full text, leaving 46 articles for extraction. The included studies were comprised of randomized controlled trials, quasi-experimental designs, systematic reviews, and non-research sources. Overall, evidence indicated that mind-body exercises improve VMS, mood, sleep quality, anxiety, cognitive function, and overall quality of life. Ba Duan Jin and other Qigong forms were particularly effective in reducing depressive symptoms and stress, while Tai Chi showed potential benefits for sleep and cognitive performance. Common methodological limitations included small sample sizes, heterogeneous protocols, and limited longitudinal data.

Conclusions : This first scoping review of English and Chinese literature highlights traditional Asian mind- body exercises as safe, feasible, and potentially beneficial for managing menopausal symptoms. Findings support their use in holistic care and offer women accessible, low-risk options. The review underscores the need for high-quality, standardized, and longitudinal studies to explore underlying mechanisms, optimize intervention formats, and expand applicability across diverse populations.

P 16.16

A Retrospective Study Evaluating the Benefits of Group Qigong for Patients with Cancer

Elias N Gennaoui 1,2 , Krisstina Gowin DO, ABOIM 3

1 California University of Science and Medicine, Colton, CA, United States

2 The Cherng Family Center for Integrative Oncology, Irvine, CA, United States

3 City of Hope, Orange County, CA, United States

Purpose : Qigong is an evidence-based mind-body intervention for patients with cancer and is represented in the American Society of Clinical Oncology-Society for Integrative Oncology guidelines for management of symptoms such as anxiety, depression, and fatigue. This retrospective study compares pre- to post-session changes in symptom burden among patients with cancer participating in Qigong classes at City of Hope (COH) and investigates the real-world impact of Qigong outside a clinical trial setting.

Method(s): Patients participated in a complementary Qigong class at COH from September 2023 to June 2025, which were offered in-person or virtual. Participants were asked to complete a pre- and post-session modified Edmonton Symptom Assessment Scale (ESAS) scale. Descriptive analysis was completed for patient demographic information. Paired t-tests compared pre- and post- session scores.

Results : Data were analyzed for 39 participants, of whom 64% were female and 36% male. The majority (62%) were aged 65 years or older. Most participants (64%) attended sessions in person, with a median of one session completed across both formats. The most common cancer types represented were breast (18%), multiple myeloma (8%), and prostate (8%) cancers. Significant improvements were observed in pain (mean change = 0.60; p < 0.001) and tiredness (mean change = 1.03; p = 0.008) following Qigong sessions, while changes in depression, well-being, and helpfulness were not statistically significant.

Conclusions : Qigong participation was associated with reductions in pain and tiredness among patients with cancer. These findings highlight the value of integrating Qigong into supportive oncology care to help patients manage treatment-related symptoms and improve quality of life in both in-person and virtual settings . Future studies are needed to evaluate the dose response relationship of Qigong intervention.

P 16.17

Preprints Posted on the Topic of Traditional, Complementary, and Integrative Medicine Research: A Bibliometric Analysis

Dr. Jeremy Y. Ng MSc, PhD 1,2,3,4 , Ms. Brenda X. Lin HBSc 1,2 , Ms. Sabrina Abdella 1,2 , Ms. Magdalene Abebe HBSc 1,2 , Ms. Isabella Y. Tao HBSc 1,2 , Dr. Holger Cramer PhD 1,2

1 Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany

2 Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Baden-Württemberg, Germany

3 Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

4 School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia

Purpose : Traditional, complementary, and integrative medicine (TCIM) includes diverse healthcare practices used globally. TCIM research faces persistent barriers, limited funding, and methodological challenges, that restrict the production and dissemination of strong evidence. Preprints, which make manuscripts publicly available before peer review, offer a pathway to accelerate dissemination, broaden access, and strengthen transparency, particularly in fields with constrained resources. This bibliometric analysis characterizes TCIM preprints across preprint servers.

Method(s): We identified TCIM-related preprints using the ASAPbio server directory, focusing on servers with subject filters such as “traditional medicine,” “complementary medicine,” and “integrative medicine.” All TCIM preprints available between June 4, 2024 and January 14, 2025, were included. Extracted metadata included server, posting date, article type, author affiliations, country of corresponding author, funding, keywords, versions, and publication outcomes. Server characteristics (scope, indexing, permanence, commenting) were also recorded. Descriptive statistics summarized preprint characteristics.

Results : From 2012 to 2024, 1980 TCIM-related preprints were identified across 11 eligible servers, representing 11 935 unique authors. Research Square hosted the largest share (n=1185), followed by SSRN (n=480) and OSF Preprints (n=191). The number of TCIM preprints peaked in 2021 (n=664, 33.6% of all postings), with a subsequent decline in 2022 and gradual rebound in 2023–2024. China was the most prolific contributor (n=785, 39.4%), followed by the United States (n=143, 7.2%) and India (n=98, 4.9%). Institutions such as the Shanghai University of Traditional Chinese Medicine and Beijing University of Chinese Medicine were leading sources of output. Of the preprints, 612 (30.9%) were subsequently published in peer-reviewed journals, most commonly in BMC Trials (n=441, 67.4%). The median time from preprint posting to journal publication was 4.89 months.

Conclusions : This bibliometric analysis provides the first comprehensive overview of TCIM preprints, highlighting both opportunities and challenges in the adoption of preprinting within this field.

P 16.18

Quality Assessment of Blinding in Traditional Chinese Medicine Clinical Trials: Based on two randomised controlled trials

Mr. Zeyang Shi , Dr. Yuan Sun, Prof. Jian-ping Liu, Prof. Zhao-lan Liu

Beijing University of Chinese Medicine, Beijing, Chaoyang, China

Purpose : This study aims to conduct a blinded implementation quality assessment of two randomised controlled trials using two quantitative blinded quality evaluation methods, with a view to promoting their application in clinical practice within traditional Chinese medicine.

Method(s): This study employed blinded evaluation methods for traditional Chinese medicine to collect relevant blinding indicators. Two quantitative blinded quality assessment methods—the James Blinded Index (JBI) and the Bang Blinded Index (BBI)—were used to conduct blinded quality assessments of two randomised controlled trials.

Results : First Randomised Controlled Trial: The overall JBI for all subjects was 0.26, with a 95%CI of [0.18, 0.34], suggesting a reasonably effective blinding design. Grouping results revealed: the trial group's BBI was 0.72 with a 95%CI of [0.55, 0.89], indicating suboptimal blinding efficacy as a significant proportion of trial participants correctly identified their own group. The control group's BBI was 0.24 with a 95%CI of [0.00, 0.49], suggesting acceptable blinding efficacy. Second Randomised Controlled Trial: The JBI for all subjects was 0.59, with a 95%CI of [0.45, 0.72], indicating successful blinding in this trial. Grouping results demonstrated: the trial group's BBI was 0.14, with a 95%CI of [-0.15, 0.44], indicating satisfactory blinding efficacy; The control group BBI was 0.20, with a 95%CI of [-0.11, 0.51], also demonstrating satisfactory blinding efficacy. This indicates that a significant proportion of subjects in both the trial and control groups failed to correctly identify their own group assignment.

Conclusions : Blinded evaluation not only reflects the accuracy of blinded outcomes and data but also enhances the credibility of research findings. It is recommended that future blinded clinical trials of traditional Chinese medicine employ a combined approach of JBI and BBI for blinded assessment throughout the research process.

P 16.19

Pranic Healing: A Fast-Growing Bioenergy Healing Modality for Pain Management in the Emergency Department

Dr. Glenn Mendoza MD, MPH , Marianne Chung MPH

Pranic Healing Research Institute, Lyndhurst, NJ, United States

Purpose : Pranic Healing is a no-touch, energy healing technique practiced in hospitals and clinics in over 120 countries. Roughly 42% of Emergency Department (ED) visits were related to pain in patients. Pain management has become a highly specialized field requiring a multidisciplinary approach including complementary alternative medicine. This study evaluated the effect of Pranic Healing on pain reduction in adult ED patients at St. Joseph Hospital Medical Center, New Jersey.

Method(s): A randomized control study was done in a quaternary regional ED with patients assigned to control group (received pain medication) and experimental group (received pain medication and PH). Adult patients (age >59 years) with acute and chronic pain were randomized after obtaining consent. Unstable patients were excluded. A Likert Scale was used to assess pain pre- and post-intervention. The study was stopped secondary to change in hospital policy to use pain medications in ED.

Results : The study was conducted on 47 patients (control n=18, experimental n=29) with an average age of 70.5±8.8 (control) and 70.4±9.3 (experimental) years. No difference in age, ethnicity or education status. The difference in pain scale pre/post-intervention was 0.8 in the control group and experimental group was 5.9 (p=0.017). Changes in heart rate, respiratory rate, systolic and diastolic pressures were appreciated but were not different.

Conclusions : There was a significant change in pain scores in the experimental group without changes in vitals. The study shows Pranic Healing is a safe energy healing technique. Pranic Healing appears to play a role in pain management in conjunction with pain medications. To validate these results we need larger studies and further evidence such as changes in biomarkers of pain.

P 16.20

Reframing Integrated Care: Traditional Healing as a Core Component of Well-Being

Simone Sena BS

University of New Mexico School of Medicine, Albuquerque, NM, United States

Purpose : American Indian & Alaska Native (AI/AN) populations often have limited access to health care and even greater limitations to accessing culturally-safe health care that represents a holistic approach. While Traditional Healing Practices (THP) and traditional medicine have existed in AI/AN communities across multiple millennia and are deeply entwined with cultural identity, most efforts to integrate care in AI/AN communities, unfortunately, ignore THP completely. Therefore, a reframed consideration of THP and Integrated care must be explored.

Method(s): We examined multiple examples of Euro-American medical care models and analyzed the exclusion of THP from healthcare systems. We also discussed an example of Canadian integration of traditional medicine and conducted two interviews of individuals incorporating THP in their respective healthcare settings. After providing evidence of why incorporating traditional healing would enhance integrated care, we introduced our “Centering THP in Integrated Care Framework”, providing a pathway to integrate ancestral healing practices with the Euro-American medical care model.

Results : Through review of the literature, we found evidence that integrating THP is both viable and beneficial and acts as a core component of patient well-being and cultural safety. Our “Centering THP in Integrated Care Framework” honors and preserves cultural heritage while enhancing patient care by including a diverse array of healing supports. This ensures holistic wellness that improves health outcomes and confidence for AI/AN communities when engaging with their local healthcare systems.

Conclusions : When Integrated care is implemented in Tribal communities, centering such efforts in Traditional Healing Practices (THP) will enhance their effectiveness and serve the larger spiritual and cultural aspects of health and healing that Western medicine does not presently address. The “Centering THP in Integrated Care Framework” can serve as a guide for clinics, clinicians, and communities to foster a deeper and comprehensive sense of connectedness between healthcare providers and their patients.

P 16.21

A Bibliometric Analysis of Case Reports in Traditional, Complementary, and Integrative Medicine

Dr. Mirela I. Bilc PhD 1,2 , Dr. Jeremy Y. Ng 1,2,3,4

1 Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, BW, Germany

2 Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, BW, Germany

3 Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

4 School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia

Purpose : In Traditional, Complementary, and Integrative Medicine (TCIM), case reports play a key role in capturing diverse therapeutic approaches and patient outcomes. This bibliometric analysis aims to quantify the volume and development of TCIM case reports and explore their thematic focus and scientific relevance.

Method(s): A bibliometric search was conducted on September 12, 2025, in the MEDLINE database via Ovid. The search strategy combined keywords and MeSH terms related to TCIM and covered the entire database history. Results were limited to case reports as the publication type. Keyword co-occurrence analysis was performed using VOSviewer, focusing on keywords with at least 50 occurrences.

Results : An initial search yielded 442,821 records, with 16,409 (3.7%) identified as case reports. For trend analysis, publications from the last 20 years (2005–2025; n=8,510) were examined. From 2005 to 2025, publication numbers were generally stable, with around 370–400 annual case reports early on, a peak of 467 between 2013–2015, a decline until 2020, and a resurgence reaching 569 in 2024—possibly related to the COVID-19 pandemic. Ten major thematic clusters emerged, including clinical/demographic features, acupuncture, herbal therapies, side effects, quality of life, holistic health, and diagnostics.

Conclusions : Case reports remain a stable and scientifically relevant publication type in TCIM, documenting clinical insights beyond controlled trials and reflecting core integrative medicine themes such as acupuncture, herbal therapies and adverse events.

P 16.22

Non-pharmacological interventions for cough in patients with lung cancer: A systematic review and meta-analysis

PhD Candidate Mengyao Cao Master of Nursing

University of Hong Kong, Hong Kong, Hong Kong, China

Purpose : To synthesize evidence on non-pharmacological interventions for managing cough in lung cancer patients.

Method(s): Nine databases (PubMed, Embase, AMED, CINAHL Plus, Cochrane Library, Web of Science, ProQuest, China National Knowledge Infrastructure, and Wanfang Data) were systematically searched from inception to December 2024. Randomized controlled trials evaluating the effects of non-pharmacological interventions on cough in lung cancer patients published in English or Chinese were included. Study quality was appraised using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. Meta-analyses were performed for quantitative synthesis, with sources of heterogeneity examined using meta-regression and subgroup analyses. An overall effect size was estimated with standardized mean differences (SMDs) using Hedge’s g and confidence interval (CI). A narrative synthesis was provided when a quantitative synthesis was inapplicable.

Results : Thirty-eight studies representing 2,995 lung cancer patients were identified. These studies investigated acupuncture therapy, moxibustion, pulmonary rehabilitation, self-management intervention, physical exercises, psychoeducation support, mindfulness, and multicomponent interventions. Non-pharmacological interventions showed positive effects on cough severity (standardized mean difference: -1.45; 95% confidence interval: -2.07 to -0.82) and cough-related quality of life (SMD: 0.90; 95% CI: 0.65 to 1.14). Additional benefits were observed for expectoration (SMD: -0.47; 95% CI: -0.86 to -0.09), dyspnea (SMD: -0.67; 95% CI: -0.95 to -0.39), and general quality of life (SMD: 1.31; 95% CI: 0.13 to 2.50). Pulmonary rehabilitation showed a greater effect on cough severity (SMD: -3.75; 95% CI: -5.04 to -2.45) than other non-pharmacological interventions.

Conclusions : Non-pharmacological interventions are promising in improving cough, expectoration, dyspnea, and general quality of life among lung cancer patients. Pulmonary rehabilitation showed the most promising effect. Future research should adopt objective cough measures in addition to self-reported measures.

P 16.23

Assessment and Control Strategies for Immortal Time Bias in Traditional Chinese Medicine Clinical Research: An Empirical Study

Dr Yuhan Chen 1 , Prof Yu Du 2

1 Center for Evidence-Based Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

2 University of Colorado Denver, Denver, Colorado, United States

Purpose : To explore the potential risk of immortal time bias and control methods in traditional Chinese medicine (TCM) cohort studies.

Method(s): Firstly, this study summarized the definition, classification of immortal time bias and its current prevalence in cohort studies through literature analysis. Then, a data simulation based on a clinical trial of an oral TCM liquid was conducted. The study defined “N-day cohort studies” where the intervention group included patients with TCM use > N days (N=0-14; N=0 represented the original RCT). The impact of misclassification and exclusion types of immortal time bias was assessed. Poisson regression was used for 90-day mortality, and logistic regression for the composite outcome of death or disability. Time-dependent Cox regression and landmark analysis were employed to evaluate and control for immortal time bias. Analyses were conducted using STATA 17.0 and Python 3.8.

Results : The literature review found that immortal time bias is a common yet frequently overlooked bias in TCM cohort studies. Data simulation revealed that immortal time bias can significantly affect the accuracy of cohort study results. In this simulation, when the misclassified immortal time exceeded 4 days, the hazard ratio for 90-day mortality in the intervention group shifted from greater than 1 to less than 1, resulting in a false-positive outcome. Landmark analysis, time-dependent Cox regression, etc., are relatively effective bias control methods.

Conclusions : Immortal time bias can substantially distort findings in TCM cohort studies, potentially leading to false-positive conclusions. Statistical methods like landmark analysis and time-dependent Cox regression are effective for bias mitigation. In the design and implementation of cohort studies, the impact of immortal time bias on results should be vigilantly monitored and controlled at the study design and statistical method levels.

P 16.24LB

A Scoping Review of Indigenous Frameworks and Models of Wellbeing: Implications for Decolonialism, Multi-eyed Seeing, and Equity in Integrative Healthcare

Dr. Joanne Qina'au PhD

UCSF Osher Center for Integrative Health, San Francisco, CA, United States

Purpose : Equitable and decolonial approaches to integrative healthcare require grounding in diverse ontologies of wellbeing. Indigenous wellbeing models and frameworks reflect values that support holistic individual thriving as a part of ecological thriving. In contrast, Western approaches often compartmentalize wellbeing, narrowing health practice and contributing to persistent disparities. Despite the proliferation of Indigenous-developed frameworks, no scoping review has synthesized contributions in this area. This review aimed to identify models and frameworks of wellbeing developed by Indigenous communities and scholars from Turtle Island (North America) and Moananuiākea (the Pacific) to inform more culturally safe and sustaining approaches to public and global health.

Method(s): Guided by the PRISMA-ScR framework, both peer-reviewed publications and grey literature were sourced from five databases (PubMed, Web of Science, EBSCO Academic Search Complete, CINAHL, and ProQuest). Additional articles were hand sourced. Included articles posed an original model, or framework of wellbeing, developed for Indigenous people, families, or communities, by Indigenous authors from those respective lands.

