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Uncontrolled therapeutic observations in complementary medicine—What is the benefit?
ARTICLE IN PRESS Abstracts / European Journal of Integrative Medicine 1 (2009) 223–260
and patients. Surprisingly, we found that the interviewed target groups consider the notion of health coaching as an advancement, which is understood as a multimodal setting. 10.1016/j.eujim.2009.08.071
PO-069 Uncontrolled therapeutic observations in complementary medicine—What is the benefit? Jens C. Tu¨rpa,b, Christian Endlerb a
School of Dentistry, University of Basel, Basel, Switzerland Interuniversity College for Health and Development, Graz/ Castle of Seggau, Austria
b
Objective: A considerable part of articles about complementary therapies focus on uncontrolled interventions administered in the context of clinical practice. According to the therapy-related hierarchy of scientific evidence /http://www.cebm.net/index.aspx?o=1025S, however, such publications are associated with a very low evidence level. Since a perceived positive therapeutic result gained after an uncontrolled intervention may be due to at least seven factors, six of which are unspecific [2], no conclusion can be drawn regarding a specific therapeutic effect (i.e., post hoc ergo propter hoc). Does that mean that such reports do not have any benefit? Method: A systematic search was carried out in electronic databases as well as in current textbooks on evidence-based medicine and complementary medicine. The reference lists of all relevant articles were perused. Results: The identified contributions suggest that the (anecdotal) information gained in uncontrolled therapeutic interventions may indeed be valuable, particularly in (but no limited to) the following cases:
detection of possible side effect, potential new therapeutic indications, and/or problems regarding compliance [1]; generation of new hypotheses [3].
Discussion: Vandenbroucke [3] suggested differentiating between two hierarchies of study design: one for intended effects of therapy (cf., /http://www.cebm.net/index.aspx?o=1025S) and another one for discovery and studying new explanations. In the latter hierarchy, the traditional ranking of the levels of evidence is reversed: uncontrolled interventions administered in the context of clinical practice (as well as findings in patient or laboratory data and in the literature) are given the greatest importance E-mail addresses: [email protected] (J.C. Tu¨rp), college@inter-uni. net (C. Endler).
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because they may serve as catalysts for follow-up research (using the traditional hierarchy), which in turn might lead to new knowledge regarding diagnosis, therapy, and/or prevention. This double strategy may open another door towards the concept of integrative medicine.
References [1] Eberhard R, Kori-Lindner C, Stammer H. Nicht-interventionelle Untersuchungen (qualifizierte Anwendungsbeobachtungen). Pharm Int 2006;68:542–50. [2] Ernst E. Observational studies. Focus Alternat Complement Ther 2007;12:153–4. [3] Vandenbroucke JP. Observational research, randomised trials, and two views of medical science. PLoS Med 2008;5:e67. 10.1016/j.eujim.2009.08.072
PO-070 The NADA-Protokoll-standardised groupacupunture for improvement of metal state in patients with different psychiatric diseases A. Ro¨be, J. Ro¨be, A. Yassouridis, U. Hemmeter Psychaitrisches Zentrum St. Gallen, St. Gallen, Switzerland Acupuncture provided for a single person is time- and cost consuming and there is less experience with acupuncture in psychiatric diseases because of the common opinion that acupuncture is not useful in acute crisis or severe phases of psychiatric diseases. In the 1970s a standardized earacupunture (NADAProtocol) for treatment of drug addiction provided for a group setting of patients was developed and showed positive clinical effects: relief of agitation and disturbance of sleep, reduction of stress and relaxing effect for patients with different mental problems. The method is used in a group setting on dressed patients without need of any detailed diagnostic steps. Therefore it is very time- and cost effective and works also well on severe sick patients. The goal of the study was to investigate the effect of earacupunture according to the NADA-protocol on general mental state additional to usual treatment in a psychiatric day care unit with mixed patients (main diagnosis field of schizophrenia, affective disorders, especially depression, anxiety –and somatoform disorders). The treatment was done once a week in a group session. In 6 month there were treated 27 patients, total treatments 211. 15 mental state characteristics were analysed. A significant advancement was demonstrated on following mental state characteristics: Lethargy [(F(4;48) ¼ 15.03, po0.0001], sleep disorder [(F(4;48) ¼ 7.16, po0.0001], anxiety [(F(4;48) ¼ 6.33, po0.0001], headache [(F(4;48) ¼ 3.95, p ¼ 0.007] and
