Positive Health Online

As complementary practitioners, research is not something we tend to think about instinctively.  Instead, we often associate research with conventional medicine, pharmacology and perhaps public health.  But there is now a viable and growing body of research in complementary therapies (CAM) and some excellent research that is available to us as practitioners.

As CAM practitioners, we may already be benefiting from research that has been done, for example, there is research documenting the ability of acupuncture to help improve low back pain and aid in the prevention of headaches and migraine; and there is ample evidence for the psychological benefits of massage therapy.[1]  Because of research, we now know much more about the significant number of people around the world who want and use various types of non-conventional approaches to maintain and improve health;[2] and through a number of different surveys, we are also seeing a change in awareness and increasing acceptance of CAM among GPs and other medical professionals.[3]  Without these and other high profile studies, CAM could not be as acceptable as it is today.  Even though the change in attitudes has been slow, it has been progressing over the last 20 years.  And yet, how many of us get the opportunity to learn how research is carried out, to appreciate what is good and what is bad research, or to really find out how research can help us develop ‘good practice’ within our own clinics and businesses?

Research into useful ways to improve practice is on the rise after a slow but steady start in the 1990s - mainly in the fields of health and education.  However, there has been a notable rise in funding for CAM research too thanks to an influx of grants from a number of countries including Europe (see the CAMbrella Project), Australia (see ARCCIM, Australian Research Centre in Complementary and Integrative Medicine), Canada (see IN-CAM Canadian Interdisciplinary Network for Complementary and Alternative Medicine Research), USA (see NCCAM National Center for Complementary and Alternative Medicine; and TRI, Touch Research Institute, Miami University) and the UK (see RCCM, Research Council for Complementary Medicine).[4] Even though this is a drop in the ocean compared to conventional research, we now have a strong research culture growing.  This has spawned new interest in developing high standards of practitioner research in a variety of complementary therapies and has started to fill the gap in knowledge about how, when and where to use different types of therapies to their best advantage – and many other questions relevant to practice. 

Here in the UK, this has resulted in an increased acceptance of CAM within the NHS and even led to an endorsement of some as therapies recommended by NICE (National Institute for Health and Care Excellence).[5] The recent launch of the CNHC (Complementary and Natural Healthcare Council)[6]  means that the NHS now endorses properly trained practitioners as accepted for referral by NHS doctors representing a number of therapies: Alexander Technique teaching;  Aromatherapy;  Bowen Therapy; Craniosacral Therapy; Healing; Hypnotherapy; Massage Therapy;  Microsystems Acupuncture; Naturopathy; Nutritional Therapy;  Reflexology;  Reiki;  Shiatsu; Sports Therapy; Yoga Therapy.   This is leading to a greater level of integration of some therapies by medical practitioners, creating a whole new vision of delivery, now often referred to as ‘Integrative Medicine’ (IM).[7]

Even though many therapists might find the idea of research intriguing, they may not be sure where they can develop the skills necessary to carry out their own research.  The answer is that UK universities and a variety of CPD courses are all providing interesting study options.  Today, research is very topical[8] and there are a variety of conferences, CPD, and degree level courses from highly regarded universities who now have well established research programmes in CAM.[9]  Even though practitioner research is not the place for a Randomised Controlled Trial, there are a variety of small scale studies that can substantially add to our collective knowledge and provide us with very useful and interesting information about how to develop ‘good practice’.  Just some of the ways that we can explore good practice through research are listed below with a research paper or reference at the end to give a flavour of the innovative work being done in CAM:

Case studies: This is probably one of the easiest approaches to understand.  Most practitioners/therapists do this all the time – reflect on their client cases.  The difference is, when you analyse a case study using rigorous research methods, you draw on other published case studies, comparing and contrasting your case with those in the published literature, and so develop your ideas on what might be the best way forward.  True, you cannot draw conclusions about the effectiveness of a particular treatment, but that is not the purpose of a case study.  What you can explore are the nuances of treatment, and the individual responses to treatment, and this may lead you to develop a theory that can later be tested in a different way by another researcher.  For example:

In 2004 Chen and Turner carried out an in-depth case study into the use of qi gong to improve serious multiple chronic conditions of high PSA, asthma, allergies, high blood pressure and oedema in the legs.  In this single case study, the patient was being treated for these conditions with medications.  Following an intensive qi gong instruction workshop, this white Caucasian male lost significant weight, came off all medications and recovered from both allergy and asthmatic symptoms as well as showing improvements of a return to normal BP and no swelling in his legs.  PSA also returned to normal levels.   See http://online.liebertpub.com/doi/abs/10.1089/107555304322849075?27&

These impressive results beg for more research to be done to discover the ways in which qi gong could be used for a variety of health problems!

Audits:  We have huge amounts of potential research data that go nowhere.  Everyone has case notes and untapped data regarding age, demographics, conditions being treated, types of treatments and treatment outcomes.  Unfortunately, this information just sits in files across the country in clinics and private practices.  If and when we choose to gather up that information into one or several clinical audits, we then have anonymised information that could be pooled with other clinics to build a much bigger picture of what is going on across the country and even around the world.  Currently, several acupuncture colleges in the UK are working on just such a pooling of information in order to build a large database of information that can then be interrogated by future researchers.  In a recent press release (2012) of data gathered at Northern College of Acupuncture student clinics, we showed promising results for several conditions that could also be investigated further:

Patients rated their most troublesome symptom using a severity scale that runs from 0 = "as good as it could be" to 6 = "as bad as it could be".  Figure 2 shows, for example, severity scores given by patients with irritable bowel syndrome (IBS), were reduced from an average score of 3.5 to just under 2.  Similar results also occurred for patients with other conditions.  This suggests that patients experienced a really worthwhile benefit. 