Results : A total of 1,473 database references and 89 additional references were identified for screening. After 62 full-text reviews, 33 manuscripts were included for analysis. Twenty-one publications originated from Moananuiākea (64%) and twelve originated from Turtle Island (36%). Synthesis of the data yielded seven themes: (1) holistic integration of all life domains; (2) spirituality and the ongoing presence of ancestors; (3) culture and preservation of tradition; (4) collective wellbeing and relationality; (5) land as a source of identity, health, and responsibility; (6) use of place-specific Indigenous metaphors and language; and (7) empowerment and self-determination.

Conclusions : Indigenous communities globally are calling for a shift from conceptual discussion of wellbeing toward tangible decolonial policy and application within health systems. Integrative healthcare systems are in a prime position to engage Indigenous wellbeing practices, epistemologies, and ontologies for the wellbeing of all, including the planet.

Topic Area 17: Whole Person Health

P 17.01

From Measurement to Meaning: Evaluating the Impact of the Whole Health Approach on Chronic Disease Management in Veteran Healthcare

Dr. Craig M. Anderson D.C. 1 , Ms. Gina E Foltz MS, RD, LDN 2 , Dr. John E Hackett PT, DPT, COMT, TPS 1 , Ms. Heather R Jensen MHA 1 , Dr. Jason B Cook DC 1

1 VA Tennessee Valley Healthcare System, Nashville, TN, United States

2 Office of Patient Centered Care and Cultural Transformation, Washington DC, DC, United States

Purpose : To evaluate the influence of the Whole Health approach on chronic disease management and Veteran well-being. By tracking changes in biometric indicators and clinical outcomes, the Whole Health Impact Dashboard (WHID) aims to assess if integrating values-based care with biomedical, behavioral, and complementary and integrative health (CIH) practices, results in statistically significant health improvements. Grounded in what matters most to each Veteran, the dashboard was designed to support data-driven shared-decision making and personalized treatment planning.

Method(s): The study cohort included Veterans first engaged in Whole Health within a three-month period, with 18-month lookback and follow-up periods. Biomarkers were extracted from VHA Corporate Data Warehouse including Systolic, Diastolic, LDL, HDL, Weight, HbA1C, Glucose. The mean change and paired t-test used to calculate statistical significance (p <0.05). Because each Veteran served as their own control, confounding variables were minimized. Whole Health services were indicated by use of clinic (CHAR4) or encounter (Health Factor) tracking mechanisms.

Results : Preliminary analyses suggest statistically significant reductions in biomarkers for chronic disease management following engagement with Whole Health services. Of the 7 included biomarkers, the average p-value was 0.004 indicating high-statistical significance improvement.

Conclusions : VA Secretary Doug Collins' strategic driver is to put Veterans first by centering on their well-being. Findings support that the Whole Health approach is key to advancing this goal by significantly improving chronic disease management in Veterans. The WHID demonstrates that Health and Wellness Coaching along with personalized treatment planning have the most positive impacts, leading to measurable health improvements. Outcomes are magnified when Whole Health services are combined with other CIH modalities. Personalized, proactive, whole-person care may have positive downstream effects on system efficiency and reduce avoidable hospitalizations. Future research with larger samples, longer follow-up, and mixed-method designs will further clarify its impact and guide improvements in Veteran care quality.

P 17.03

Arts and Humanities for Health and Well-Being: Understanding Factors Underlying Robust VA-Community Partnerships

Vincent Song AB 1 , Maria Venegas PhD 1,2 , Makayla Dones MS 1 , Anna Barker MS 1 , Justeen Hyde PhD 1,3 , Donna Faraone MPA 4 , Barbara Bokhour PhD 1,5 , Ekaterina Anderson PhD 1,5

1 VA Center for Health Optimization & Implementation Research (CHOIR), Bedford, MA, United States

2 Boston University School of Medicine, Boston, MA, United States

3 Harvard Medical School, Boston, MA, United States

4 VA Office of Patient Centered Care and Cultural Transformation, Lyons, NJ, United States

5 UMass Chan Medical School, Worcestor, MA, United States

Purpose : With its transformation toward a Whole Health system of care, the U.S. Veterans Health Administration (VA) is promoting Veterans’ health and well-being via arts and humanities offerings. An innovative feature of this programming is the involvement of community organizations and artists. We sought to understand the state of VA-community partnerships and factors underlying robust partnerships.

Method(s): As part of a larger partnered evaluation, we conducted 36 semi-structured interviews with representatives of 16 VA Medical Centers and 14 community partners (CPs) about their partnership experiences. We applied rapid qualitative analysis to the transcripts.

Results : VA-community partnerships in the sphere of arts and humanities programming varied in terms of formal status (from purely informal to fully formalized partnerships) and funding (from non-monetary to fee-for-service arrangements). Stronger partnerships generally shared the following characteristics. VA staff were passionate about the mission and collaborated effectively across multiple departments. In some cases, VA staff were physically present and collaborated with the CP instructors/facilitators to increase Veterans’ comfort level. CPs were eager to ensure accessibility and accommodate Veterans’ unique characteristics and needs, as well as motivated to work with Veterans due to personal interest and/or organization’s mission. Both parties expressed mutual respect, communicated clearly and consistently, and displayed flexibility and patience about logistical obstacles.

Conclusions : VA Medical Centers and community organizations and artists partnered in diverse ways to create arts and humanities offerings that promote Veterans’ health and well-being. Although there does not appear to be one right way to form a robust partnership, several patterns emerged, with the strongest partnerships supported by flexible interpersonal relationships and shared investment in Veteran success. These findings contain important lessons for VA and other health systems pursuing community partnerships to promote patients’ health and well-being.

P 17.04

Empowering Veteran Health and Well-Being: The Role of Arts and Humanities in VHA's Whole Health Approach

Corrin N Heesch 1 , Donna Faraone MPA 2 , Marc Zaremski MS 3

1 Veterans Health Administration, Kansas City, MO, United States

2 Veterans Health Administration, Lyons, NJ, United States

3 Veterans Health Administration, Indianapolis, IN, United States

Purpose : The abstract describes the Veterans Health Administration's (VHA) initiative to integrate arts and humanities into its Whole Health approach, aiming to enhance veterans' health and well-being. By increasing access to creative arts therapies and self-directed arts activities, the initiative supports individual health goals, builds community connections, and expands program reach, particularly in underserved areas. The session details partnership evolution, non-monetary collaboration advocacy, and tools for replicating the program in other medical centers.

Method(s): The abstract's methods describe the integration of arts and humanities into the VHA’s Whole Health approach through a collaborative initiative. Initially piloted in 2015, the initiative expanded to include teams from numerous medical centers. Key strategies include fostering self-directed arts activities, building partnerships with community artists and organizations, and increasing Veteran access to the arts and humanities in addition to Creative Arts Therapies. The initiative utilizes evaluation tools to measure well-being and focuses on reaching underserved and marginalized veteran populations through non-monetary partnerships.

Results : The results of the initiative show substantial growth and impact: starting as a pilot in 2015 with ten teams from five medical centers, the program expanded to 125 teams from 99 medical centers and one Department of Defense team. Veterans gained increased access to Creative Arts Therapies and self-directed arts activities, enhancing their health and well-being. The initiative also successfully connected veterans with community artists and organizations, fostering social connections and broadening engagement in arts and humanities. Results of qualitative research based on interviews with organizational staff, Veterans, and community partners will be presented.

Conclusions : The conclusions of the abstract highlight the successful integration of arts and humanities into the VHA’s Whole Health approach, demonstrating the initiative’s effectiveness in enhancing veterans' health and well-being. The program's expansion and strong collaborative partnerships indicate sustainability and scalability. By increasing access to creative arts therapies and community resources, the initiative positively impacts veterans, especially those in underserved areas. Tools and strategies shared can help replicate this model in other medical centers, promoting holistic health care.

P 17.05

A Whole-Person, Integrative Model for Teen Mental Health Recovery: A Clinical Approach to Healing the Brain, Reducing Medication Dependence, and Restoring Resilience

Dr. Christina Brown MD

True Teen Wellness, Paris, TX, United States

Purpose : Adolescent mental health disorders are rising at unprecedented rates, with conventional treatments often relying on pharmacotherapy and no root cause analysis. Many patients experience limited improvement or intolerable side effects, leaving families searching for safer, more comprehensive solutions. Within primary care, there exists an opportunity to address the biological, psychological, social, and spiritual roots of mental illness rather than simply managing symptoms with medications.

Method(s): This clinical model was developed and implemented within a family medicine and telehealth setting focused on whole-person healing. Each teen undergoes a comprehensive evaluation, including detailed nutritional and psychosocial history, targeted laboratory testing to identify deficiencies, environmental and lifestyle contributors to mood dysregulation. Treatment plans are individualized and incorporate: nutritional medicine and supplementation, exercise/sleep prescriptions, parent/teen life coaching, stress management, communication skills, spiritual guidance, deprescribing - by safely reducing or discontinuing medications.

Results : Patients treated with this model demonstrated significant improvements in mood stability, sleep quality, focus and overall functioning. Many were able to lower or discontinue psychiatric medications under my medical supervision. Anecdotal outcomes suggest higher treatment satisfaction, improved family relationships, and greater adherence to wellness practice compared with conventional medical care alone.

Conclusions : This integrative clinical approach represents a practical, effective, and compassionate model for adolescent mental health care within primary practice. By addressing root causes through nutritional, lifestyle, and spiritual interventions, clinicians can help teens restore brain health, enhance resilience, and reduce medication dependency-transforming outcomes for a vulnerable and underserved population. My goal is to build healthy teens that can flourish into adulthood.

P 17.06

Embedding a Whole Health Approach in Academic Medicine: Development of the UCLA Holistic Health Model

Mrs. Hailey P Crugnale Psychology A.A. , Dr. Rashmi Mullur MD, Dr. Elizabeth Ko MD, Dr. Helen Lavretsky MD

UCLA, Los Angeles, California, United States

Purpose : In alignment with the National Academies’ call for Whole Health, the UCLA Integrative Medicine Collaborative (IMC) developed the Holistic Health Model to unify integrative practices across UCLA Health. The IMC encompasses more than 35 programs that have independently advanced whole-person care for years, reflecting deep institutional commitment yet resulting in variation in patient education and inconsistent teaching of foundational wellness skills across clinics. The model addresses this fragmentation by creating an evidence-based framework that supports both clinicians and patients. Building upon the VA Whole Health framework, it defines shared wellness competencies, establishing a coordinated foundation for integrative, patient-led care throughout UCLA Health.

Method(s): Model development followed a three-phase, transdisciplinary process. Phase one focused on consolidation of IMC resources to identify shared domains of wellness. Phase two focused on framework design and validation through iterative review with the IMC Steering Committee to ensure accessibility and clinical alignment. In phase three, we will pilot implementation in primary and specialty clinics, with clinician and patient-facing materials in progress. This phase integrates implementation science and training opportunities for junior investigators to build institutional research capacity in Whole Health evaluation.

Results : The consolidation process involved gathering and reviewing educational materials, clinical tools, and patient resources from more than 35 IMC programs. Thematic overlaps—such as sleep and emotional regulation—were identified as foundational domains to inform the creation of a comprehensive, system-wide Whole Health model. A mixed-methods review and evaluation are planned to assess feasibility, acceptability, and early outcomes.

Conclusions : The UCLA Holistic Health Model demonstrates how a transdisciplinary academic health system can translate Whole Health principles into coordinated, patient-led education and practice. It provides a scalable roadmap for patients to strengthen foundational health skills and navigate IMC’s programs. The framework enhances patient engagement and clinician efficiency, laying the groundwork for scalable, integrative care across academic medical institutions.

P 17.07

Healing Beyond Hospitalization: Bringing Whole Health to Acute Care

Candace McNulty MSN, Ashley Rush LCSW-QS

Orlando VA, Orlando, FL, United States

Purpose : The VA’s Whole Health program is a transformative care model that shifts from disease-centered treatment to focusing on what matters most to each Veteran. Integrating physical, mental, and emotional health, it emphasizes proactive, personalized, and patient-driven care. Despite its availability, many vulnerable Veterans remain unaware of or disconnected from Whole Health resources.

Method(s): This project aims to bridge that gap for hospitalized Veterans by: 1) providing education about the Whole Health program, 2) offering holistic bedside interventions, and 3) facilitating Whole Health consults at discharge. A collaboration between the Whole Health program and Acute Care Nursing at the Orlando VA, the pilot included 309 patients, 84.1% of whom had not previously heard of Whole Health. As a result of the pilot, 64% received consults placed upon discharge.

Results : Bedside interventions included deep breathing, virtual reality for wellbeing, meditation, guided imagery, chair Tai Chi, and the Personal Health Inventory, with Battlefield Acupuncture and NADA interventions planned. Using feedback from two pilot data sets, the team improved consult workflows, developed a process map, and created a Power BI tracking tool for data management. These refinements led to a 16% increase in completed consults.

Conclusions : Whole Health empowers Veterans and has demonstrated benefits in managing chronic conditions such as diabetes, obesity, pain, and tobacco dependence. The Whole Health Pathway through Holistic Nursing serves as an entry point to connect Veterans to preventive care and Health & Wellness Coaching after discharge, supporting self-efficacy and long-term well-being. Building on the Orlando VA’s success, the project is applying for replication across other VHA sites to evaluate scalability, track Well-Being scores, and assess secondary impacts such as digital divide consult improvement and increased Whole Health utilization.

P 17.08

Understanding Whole Health Use in VA's Primary Care-Mental Health Integration Clinics among Rural Veterans with Co-Occurring Chronic Pain and PTSD: A National Retrospective Cohort Study

Dr Martha Michel PhD, MS 1 , Dr Steve Zeliadt PhD 1,2 , Dr. Charles Engle MD, MPH 1,2 , Dr. David E Reed, II PhD 1,2

1 VA Puget Sound, Seattle, WA, United States

2 University of Washington, Seattle, WA, United States

Purpose : Recent paradigm shifts in healthcare delivery include virtual and whole person care. The Veterans Health Administration (VA) has led these efforts through VA Whole Health, which addresses the mind, body, and spirit. However, it remains unclear which Veterans are using these services and how they impact symptom management in VA’s Primary Care-Mental Health Integration (PC-MHI) clinics. The objective of the study is to examine whether rurality was associated with greater Whole Health use in PC-MHI in a national sample of Veterans with co-occurring chronic pain and PTSD.

Method(s): We conducted a retrospective cohort study of n = 3,328 Veterans with co-occurring chronic pain and PTSD who received PC-MHI services and screened positive for significant symptoms of PTSD, depression, and/or anxiety. We defined our exposure period as 12-months from their initial PC-MHI visit or final PTSD, depression, or anxiety assessment. We examined demographic and health characteristics at baseline, Whole Health use, and Whole Health use modality (virtual vs. in-person vs. both) during the exposure period. Negative binomial regression was used to identify whether rurality predicted PC-MHI service use during the exposure period.

Results : Veterans residing in rural areas were significantly more likely to receive PC-MHI Whole Health services (IRR=1.11, 95% CI: 1.01–1.21). Older Veterans (e.g., age 75+: IRR=1.43, 95% CI: 1.23–1.67), women (IRR=1.17, 95% CI: 1.09–1.27), and Hispanic Veterans (IRR=1.20, 95% CI: 1.04–1.39) were also more likely to receive services. Higher comorbidity burden was modestly associated with increased service use (IRR=1.02, 95% CI: 1.00–1.03).

Conclusions : Rural Veterans are more likely to use VA Whole Health services in PC-MHI, suggesting this is an appropriate modality of Whole Health delivery. Findings support continued investment in virtual Whole Health services to ensure equitable access and symptom improvement for Veterans with complex mental and physical health needs.

P 17.09

Quality Improvement Project: Integration of Whole Health in Primary Care visit

Dr. Davinder Bhullar MD , Ms. Cailtlyn Christine Rodriguez NP

Louis Stokes Cleveland VA, Cleveland, Ohio, United States

Purpose : To understand and articulate why integrating Whole Health into primary care is important for building patient trust and improving health outcomes . When patients see their personal values and life goals reflected in their care, they are more likely to participate actively, adhere to recommendations, and feel respected by the health care team. Collaborative goal setting and shared decision-making will improve patient satisfaction.

Method(s): Educated healthcare providers on the principles and practices of Whole Health in one on one sessions and in group WH 202 training by a Whole Health educator Provided training on how to identify and integrate the veteran’s Mission Aspiration Purpose (MAP) into care plans by using VHA developed tools and protocols for assessing the MAP of each veteran. Involved veterans in defining and agreeing on shared health goals. Referrals to the Whole Health coaching program to support veterans in understanding and engaging with the Whole Health approach. Use coaches to monitor progress and provide ongoing support and motivation. Evaluated the effectiveness of Whole Health integration with patient feedback through patient satisfaction survey, self-attestation of health outcomes such as mental and physical health and the VHA developed wellbeing signs.

Results : The patients completed the satisfaction survey and VHA well being signs before integration of Whole Health in their visit and treatment plan and 3 months after showing 35% increase in trust in health care team, 38% self reported improvement in mental health, and physical health and 40% increase in scientific knowledge and actionable tools for self care 52% increase in perception of collaboration between patient and provider in creating of treatment plan.

Conclusions : Integrating Whole Health into primary care is essential for building patient trust in the healthcare team. By focusing on what is important to the veteran and creating shared goals, healthcare providers can foster a trusting relationship that leads to better adherence, engagement, and overall health outcomes

P 17.10

“See Me, Hear Me, Comfort Me”: Integrating Whole Health Principles to Honor Veteran Preferences for End-of-Life Care

Dr. Denise Kresevic RN PhD APN-BC FGSA, FAAN , Dr. Rosalie Diaz Psy.D.

