Remote Delivery of Mindful Movement Within Healthcare Systems: Lessons Learned From the Veterans Health Administration.

Mindful Movement approaches have been a growing part of the Veterans Health Administration (VA). Innovations in tele-health technology had been an important initiative before the public health emergency to meet the needs of rural veterans as well as challenges in getting to a physical location for care. The onset of the COVID-19 pandemic accelerated this transition to tele-delivery of many practices including mindful movement. This paper aims to share lessons learned from virtual delivery of mindful movement as part of clinical and well-being programs in VA. Benefits of virtual care discussed include the convenience and decreased travel burden; accessibility for adaptive movement options; translation to home practice; and shifting the emphasis to interoceptive skills-building supportive of self-efficacy for exploring and identifying safe movement. Important challenges are also identified such as technology related barriers; teachers trained to meet the need of offering adaptations for a heterogenous population and supporting interoceptive skill-building; and supporting both physical and psychological safety. Examples are provided of medical groups incorporating virtual mindful movement within programs for diabetes and pain care to further explore the potential benefit of these practices being integrated within the care itself, rather than as a separate practice. It is hoped that the lessons learned will provide support for Veterans and staff, and the wider health care community, in what they need to participate in virtual care that is high quality, accessible, and meets the needs for greater health and well-being.

Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization.

Background: While there is recognition by the greater medical community and physical therapists to address the biopsychosocial needs of people with chronic, persistent pain, there are challenges in implementation and delivery including wide variability in interventions, lack of clear rationale, and absence of clinical models that are feasible and acceptable on a large scale. Important components for psychologically informed physical therapy (PiPT) for pain care include behavioral approaches (e.g., Acceptance and Commitment Therapy), mindfulness, pain neuroscience education, motivational interviewing (MI), and interoceptive skills-building. The Empower Veterans Program (EVP) Mindful Movement framework blends these components and emphasizes a mindfulness and self-compassion approach with MI and body-based experiential learning. This program was offered in-person at the Atlanta and Maryland VA Health Care Centers with published positive Patient Reported Outcomes (PRO) pre-COVID 19 crisis and shifted to entirely remote delivery in March 2020. Objective: This paper offers an evidence-based and theory driven framework to operationalize a remotely delivered group-based psychologically informed mindful movement physical therapy intervention as part of an interdisciplinary pain care program. Methods: Since 2021 PRO and demographics are collected using a survey administered through Qualtrics over a 12-month period at baseline, immediately post TelePain EVP, at 6 months, and at 12 months, with findings forthcoming. Discussion/Results: Tele-pain EVP offers 6-9 groups a week with 7-9 veterans from Atlanta based team and 3-4 groups a week with 5-9 veterans from Maryland based team. Adaptations for remote delivery optimized mindfulness and active learning strategies including interoceptive skills-building and use of MI to support self-efficacy to trust, restore a sense of safety in the body, and explore adaptations for safe movement. Conclusion: TelePain-EVP Mindful Movement provides a framework for other programs to translate for their populations and systems to further develop best practices in PiPT for pain care and integration into interdisciplinary care.

Guiding Principles for the Practice of Integrative Physical Therapy.

Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition. IMPACT: This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care.

Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience.

Yoga therapy is a newly emerging, self-regulating complementary and integrative healthcare (CIH) practice. It is growing in its professionalization, recognition and utilization with a demonstrated commitment to setting practice standards, educational and accreditation standards, and promoting research to support its efficacy for various populations and conditions. However, heterogeneity of practice, poor reporting standards, and lack of a broadly accepted understanding of the neurophysiological mechanisms involved in yoga therapy limits the structuring of testable hypotheses and clinical applications. Current proposed frameworks of yoga-based practices focus on the integration of bottom-up neurophysiological and top-down neurocognitive mechanisms. In addition, it has been proposed that phenomenology and first person ethical inquiry can provide a lens through which yoga therapy is viewed as a process that contributes towards eudaimonic well-being in the experience of pain, illness or disability. In this article we build on these frameworks, and propose a model of yoga therapy that converges with Polyvagal Theory (PVT). PVT links the evolution of the autonomic nervous system to the emergence of prosocial behaviors and posits that the neural platforms supporting social behavior are involved in maintaining health, growth and restoration. This explanatory model which connects neurophysiological patterns of autonomic regulation and expression of emotional and social behavior, is increasingly utilized as a framework for understanding human behavior, stress and illness. Specifically, we describe how PVT can be conceptualized as a neurophysiological counterpart to the yogic concept of the gunas, or qualities of nature. Similar to the neural platforms described in PVT, the gunas provide the foundation from which behavioral, emotional and physical attributes emerge. We describe how these two different yet analogous frameworks-one based in neurophysiology and the other in an ancient wisdom tradition-highlight yoga therapy's promotion of physical, mental and social wellbeing for self-regulation and resilience. This parallel between the neural platforms of PVT and the gunas of yoga is instrumental in creating a translational framework for yoga therapy to align with its philosophical foundations. Consequently, yoga therapy can operate as a distinct practice rather than fitting into an outside model for its utilization in research and clinical contexts.

Toward an Explanatory Framework for Yoga Therapy Informed by Philosophical and Ethical Perspectives.

Context • Yoga Therapy is an emerging complementary and integrative health practice for which there is increasing interest from both clinical and research perspectives. Currently missing, however, is an explanatory framework for the profession that provides practitioners, clients, and the public with an understanding of how various yogic traditions and principles can be understood in modern health care contexts. Objective • This study proposes an explanatory framework for yoga therapy, informed by phenomenology, eudaimonia, virtue ethics, and first-person ethical inquiry. Conclusions • These 4 philosophical perspectives-phenomenology, eudaimonia, virtue ethics, and first-person ethical inquiry-provide a lens through which to understand how yogic practices support the individual's transformation in the experience of illness, pain, or disability. We propose that this transformation occurs through facilitating a reharmonization of body, mind, and environment toward the experience of eudaimonic well-being.