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Research: BLOOM and colleagues, Uni
Listed in Issue 56
Abstract
BLOOM and colleagues, University of Pennsylvania, USA performed an evaluation of randomized controlled trials on complementary and alternative medicine.
Background
The use of complementary and alternative medicine (CAM) is growing in all Western countries. The aim of this study was to evaluate the quality of randomized controlled trials (RCTs) for CAM interventions for specific diagnoses to assist informed clinical decision making.
Methodology
MEDLINE and related databases were searched for CAM RCTs. A visual review was performed of bibliographies, meta-analyses, and CAM journals. Inclusion criteria for review and scoring were blinded RCT, specified diagnosis and intervention, complete study published between January 1, 1966 and July 31, 1998 in an English-language, peer-reviewed journal. Two reviewers independently scored each study.
Results
More than 5,000 trials were found, but only 258 met all study inclusion criteria. The main cause for rejection (> 90%) was that the study was not a RCT or had no blinding. The mean score across 95 diagnosis/intervention categories was 44.7 (S.D. +/- 14.3) on a 100-point scale. Ordinary least-squares regression found date of publication, biostatistician as author or consultant, published in one of five widely read English-language medical journals and diagnosis/intervention category of hypertension/relaxation as significant predictors of higher scores.
Conclusion
The overall quality of evidence for CAM RCTs is poor but is improving slowly over time. This is comparable to that of biomedicine. Thus, most clinical decision making is provided without good evidence of benefit.
References
Bloom BS et al. Evaluation of randomized controlled trials on complementary and alternative medicine. International Journal of Technology Assessment in Health Care 16(1): 13-21. Winter 2000.
