Enhancing Evidence-Based Practice for Emerging Therapeutic Modalities in Rehabilitation, Integrative, and Preventive Medicine

Abstract

Within emerging therapeutic modalities, cupping therapy (CT) has gained increasing visibility across rehabilitation, integrative, and preventive medicine, particularly following the 2016 Rio Olympics, when elite athletes displayed visible cupping marks. In the United States, however, the rapid rise in public and clinical interest has outpaced the development of standardized safety guidelines, regulatory oversight, and competency-based training. This dissertation addresses these gaps through six chapters and advances a framework for strengthening evidence-based practice, patient safety, and workforce preparedness. Chapter I establishes the clinical and conceptual foundation of cupping therapy modalities (CTM), outlining their historical development, proposed mechanisms of action, and relevance across rehabilitation, integrative, and preventive healthcare. It argues that CTM should be evaluated not merely as traditional practices, but as emerging therapeutic modalities requiring the same standards of safety, evidence, and professional accountability expected in modern healthcare. Chapter II presents a systematic review of literature published between 2016 and 2023 and develops a novel safety taxonomy for adverse events, providing a standardized framework for categorizing clinical risks and highlighting the need for clearer terminology, stronger safety reporting, and greater procedural consistency. Chapter III examines the regulatory landscape of CT in the United States. Findings reveal substantial fragmentation in terminology, oversight, and scope of practice across states, underscoring the need for greater policy alignment to improve patient safety, administrative clarity, and consistent professional standards. Chapter IV investigates health science students’ perceptions and knowledge of CTM using the TPB. Subjective norms were the strongest predictor of intention, while limited academic exposure contributed to insufficient formal preparation and skill development among future providers. Chapter V evaluates a theory-based educational intervention grounded in the Theory of Planned Behavior and the Health Belief Model. Among 84 participants, knowledge increased from 9.67 to 16.30 with a large effect size (d = 1.22), and the integrated model explained 69.4% of the variance in behavioral intention. Subjective norms, attitude, and perceived barriers emerged as the most influential determinants of readiness for future clinical integration. Chapter VI synthesizes these findings and proposes a strategic framework to advance the safe, sustainable, and evidence-informed integration of CT into U.S. healthcare.