VA Northeast Ohio Healthcare System, Cleveland, OH, United States

Purpose : Honoring Veterans’ individualized preferences for end-of-life interventions is central to both hospice philosophy and Whole Health. Traditional pharmacological approaches may contribute to sedation and reduced engagement. Balancing comfort and alertness requires integrating non-pharmacological modalities to enhance physical and psychological well-being.

Method(s): To address this, the “See Me, Hear Me, Comfort Me” conceptual model was developed, rooted in critical components of hospice care—communication, symptom management. This model aligns with Whole Health principles emphasizing care begins with what matters most to Veterans, not what’s the matter with them.

Results : A pilot program was implemented with 27 terminally ill Veterans admitted to an inpatient hospice unit during the COVID-19 pandemic. Veterans identified preferred pharmacological and non-pharmacological interventions for managing symptoms such as pain, anxiety, and delirium. Providers received education on both the model and the VA Whole Health approach through various resources. Complementary and integrative health (CIH) virtual offerings included aromatherapy, guided imagery, mindfulness, meditation, and stress management. Staff successfully implemented multiple non-pharmacological strategies, including lighting adjustments (63%), emotional support (63%), noise reduction (59%), repositioning (48%), and snack provision (48%), while family involvement was limited (15%) due to pandemic restrictions. Findings indicate that even in resource-constrained environments, individualized care preferences can be honored and implemented effectively. With the addition of non-pharmacological interventions, overall, pain scores decreased significantly from admission (mean=2.74, sd=3.59) to discharge (mean=.59, sd=1.62) (paired t=2.99, p=.006). Behavioral symptoms improved 89% of the time, resolved 7% of the time, and 4% stayed the same post intervention. Similarly, confusion also decrease slightly (McNemar test z=.28, p=.78), from admission (n=8, 29.6%) to discharge (n=7, 25.9%).

Conclusions : The model demonstrates use of both pharmacologic and non-pharmacologic approaches enhances end-of-life comfort, dignity, and connection. Integrating Whole Health principles within hospice care supports personalized, multi-modal interventions addressing physical, emotional, and spiritual dimensions of comfort.

P 17.11

Ayurveda and Whole Health: Bridging Traditional Wisdom and Modern Well-Being

Dr. Anupama Kizhakkeveettil BAMS (Ayu), MAOM, L.Ac., C-IAYT, FAIHM, PhD

Southern California University of Health Sciences, Whittier, CA, United States

Purpose : The purpose of this presentation is to explore Ayurveda as a traditional healing system that aligns closely with the Whole Health model. Rooted in balance and self-awareness, Ayurveda emphasizes prevention, lifestyle harmony, and individualized care. This work aims to highlight how Ayurvedic principles through physical, emotional, and spiritual integration can serve as a framework for cultivating resilience, purpose, and sustainable well-being in modern health care.

Method(s): This presentation draws from classical Ayurvedic texts, current integrative health research, and clinical observations within Whole Health practice. Guided by key Ayurvedic principles including Dinacharya (daily routine), Ritucharya (seasonal regimen), Ratricharya (night routine), Tridosha balance, Sadvritta (code of conduct), and Rasayana (rejuvenation therapies), the approach examines how diet, lifestyle, herbal support, and mind-body practices such as yoga, meditation, and breathwork contribute to holistic well-being. These elements are analyzed in alignment with Whole Health domains emphasizing personal development, connection, and self-care.

Results : Evidence from Ayurvedic and contemporary research shows that personalized lifestyle routines, yoga, meditation, consciousness-based practices, herbal formulations, balanced nutrition, and rejuvenation therapies enhance vitality, emotional balance, and stress resilience. Ayurveda emphasizes living in tune with natural cycles and circadian rhythms through mindful routines and seasonal adaptation. This alignment between personal behavior and nature’s rhythms reflects the core of Whole Health, fostering self-awareness, prevention, and empowerment in maintaining long-term physical, emotional, and spiritual well-being.

Conclusions : Ayurveda embodies the true essence of Whole Health by recognizing the inseparable connection between body, mind, spirit, and environment. It also emphasizes compassion, community engagement, and interpersonal relationships as vital to healing. At its core, Ayurveda is person-centered, looking beyond symptoms to understand the individual and what truly matters to them. By guiding people to live in balance with themselves, their communities, and nature, Ayurveda stands as a timeless and complete model of Whole Health.

P 17.12

Benefits of Using HeartMath at the Atlanta VA

Dr Chanique Cousins MBBS, BBMedSci 1,2 , Dr Meena Visvanathan MD 1 , Anthony Bell LPN 1 , Alice Fann MD, Phd 1

1 VA, Atlanta, Georgia, United States

2 Georgia State University, Atlanta, Georgia, United States

Purpose : The Veterans Health Administration (VHA) Whole Health Program promotes an integrative model empowering veterans to set personal health goals and engage in evidence-based wellness modalities. HeartMath, an intervention focusing on emotional and physiological regulation through Heart-Focused Breathing, was implemented virtually at the Atlanta VA Medical Center.

Method(s): Between February 2024 and September 2025, 35 veterans participated in HeartMath sessions. Follow-up telephone surveys assessed recall, frequency of technique practice, and perceived benefits across domains including mood, emotional regulation, pain, sleep, focus, relationships, and decision-making.

Results : Fifteen (15) veterans completed the survey; eleven (11) did not recall the session. Among those recalling, 87% reported integrating HeartMath techniques into daily life, particularly during stressful or painful situations. More than 60% observed improvements in mood, emotional control, and physical comfort. Modest correlations suggested that higher practice frequency was associated with enhanced emotional regulation, mood stability, pain management, and focus. Although limited by sample size and categorical response options, findings indicate consistent HeartMath practice may increase program effectiveness.

Conclusions : Early evaluation demonstrates high acceptability and perceived benefit among veterans who remain engaged. However, one-third inability to recall the intervention underscores retention challenges, highlighting the critical need for sustained engagement and follow-up strategies. To advance the revolution in healthcare, standardizing meaningful outcomes and reinforcing adherence to practice are essential steps to measure what truly matters. Scaling proven components of HeartMath across the VA Whole Health system supports adopting evidence-based, personalized, and integrative care models that deliver measurable impact at scale.

P 17.13

Taking a Whole Health Perspective to Understand Surgical Transition

Emma M Millon PhD , Andrea Shang PhD, Christen Boardman BS, RN, RNC-OB, C-EFM, Patrick Treacy MS, BSN, RN, Giselle Pena, Mason Ballinghoff, Kevin Moore DNP, RN, Devynn Emory RN, Benjamin Bass MS, Rachel Bluebond-Langner MD, Lee Zhao MD, Moriah E. Thomason PhD, Kathleen A. DeMarco PhD, RN

NYU Langone Health, New York, NY, United States

Purpose : This study addresses the significant health disparities and unmet healthcare needs among sexual and gender minoritized (SGM) individuals by focusing on the experiences of transfeminine individuals undergoing vaginoplasty. Gender confirmation surgery (GCS), such as vaginoplasty, is transformative, with up to 35% of SGM individuals pursuing surgery to improve mental health, life satisfaction, and quality of life. Despite its benefits, little is known about the biopsychosocial factors influencing surgical outcomes. This longitudinal mixed-methods study adopts a whole health approach to examine the socioemotional and physical well-being of people undergoing vaginoplasty and inform gender-affirming interventions for enhanced surgical care.

Method(s): Over five months, data were collected pre- and post-surgery. Four data methods were employed: (1) semi-structured interviews, (2) psychometric assessments of body congruence, gender dysphoria, and socioemotional well-being, (3) ecological momentary assessment (EMA) via daily SMS capturing mood, stress, discrimination, social support, and sleep quality, and (4) physiological monitoring using the Ōura Ring, tracking metrics such as heart rate, temperature, and activity.

Results : As of submission, 18 participants (89% employed, 60% aged 26-35, 82% White) have completed pre-surgery assessments; 9 have completed post-surgery assessments. Among those with pre- and post-surgical data (n=9), EMA adherence was 91%, with 99% of participants adhering to daytime wearable use. Findings from participant interviews indicated that emotional readiness, mental health preparedness, therapy, social connections, and clear communication with medical teams were critical in reducing pre-surgical anxiety and fostering successful recovery. Many participants described the surgery as empowering and pivotal to enhancing their sense of self. Results demonstrate the feasibility of using wearables and daily surveys in SGM populations during the critical time of surgical transition and the importance of social and mental health support.

Conclusions : This study highlights the need for personalized, evidence-based, gender-affirming perioperative care to promote equity and optimize outcomes for transfeminine individuals undergoing GCS.

P 17.14

Program Evaluation of the Deepening Practice Lab: Transforming Clinical Practice through Whole Health Integration

Dr. Amy Collings PhD 1 , Dr. Natalie J Cross PhD 1 , Dr. Heather Nevins-Jones PsyD 2

1 VHA Office of Patient Centered Care and Cultural Transformation, Washington, DC, United States

2 Robley Rex Department of Veteran Affairs Medical Center, Louisville, KY, United States

Purpose : The Deepening Practice Lab is an implementation science tool designed to empower healthcare professionals in the Veterans Health Administration (VHA) to center their clinical practice on “what matters most” to Veterans. By starting with clinician wellness and professional values alignment, the Lab helps translate Whole Health Clinical Care Education into practice. The Lab, based on Transformational Learning, Appreciative Inquiry, and Positive Psychology, provides space for clinicians to discuss and integrate Whole Health Clinical Care. This evaluation examines the feasibility, usability, acceptability, and adoption of the model.

Method(s): The Lab includes an orienting session to build community and set shared goals, followed by weekly 30-minute huddles over 10-12 weeks. Topics cover clinician self-care, Mission, Aspiration, and Purpose (MAP), co-creating Shared Goals with Veterans, and incorporating Well-Being Signs into clinical practice, among others. Participants were identified via referrals from Whole Health leadership, self-referrals, and Field Implementation Consultants. All participants had prior Whole Health Clinical Care education. Qualitative and quantitative feedback was gathered from 17 participants across four medical centers.

Results : Preliminary feedback indicates high satisfaction with the Deepening Practice Lab, with participants highly engaged and willing to recommend it to colleagues. Voluntary participants had higher satisfaction scores than those recommended by supervisors. Interest in facilitating labs was mixed, with perceived lack of time and resources noted as barriers. Anecdotal feedback was favorable, highlighting helpful aspects and minimal suggestions for improvement. Participants effectively incorporated Whole Health elements into their practice.

Conclusions : Preliminary feedback suggests the Deepening Practice Lab is feasible, usable, and acceptable, with ongoing adoption among clinicians identified as Whole Health Integration Champions. The Lab fosters clinician wellness and growth, facilitating Whole Health principles' integration into clinical practice. These promising trends indicate potential for widespread adoption and sustained impact within the VHA and other healthcare organizations.

P 17.15

A qualitative exploration of faith-based support for healing moral injury in military veterans: “You’re human, and we’re human, and you’re not alone”

Margaret D Whitley 1 , Kathryn P Derose 1,2 , Julia Vidal Verástegui 3 , Eunice Wong 1

1 RAND, Santa Monica, CA, United States

2 University of Massachusetts, Amherst, Amherst, MA, United States

3 RAND, Washington, DC, United States

Purpose : The Whole Health model includes spiritual wellbeing as integral to overall health. Approximately 40% of recent U.S. veterans experience moral injury (MI) —psychological distress from actions violating one’s personal moral codes. MI contributes to PTSD and suicide risk, yet traditional treatments often overlook its spiritual dimensions. Faith-based organizations increasingly address MI through spiritually-grounded programs, but little is known about their structure, implementation, or impact. This study qualitatively examines faith-based MI programs for veterans nationwide.

Method(s): We are conducting semi-structured qualitative interviews with representatives from faith-based programs supporting veterans with MI. We identified organizations through an environmental scan of online and grey literature sources. Guided by the Consolidated Framework for Implementation Research, interviews explore program structure, mechanisms of impact, partnerships with Veterans Affairs (VA), and evaluation. Transcripts are analyzed using RAND’s Muse QDA software, applying a blended inductive-deductive coding approach to identify key themes and illustrative examples.

Results : We have completed 12 interviews representing 10 U.S. organizations and have 6 additional interviews pending. Most programs are Christian-affiliated and emphasize small-group workshops or retreats fostering confidentiality, reflection, and forgiveness. Activities include storytelling, writing, and symbolic rituals to process MI and reconnect. Programs vary in their collaboration with VA and evaluation rigor but consistently report improved emotional, social, and spiritual wellbeing among participants, including reduced isolation and renewed faith engagement. One program leader summarized the impact saying: “we know you’re human… and you’re not alone.”

Conclusions : Faith-based programs play a distinctive role in addressing MI among veterans by integrating spiritual healing with psychosocial support. This qualitative study provides foundational insight into their structure, mechanisms, and partnerships, contributing to a limited but growing evidence base. Findings highlight opportunities for collaboration between faith-based and clinical systems to enhance veteran care. Future research should evaluate program effectiveness and explore applicability to other populations exposed to morally injurious events.

P 17.16LB

Orienting a Whole Health University: Preliminary Findings from SCU's Whole Health Employee Training

Dr. Steffany Moonaz PhD , Dr. Leah Grout PhD, MPH, Ms. Barbara Gibson MS, Dr. Melissa Nagare DC, LAc

Southern California University of Health Sciences, Whittier, CA, United States

Purpose : U.S. healthcare systems face escalating costs, worsening outcomes, and a provider burnout crisis. Education models have struggled to keep pace with the need for integrative, prevention-focused care. Southern California University of Health Sciences (SCU) addresses this gap by adapting the U.S. Department of Veterans Affairs’ (VA) evidence-based Whole Health model—shown to improve satisfaction, reduce opioid use, and enhance workforce well-being—to a university-wide setting.

Method(s): SCU offers a voluntary employee orientation to WH, either a half-day on campus or a 90-minute online session. The voluntary program evaluation includes Qualtrics surveys at baseline, post-training, and 6 months later (pending). Baseline surveys include demographics, PROMIS-10, Whole-Person Health Index (WPHI), Wellbeing Signs (WBS), and Thriving at Work (TAW). The post-training survey includes repeat outcome measures and mixed-methods satisfaction and suggestion questions. Paired T-tests and Wilcoxon signed-rank tests compare pre- and post-training outcomes, depending on the data's normality.

Results : So far, 23 of 50 enrolled participants completed the post-training surveys. Completers were mostly full-time and represented most departments. Over half identified as White, middle-aged, and women. They reported strong training satisfaction, with 90% rating it as Excellent or Good, 91% reporting that it deepened WH understanding, and 96% Very Likely or Likely to apply it. In open-ended questions, they mostly valued Connection with others, Goal setting, Understanding WH, and Considering meaning/values. Outcomes were mostly non-significant, except for a slight decrease in WBS (p=0.02) and a trend toward improved WPHI (p=0.06).

Conclusions : As a Whole Health University, SCU is committed to changing health education and healthcare. Feedback from this survey will be used to refine existing and future WH programming for SCU employees. Ongoing assessment will continue to evaluate the impact of this approach for all stakeholder groups with future plans to engage students, patients and the broader SCU community.

Topic Area 18: Yoga

P 18.01

Socio-Cultural Predictors of Engagement Preferences in a Culturally Adapted Yoga Intervention for Latina Cancer Survivors

Gabrielle R Osher BS 1,2 , Alexandra Haney 1,2 , Sofia Koziura 1,2 , Bruriah Horowitz MEd 1,2 , Christina Sauer MS, CAGS 1,2 , Judy Guitelman 3 , David Victorson PhD 1,2

1 Northwestern University Feinberg School of Medicine, Chicago, IL, United States

2 Osher Center for Integrative Health at Northwestern University, Chicago, IL, United States

3 Alas Wings Latina Association for Breast Cancer, Chicago, IL, United States

Purpose : Latina cancer survivors face significant disparities in access to culturally tailored supportive oncology care. Our group’s previous Spanish-language yoga study among 35 Latina cancer survivors with overweight and obesity demonstrated significant benefits for physical symptom reduction and improved psychosocial well-being. This secondary analysis examined associations between cultural preferences, as well as changes in biomarkers over time, in Spanish-speaking Latina cancer survivors who participated in a 12-week yoga intervention with follow-up at 24 weeks.

Method(s): Data were drawn from a single-arm, 12-week yoga intervention for Spanish-speaking Latina cancer survivors, with assessments at baseline, 12 weeks (post-intervention), and 24 weeks (follow-up). Pearson’s correlation coefficients were computed to examine associations between cultural preferences related to the yoga program and socio-demographics, anthropomorphic and physiological indicators, and PROMIS measures (physical function, fatigue, sleep disturbance, pain interference, depression, anxiety, positive affect & wellbeing, and satisfaction with social roles).

Results : Higher baseline systolic blood pressure correlated with less preference for a Latino instructor (r=.35). Higher baseline and 24-week physical function, positive affect scores, and social role satisfaction related to less preference for cancer-survivor instructors (r=−.34, −.40, −.36, −.44). Higher income and longer U.S. residency correlated with less preference for Spanish-speaking instructors (r=−.39, −.41) and peers (r=−.40). Greater baseline sleep disturbance predicted stronger preference for survivor peers (r=.40). All associations were significant (p<.05).

Conclusions : Individuals with lower acculturation, greater distress, or limited physical function tended to seek connection through shared language, ethnicity, or survivorship, while those with more socioeconomic resources or well-being emphasized the activity itself over cultural concordance. These trends align with acculturation processes, suggesting greater U.S. exposure reduces reliance on shared identity for comfort and comprehension. Flexible intervention models offering diverse identification modes—linguistic, cultural, or experiential— may best enhance engagement among diverse cancer survivor populations.

