Adjunctive therapies in clinical practice
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Adjunctive Therapies in Clinical Practice: Definitions and General Use
Adjunctive therapies are additional treatments used alongside standard medical interventions to enhance patient outcomes. These therapies can be pharmacological, physical, psychological, or technological, and are applied across a wide range of clinical conditions, including sepsis, spasticity, acute and chronic pain, cancer, stroke rehabilitation, and more Girardis2024Schillebeeckx2022Teasell2022+3 MORE.
Adjunctive Therapies in Sepsis and Critical Care
In sepsis and septic shock, adjunctive therapies such as corticosteroids, blood purification, immunoglobulins, granulocyte/monocyte colony-stimulating factors, and specific immune therapies (like interferon-gamma, IL7, and AntiPD1) are frequently considered. However, there is a lack of strong clinical evidence supporting their effectiveness, and their use is often based on expert consensus rather than robust trial data . Similarly, in acute respiratory distress syndrome (ARDS), adjunctive strategies like neuromuscular blockade, prone positioning, extracorporeal membrane oxygenation, and inhaled vasodilators are inconsistently applied, with many patients not receiving any adjuncts despite potential benefits. More evidence-driven and consistent use of these therapies could improve outcomes .
Adjunctive Therapies in Rehabilitation and Spasticity Management
For patients with limb spasticity, especially after neurological injuries, adjunctive therapies are commonly used alongside botulinum toxin injections. The most frequently recommended interventions are active home exercise programs, stretching, and splinting. However, barriers such as lack of time, financial resources, and limited evidence restrict their broader use Schillebeeckx2022Ip2020. In stroke rehabilitation, adjunctive therapies are divided into those that stimulate the brain (e.g., repetitive transcranial magnetic stimulation, mental practice, virtual reality) and those that facilitate peripheral recovery (e.g., robotics, EMG biofeedback, constraint-induced movement therapy). Despite strong evidence, these therapies are underutilized in clinical practice, prompting calls for structured frameworks to guide their implementation .
Adjunctive Therapies in Pain Management
Adjunctive therapies play a significant role in managing both acute and chronic pain. For acute pain, immersive virtual reality (IVR) has shown moderate evidence for immediate and short-term pain reduction and some improvement in physical function, with minimal adverse effects. However, evidence for long-term benefits is limited, and more high-quality studies are needed . In chronic nonmalignant pain, combining exercise with psychoeducational approaches—such as communication, coping, and problem-solving strategies—can significantly reduce pain and improve function .
Adjunctive Therapies in Cancer Care
In cancer management, under-recognized adjunctive therapies such as exercise, stress-reduction techniques (mindfulness, yoga, massage), sleep management, dietary modifications, and selective supplements (e.g., aspirin, green tea, turmeric, melatonin) can improve quality of life and possibly survival. These interventions should be tailored to individual patients and are more effective when recommended by trusted healthcare providers .
Adjunctive Therapies in Dentistry and Reproductive Medicine
In endodontics, adjunctive therapies like antimicrobial photodynamic therapy, laser canal irradiation, ozone therapy, and ultrasonically activated irrigation have been studied for treating apical periodontitis. However, current evidence does not support their routine use due to insufficient and low-quality data . In IVF laboratories, many adjunct treatments (e.g., embryo glue, time-lapse imaging, preimplantation genetic screening) are offered without robust evidence of benefit. High-quality studies are needed before these adjuncts are routinely recommended to patients .
Barriers to Implementation and the Need for Evidence
Across all fields, common barriers to the use of adjunctive therapies include lack of strong evidence, limited clinician time, financial constraints, and inconsistent application in practice Girardis2024Schillebeeckx2022Duggal2020+3 MORE. There is a clear need for more rigorous research, standardized frameworks, and evidence-based guidelines to ensure adjunctive therapies are used effectively and safely.
Conclusion
Adjunctive therapies are widely used in clinical practice to enhance standard treatments across many medical fields. While some adjuncts have strong evidence and clear benefits, many are applied inconsistently or without sufficient supporting data. Overcoming barriers such as lack of evidence, time, and resources, and developing structured, evidence-based frameworks, are essential steps to optimize the use of adjunctive therapies and improve patient outcomes.
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