A Q&A with Stephanie Taylor, Ph.D., M.P.H.

The APPROACH Trial: Assessing Pain, Patient Reported Outcomes and Complementary and Integrative Health (A VA National Demonstration Project)

Stephanie L. Taylor, Ph.D., M.P.H. is the director of the National Center of Complementary and Integrative Health Evaluation, a VA QUERI Partnered Evaluation Initiative, and an Associate Director of the VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy in the VA Greater Los Angeles Healthcare System. As a medical sociologist and health services researcher, Dr. Taylor’s work focuses on the implementation of complementary and integrative health approaches, and social, environmental and organizational influences on health and healthcare.

Steve Zeliadt, Ph.D., M.P.H. is a Research Associate Professor in the Department of Health Services in the University of Washington’s School of Public Health and the Associate Director for the Seattle VA Health Services Research & Development Center of Innovation to Promote Veteran-Centered and Value-Driven Care. Dr. Zeliadt’s work focuses on using data to appropriately inform care delivery, with special attention to gaps in knowledge about population outcomes associated with policy implementation and healthcare interventions.

Q: Tell us about your trial.


Stephanie Taylor (ST): The APPROACH trial is conducting a secondary analysis of a survey of up to 18,000 veterans, making it the largest study of complementary and integrative health therapies, or “CIH”, conducted in the United States.  Our primary research question is, "Do CIH therapies that you do yourself, or self-care, have a bigger effect on decreasing pain than CIH therapies that providers administer?"  To answer this question, we're examining six complementary and integrative health therapies and several outcomes. Half of the six therapies are self-care (meditation, yoga, and Tai Chi/Qigong) and half are  provider-delivered therapies (acupuncture, chiropractic care, and therapeutic massage). While the impact on pain is the primary outcome we are concerned with, we are also looking at other outcomes, like quality of life, anxiety, depression, and fatigue.  We hypothesize that the therapies patients do on their own will have a bigger impact on their health than therapies done to them, and if they are, why they are effective.  We are thinking that when people can use self-care in their pain management plan, it might empower them—and that feeling of empowerment might improve their ability to manage their pain.  Further, people with pain might feel less dependent on others to take care of pain.  Again, that’s what we are thinking, but we don’t really know because we aren’t aware of any studies compare the effectiveness of the two forms of care. 

Q: What is the biggest challenge of a large national pragmatic survey such as the APPROACH trial?


ST: Doing pragmatic trials is extremely difficult because the interventions are not consistent across the country. For example, yoga at the Tampa VAMC might not be the same as yoga at Chicago VAMC.  If veterans aren’t all using the same intervention, it makes it difficult to measure the intervention’s effectiveness.

Q: Why study complementary and integrative health therapies for pain management in veterans?


ST: The average veteran takes a large number of medications, and they don't necessarily want to take them all. Some medications produce unwanted side effects or don’t work.  So it’s important to offer patients nonpharmacological pain management options such as physical therapy, exercise or complementary integrative health therapies.

Q: Speaking very broadly, what should we know about complementary and integrative health therapies for pain management?


ST: Some complementary and integrative health therapies have long been shown to be effective for pain. These therapies can be one of many tools in a physician’s toolbox. It’s important that physicians and patients are aware of the effectiveness and availability or these therapies as possible options for pain management.  Of course, there is a whole host of barriers to informing clinicians and patients about the possible benefits of some integrative health therapies.  For more detailed information on these barriers and possible ways to overcome them, please see information from two our studies.

Q: Where can we go to learn more about how integrative health is accessed and utilized by different demographic groups?


ST: As part of my QUERI center, the VA’s Complementary and Integrative Health Evaluation Center, we have a data repository called Data Nexus where we examine all the complementary and integrative health utilization that's recorded in VA administrative data. Steven Zeliadt, Ph.D., M.P.H., the co-PI on this PMC study, leads that effort. We produced our first report, the “Compendium on Use of Complementary and Integrative Health Therapies and Chiropractic Care at the VA” , that shows that there are definite patterns by age, gender, race, and ethnicity of who is more likely to use particular  complementary and integrative health therapies. You can learn more about it through this link to our first report.


Q: Why study pain?


ST: It’s important to study chronic pain because it's one of the most prevalent debilitating conditions worldwide.   We don't want everybody to feel they have to  turn to medications for managing their chronic pain because there are other options, one being some complementary and integrative health therapies.

Q: What does being a part of the Pain Management Collaboratory mean to you?


ST: It's an absolute honor to work with the top pain researchers in the nation.  I'm not a pain researcher. I'm a complementary and integrative health researcher, but I'm becoming a lot more familiar with pain research as I listen to them and collaborate to solve problems.  Some of the brightest minds are part of the Collaboratory and we have so much fun. It's a very rewarding experience.   It's incredibly valuable to have a collaborating center and it's really making a huge difference.