P 18.02

Yoga for Corporate Wellness: Assessing the Impact of a Daily Surya Namaskar Routine on Mental Well-Being Among a Global Workforce

Ms Shubhangi S Joshi Masters (Yoga) 1 , Dr. Neha Gothe PhD 2

1 Multinational Organization, Pune, Maharashtra, India

2 Northeastern University, Boston, MA, United States

Purpose : The objective of this study was to evaluate the impact of a daily yoga-based workplace intervention, titled “The Surya Namaskar Challenge,”on employees’ mental well-being across a global workforce, measured using the World Health Organization-Five Well-Being Index (WHO-5). The study explored whether consistent practice of Surya Namaskars (sun salutations) could enhance psychological health, positivity, and overall well-being among employees from diverse regions and cultural contexts.

Method(s): The Surya Namaskar Challenge included Asanas, Pranayama, Yoganidra practice led by certified yoga teacher. A virtual session 60 mins was offered daily for participants to engage in a group format. Each session started with centering, Sukshma Yoga (Warm Up) followed by a guided Surya Namaskar coaching and participants were asked to repeat the sequence multiple times in 30 mins at their own pace and concluded with yoganidra relaxation. The WHO-5 Well-Being Index was administered before and after the intervention.

Results : The program initially received 3923 global registrations, with an average of 400 participants consistently engaging in daily sessions across various regions.A total of 161 employees (average age: 38 years; 58% male) from a multinational corporation participated in a daily morning practice of Surya Namaskars for five consecutive weeks. Data were analyzed to assess changes in overall WHO-5 scores and the proportion of participants demonstrating improvement in mental well-being. Post-intervention analysis revealed a significant improvement in mental well-being, with mean WHO-5 scores increasing from 69% at baseline to 84% after five weeks of daily practice, t(160) = 8.81, p<.001. A majority of participants (104 reported positive change, 32 - no change, 25 - negative change) exhibited individual enhancement in their well-being scores. At the end of the program, participants reported qualitative feedback with many reporting greater physical function (flexibility, stability etc), better emotional regulation, better sleep, improved productivity & peer relationship at work.

Conclusions : The Surya Namaskar Challenge demonstrates that a brief, consistent, and accessible yoga-based intervention can effectively promote mental health and foster a culture of holistic wellness among employees across global organizations.

P 18.03

Feasibility of an Online Yoga Program for Managing Symptoms of Post-Treatment Lyme Disease Syndrome (PTLDS)

Zulkayda Mamat PhD 1,2 , Adriel Brown PhD 1,2 , Louise Mahoney 1 , Santiago Allende 1 , Jasmin Francisco 1 , Annie Lau 1 , Peter Bayley PhD 1,2

1 Palo Alto VA Medical Center, Palo Alto, CA, United States

2 Stanford University, Stanford, CA, United States

Purpose : This study evaluated the feasibility and efficacy of a 12-week synchronous online yoga program for managing post-treatment Lyme disease syndrome (PTLDS) symptoms, focusing on pain, physical functioning, and cognitive performance.

Method(s): Thirteen participants with PTLDS (aged 21-60 years; 92% female) were enrolled in a 12-week online yoga program using HIPAA-compliant telehealth software. The program included 75-minute weekly sessions led by certified yoga instructors, with 15-20 minutes of daily homework on five non-treatment days. The protocol incorporated seated, standing, supine postures, breathing exercises, and meditation, with modifications for limited mobility. Outcome measures were assessed via the Health-Related Quality of Life - Short Form (SF-36), Brief Pain Inventory (BPI), and the Cambridge Neuropsychological Test Automated Battery (CANTAB).

Results : The primary feasibility goals were met with a retention rate of 92.50%, treatment adherence of 82.70%, and a treatment satisfaction score of 3.4/5. The missing data rate was low at 3.90%. Significant improvements were observed in pain levels, as indicated by the SF-36 pain scale (t[11] = -3.19, p = 0.01, d = -0.92), and pain interference significantly decreased during daily activities, as measured by the BPI (t[11] = 2.61, p = 0.02, d = 0.75). Participants also reported fewer physical limitations during personal activities (t[11] = -2.46, p = 0.03, d = -0.71; SF-36). Cognitive improvements were shown by a significant reduction in errors on the CANTAB Spatial Working Memory task (t[8] = 3.11, p = 0.02, d = 1.04). Although other CANTAB tasks assessing memory and sustained attention showed trends toward improvement, these results did not reach statistical significance.

Conclusions : The online yoga program demonstrated feasibility and was associated with significant reductions in pain, improved physical functioning, and enhanced cognitive performance among participants with PTLDS. These findings suggest that online yoga may be a scalable, accessible, and effective intervention for managing PTLDS symptoms.

P 18.04

“Examining Cognitive, Sleep, and Psychosocial Changes from a Culturally Adapted Yoga Program in Midlife Women: A Pilot and Single-Arm Phase II Study”

Dr Fauzia Nausheen MD 1 , Dr. Ashley Faytol 2 , Dr. Alexandra L Lopez Vera 1 , Dr Jyoti Mishra, 2 , Jafer V Vazquez Alcaraz 2 , Dr Hazel Soriano 2 , Dr Ariel J. Lang 2

1 CUSM, Colton, CA, United States

2 University of SanDiego, San Diego, CA, United States

Purpose : To evaluate the feasibility, acceptability, and preliminary effects of a culturally adapted yoga and meditation program on sleep, stress, quality of life, and cognition in midlife women.

Method(s): Pilot enrolled 6 midlife women and informed the design of a Phase II, single-arm, within-subjects study (n = 48). Assessments occur at 0, 8, and 16 weeks to assess change over an 8-week waiting period followed by an 8-week intervention. Program includes weekly guided yoga sessions and daily at-home meditation (Spanish/English). Outcomes include sleep quality (PSQI), perceived stress (PSS), menopause-related quality of life (MENQOL), and cognitive function.

Results : Pilot Phase: Quantitative: Across all six participants, the mean MENQOL score decreased from 42 (range 13–61) pre-yoga to 16 (range 2–44) post-yoga, with an average reduction of about 26 points. Out of the six participants, five showed meaningful improvement in their scores, ranging from modest (–11) to very substantial (–55). One participant’s score slightly worsened (+2), indicating variability in individual response. Overall, the pattern suggests that yoga was associated with a general trend of improvement in menopause-related quality of life. PSS improved for most participants (e.g., 26→17; 24→18; 6→1). PSQI improved in 4 of 6 participants (e.g., 10→4; 9→7). Among the cognitive domains, there was significant change in distractor processing (p = .01) and promising movement in working memory (p = .04) and emotion bias (p = .08). Qualitative Participants described yoga and meditation as enjoyable, relaxing, socially supportive, and beneficial for improving sleep, reducing stress, enhancing relaxation, and increasing self-awareness. Phase II (n = 48) is ongoing. Qualitative interviews will further explore openness to future adjunctive tools such as vestibular stimulation.

Conclusions : Pilot results indicate improvements in quality of life, stress, sleep, and cognition; Phase II will further clarify individual changes and assess the feasibility of wider community implementation.

P 18.05

Feasibility of Remotely-delivered Yoga Nidra and Self-help Education in Older Adults Taking Benzodiazepine Medications

Ryan Bradley ND, MPH 1 , Erica Sharpe PhD 2,3 , William Sieber PhD 1

1 University of California, San Diego, La Jolla, CA, United States

2 National University of Natural Medicine, Portland, OR, United States

3 SUNY Empire, Saratoga, NY, United States

Purpose : Older adults are especially vulnerable to anxiety and insomnia, and drug treatments can lead to dependency, falls and other accidents. The purpose of this research was to determine the feasibility of remotely delivered yoga nidra and self-help education for older adults with anxiety and/or insomnia.

Method(s): We conducted a randomized, education-controlled clinical trial to determine the feasibility of remotely-delivering yoga nidra (YN), a traditional, recorded meditation, for anxiety and/or insomnia in older adults taking benzodiazepine medications. Participants were randomised to either having access to YN recordings or access to sleep hygiene, anxiety and benzodiazepine education (SHABE) materials for 2 weeks. After a Week 2 assessment, they were provided access to the alternative materials, and given ad libitum access to YN + SHABE for an additional 6 weeks. Feasibility was determined based on recommended metrics from the Bowen framework (e.g., demand, acceptability, implementation, etc.) Anxiety symptoms (GAD-7) and categorical sleep changes were recorded at Baseline, and again at Weeks 2, 4 and 8.

Results : Twenty-two older adults were randomized (35% yield from screening) and 19 completed the trial (86% retention). At Week 2, the YN group had greater reductions in GAD-7 scores compared to SHABE: -3.25 (4.2) vs. -0.18 (2.3), p=0.06. Compared to Baseline, GAD-7 scores for the entire sample (YN + SHABE) were significantly reduced at Week 8: -2.7 (3.3), p=0.002, with meaningful within group changes in both inital groups: Initial YN: -4.0 (3.5), p=0.03 and Initial SHABE: -1.7 (2.9), p=0.07. Regarding sleep, at Week 2 55% of the YN group reported “improved” sleep vs. 18% of the SHABE group. By Week 8, 74% of participants reported “improved” sleep.

Conclusions : Remotely-delivered yoga nidra and education appears feasible and acceptable to deliver to older adults taking benzodiazepine medications. Yoga nidra combined with education may reduce anxiety and improve sleep in older adults. Future research is needed in larger sample sizes to refine estimates of effect.

P 18.06

The Impact of iRest Yoga Nidra on Meaning, Mood, and Well-Being in the Veteran Population

Dr. Rosalie Diaz Psy.D.

VA Northeast Ohio Healthcare System, Cleveland, OH, United States

Purpose : iRest Yoga Nidra is an evidence-based form of guided meditation that fosters deep relaxation, self-awareness, and emotional resilience. As part of the VA Whole Health initiative, iRest has been integrated to help Veterans reduce stress, improve sleep, and strengthen emotional regulation. This project examined how ongoing participation in iRest Yoga Nidra influences meaning and purpose, mood, and physical well-being among Veterans engaged in Whole Health.

Method(s): Veterans participated in recurring group-based iRest Yoga Nidra virtual sessions. Pre- and post-session surveys and health factor data were analyzed to evaluate changes in purpose, mood, connection, and well-being.

Results : Participants reported a self-rated improvement of mental health moving from 3.3 (SD 1.0) to 2.9 (SD 1.0) pre and post 6 week series. Participants reported improvement in overall rating of physical health, moving from 3.4 (SD 1.0) to 3.1 (SD 1), a lowering score indicates movement towards excellent physical or mental health rating. A slight improvement was seen in sense of purpose, and meaningful life, was noted pre versus post program feedback, with a change from 3.4 (SD 1.3) to 3.2 (SD 1.8). 44% of Veterans were male and 56% were female. Power of the Mind was rated the highest interest for Domain of Care, followed by Personal Development, indicating a good match between value and what matters most top them, with value aligned programming.

Conclusions : iRest Yoga Nidra provides a low-cost, non-pharmacological intervention that supports Veterans’ mental, emotional, and spiritual health. The practice fosters calm awareness, connection, and clarity of purpose, aligning with Whole Health goals of empowerment and self-directed healing. Sustained participation deepens outcomes, reinforcing iRest as an effective tool for holistic well-being and resilience.

P 18.07

A Retrospective Study Evaluating the Benefits of Group Yoga for Patients with Cancer

Elias N Gennaoui 1,2 , Krisstina Gowin DO, ABOIM 3

1 California University of Science and Medicine, Colton, CA, United States

2 The Cherng Family Center for Integrative Oncology, Irvine, CA, United States

3 City of Hope, Orange County, CA, United States

Purpose : Yoga is an evidence-based mind-body therapy recommended for managing anxiety, depression, and fatigue in patients with cancer. This retrospective study examined pre- to post-session changes in symptom burden among patients participating in yoga classes at City of Hope (COH), evaluating the impact of yoga outside a clinical trial setting.

Method(s): Patients participated in a complementary yoga class at COH from October 2023 to May 2025, which were offered in-person or virtual. Participants were asked to complete a pre- and post-session modified Edmonton Symptom Assessment Scale (ESAS) scale. For single-session participants, paired t-tests compared pre- and post-scores. Patients attending 2–8 sessions were compared with those attending more than 8 sessions to assess changes in scores.

Results : We analyzed results among 28 participants. Among those who reported gender, 75% were female and 25% were male. Most respondents were aged ≥ 65, and among those reporting a diagnosis, one-third had lymphoma. Participants attended a median of 2.5 yoga sessions, with 78% participating in person. Among single-session participants, tiredness decreased significantly (mean change = 1.17, p = 0.001), with trends towards reduced depression (0.83, p = 0.075) and pain (0.83, p = 0.054). Among participants who attended 2-8 sessions (n=8), the mean changes showed significant post-yoga decreases in depression (-1.10, p < 0.001), tension (-1.80, p < 0.001), and tiredness (1.54, p < 0.001). Compared with these participants, those who completed more than 8 sessions (n=8) demonstrated smaller mean improvements in tension (-0.68, p =0.022) and pain (-0.68, p = 0.004), suggesting that symptom relief may plateau after multiple sessions.

Conclusions : Yoga participation at COH was associated with significant reductions in tiredness, tension, and depression, and improved well-being. Benefits were greatest with multiple sessions, suggesting cumulative effects. Overall, yoga participation was associated with meaningfully improved physical and emotional symptoms among cancer patients.

P 18.08

Women’s Lived Experiences and Quality of Life After mTBI; and their Interest in Restorative Yoga Interventions

Dr. Martina Anto-Ocrah PhD

University of Pittsburgh, Pittsburgh, PA, United States

Purpose : A growing number of women experience mild traumatic brain injuries (mTBIs) or concussions and often report poorer long-term outcomes than men. Despite this, limited research has explored women’s lived experiences following mTBI. This project used a mixed methods approach to examine women’s quality of life after mTBI (Study 1) and to assess the acceptability of a restorative yoga intervention as a treatment option (Study 2).

Method(s): An online survey was distributed through Facebook mTBI/concussion support groups. The survey included demographic questions, open-ended qualitative questions, and the 36-Item Short Form Survey (SF-36). In Study 1, qualitative responses were clustered and compared using SF-36 domain scores, with higher scores (0–100) indicating better health status. Study 2 evaluated participants’ acceptability of restorative yoga based on qualitative responses.

Results : In Study 1, common symptom clusters included cognitive disruptions (64.7%), sensory disruptions (61.8%), pain (50%), and inability to work (44%). Participants reporting these symptoms demonstrated lower SF-36 Physical Functioning and Role Limitations due to Physical Health scores, with particularly low scores among those unable to work. In Study 2, most participants expressed interest in mind–body interventions such as yoga, citing prior positive experiences, overall health benefits, and support for balance, healing, and mindfulness. Those not interested primarily reported concerns related to physical limitations.

Conclusions : mTBIs significantly affect women’s quality of life, particularly in cognitive, sensory, pain, and occupational domains. Many view restorative yoga as an acceptable and potentially beneficial treatment modality.

P 18.09

Mindfulness-based Yoga vs Physical Exercise Impact on Psychological Well-Being in Young Adults with Visual Impairment: A Randomized Controlled Pilot Trial

Dr. Danqing Li PhD 1 , Prof. Soubhagyalaxmi Mohanty PhD 1 , Prof. Ramesh Mavathur PhD 1 , Mr. Anup Jain BSc 1 , Dr. Arun Gopi PhD 2 , Dr. Vikas Upadhyay PhD 3

1 Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University, Bengaluru, Karnataka, India

2 JSS Medical College, Mysore, Karnataka, India

3 All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, Uttarakhand, India

Purpose : Individuals with visual impairment (VI) face higher psychological distress. This study investigates the impact of mindfulness-based yoga (MY) and physical exercise (PE) on the psychological well-being of young adults (18-25 years) with VI, comparing the effects of these interventions.

Method(s): Thirty-two subjects with VI were randomly assigned to MY or PE groups using a computer-based randomizer after matching age, gender, and severity of vision loss. Both groups underwent 8-week interventions (5 days/week, 1 hour/day) with audio and tactile stimuli. Assessments were conducted before (T1) and after (T2) the interventions, measuring primary outcomes using the Hospital Anxiety and Depression Scale (HADS), Oxford Happiness Questionnaire (OHQ), and levels of hormones (dopamine, serotonin, beta-endorphin, and melatonin). Secondary outcomes included mobility, lower limb strength, social and spiritual well-being, and vision-related quality of life.

Results : Both the MY and PE groups exhibited some statistically significant improvement. Notably, PE showed superior outcomes in reducing anxiety (T1: 5.69±3.47; T2: 2.69±1.97; p=0.013) and improving social wellbeing (p=0.01), while MY excelled in enhancing lower limb strength (T1: 16.89±3.75; T2: 22.11±5.64; p=0.012). Biomarker analysis revealed intriguing trends. Though not statistically significant, PE induced an increase in all hormone levels, including dopamine (T1:9.48±0.64; T2:10.42±3.84; p=0.093), serotonin (T1:19.17±6.61; T2:22.43±5.68; p=0.129), beta-endorphin (T1:76.81±55.06; T2:88.54±89.64; p=0.349), and melatonin (T1:645.10±175.97; T2: 656.87±217.29; p=0.699). But MY only showed increases in serotonin (T1:18.05±4.92; T2:656.87±217.29; p=0.699). But MY only showed increases in serotonin (T1: 18.05±4.92; T2:20.09±2.95; p=0.285) and endorphin (T1:59.28±12.87; T2:63.03±24.37; p=0.639). Increases in these hormones indicate positive psychophysiological changes.

Conclusions : Contrary to early studies, PE outperformed MY in addressing psychological distress, suggesting age and teaching style may influence outcomes. However, further research is needed.

