Participating in Complementary and Integrative Health Approaches Is Associated With Veterans' Patient-reported Outcomes Over Time

Med Care. 2020 Sep;58 Suppl 2 9S:S125-S132. doi: 10.1097/MLR.0000000000001357.


Background: Veterans Affairs is dedicated to providing a Whole Health approach to care, including offering complementary and integrative health (CIH) approaches to Veterans.

Objective: The objective of this study was to examine the association of CIH participation with Veterans' patient-reported outcomes over time.

Research design: A survey of patient-reported outcomes at 5 timepoints: baseline, 2, 4, 6, and 12 months.

Subjects: Veterans participating in any type of CIH approach at 2 Veterans Affairs medical centers.

Measures: Mixed hierarchical models with repeated variables were used to test the hypothesis that participating in any CIH approach would be associated with Veterans' overall physical/mental health [Patient-Reported Outcomes Measurement Information System 28 (PROMIS 28)], pain intensity, perceived stress (Perceived Stress Scale-4), and engagement in their care (Patient Activation Measure-13), controlling for age, male sex, site, participation in other CIH approaches, and surveys completed.

Results: We received 401 surveys from 119 Veterans (72% male, age range: 29-85 y) across all timepoints. Yoga participation was related to decreases in perceived stress (P<0.001), while tai chi participation was associated with improvements in overall PROMIS 28 physical and mental health functioning (P<0.02). Specific types of CIH were associated with significant improvements in PROMIS 28 subscales: meditation participation with physical functioning at 2, 6, and 12 months; tai chi participation with anxiety at 2 and 6 months, and ability to participate in social role activities at 2 months. No CIH approach was associated with Veterans' pain or engagement in their care.

Conclusion: As specific CIH approaches are associated with improvements in patient-reported outcomes, clinicians, Veterans, and family members may use this information in discussions of nonpharmacological options to address health and well-being.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Complementary Therapies / statistics & numerical data*
  • Female
  • Health Status
  • Humans
  • Integrative Medicine / statistics & numerical data*
  • Longitudinal Studies
  • Male
  • Mental Health
  • Middle Aged
  • Pain Management
  • Pain Measurement
  • Patient Participation
  • Patient Reported Outcome Measures*
  • Stress, Psychological / therapy
  • United States
  • United States Department of Veterans Affairs
  • Veterans / statistics & numerical data*
  • Veterans Health