Other data gathered suggest further benefits, such as increased activity levels and an improved sense of well-being.  Initial indications are that symptoms became less severe over time and that improvements were sustained for at least 3 months, in some cases longer.

Although this research is in its early stages, these initial results are very encouraging - for each of the five conditions patients appear to have experienced worthwhile improvements.

Interviews/questionnaires and surveys:  Many students are already beginning to build their research skills by writing dissertations for a post-graduate degree and other types of studies.  An interesting way of approaching this research is to find out how therapists practise, how they make decisions, how clients feel about treatments, why clients/patients choose one type of therapy over another, what qualities they appreciate in a therapist – answers to all of these kinds of questions are easily gathered and analysed using interviews, questionnaires or larger surveys as a method.

Here are links to some interesting studies done by our own students at the Northern College of Acupuncture using these and other methods:

• What is the impact of a 12 month pilot acupuncture clinic in primary care? An evaluation of patient health outcomes, patient satisfaction and GPs’ views.
• Obesity: A literature review investigating the potential of acupuncture as an effective aid to weight loss.
• Information sources of dietary advice used by prostate cancer patients, the range of advice offered and patient uptake: a questionnaire survey
• An observational study of patients, practitioners and practice in clinical settings offering traditional Mongolian medicine in Mongolia.

So, the real question is, what do practitioners need to know to improve their practice?  What would they like to find out or measure?  Some readers will be practitioners who like to work with specific populations or conditions as a specialty.  What better way to improve knowledge than to research a topic that is of particular interest!  Other practitioners might want to be able to easily read and evaluate the research done by others.  Equally, some may wish to fill a gap in knowledge by using their own expertise to design a specific research project.  Whatever the interest might be, further study will enhance any practitioner’s knowledge and help them to understand the subtleties of treatments, to stay on the cutting edge of innovation in their particular field of interest, and to mark them out as someone with special knowledge, training and abilities.

As a remedial/sports massage therapist for nearly 20 years, I am passionate about practitioner developed research.  The questioning practitioner is really well-placed to identify the right types of questions to ask and yet also to appreciate the types of research design that are likely to resemble what actually happens in practice rather than just ‘in the laboratory’.  Properly designed research will get really useful information for your own practice and for others and will open up discussion and the sharing of new knowledge.    

As mentioned at the beginning of this article, CAM therapies are building a strong body of knowledge that everyone can use.  If you have not looked into the research that is openly available to you at no charge, try browsing some of these databases and libraries: 

• The complementary and Alternative Medicine Library and Information Service (CAMLIS) at http://www.uclh.org/Research/Pages/RandD.aspx
• The Cochrane Library for complementary and alternative medicine reviews: http://www.thecochranelibrary.com/view/0/browse.html?cat=ccochcomplementaryalternativemedicine
• Pubmed – freely available medical database http://www.ncbi.nlm.nih.gov/pubmed/?term=complementary+medicine
• DARE (database of abstracts of effectiveness http://www.crd.york.ac.uk/crdweb/

Please think about research.  You may have something vital to develop and share with others! 

References

1. Lee, J.H. et al, Acupuncture for acute low back pain: a systematic review, Clinical Journal on Pain, 29(2):172-85. http://www.ncbi.nlm.nih.gov/pubmed/23269281, 2013; Moyer, C.A. et al, A Meta-Analysis of Massage Therapy Research. Psychological Bulletin, 130(1):3-18 doi:10.1037/0033-2909.130.1.3 accessed 11/1/14 http://psycnet.apa.org/journals/bul/130/1/3/ 2004.
2. Bishop, F.L., Lewith, GT, Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use, Evidence-Based Complementary and Alternative Medicine, 7(1):11-28 at http://dx.doi.org/10.1093/ecam/nen023 2010.
3. Frass, M, et al Use and Acceptance of Complementary and Alternative Medicine Among the General Population and Medical Personnel: A Systematic Review. The Ochsner Journal: 12(1):45-56. Avail at http://www.ochsnerjournal.org/doi/abs/10.1043/1524-5012-12.1.45 2012.
4. See for example http://anh-europe.org/news/european-commission-to-fund-research-into-complementary-medicine; http://grants.nih.gov/grants/guide/pa-files/PAR-00-027.html;  Lewith, G. et al. Developing CAM research Capacity for Complementary Medicine, Evidence-Based Complementary and Alternative Medicine, 3(2):283-289; http://dx.doi.org/10.1093/ecam/nel007 2006.
5. NICE clinical guideline 88, Early management of persistent non-specific low back pain guidance.nice.org.uk/cg88 at  http://www.nice.org.uk/nicemedia/live/11887/44343/44343.pdf 2009.
6. CNHC see http://www.cnhc.org.uk/index.cfm?page_id=3
7. Welch, P, et al, Working  at  the  coalface:  Using  action  research  to  study  ‘integrative medicine’  in  the  NHS, European  Journal  of  Integrative  Medicine 2012.  http://dx.doi.org/10.1016/j.eujim.2012.08.004
8. E.g. RCCM, ACHRN, ATPRN (Art Therapy Practice Research Network Symposium, Friday 4th April 2014, "PRACTICE BASED RESEARCH AND EFFECTIVENESS", Acupuncture?
9. Westminster, Southampton, Middlesex, Cardiff, Lincoln to  name only a few.

Further Information

If you would like to find out more about research or for further information, please contact Peggy Welch at peggywelch@chinese-medicine.co.uk  www.chinese-medicine.co.uk/

See our new on-line MSc courses* (subject to validation) and further CPD Options!

 * MSc in Advanced Oriental Medicine (Research and Practice)  www.chinese-medicine.co.uk/studying/online-msc-courses/

 * MSc in Advanced Complementary Medicine (Research and Practice) www.chinese-medicine.co.uk/studying/online-msc-courses/