P 18.10

Culturally Tailored Yoga and Inflammation: Psychosocial, Physiological, and Cultural Correlates Among Spanish-Speaking Latina Cancer Survivors

Gabrielle R Osher BS 1,2 , Alexandra Haney 1,2 , Sofia Koziura 1,2 , Bruriah Horowitz MEd 1,2 , Christina Sauer MS, CAGS 1,2 , Judy Guitelman 3 , David Victorson PhD 1,2

1 Northwestern University Feinberg School of Medicine, Chicago, IL, United States

2 Osher Center for Integrative Health at Northwestern University, Chicago, IL, United States

3 ALAS Wings Latina Association for Breast Cancer, Chicago, IL, United States

Purpose : Latina cancer survivors face disparities in access to culturally tailored supportive oncology care. In our prior 12-week Spanish-language yoga study among 35 Latina cancer survivors with overweight and obesity, participants showed significant physical symptom and psychosocial improvements. This secondary analysis examined associations between inflammatory biomarkers (C-reactive protein [CRP] and interleukin-6 [IL-6]) and patient-reported outcomes (PROs), physiological measures, and cultural preferences, and longitudinal changes in biomarkers after the 12-week intervention and at 24-week follow-up.

Method(s): Data came from a single-arm, 12-week yoga intervention for Spanish-speaking Latina cancer survivors, with assessments at baseline, 12 weeks, and 24 weeks. CRP and IL-6 were assayed from dried blood spots and log-transformed (×10) to normalize distributions. Pearson’s correlation coefficients examined associations between biomarkers, PROs (PROMIS depression, anxiety, sleep disturbance), BMI, blood pressure, and cultural preferences regarding the intervention. ANCOVA models assessed changes in biomarkers over time, adjusting for baseline expectancy and yoga session attendance.

Results : Higher baseline depression correlated with higher CRP at all timepoints (r=.37, .43, .44). Anxiety predicted higher 12-week CRP (r=.38). Systolic BP correlated with CRP at all timepoints (r=.48, .30, .43) and IL-6 at baseline and 24 weeks (r=.50, .51). Sleep disturbance predicted higher 24-week CRP (r=.40). Valuing Spanish-speaking or survivor peers/instructors correlated with lower IL-6 and CRP (r=−.34–−.43). CRP rose then declined over the intervention; IL-6 decreased linearly. All associations/changes were significant (p<.05).

Conclusions : Sustained IL-6 decreases and delayed CRP reductions aligned with psychosocial burden and cultural preferences, including valuing survivor instructors and Spanish-speaking and survivor peers. Therefore, tailoring program staffing and group composition (language and survivorship concordance) may enhance outcomes and address equity gaps for Spanish-speaking survivors. Associations with systolic blood pressure highlight importance of cardiometabolic risk screening and primary care coordination. Results support integrating culturally responsive yoga into survivorship care and further investigation into intervention modalities.

P 18.11

Yoga versus health education for persistent fatigue in patients with post-COVID syndrome: A multicenter randomized controlled trial

Lisa Mörchen 1,2 , Prof. Dr. Holger Cramer 1,2

1 Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany

2 Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Baden-Württemberg, Germany

Purpose : Post-COVID syndrome, defined by persistent symptoms lasting beyond 12 weeks of a SARS-CoV-2 infection, affects both severe and mild COVID-19 cases. Fatigue is the most common symptom, impacting 58% of patients. Other symptoms include mental symptoms, cardiovascular and respiratory issues, and autonomic dysfunction. Chronic inflammation and immune dysregulation seem to be associated with post-COVID fatigue. Despite its impact on healthcare and the economy, effective treatments are limited. Yoga and health education have been shown to be effective for fatigue in other related conditions. The aim of this study therefore is to investigate the efficacy, safety, and cost-effectiveness of yoga and health education on post-COVID persistent fatigue.

Method(s): A randomized controlled trial with 100 patients with persistent fatigue due to post-COVID syndrome is being conducted at three study centers. Patients are randomized to two interventions, yoga and health education. Both interventions include 12 weeks of 90-minute supervised group sessions and 60 minutes of home practice per week. The primary outcome measure is fatigue on the Chalder Fatigue Scale 12 weeks after randomization. Secondary outcome measures include post-exertional malaise (DSQ-PEM), health-related quality of life (SF-12, EQ-5D-5L), anxiety, depression (HADS), stress (PSS10), sleep quality (PSQI), hand grip strength, laboratory parameters and adverse events. Physical activity analysis and heart rate variability are assessed exploratively. In addition, health economic analyses as well as mediator and moderator analyses including self-reported body awareness, self-efficacy, personality traits, and treatment credibility/expectations are conducted.

Results : Presentation of the primary outcome measure is planned following data analysis in February.

Conclusions : The study can provide insights on the efficacy, safety, and cost-effectiveness of yoga and health education for post-COVID fatigue to inform health policy and improve healthcare. Its strengths include an active control group to account for therapist and patient attention, comprehensive assessments of patient-reported outcomes, laboratory and performance data, and a societal perspective.

P 18.12

Progress, Barriers, and Facilitators Toward National Implementation of Yoga Across the Veterans Health Administration Healthcare System

Bella Etingen PhD 1,2 , Alison M. Whitehead MPH, C-IAYT, ERYT 200 3 , Marlysa Sullivan DPT, PT, C-IAYT, ERYT 500 3 , Stephanie L. Taylor PhD 4 , Spencer Hildie BS 5 , Collin Calvert PhD 6,7 , Timothy P. Hogan PhD 8,2 , Steven B. Zeliadt PhD 5,9 , Diana J. Burgess PhD 6,7

1 Research and Development Service, Dallas VA Medical Center, Dallas, TX, United States

2 Department of Health Economics, Systems, and Policy, Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, United States

3 Office of Patient-Centered Care and Cultural Transformation, United States Veterans Health Administration, Washington, DC, United States

4 Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, United States

5 Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, United States

6 Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States

7 University of Minnesota Medical School, Minneapolis, MN, United States

8 Center for Health Optimization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States

9 Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States

Purpose : The Veterans Health Administration (VHA) provides eight complementary and integrative health (CIH) therapies, including yoga, to Veterans. This evaluation assessed progress toward, and barriers to, implementation of yoga nationally across VHA.

Method(s): We conducted a national survey of VHA facilities. We invited individuals who were identified as being most knowledgeable about yoga offerings at each facility to complete the online survey. Data were analyzed using descriptive statistics.

Results : We invited 230 individuals to participate and received 172 responses (75% response rate) representing 113 of 132 VHA facilities from which we sampled. Most (92%) indicated yoga was being offered at their facility, and received subsequent questions about their yoga programs. Three-fourths (76%) reported that yoga was offered in-person (76%), however, 57% indicated virtual options were also available. At facilities where condition-specific yoga was offered (35%), pain was the most common condition (80%). At facilities where practice-specific yoga was offered (26%), adaptive yoga was most commonly offered (90%). Within most facilities (77%), any interested Veterans may participate and were most commonly connected through care team member referral (80%). Full-time VHA employees provided yoga at most facilities (75%), and most had ≥200-hour certifications. The most common Veteran-related barriers included concerns about difficulty (52%), lack of knowledge of potential benefits (47%), and negative perceptions (43%) of yoga. Most common care team member-related barriers included not knowing when it is appropriate to (47%) or how to (45%) refer Veterans to yoga. Most common logistical barriers included limited human resources support (37%), lack of recognition of yoga as a local or national priority (36%), and difficulty hiring yoga instructors (34%).

Conclusions : VHA has made considerable progress toward national implementation of yoga. Strategies for further bolstering implementation include marketing and education to patients/care team members, increased administrative support, and improved visibility of yoga as a priority.

P 18.13

Cost-Effectiveness of Yoga: A Systematic Review

Alina Schleinzer 1,2 , Julia Fernandes 2 , Thomas Ostermann 3 , Holger Cramer 1,2

1 Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany

2 Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Baden-Württemberg, Germany

3 Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Nordrhein-Westfalen, Germany

Purpose : Due to the limited availability of healthcare resources, cost-effectiveness is a critical factor for policymakers when deciding which interventions to incorporate into routine care. Although the clinical effectiveness of yoga has been studied, its economic impact is less well-known. While some studies provide economic data on yoga, no systematic review has comprehensively summarized the evidence on its cost-effectiveness. This review aims to address this gap by examining the current literature on the cost-effectiveness of yoga as a therapeutic intervention and providing evidence for health policy and resource allocation decisions.

Method(s): A systematic review was conducted by searching electronic databases for relevant studies. The review included randomized controlled trials that reported full health economic assessments of costs and health outcomes. Yoga was the primary intervention compared with any control group. Two authors independently performed the screening process, data extraction, and quality assessment. Quality was evaluated using the Consensus on Health Economic Criteria (CHEC) assessment tool.

Results : Six studies met the inclusion criteria. From a societal perspective, yoga was cost-effective, achieving more incremental quality-adjusted life years (QALYs) at a lower cost than standard treatment. From the perspective of healthcare systems or employers, yoga led to additional QALYs but at a higher cost. However, the incremental costs remained below the €20,000 willingness-to-pay threshold. The quality assessment found that 63% to 89% of the studies met the quality criteria.

Conclusions : This review of six studies is the first systematic review to examine the cost-effectiveness of yoga. The results indicate that yoga costs are below the willingness-to-pay threshold, suggesting that yoga is cost-effective, especially from a societal perspective when productivity losses are considered.

P 18.14

Defining Yoga Therapy in U.S. Clinical Research: Implications for Standards, Certification, and Healthcare Integration

Dr. Kelli Bethel PT, DPT 1 , Leigh Leibel PhD Candidate, MSc 2 , Dr. Marilyn Peppers-Citizen PhD 3 , Dr. L. Susan Wieland MPH, PhD 4 , Maxwell Bethel MSc, OMS-II 5

1 University of Maryland Graduate School, Baltimore, MD, United States

2 Columbia University Irving Medical Center, New York, NY, United States

3 Notre Dame of Maryland University School of Integrative Health, Baltimore, MD, United States

4 Georgetown University School of Medicine, Washington, DC, United States

5 Touro College of Osteopathic Medicine, Great Falls, MT, United States

Purpose : This study evaluated how yoga therapy is defined, differentiated from general yoga, and implemented in U.S.-based clinical research, and examined the extent to which this research aligns with professional standards established by the International Association of Yoga Therapists (IAYT). Although IAYT provides a consensus definition and scope-of-practice guidelines, the degree of adherence to these standards within U.S. clinical research remains unclear.

Method(s): We performed a scoping review of peer-reviewed clinical research describing 'yoga therapy'. Of 178 clinical studies published between 2016 to 2024, 22 studies published in the U.S. met inclusion criteria for this U.S.-focused analysis. Data extraction captured study design, targeted health conditions, intervention protocol components, interventionist professional qualifications, assessment practices, and the use of intervention modifications. Findings were compared with U.S.-specific IAYT definitions and scope-of-practice standards.

Results : Among the 22 studies, 27% explicitly defined yoga therapy and 23% differentiated it from general yoga. Baseline assessments were reported in 96% of studies, while history or current condition assessments appeared in 55%. Therapeutic goal setting was reported in 23% of studies, and intervention adaptability in 64%, with physical or procedural modifications described in 55% of those cases. Intervention protocols most commonly included yoga postures (82%), breathing practices (73%), and meditation or mindfulness (73%). Relaxation techniques were included in 36% of studies, lifestyle guidance in 9%, and hand gestures or yogic philosophy in 5%. Interventions were delivered by yoga therapists in six studies, with four reporting professional certification.

Conclusions : Yoga therapy terminology and implementation in U.S. clinical research demonstrate inconsistent alignment with IAYT definitions and standards, particularly regarding comprehensive assessment practices, inclusion of non-physical components, and credential reporting. Greater standardization will be essential to strengthen professional credibility, support policy recognition, and facilitate the integration of yoga therapy into the U.S. healthcare system.

P 18.15

Remote-Delivered Yoga Interventions for Pain Management: a Scoping Review

Dr. Mirela I. Bilc PhD 1,2 , Alina Schleinzer 1,2 , Holger Cramer 1,2

1 Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, BW, Germany

2 Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, BW, Germany

Purpose : Yoga is increasingly recognized as an effective non-pharmacological approach for managing various types of pain. Remote delivery of yoga has gained interest as a way to improve accessibility and overcome barriers to in-person participation. This scoping review aimed to map the extent and type of evidence related to remote-delivered yoga interventions for pain management.

Method(s): The review was conducted in accordance with JBI methodology for scoping reviews and reported following PRISMA-ScR guidelines. A comprehensive search was performed in August 2025 across Medline, Cochrane Library, Embase, PsycINFO, CINAHL, and the grey literature database BASE. Eligibility screening and data extraction were performed independently by two assessors.

Results : A total of 48 peer-reviewed studies were included. Eighteen studies (38%) addressed pain as a primary symptom, while 30 studies (63%) considered pain as a secondary symptom. In 43 studies (90%), yoga was the sole intervention, while 5 studies (10%) combined yoga with educational content. Yoga was remote-delivered synchronously via video conferencing in 23 studies (48%), asynchronously through platforms such as audio, video, VR, or web-based content in 15 studies (31%), and using both delivery methods in 6 studies (13%). Four studies (8%) did not report delivery details. The study designs were diverse, including 25 randomized controlled trials (52%), 9 before-and-after studies (19%), 5 non-randomized studies (10%), 5 mixed-methods studies (10%), 3 qualitative studies (6%), and 1 survey (2%). Seventeen of the included studies (35%) were classified as feasibility studies. In terms of timing, 11 (23%) studies were conducted pre-COVID-19-pandemic, 23 (48%) during the pandemic, and 14 (29%) were likely conducted during the pandemic based on publication date only.

Conclusions : This scoping review highlights a growing and diverse body of evidence on remote-delivered yoga interventions for pain management across various populations and settings. However, variability in delivery methods and intervention reporting suggests the need for further high-quality research to assess effectiveness and guide implementation.

P 18.16

Cost-effectiveness of a yoga intervention in addition to usual care for patients with post-covid fatigue compared to health education in addition to usual care

Alina Schleinzer 1,2 , Lisa Mörchen 1,2 , Mirela-Ioana Bilc 1,2 , Michael Jeitler 1,2,3,4 , Christian Keßler 3,5,4 , Holger Cramer 1,2

1 Institute of General Practice and Interprofessional Care, Tübingen, Baden-Württemberg, Germany

2 Rober Bosch Centrum for Integrative Medicine and Health, Stuttgart, Baden-Württemberg, Germany

3 Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Berlin, Germany

4 Department of Internal and Nature-Based Therapies, Immanuel Hospital Berlin, Berlin, Berlin, Germany

5 Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Berlin, Berlin, Germany

Purpose : Post-COVID fatigue, the most common symptom experienced by patients after a SARS-CoV-2 infection, represents a new clinical condition that affects individuals, their environments, the healthcare system, and the broader economy. Effective treatments are needed to address these negative consequences for affected individuals and systems. Thus, when evaluating therapeutic interventions, it is crucial to consider the necessary resources to achieve desired effectiveness, particularly given limited healthcare resources. This study aims to evaluate the cost-effectiveness of yoga in addition to usual care versus health education in addition to usual care.

Method(s): An economic evaluation is being conducted alongside a multicenter, randomized, controlled trial (RCT) of a 12-week yoga program for patients with persistent fatigue due to post-COVID syndrome. As Economic evaluation, cost-effectiveness and cost-utility analyses are being carried out and presented from the societal perspective. The Chalder Fatigue Scale score is used as the health outcome for the cost-effectiveness analysis. For the cost-utility analysis, quality-adjusted life years (QALYs) are derived from the EQ-5D-5L. The incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR) are calculated, and cost-effectiveness and cost-utility acceptability curves are generated. Additionally, sensitivity analyses are performed to determine the robustness of the estimated costs.

Results : One hundred patients were randomized to either the intervention group (yoga) or the control group (health education). The RCT is expected to conclude in January of 2025.

Conclusions : To our best knowledge, this is the first study to evaluate the cost-effectiveness of yoga for post-Covid fatigue. The strengths of this study include its societal perspective, its use of QALYs for comparison with other treatments, and its use of patient-reported outcomes. The study's findings will provide evidence of the potential of yoga and health education to improve patient outcomes, optimize healthcare delivery, and reduce the economic burden.

P 18.17

Yoga for asthma: A systematic review and meta-analysis

Alina Schleinzer 1,2 , Thomas Zsakany 1 , Michael Jeitler 1,2,3,4 , Mirela-Ioana Bilc 1,2 , Dennis Anheyer 1,2,5 , Holger Cramer 1,2

1 Institute of General Practice and Interprofessional Care, Tübingen, Baden-Württemberg, Germany

2 Robert Bosch Centrum for Integrative Medicine and Health, Stuttgart, Baden-Württemberg, Germany

3 Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Berlin, Germany

4 Department of Internal and Nature-Based Therapies, Immanuel Hospital Berlin, Berlin, Berlin, Germany

5 Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Nordrhein-Westfalen, Germany

Purpose : Asthma, a chronic respiratory disease, affects three hundred million people worldwide, and its prevalence has increased significantly since 1980. While pharmacological treatments are central to asthma management, many patients use yoga to improve their condition. A 2014 systematic review and meta-analysis of 15 studies concluded that yoga, including breathing exercises, is more effective than standard care in alleviating asthma symptoms and is relatively safe for patients with asthma. However, the authors concluded that there is insufficient evidence to recommend yoga as a routine intervention for asthma patients. Given the growing body of research on this topic in the last 10 years, this systematic review aims to provide an updated overview of the effects of yoga on asthma patients.