and patients. Surprisingly, we found that the interviewed target groups consider the notion of health coaching as an advancement, which is understood as a multimodal setting. 10.1016/j.eujim.2009.08.071
PO-069 Uncontrolled therapeutic observations in complementary medicine—What is the benefit? Jens C. Tu¨rpa,b, Christian Endlerb a
School of Dentistry, University of Basel, Basel, Switzerland Interuniversity College for Health and Development, Graz/ Castle of Seggau, Austria
b
Objective: A considerable part of articles about complementary therapies focus on uncontrolled interventions administered in the context of clinical practice. According to the therapy-related hierarchy of scientific evidence /http://www.cebm.net/index.aspx?o=1025S, however, such publications are associated with a very low evidence level. Since a perceived positive therapeutic result gained after an uncontrolled intervention may be due to at least seven factors, six of which are unspecific [2], no conclusion can be drawn regarding a specific therapeutic effect (i.e., post hoc ergo propter hoc). Does that mean that such reports do not have any benefit? Method: A systematic search was carried out in electronic databases as well as in current textbooks on evidence-based medicine and complementary medicine. The reference lists of all relevant articles were perused. Results: The identified contributions suggest that the (anecdotal) information gained in uncontrolled therapeutic interventions may indeed be valuable, particularly in (but no limited to) the following cases:
detection of possible side effect, potential new therapeutic indications, and/or problems regarding compliance [1]; generation of new hypotheses [3].
Discussion: Vandenbroucke [3] suggested differentiating between two hierarchies of study design: one for intended effects of therapy (cf., /http://www.cebm.net/index.aspx?o=1025S) and another one for discovery and studying new explanations. In the latter hierarchy, the traditional ranking of the levels of evidence is reversed: uncontrolled interventions administered in the context of clinical practice (as well as findings in patient or laboratory data and in the literature) are given the greatest importance E-mail addresses: [email protected] (J.C. Tu¨rp), college@inter-uni. net (C. Endler).
259
because they may serve as catalysts for follow-up research (using the traditional hierarchy), which in turn might lead to new knowledge regarding diagnosis, therapy, and/or prevention. This double strategy may open another door towards the concept of integrative medicine.
References [1] Eberhard R, Kori-Lindner C, Stammer H. Nicht-interventionelle Untersuchungen (qualifizierte Anwendungsbeobachtungen). Pharm Int 2006;68:542–50. [2] Ernst E. Observational studies. Focus Alternat Complement Ther 2007;12:153–4. [3] Vandenbroucke JP. Observational research, randomised trials, and two views of medical science. PLoS Med 2008;5:e67. 10.1016/j.eujim.2009.08.072
PO-070 The NADA-Protokoll-standardised groupacupunture for improvement of metal state in patients with different psychiatric diseases A. Ro¨be, J. Ro¨be, A. Yassouridis, U. Hemmeter Psychaitrisches Zentrum St. Gallen, St. Gallen, Switzerland Acupuncture provided for a single person is time- and cost consuming and there is less experience with acupuncture in psychiatric diseases because of the common opinion that acupuncture is not useful in acute crisis or severe phases of psychiatric diseases. In the 1970s a standardized earacupunture (NADAProtocol) for treatment of drug addiction provided for a group setting of patients was developed and showed positive clinical effects: relief of agitation and disturbance of sleep, reduction of stress and relaxing effect for patients with different mental problems. The method is used in a group setting on dressed patients without need of any detailed diagnostic steps. Therefore it is very time- and cost effective and works also well on severe sick patients. The goal of the study was to investigate the effect of earacupunture according to the NADA-protocol on general mental state additional to usual treatment in a psychiatric day care unit with mixed patients (main diagnosis field of schizophrenia, affective disorders, especially depression, anxiety –and somatoform disorders). The treatment was done once a week in a group session. In 6 month there were treated 27 patients, total treatments 211. 15 mental state characteristics were analysed. A significant advancement was demonstrated on following mental state characteristics: Lethargy [(F(4;48) ¼ 15.03, po0.0001], sleep disorder [(F(4;48) ¼ 7.16, po0.0001], anxiety [(F(4;48) ¼ 6.33, po0.0001], headache [(F(4;48) ¼ 3.95, p ¼ 0.007] and