Method(s): Electronic databases were searched up to April 2024 to identify relevant articles. Randomized controlled trials (RCTs) of yoga for patients with asthma of all ages, compared to any control intervention, were included. Eligible RCTs had to assess asthma control, symptoms, quality of life, or pulmonary function. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Two authors independently conducted the screening process, data extraction, and quality assessment. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool 2.0.

Results : A total of 37 RCTs with 3,185 participants met the inclusion criteria and were included in the qualitative analysis. Twenty-three of these studies (62%) were published less than 10 years ago. More than half of the included studies, 19, were conducted in India. Meta-analysis and quality assessment are currently being performed, and the results will be presented at the congress.

Conclusions : This study provides an updated overview of the current evidence on the effectiveness of yoga for people suffering from asthma.

P 18.18

Common Yoga Protocol as an Integrative Approach for Neurological and Cognitive Well-Being

Professor Akshay Anand PhD , Dr Kanupriya Sharma PhD

Post Graduate Institute of Medical Education And Research, Chandigarh, Chandigarh, India

Purpose : Sedentariness is a cause of various lifestyle disorders, including atherosclerosis, diabetes, hypertension, and cardiovascular diseases (CVDs). Lifestyle modification by the inclusion of Yoga and similar activities has shown beneficial effects in disease prevention and psychological management. Through this exploratory controlled study, we wanted to understand the molecular mechanism through which Mind Body technique-based yoga protocol helps in amelioration of lifestyle-based disorders.

Method(s): As a non-randomized controlled study, N=70 healthy adults between the age of 18-55 years were given 3 months of Common Yoga Protocol intervention for 5 days/week and for the control group, N=70 healthy adults were recruited (no intervention was given). For comparison of short term and long term of yoga practice N=70 yoga trainers were recruited for this study. Blood samples of Yoga intervention group and control group was collected at baseline, after 1 month and after 3 months and in case of Yoga trainer’s blood sample was taken at one time point. Blood samples were assessed for serum BDNF, VEGF, Angiogenin and Amyloid β. Yoga intervention and control group were assessed for psychological tests Digit Span test (DST), Trail Making Test (TMT A & TMT B) and Digit Symbol Substitution Test (DSST), General Health Questionnaire (GHQ) and stress and anxiety through STAI questionnaire at baseline and after 3 months

Results : After 3 months, Yoga intervention group showed a significant increasing trend in BDNF, VEGF, Angiogenin and Amyloid β with time, however control group did not show any change with time. Yoga intervention group also showed an overall improvement in general health and a decline in stress and anxiety score. Yoga intervention group also showed an improved executive function by showing reduced TMT B score. No significant change in the lipid profile was observed

Conclusions : In conclusion, Common Yoga Protocol practice appears to modulate neurological pathways and promote cognitive function, thereby supporting cellular homeostasis that in long term may therefore aid in providing potential benefits in the prevention and management of lifestyle-related disorders

Author Index

A

Abadi, Melissa H: P 05.13LB

Abdella, Sabrina: P 16.17

Abebe, Magdalene: P 16.17

Abrams, Donald I: OA 01.01

Abuelo, Carolina E: OA 08.01

Acabchuck, Rebecca: P 10.14LB

Acabchuk, Rebecca L: OA 13.02

Adam, Ellie: P 14.05

Adamowicz, Jenna: OA 11.03

Adamson, Ade: OA 02.01

Adapa, Karthik: OA 09.04

Adjognon, Omonyele L: OA 22.04

Ahdoot, Azziza: P 01.23LB

Ahmadi, Sarah: OA 08.03

Ahmann, Elizabeth: P 03.07

Ahn, Lorien S: P 01.12

Akarasereenont, Pravit: P 04.03

Albertson, Andrea K: P 08.04

Alcorn, Karen S: P 16.11

Alendy, Fariza: P 15.10

Alexis, Sherwood: P 16.13

Allen, Kelli: OA 11.03

Allende, Santiago: P 18.03

Alli, Bisi: P 06.02

Amieux, Paul S: OA 04.02

Amin, Alpesh: P 01.23LB

Anand, Akshay: P 18.18

Anderson, Alan R: P 14.02

Anderson, Belinda J: OA 07.03

Anderson, Craig M: P 17.01

Anderson, Ekaterina: OA 20.01, OA 20.04, P 03.03, P 03.04, P 03.05, P 17.03

Andriola, Clare: OA 19.03

Anheyer, Dennis: P 13.14, P 18.17

Anim, Samuel: P 14.02

Anto-Ocrah, Martina: P 18.08

Anzolin, Alessandra: P 16.14

Asiamah, Nestor: OA 07.04

Atreya, Chloe: OA 15.02

Aucoin, Monique: P 04.07, P 11.03, P 13.10

Azhar, Faiza: P 11.02

B

Babalola, Dolapo: P 06.02

Babbott-Bryan, Noah: OA 12.02

Badawi, Alia: P 13.17

Bailey, Aiko: OA 16.01

Bakshi, Kavita: OA 21.03

Balgobin, Droma: P 03.08

Ballinghoff, Mason: P 17.13

Ballingoff, Mason: P 10.01

Bangerter, Ann: P 14.04

Banu, Roohi: P 01.11

Barata, Anna: OA 08.02

Barbel Johnson, Kim: P 13.09

Barbera, Antonio: P 06.07, P 06.08

Barker, Anna: P 17.03

Barreto, Esteban: OA 08.01

Bartels, Sophia: OA 20.04, P 03.05, P 03.04, P 08.02

Baser, Raymond: P 01.23LB

Bass, Benjamin: P 10.01, P 17.13

Bastian, Letty: OA 16.03

Bateman, Melanie: OA 05.04, P 15.01, P 15.02

Batson, Richard D: P 04.07

Baumann, Anthony N: OA 10.02

Bauwens, Maggie: P 13.09

Bayley, Peter: P 18.03

Beal, Anthony: P 01.18, P 01.19

Beal, Zoel: P 11.03

Beaton-Starr, Meredith: P 14.06

Becker, William C.: OA 12.03

Beeghly, Summerlyn: P 10.07

Beestrum, Molly: P 05.11LB

Begum, Momotaz: P 15.14

Beidas, Rinad S: P 05.11LB

Beiting, Kimberly: OA 13.03

Bell, Anthony: P 17.12

Bell, Debra G: P 02.01, P 13.16

Benitez, Alain: OA 10.05, P 06.01

Bensel, Victoria: P 07.03

Berg, Michelle: P 04.07

Bernstein, Carolyn A: P 14.06

Bertisch, Suzanne: OA 12.04

Betancourt, Arlene: P 04.05

Bethel, Kelli: P 18.14

Bethel, Maxwell: P 18.14

Bhardwaj, Vrinda: OA 17.03

Bhoodai, Parvita: P 05.05

Bhullar, Davinder: P 17.09

Biddle, Amanda M.: P 07.11LB

Bierbaugh, Heather: P 06.09

Bilaver, Lucy: P 05.11LB

Bilc, Mirela-Ioana: P 16.21, P 18.15, P 18.16, P 18.17

Birdee, Gurjeet: OA 13.03

Bluebond-Langner, Rachel: P 10.01, P 17.13

Blumberg, Stephen J: OA 22.01

Boardman, Christen: P 10.01, P 17.13

Bohigian, Katherine: OA 05.02

Bokhour, Barbara G: OA 12.03, OA 20.01, OA 22.04 P 03.03, P 17.03

Bolden, Caleb: OA 02.01

Bolton, Rendelle E: OA 12.03

Bonthu, Amrita: P 10.011

Booth-LaForce, Cathryn: OA 04.01

Bozeman, Sara M.: OA 20.03, P 08.03

Bozkurtian, Julia: P 07.10

Bradley, Ryan: OA 04.01, OA 04.03, OA 06.04, P 05.08, P 18.05

Bratton, Susan: OA 06.02

Brennan, Kailey: P 11.04

Bretz, Slate: OA 05.01, P 14.02

Brewer, Judson: P 10.14LB

Bronfort, Gert: OA 11.03

Brown, Adriel: P 18.03

Brown, Christina: P 17.05

Brown, Jake: P 03.06

Brown, Richard: P 07.02

Broyles, De'ja: OA 08.04

Bruton, Alisha: P 04.07, P 11.03

Buchan, Marissa: OA 06.02

Burgess, Diana J: OA 11.03, P 14.04, P 18.12

Burns, Ryan: OA 22.03

Burton, Wren M: OA 10.01, P 07.03, P 07.06, P 14.09LB

Bussières, André: P 07.10

Buttolph, Lita: P 04.07, P 13.04

Byrnes, Julia: P 10.07

C

Cai, Guanrong: P 06.06

Calabrese, Carlo: P 05.08

Caldas, Stephanie: P 15.06

Caldwell, Deborah: OA 15.02

Call, Megan: OA 05.03

Callan, Nini: P 05.08

Calvert, Collin: OA 11.03, P 18.12

Cao, Mengyao: P 16.22

Caputo, Jacqueline: OA 02.04, OA 05.01

Carlson, Linda E: OA 02.03

Carriel, Maria Fernanda: P 08.01, P 10.03

Cassidy, Claire M: P 01.15, P 05.06

Castro, Louis: P 05.04, P 15.05

Cetilin, Madeline: OA 12.01

Chamberlin, Steve: P 05.08

Chang, Joe: P 01.19

Chao, Maria T: OA 01.01, OA 15.02, OA 15.03, P 02.02

Chatzipanagiotu, Odysseas: OA 05.01

Chauhan, Rahul: P 16.01

Chen, Tiffany Y.: P 05.09

Chen, Timothy: OA 14.02, P 12.01

Chen, Xin: P 04.03

Chen, Yuhan: P 16.23

Cheng, Hannah: P 05.11LB

Cheng, Jack: P 05.03

Cheng, Xueyan: P 01.01

Cheok, Heng: OA 16.03

Cherkin, Dan: OA 11.04, OA 16.01

Childs, Kennedi: OA 10.06LB, P 14.03

Chimonas, Susan: OA 09.02

Chin, Eliza: P 06.02

Chowdhary, Anoushka: P 10.12LB

Christian, Stephanie: OA 01.02

Christie, Aimee J: OA 02.01

Chu, T Julian: P 16.09

Chua, Winona: P 01.03

Chung, Marianne: P 16.19

Clausen, Michelle E: P 15.18LB

Clayman, Marla: P 03.03

Cloutier, Joanna: OA 08.02

Cole, Jill S.: P 07.11LB

Colgan, Dana Dharmakaya: P 13.04, P 13.05, P 13.06

Collings, Amy S.: OA 20.03, P 08.03, P 17.14

Collins, Tom: OA 16.03

Colón, Ricardo: P 11.11

Conboy, Lisa A: P 01.08, P 01.09, P 01.15, P 01.18, P 01.19, P 01.20, P 03.07, P 05.06 P 11.04, P 16.05

Cook, Jason B: P 17.01

Cooley, Kieran: P 04.02, P 13.10

Corr, Patrick G: P 15.08, P 15.18LB

Cotton, Sian: OA 14.03, OA 14.04, P 05.07, P 07.01

Coulter, Ian D: OA 04.02, OA 04.04, OA 10.04, P 04.02 P 04.08, P 08.04

Cousins, Chanique: P 17.12

Cramer, Holger: OA 09.04, P 13.14, P 15.15, P 16.17, P 18.11, P 18.13, P 18.15, P 18.16, P 18.17

Crandall, Robert J: P 10.02

Crawford, Laurie: P 13.01

Cross, Lee J S: OA 11.03, P 14.04

Cross, Natalie J: P 08.03, P 17.14

Crow, Thomas: OA 13.01

Crugnale, Hailey P: P 17.06

Cunningham, Lora: P 06.09

Cupler, Zachary A: OA 03.04

Czap, Sue: OA 06.03

D

Dangoria, Saloni: OA 17.03, P 01.07, P 05.02, P 09.04

Daniels, Sydney: P 03.01

Datta, Tanya: P 13.17

Daus, Catherine: OA 13.04

Davenport, Todd E: P 13.04, P 13.05, P 13.06

Davidson, Carolyn: P 09.02

Davis, Gabrielle D: P 15.06

Dawson, Catherine: P 08.02

De Carlo, Cynthia : P 11.16LB

Deal, Conor: OA 03.01

DeLa Cruz, Ruth: OA 08.01

Delgado, Yamixa P 11.11

DeMarco, Kathleen:

DeMarco, Kathleen A: P 05.05, P 10.01, P 15.06, P 15.10, P 17.13

DeMartin, Ron: P 03.07

Deng, Gary: P 01.23LB

Deng, LingLing: P 11.07

Denneson, Lauren M: OA 12.03

Derose, Kathryn P: P 17.15

DeWitt, Amelia: P 05.05

Dhruva, Anand: OA 01.01

Diaz, Rosalie: P 16.12, P 17.10, P 18.06

Dignan, Katherine: P 05.01, P 13.11, P 15.04

Djukic, Nina: P 02.02

Dobner, Piper: P 16.08

Dones, Makayla: P 03.03, P 17.03

Dossett, Michelle L: P 01.17

Dougherty, Paul E: OA 03.01

Dryden, Eileen: OA 20.01, P 08.02

Du, Mengmeng: OA 01.04

Du, Yu: OA 17.04, P 11.12, P 11.13, P 16.23

Dubinsky, Emma: OA 10.01, P 07.06

Duchemin, Anne-Marie: OA 02.04, OA 05.01

Dupont-Versteegden, Esther E.: P 07.11LB

Duri, Rudo: P 11.15LB

Dusek, Jeffery A: OA 04.03, P 14.02

Dvorak, Theresa: P 13.16

Dvorin, Kelly: OA 20.01, OA 20.04, P 03.04, P 03.05

Dyer, Natalie L: P 10.13LB

E

Eason-Marchi, Mikki: P 01.07

Edman, Joel: P 06.07, P 06.08

El Iskandarani, Sarah: P 01.23LB

El-Jawahri, Areej: OA 08.02

Ellis, Tosha: P 08.03

Elmore, Catherine: P 01.18

Emerson, Angela: OA 02.04, OA 05.01

Emory, Devynn: P 10.01, P 17.13

Engle, Charles: P 17.08

Erande, Ashwini: P 14.02

Erato Garza, Gina: P 06.05

Esquenazi-Karonika, Shari : P 15.06, P 15.10

Esserman, Denise: OA 12.03

Estabrooks, Paul: OA 22.03

Estave, Paige M: P 10.07, P 14.05

Etingen, Bella: OA 22.04, P 18.12

Evans, Roni: OA 11.03, P 07.10, P 14.04

F

Fagerlin, Angela: OA 05.03

Fann, Alice: P 17.12

Faraone, Donna: P 17.03, P 17.04

Farewell, Charlotte V.: OA 14.01

Farnam, Emelia: OA 08.02

Faydenko, Jocelyn: P 08.04

Faytol, Ashley: P 18.04

Felder, Jennifer: P 10.12LB

Fernandes, Julia: P 18.13

Ferrell, Bree: OA 20.03

Figueroa, Edwin: P 11.11

Figueroa, Juan: P 11.11

Filbin, Patricia: P 16.08

Fink, Karen: P 10.13LB

Finkelstein-Fox, Lucy: OA 08.01, OA 08.02

Finnell, John S: OA 07.01

Fischer, Michael A: P 07.10

Fischer, Ryan A: OA 03.01, OA 03.04, OA 10.03

Fisher, Sarah: OA 11.02, P 10.12LB

Flack, Andrew: OA 03.01

Fletcher, Taron: P 13.15

Flike, Kimberlee: OA 20.04, P 03.04, P 03.05

Floyd, Junelyn: P 10.07, P 14.05

Flyckt, Rebecca: OA 09.03

Follestad, Payton A: P 16.08

Foltz, Gina E: P 09.02, P 17.01

Foss, Angelique: P 14.02

Frame, Leigh A: P 11.08, P 15.08

Francisco, Jasmin: P 18.03

Fuqua, Tranaka: P 14.02

G

Gamez-Perez, Monica: P 10.05

Ganesh, Varsha: OA 14.02, P 12.01

Garcia, Evelyn: P 02.02

Gardiner, Paula: OA 12.02, OA 15.04, OA 17.02, P 02.04, P 10.07, P 14.05

Gareau, Elena P: OA 17.03, P 01.07, P 05.02, P 09.04

Garlipp, Bailey: OA 06.03

Garmisa, Bridget S: P 09.03, P 15.16

Garnsey, Camille L: OA 08.03

Gawande, Richa: P 02.04

Gennaoui, Elias N: P 16.16, P 18.07

Gentile, Nikki: OA 16.01

Gergen-Barnett, Katherine: P 07.10

Gershan, Lynn: P 01.03

Geyer, Rachel: OA 16.01

Gibson, Barbara A: P 01.14, P 17.16LB

Gill, Kimberly: OA 06.01

Giovannucci, Edward L: OA 01.04

Glassy, Nathaniel: OA 12.02

Gliedt, Jordan A: OA 03.04

Glynn, Teresa K: P 13.16

Gnall, Katherine E: OA 03.02, OA 08.03, OA 18.04

Godfrey, Emily M: P 15.07

Goertz, Christine M: OA 10.02, OA 10.04

Gold, Jeffrey I: OA 17.03, P 01.07, P 05.02, P 09.04

Goldberg, Simon: OA 13.02, P 10.14LB

Goldenberg, Joshua Z: P 04.02, P 04.07, P 11.03

Goldsmith, Elizabeth: OA 11.03

Golubic, Mladen: P 05.07, P 07.01

Goodman, Rachel: OA 08.01

Gopi, Arun: P 18.09

Gorthi, Viraj: P 14.02

Goshe, Brett M: OA 08.01, OA 08.02

Gothe, Neha: P 18.02

Gowin, Krisstina: P 16.16, P 18.07

Grant, Alexis: OA 11.03

Grant, Claire E.: P 08.02

Grant, Suzanne: OA 02.02

Greeson, Carly: OA 22.02

Greeson, Jeffrey: P 10.08, P 15.13

Gregory, Regan: OA 13.02

Gregory, Stephen: P 01.05

Grewal, Marcus: OA 14.03, P 05.07, P 07.01

Groessl, Erik J: OA 03.02, OA 21.02

Grout, Leah: OA 03.03, P 01.10, P 17.16LB

Grow, Tabitha: P 13.04, P 13.05, P 13.06

Guenther, Grace: P 15.07

Guerrera, Mary: P 04.11

Guirette, Melanie: OA 06.02

Guitelman, Judy: OA 12.01, P 18.01, P 18.10

Guo, Alan: OA 19.01, P 01.04

Guo, Jason: P 03.02

Guo, Jia-Wen: P 11.10

Guo, Ning: OA 16.02

Guo, Ningyi: P 11.01

Gupta, Prashant K: OA 09.04

Gutierrez, Gabriela: OA 15.02, OA 15.03

Guzman, Jacqueline: OA 10.01, P 07.06

H

Haas, Niina: OA 12.02

Hackett, John E: P 17.01

Haddow, Susan: OA 20.02, P 02.03, P 02.05LB, P 07.10

Hadlandsmyth, Katherine: P 14.04

Hagan, Thomas J OA 10.01

Hagel Campbell, Emily M.: P 14.04

Hagen, Thomas J: P 07.06

Hager, Wren: OA 08.02

Haley, Alexander C.: OA 11.03, P 14.04

Hall, Daniel L: OA 02.01

Halpern, Jacob: P 16.11

Hamilton, Katherine: P 14.05

Han, Lihong: P 11.05

Haney, Alexandra: OA 14.02, P 12.01, P 18.01, P 18.10

Hanley, Adam W.: OA 10.06LB, P 14.03

Hanson, Chris: P 08.04

Haramati, Aviad: OA 05.02

Hardy, Dallin: P 13.07, P 13.08

Harold, Coutney: OA 08.04

Harris, Richard E: P 16.14

Hartogensis, Wendy: OA 01.01, OA 11.02, P 02.02, P 10.12LB

Hausdorff, Jeffrey: P 14.09LB

Hayashida, Kenneth: P 05.04, P 15.05

Haygood, Laura: OA 13.02, P 10.14LB

He, Zehui: OA 17.01

Hecht, Frederick M: OA 01.01, OA 11.02, P 10.10, P 10.12LB

Hedrick, Kathy H.: OA 20.03

Heesch, Corrin N: P 17.04

Helfrich, Christian: P 03.03

Hendrix, David: P 10.07, P 14.05

Henley, Elisabeth C: OA 02.01

Hennessey, Jessica: P 08.03

Herman, Patricia M: OA 04.02, OA 04.04, OA 13.02, P 04.08, P 13.10

Hibben, Kristen Cibelli: OA 22.01

Hildebrand, Celia: P 01.03

Hildie, Spencer: P 18.12

Hill, Jacob D: OA 16.02, P 10.011, P 14.07

Hirana, Hirofumi: OA 16.04

Ho, Joanna: OA 19.04

Ho, Thoa: P 01.02

Hogan, Julianna: P 09.02

Hogan, Timothy P: OA 22.04, P 18.12

Hoge, Elizabeth A: P 10.14LB

Holmbeck, Katie: OA 08.02

Horick, Nora: OA 08.02

Horowitz, Bruriah: OA 12.01, OA 14.02, P 12.01, P 18.01, P 18.10

Hou, Yen-Nien: OA 09.02

Houle, Timothy T: P 14.05

Houston, Reyna: P 15.07

Howard, Carrie: P 02.03

Howell, Caroline Sariah: P 16.15

Howes, Lydia A: P 16.15

Hrose, Keiko: P 16.06

Hsu, Chien-Yeh: P 11.10

Hsu, Ellie: P 13.02

Hsu, Kai-Yin: P 01.19

Huedo-Medina, Tania: OA 03.02

Huerta, Zephelline A: OA 19.02, P 13.17

Huffman, David W: OA 20.03

Hui, Edward: P 04.03, P 05.03

Hui, Gene: P 05.03

Hui, Ka-Kit: P 04.03, P 05.03

Hullender Rubin, Lee: OA 09.03

Humbert, Andrew: OA 16.01

Hundal, Jasmin: OA 16.02

Hurstak, Emily: P 16.11, P 16.13

Huston, Alissa: OA 06.03

Hyde, Justeen K: OA 20.01, OA 20.04, P 03.03, P 03.04, P 03.05, P 17.03

I

Iachini, Barbara: P 03.07

Ijaz, Nadine: OA 01.02

Ikejiri, Yumi: OA 16.04

Incollingo-Rodriguez, Angela: P 01.09

Ingersoll, Sarah: P 05.04, P 15.05

Ishikawa, Hideki: OA 16.04

J

Jackson, Jhia: P 02.02

Jackson, Justin: OA 22.03

Jackson, Milo: P 11.04

Jaffe, Atara: P 16.08

Jain, Anup: P 18.09

Jamieson, Paige E: OA 06.04

Jang, Andrew: P 04.03

Jang, Bo-Hyoung: P 16.02

Jaramillo, Natalia: P 01.07, P 05.02, P 09.04

Jeitler, Michael: P 18.16, P 18.17

Jenerette, Coretta: P 14.02

Jensen, Heather R: P 17.01

Jewell, Teresa: P 11.04

Jha, Amishi: P 06.04

Jindal, Ria: OA 14.03, OA 14.04, P 05.07, P 07.01

John, Sydney: OA 06.03

Johnson, Angela: P 07.01

Johnson, Blair T: OA 13.02, P 10.14LB

Johnson, Linnette M: P 01.09, P 01.18

Johnson, Sara: OA 06.01

Jones, Jennifer M.: OA 02.03

Jones, Lucas: OA 09.03, P 10.13LB

Joseph, Janet O: P 06.05

Joseph, Reversa: P 06.09

Joshi, Shubhangi S: P 18.02

Joss, Diane: OA 18.01, OA 18.02

Joyce, Christopher T: P 16.11

Joyce, Kelly V: OA 22.02

Judd, Adam: P 06.09

Jujjavarapu, Shilpa: P 10.10

Jung, Erika: P 10.12LB

Justice, Catherine: OA 20.02, P 02.03, P 02.05LB

Jyung, Hyowoun: OA 09.02

K

Kaiser, Christine: OA 09.03

Kaji, Masahide: OA 16.04

Kakati, Rasha: P 14.01

Kallenberg, Gene: OA 04.03

Kang, Paul: P 06.02

Kantor, Elizabeth D.: OA 01.04

Karakcheyeva, Viktoriya: P 15.08

Karasz, Alison: P 14.02

Kartusch, Katherine: P 11.03

Katiyar, Sanjana: OA 14.03, OA 14.04, P 05.07

Katz, Patricia: OA 11.02

Kaushal, Divya: OA 06.01

Kazal, Jr., Louis A.: OA 09.06LB, P 01.10

Keck-Kester, Terrah: P 13.01

Kedilaya, Sujatha: P 07.04

Kekan, Manasi: P 06.02

Keller, Hanna: P 14.01

Kendall, Kayla: P 04.11

Kenyon, Kayla: P 15.07

Ketter, Priscilla: P 14.02

Keßler, Christian: P 18.16

Khan, Sarah: OA 17.03, P 01.07

Khawand, Annmarie: OA 18.04

Kilgore, Karen: OA 10.01, P 07.06, P 14.06

Kim, Tae Youn: P 01.17

King, Mya: P 04.10

Kinkead, Becky: P 09.01

Kipp, Alex J: P 13.13

Kizhakkeveettil, Anupama: P 16.07, P 17.11

Klatt, Maryanna D: OA 02.04, OA 05.01

Klein, Margaret J: P 01.07

Kleppe, Maranda: P 07.02, P 07.03, P 07.04

Knight, Nina: OA 02.04

Knox, Jadyn: OA 20.02, P 02.03, P 02.05LB

Ko, Elizabeth: P 17.06

Kobylecka, Monika: P 01.07

Koch, Anna K: P 15.15

Koh, Sarah: OA 19.03

Kohman, Leslie: P 15.14

Konganige, Shiran: OA 17.01

Kosik, Kyle: P 07.11LB

Kowalski, Matthew: P 14.09LB

Kowalski, Matthew H: OA 10.01, P 07.06, P 14.06

Koziura, Sofia: P 18.01, P 18.10

Kresevic, Denise: P 17.10

Kretzschmar, Doris: P 11.15LB

Kuhlthau, Karen: OA 08.01

Kumar, Pradeep: P 01.11

Kuon, Carla: OA 15.03

Kurszewski, Wesley: OA 22.02

Kwan, Anna: P 01.04

L

La Monica, Marita : OA 07.02

Labak, Collin M: OA 10.02

LaChance, Laura: P 11.03, P 13.10

Laird, Lance: P 07.10, P 16.11, P 16.13

Lam, Chun Sing: OA 01.04, OA 09.02

Lam, Man Sze: P 01.13

Lang, Ariel J.: P 18.04

Langley, Blake O: OA 06.04 P 11.04

Larbi, Amma: OA 13.02

Larbi, Nana Amma: P 10.14LB

Lau, Annie: P 18.03

Laumann, Laura E: OA 18.04, P 06.05

LaValley, Michael: P 07.10

Lavretsky, Helen: P 16.11, P 17.06

Law, Alexander: P 11.15LB

Law, Annie: P 05.03

Lawal, Oluwaseyi A.: OA 02.03

Lee, Hang: OA 02.01

Lee, Juha: OA 19.03

Lee, Madeline: P 15.14

Lee, Myeong Soo: OA 09.04

Lee, Yoon Jae: P 11.14LB

Leibel, Leigh: P 18.14

Leiferman, Jenn: OA 14.01

Leininger, Brent D: OA 11.03, P 14.04

Lewis, Kelsey L: OA 10.02

Li, Alan: P 01.22LB

Li, Chen: OA 13.02, P 10.14LB

Li, Danqing: P 18.09

Li, Haoyue: P 04.03

Li, Hongyang; OA 16.04, P 16.04

Li, Min: P 04.03

Li, Shao: OA 09.04

Li, Steven W.: P 01.02

Li, Susan Q: P 01.23LB

Lill, Sarah: P 15.07

Limoico, Ellala: P 11.15LB

Lin, Brenda X.: P 16.17

Lin, Shin: OA 19.01, P 01.04

Lin, Yvonne: OA 04.01

Lipton, Richard B: P 14.05

Litrownik, Daniel: OA 10.01, P 07.06

Liu, Hui-lan: P 11.12

Liu, Jian-ping: P 16.18

Liu, Kai: P 11.05, P 11.12, P 11.13

Liu, Rihe : P 11.05

Liu, TingXiu: P 11.05, P 11.12, P 11.13

Liu, Zhao-Lan: P 11.12

Liu, Zhao-lan: P 16.18

Liu, Zhaolan: P 11.05, P 11.13

Lo, Louise: OA 15.02

Locke, Amy B: OA 05.03, OA 22.03

Loeff Goldsztein, Isabela: P 15.06

Loew, Brenda: P 12.02

Long, Cynthia R: OA 10.01, OA 10.04, P 07.06, P 14.06, P 14.09LB

Lopez Vera, Alexandra L: P 18.04

Lopez, Gabriel: OA 06.02

Lopez, Karen A: OA 08.01

Loucks, Eric B: OA 13.02, P 10.14LB

Loy, Michelle: P 13.02, P 16.03

Lumiere, Kathleen: P 01.21

Lyle, Kelly: P 13.16

M

Ma, William: OA 19.01, P 01.04

Ma, Yan: OA 02.03, OA 12.04, P 14.09LB

Mahaffey, Brittain: OA 08.01

Mahaffey, Mallory: P 14.04

Mahoney, Eugene L: P 01.20

Mahoney, Louise: P 18.03

Maiers, Michele J: OA 04.02, OA 04.04, P 04.08

Majd, Iman: OA 16.01, P 13.16

Malik, Shaista: P 01.23LB

Mallaiah, Smitha: OA 21.01

Malloy, Laura: OA 08.02

Mamat, Zulkayda: P 18.03

Manor, Brad: P 14.09LB

Manson, JoAnn E: OA 01.03

Mao, Jun J: OA 01.04, OA 09.02, P 01.23LB

Margol, Caitlyn: P 10.07

Martel, Matthew B: OA 20.04, OA 22.04, P 03.04, P 03.05

Martin, Aaron M.: OA 12.03

Martínez, Jesus: P 11.15LB

Martínez-Ramos, Nicolás: OA 12.01

Mascarenhas, Maria R: OA 10.05, P 01.03, P 06.01, P 04.10, P 09.03, P 13.12

Mason, Ashley: P 10.10, P 10.12LB

Masoud, Hesham: P 15.14

Mathersul, Danielle C: OA 21.02

Mathews, Patenne: P 15.06

Matthias, Marianne S: OA 11.03, P 14.04

Mattson, Liz: P 13.09

Mavathur, Ramesh: P 18.09

Mazure, Tammy: P 04.07

McCall, Cordero L: P 04.09

McCarey, Jacob: OA 10.01, P 07.04, P 07.06, P 14.09LB

McCarty, Narissa: P 16.13, P 14.07

McDermott, Kena: P 14.06

McDonald-McGinn, Donna M: P 06.01

McGrory, Aileen: OA 20.01, P 08.02

McKnight, Shannon: P 07.01

McNulty, Candace: P 15.09, P 17.07

Medeiros, Stasha: P 03.01

Mehling, Wolf: OA 03.02

Mehta, Darshan: OA 09.04, OA 19.04

Melendez, Gabriela: P 15.15

Mendenhall, Kris: P 05.04, P 15.05

Mendoza, Glenn: P 11.09, P 16.19

Mensinger, Janell L: P 08.01, P 10.03, P 14.11LB

Mercouffer, Ariadna: P 04.06

Metz, Tom O.: OA 06.04

Miah, Jamila S.: P 08.03

Miccio, Robin: P 06.01, P 13.12

Michel, Martha: P 17.08

Miller, Megan: OA 22.03

Miller, Ronald A: P 15.14

Millon, Emma M: P 10.01, P 15.06, P 15.10, P 17.13

Millstein, Rachel A: OA 08.01

Minichiello, Vincent: P 04.01

Miranda, Isabelle: OA 08.01, OA 08.02

Mishra, Kavita K: OA 15.02

Mishra, Jyoti: P 18.04

Mittman, Brian S: P 16.11, P 16.13

Mixon, Amanda: OA 13.03

Mohacsi, Savannah: OA 17.01

Mohanty, Soubhagyalaxmi: P 18.09

Monroy-Iglesias, Maria J.: OA 01.04

Monteverdi, Kiran: OA 19.03

Moonaz, Steffany: P 17.16LB

Moore, Brian: P 14.05

Moore, Justin B: P 10.07, P 14.05

Moore, Kevin: P 10.01, P 17.13

Moosburner, Alina: P 13.14

Moran, Patricia J: OA 11.02, P 10.10

Morasco, Benjamin J.: OA 12.03

Morelock, Kara: P 13.09

Mori, DeAnna L.: OA 13.01, OA 18.03

Mori, Keita: OA 16.04

Morone, Natalia E: OA 03.01, P 07.10

Mullington, Janet: OA 12.04

Mullur, Rashmi: P 17.06

Mulugeta, Yulia: OA 02.04, OA 05.01

Munir, Yumi: OA 19.03

Munk, Niki: P 07.05, P 07.11LB

Muñoz-Vergara, Dennis: OA 01.03, P 14.06

Murakami, Nozomu: OA 16.04

Murillo, Raúl: OA 12.01

Murphy, Melissa: P 13.10

Murphy, Shalynn M: P 14.11LB

Mussallem, Dawn: P 13.09

Mörchen, Lisa: P 18.11, P 18.16

N

Naganuma-Carreras, Julia: P 02.04

Nagare, Melissa: P 17.16LB

Naidu, Mila: P 10.07, P 14.05

Nakata, Kengo: P 05.12LB

Nanavati, Kaushal B: P 06.03, P 15.14

Natrakul, Anna: P 07.10

Nault, Daryl: P 04.02

Nausheen, Fauzia: P 18.04

Navas, Elena: OA 12.01

Naylor, Grace: P 16.11

Nelson, Camden: P 10.07, P 14.05

Nelson, Genevieve: OA 17.01

Nephew, Benjamin: P 01.09

Nevins-Jones, Heather: P 17.14

Ng, Jeremy Y: OA 09.04, P 15.15, P 16.17, P 16.21

Nguyen, Thuy: OA 16.02

Nguyen, Viviane: OA 10.01, P 07.06, P 14.06

Nicolosi, Gabriella: OA 08.01

Niles, Barbara L: OA 13.01, OA 18.03

Nives, Dani: OA 05.03

Nock, Nora L.: P 10.011

Norton, Kayla: OA 22.03

Nourse, Pam: OA 08.01

Nuffer, Monika: P 15.12

Nusrat, Aterah: P 12.02

O

O'Brien, Hannah: P 10.07, P 14.05

O'Cleirigh, Conall: OA 02.01

O'Connell, Nathaniel: P 10.07, P 14.05

Oberoi, Devesh: OA 02.03

Ogawa, Masao: OA 16.04

Ogawa-Ochiai, Keiko: OA 16.04, P 05.12LB

Oliphant, Vanessa N.: OA 08.04

Oliver, Caroline: P 10.07, P 14.05

Olson, Beatriz: P 06.02

Olson, Emery: P 11.04

Olson, Juli: P 01.05

Oreper, Sandra: OA 15.03

Orozco-Segura, Laura J: OA 12.02, P 14.08

Osha Chesnutt-Perry, Osha: P 13.17

Osher, Gabrielle R: OA 12.01, P 18.01, P 18.10

Osherow, Erika: OA 08.03

Ostermann, Thomas: P 18.13

Owusu-Ansah, Amma: P 14.02

O’Connell, Kelli: OA 01.04

P

Pai, Jonathan: OA 17.01

Painter, Jacob T: OA 12.03

Pallerla, Aaditya: OA 14.03, P 05.07, P 07.01

Pallerla, Harini: OA 14.03, OA 14.04, P 05.07, P 07.01

Palmer-Kelly, Elizabeth: OA 02.04, OA 05.01

Panduru, Ioana D: P 16.05

Pandya, Leena: P 10.12LB

Park, Crystal L: OA 03.02, OA 08.03, OA 18.04, 452

Park, Elyse R: OA 02.01, OA 08.01, OA 08.02

Park, Linda S.: OA 15.01

Park, Sarah J: OA 01.03, OA 15.04

Parker, Tabatha: OA 07.01

Patel, Hemal: OA 04.03

Patterson, Sarah L: OA 11.02

Pawlik, Tim: OA 02.04, OA 05.01

Peecharoensap, Siwaphorn: P 11.06

Pei, Mingzhuo: P 10.12LB

Pena, Giselle: P 10.01, P 17.13

Penna, Sivaranjani: OA 05.04, P 15.01, P 15.02

Penza, Charles: OA 03.01

Peppercorn, Jeffrey: OA 02.01

Peppers-Citizen, Marilyn: P 18.14

Pereira, Cora: P 16.11

Perez, Giselle K: OA 08.01, OA 08.02

Perez, Jaime A: OA 10.02

Perlmutter, Austin: P 16.08

Perrin, Adam: P 04.11

Pescatello, Linda: OA 18.04

Peterson, Mark A: P 04.04

Petito, Bruna: P 10.04

Pettineo, Sarah: P 03.01

Phillips, Joshua: OA 12.02, P 10.07, P 14.05

Piedalue, Katherine-Ann: OA 02.03

Pimpa, Ritichai: OA 07.04

Pinski, Jacek K: OA 17.01, P 06.06

Pirrello, Michael J: OA 19.01, P 01.04

Pless Kaiser, Anica: OA 13.01

Pluimer, Brock: P 16.14

Pogosyan, David: P 15.03

Pohlman, Katherine A: P 04.02, P 07.02

Polizzi, Craig: OA 13.01, OA 18.03

Pollak, Christine: OA 15.02

Powers, Scott W: P 10.07, P 14.05

Prasad, Arti: OA 20.02, P 02.03, P 02.05LB

Prasad, Tanuja: P 01.15, P 05.06

Prater, Paige L: P 05.10

Prathikanti, Sudha: OA 19.03

Prelock, Patricia: P 03.01

Price, Malena M: P 06.04

Printon, Richard: P 07.10

Printz Pereira, Destiny: P 06.05

Pryor, R. Leah: P 13.16

Purcell, Natalie: OA 12.03

Purushotham, Archana: P 01.11, P 16.01

Pyland, Derek: P 10.07

Q

Qiao, Lili : P 01.22LB

Qina'au, Joanne: P 16.24LB

R

Rader, Caitlin: OA 16.02

Rahim, Asifa: OA 03.01, P 07.10

Rai, Krish: OA 11.02

Rai, Zenith: OA 20.04, P 03.04, P 03.05

Raja, Menaja: OA 18.04

Rand, Jennifer: OA 19.03

Randolph, Macy: P 07.03, P 14.06

Rauk, Kirsten: P 01.18

Ravani, Shraddha: OA 19.03

Rebang, Jacinta: OA 20.02, P 02.03, P 02.05LB

Reddy, Kavitha P: OA 12.03

Reddy, Sanjay: OA 01.01

Redwine, Laura S: P 13.16

Reed, Grace: OA 19.03

Reed, II, David E: P 17.08

Reeves, Tegan: OA 20.02

Reineck, Eva: P 13.09

Reisner, Lianna Levine: P 13.02

Resnicoff, Marci: P 03.08

Rhaney, Laura D: P 13.09

Richard, Bonnie O: P 05.13LB

Ricker, Mari: P 13.13

Ring, Melinda: OA 09.04, P 13.16

Rini, Christine: P 05.11LB

Rinne, Seppo: P 03.03

Rios, Savannah N: P 04.01

Rippey, Rosalie: OA 08.01

Rist, Pamela M: OA 10.01, P 07.06, P 14.06

Ritter, Alayna: P 06.02

Roberts, Lindsay: P 02.03

Roberts, Sydney: P 10.011

Rodgers-Melnick, Samuel N: OA 09.03, P 14.02

Rodriguez, Cailtlyn Christine: P 17.09

Rodríguez, Keisy: P 11.11

Romeiser, Jamie Romeiser: P 06.03

Rooney, Meghan: P 09.02

Rose, Gail L: P 03.06

Roseen, Eric J: OA 03.01, OA 10.03, P 07.10, P 16.11, P 16.13

Rosen, Rachel L: OA 01.03

Roth, Isabel: OA 01.02

Roth, Maya: P 08.04

Rouchka, Jenny: P 01.06

Rubinstein, Sidney: P 07.02

Ruddick, Mary: P 13.04, P 13.05, P 13.06

Rupp, Tracy L: P 07.09

Rush, Ashley: P 15.09, P 17.07

Rutt, Kayla: P 13.01

Ruvalcaba, Denise: P 02.02

S

Sajjan, Seema: P 13.17

Salem, George: P 06.06

Salmaggi, Darah K: P 15.10

Salsbury, Stacie A: P 07.02

Sanjuan, Pilar M: P 16.13

Santa Mina, Daniel: OA 02.03

Santiago, Clara: P 11.11

Santilli, Luc A: P 06.01, P 13.12

Saper, Robert B: OA 10.03, OA 16.02, P 07.10, P 16.11, P 16.13

Sauer, Christina: OA 12.01, OA 14.02, P 12.01, P 18.01, P 18.10

Saviet, Micah: P 03.07

Scanlon, Paul J: OA 22.01

Schleinzer, Alina: P 18.13, P 18.15, P 18.16, P 18.17

Schlossman, Julia: OA 06.03

Schmidt, Beth Ann: P 01.19

Schneider, Michael J: OA 03.01

Schult, Tamara: OA 22.04

Schuman-Olivier, Zev: OA 18.02, P 10.07, P 14.05

Schuster, Andres: OA 10.02

Seal, Karen H: OA 12.03

Searfoorce, Geeda: P 12.02

Sekowski, Natalie Sekowski: OA 19.03

Sena, Simone: P 16.20

Serpa, J. Greg: OA 11.03

Sesso, Howard D: OA 01.03

Setabutr, Dhave: P 04.03

Seymour, Heather: P 06.09

Shafto, Kate G: OA 20.02, P 02.03, P 02.05LB

Shakir, Mariam: P 10.07

Shallcross, Amanda J: P 10.06, P 10.11, P 14.07

Shamblen, Stephen R: P 05.13LB

Shanavas, Yuktha: P 06.03

Shang, Andrea: P 10.01, P 17.13

Shang, Dong: P 04.03

Shankarganesh, Ramalakshmy: OA 02.04

Shannnahan, Anna B: P 13.13, P 13.16

Shannon, Zacariah K: OA 10.04

Sharma, Kanupriya: P 18.18

Sharpe, Erica: P 18.05

Sheikh, Selim: OA 22.03, P 07.07

Sheng, Xiaoming: P 01.08

Shepherd, Martha: OA 06.01

Shi, Lei: P 11.12

Shi, Zeyang: P 11.05, P 11.13, P 16.18

Shih, Min-Chieh: OA 09.05

Shin, Boyoung: P 16.02

Shoemaker, Laura: OA 16.02

Shrestha, Shikhar: OA 10.03

Shridhar, Manisha: OA 09.04

Shu, Jing: P 04.03

Sico, Jason: P 14.06

Sieber, William: P 18.05

Simon, Michelle: P 05.08

Sinnott, Sinead M: OA 18.04

Sipai, Rifa: P 09.05

Siwik, Chelsea J: P 10.10

Slone, Stacey: P 07.11LB

Smith, Alyssa M: P 03.01

Smith, Ben: P 15.17LB

Smith, Benjamin P: P 07.08, P 09.01

Smith, Clair N: OA 03.01

Smith, Julia: P 05.05

Smith, Katherine: P 03.07

Solis, Samuel: P 02.02

Song, Vincent: P 17.03

Song, Yike: P 11.05, P 11.13

Soriano, Hazel: P 18.04

Soumyanath, Amala: P 11.15LB

Souza, João Paulo: OA 09.04

Speca, Michael: OA 02.03

Spruill, Tanya M: P 10.06

Squires, Lisa: P 01.03, P 04.10

Sridhar, Apeksha: P 16.14

Srinivasan, Roshini: OA 03.04

Staab, Carina A: OA 06.04

Stadler, Diane E: P 13.04, P 13.05, P 13.06

Starkweather, Angela R: OA 03.02

Steer, Eliot: OA 19.03

Steinberg, Beth: OA 02.04, OA 05.01

Stevens, Jan F.: OA 06.04

Stevenson, Stefanie: OA 20.02

Stine, Morgan: OA 06.01

Stogianni, Eleni: P 10.10

Stroud, Laura R: P 06.05

Stuber, Kent: P 07.02

Sullivan, Marlysa: P 18.12

Sun, Lingyun: OA 09.02

Sun, Shufang: OA 13.02, P 10.14LB

Sun, Yuan: P 16.18

Sung, Anthony: OA 02.01

Suri, Pradeep: OA 03.01

Susanto, Jeremiah A: OA 19.01, P 01.04

Sussman, Andrew: P 16.13

Swarup, Sanjay: P 11.09

Swedlow, Pamela: P 02.02

Swygert, Kristin: OA 13.03

Sy, John: P 15.06

Syed, Niveen: P 15.15

Syed, Zubair: P 14.01

Szabo, Andrea: P 04.10

T

Tae Kim, Sung: OA 09.03

Taimish, Jay: P 05.02

Takahashi, Jonathan: OA 15.01

Tamol, Nicole: P 10.07, P 14.05

Tamura, Yoshihiro: P 01.16

Tan, Jamie: OA 09.04

Tan, Qiuxue T: P 01.12

Tangkiatkumjai, Mayuree: P 11.06

Taniguchi, Takumi: OA 16.04

Tankha, Hallie: P 14.07

Tao, Isabella Y: P 16.17

Taranto, Melany: P 06.03

Taromina, Katherine: P 11.04

Tatsuno, Yutaka: OA 16.04

Tatsuzawa, Yasuhiko: OA 16.04

Tavakoly, Rahele: P 13.14

Taw, Lawrence: P 01.12

Taylor, Brent C: OA 11.03, P 14.04

Taylor, Stephanie L.: OA 11.03, P 14.04, P 18.12

Taylor-Swanson, Lisa J: P 01.09, P 01.18, P 01.19, P 01.21, P 16.15

Tellez, Claudia: OA 12.01

Tenaglia, Marcus: P 16.10

Thomason, Moriah E: P 10.01, P 17.13

Thompson, Brice: P 16.08

Thompson, Kirsten T: P 05.13LB

Thompson, Traci: P 13.16

Thompson-Lastad, Ariana: OA 01.02, P 02.02

Thorfinnson, Hannah: OA 03.04

Tiedt, Malik: OA 15.04

Ting, Maria A: OA 13.01, OA 18.03

Todd, Abigail K: P 15.11

Traeger, Lara: OA 02.01

Trager, Robert J: OA 03.04, OA 10.02, OA 10.03

Tran, Ethan R.: OA 19.01, P 01.04

Tran, Thu: P 14.01

Treacy, Patrick J: P 10.01, P 17.13

Tsa-Wei, Denice: OA 17.01

Tu, Wen: P 16.15

Tutulugdzija, Ranko: P 01.12

Twaalfhoven, Kristina: OA 10.01, P 07.06, P 14.06

U

Ueland, Frederick R.: P 07.11LB

Upadhyay, Vikas: P 18.09

Upadhyaya, Aparna: OA 19.03

Uppal, Divjot: OA 19.03

V

Vaidya, Shivani: P 14.05

Van Iseghem, Theresa M.: OA 12.03

Vasu, Varsha: P 16.01

Vatovec, Christine: P 12.02

Vazquez Alcaraz, Jafer V: P 18.04

Veldheer, Susan: P 13.01

Venegas, Maria: P 17.03

Vertovec, Ann: P 12.02

Victorson, David: OA 12.01, OA 14.02, OA 19.04, P 05.11LB, P 12.01, P 18.01, P 18.10

Vidal Verástegui, Julia: P 17.15

Vieira Neves, Vinicius: P 10.14LB

Vieten, Cassandra: OA 04.03

Vigo, Katrina: P 05.05, P 10.05

Vilela Braga, Alexandre: P 03.03

Villanueva, Jamie: P 01.18

Vining, Robert D: OA 10.01, OA 10.04, P 07.03, P 07.04, P 07.06, P 14.06, P 14.09LB

Vinjamury, S. Prasad: OA 07.02

Visvanathan, Meena: P 17.12

Visvanathan, Pallavi D: P 10.06, P 10.011

Vogt, Dawne: OA 22.04

Voyles, Claudia: P 01.05, 187

Vu Pham, Nathan : P 03.02

W

Wagner, Lynne I: OA 02.01

Waldron, Elizabeth: OA 08.02

Walker, Barbara: OA 14.03, OA 14.04, P 12.02

Walsh, Jessica: P 09.02

Walsh, Lori A: P 13.16

Walter, Joan: OA 10.04

Wang, Chenchen: OA 13.01, P 16.11, P 16.13

Wang, Jingli: OA 19.04

Wang, Peng: OA 01.04

Washington, Marcus: OA 13.04

Wayne, Peter M: OA 01.03, OA 02.03, OA 10.01, OA 12.04, P 07.06, P 14.06, P 14.09LB

Wei, Chang-Ching: OA 09.05

Weiner, Debra K: OA 03.01

Weir, Rachel: OA 22.03

Wells, Rebecca Erwin: P 10.07, P 14.05

Wells, Traci: P 04.03

Wen, Yaqian: P 11.05

Wennik, Jesse: P 02.02

Werner, Whitney: OA 05.03

Westervelt, Karen C: P 03.01, P 03.06, P 13.16

Wexler, Ryan S: P 04.07, P 16.11

Whedon, James M: OA 03.03, P 01.10

White, Lauren K: P 06.01

White, Stephanie M: P 07.08, P 13.16, P 15.17LB

Whitehead, Alison M: P 18.12

Whitley, Margaret D: P 04.02, P 17.15

Wieland, L. Susan: P 18.14

Wiener, Renda: P 03.03

Williams, Chanda: P 05.10

Williams, Renee: OA 08.01

Willis, Regime: P 05.01

Wilson, Deborah: P 06.09

Winklosky, Brian: OA 08.01

Wise, Sylvia: P 10.011

Wold, Carly: P 05.02

Wolever, Ruth Q: P 05.13LB, P 14.06

Wolf, De'Sha: OA 11.01

Wolfson, Hannah: OA 17.01

Wong, Eunice: P 17.15

Wu, Julia: P 02.02

Wu, Juliet: OA 20.01

Wu, Po-Yuan: OA 09.05

Wu, Xiaqiu: P 04.03

Wu, Yin: OA 18.04

Wuopio, Alexandra: OA 15.04

X

Xiao, ZhiMin: OA 07.04

Xiong, Shigang: OA 17.01

Y

Yaghmour, George: OA 17.01

Yam, Scott: P 16.09

Yamada, Keisuke: OA 16.04

Yang, Anna: P 04.03

Yang, Dershung: OA 12.01

Yang, Pei-Shan: OA 09.05

Yang, Wu-Hsun Tom: OA 16.01

Yarlagadda, Shreeya: P 13.09

Yates, Chrys: P 13.09

Yedavalli, Anjali: P 13.09

Yeh, Gloria: OA 01.03, OA 02.01, OA 12.04

Yen, Hung-Rong: OA 09.05, P 04.03

Yeung, George S: OA 01.01

Yoannou, Nicole: P 13.10

York, Kaki: P 09.02

Yoshino, Tetsuhiro: OA 09.04

Youn, Jaeyoung: P 11.14LB

Young, Tiff: P 12.02

Yu, Hainan: P 13.10

Yuen-Loc, Nina: P 05.03

Yun, Ye-Rim: P 11.14LB

Yusipova, Yulia: P 13.03

Z

Zabel, Samantha: P 07.05

Zaccari, Belle: P 14.10LB

Zananski, Adam J.: OA 20.03

Zappa, Melissa: P 15.17LB

Zaremski, Marc: P 17.04

Zavotsky, Kathleen: P 10.05

Zeliadt, Steven B.: P 03.03, P 17.08, P 18.12

Zhang, Tony: OA 16.03

Zhang, Weijun: P 03.02, P 04.03, P 05.03, P 05.09, P 16.13

Zhang, Xiaohan: P 11.05

Zhao, Lee: P 10.01, P 17.13

Zheng, Zhen: OA 16.03

Zhou, Phoebe: OA 09.01

Zsakany, Thomas : P 18.17

Zwickey, Heather: OA 04.01, OA 04.02, OA 04.04, P 01.20, P 04.07, P 04.08, P 13.04, P 13.05, P 13.06, P 16.08, P 16.10