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Perspectives on the Effects and Mechanisms of Craniosacral Therapy: A Qualitative Study of Users’ Views
... Another way to measure the output of research in universities is the number of successful PhD completions and this is also counts in the REF. A PhD usually provides the opportunity for a researcher to really focus on an area of special interest and provides a good starting point for a career, (not only in terms of developing research skills but can provide opportunities to publish at an early stage) [1,2]. If able to carry out research while an undergraduate and publish, this promotes the students enthusiasm for research as well as kudos [3]. ...
... Evidence regarding its effectiveness or mechanisms of action is limited. A qualitative study of 29 users' expectations and the effects they attributed to CST is explored in Brough et al's article [2]. All participants reported positive health changes and most attributed these to CST. ...
... (15) A qualitative study found that people usually opt for CST for numerous chronic disorders such as back pain, headache, chronic fatigue, anxiety, and depression. (16) A recent meta-analysis by Haller et al. suggested that CST can have significant effects in chronic pain disorders such as neck pain, backache, migraine, fibromyalgia, and pelvic pain. (17) However, the study reported only two randomized controlled trials (RCTs) (18,19) conducted in FMS. ...
Background:
Sleep disturbance is one of the key symptoms of fibromyalgia syndrome (FMS), which negatively affects the participants' quality of life. Craniosacral therapy (CST) is a gentle manual technique found to have significant effects on pain and function in chronic pain participants. However, limited evidence exists on its effectiveness on sleep quality in FMS participants.
Purpose:
To evaluate the feasibility and effectiveness of CST on sleep quality in FMS participants.
Setting:
Outpatient physiotherapy department of a hospital in Bangalore.
Participants:
Participants diagnosed with FMS.
Research design:
A pre/post pilot trial.
Intervention:
Once weekly, 45-minute sessions of CST for 12 weeks. The participants continued the standard medical care prescribed by the physician.
Main outcome measure:
The sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI) at baseline and 12 weeks. The data analysis was carried out using paired t test.
Results:
9 out of 10 included participants completed the treatment and were included for analysis. The results of the paired t test showed significant improvement in the global PSQI score (p = .001, mean difference = 5.44±3.28, 95% CI = 2.92-7.97), as well as the 5 components of PSQI (p < .05).
Conclusion:
CST was feasible to deliver with high retention, acceptability, and minimal adverse events. It significantly improved sleep quality in FMS participants along with standard medical care. However, future studies with larger sample sizes and appropriate control groups are required to confirm the findings.
... There are also important psychological processes through which outcomes may be achieved. These include the achievement of a trusting therapeutic relationship which facilitates movement of patients into altered perceptual states which have been reported to facilitate a new awareness level in relation to the body, mind and spirit 71 . This systematic review found very limited evidence (one study) that craniosacral therapy added to standard obstetric care was superior to standard obstetric care alone for selected outcomes including pain intensity in the morning and disability in pregnant women with pelvic pain 39 . ...
Background
Majority of pregnant women experience pain and discomfort due to musculoskeletal conditions; with over a quarter experiencing some disability; all of which reduce quality of life during pregnancy. Community-based non-pharmacological interventions are more affordable, accessible, and acceptable, and have the capacity to reduce inequalities.
Objectives
To summarise community-based non-pharmacological interventions and determine their effectiveness for improving pain, disability, and quality of life amongst pregnant women with musculoskeletal conditions.
Search Strategy
Twelve bibliographic databases (and reference list of relevant systematic reviews) were searched from inception until March 2022.
Selection Criteria
All primary studies of community-based non-pharmacological interventions for pregnant women with musculoskeletal conditions reported in English which investigated pain, disability and quality of life were included.
Data Collection and Analysis
Data were extracted using modified Cochrane’s data extraction template. Studies were appraised using Cochrane Collaboration’s risk of bias tool. Narrative synthesis was used to summarise findings. This review registration number with PROSPERO is CRD42020189535.
Main Results
33 studies involving 4,930 pregnant women with low back pain, pelvic pain, and lumbopelvic pain. Osteopathic manipulation plus standard obstetric care produced significantly superior reduction in pain intensity and disability than sham ultrasound therapy plus standard obstetric care amongst pregnant women with low back pain (moderate level of evidence). There was limited or conflicting evidence for other results. Acupuncture was more effective than placebo in reducing disability/sick leave but not pain intensity and quality of life. There was little or no added benefit of craniosacral therapy to standard obstetric care. Exercise and spinal manipulative therapy were equally effective, and better than no treatment. Home versus in-clinic exercise and aquatic versus land-based exercise were similar in effectiveness with conflicting evidence when compared with standard obstetric care. Wide flexible lumbopelvic belts or the addition of textured sacral pad was better than thin rigid lumbopelvic belts, belts without padding, or no belt. Kinesiotaping may not be better than placebo. Effectiveness of self-management programmes was inconsistent.
Conclusions
Community-based non-pharmacological interventions were better than no treatment and were better or as effective as standard obstetric care in improving pain intensity, disability, and quality of life.
... Craniosacral Therapy (CST) is a hands-on mind-body modality that has its origin in Osteopathy [7] and has been reported to support positive outcomes in the areas of physical, mental, social relational and spiritual wellbeing [8]. CST has also been used with patients who have long term conditions such as chronic lower back pain [9] and fibromyalgia [9][10][11]. ...
Introduction
: Post covid-19 syndrome or Long Covid has been estimated to impact 1.3 million individuals in the UK. This study evaluates the outcomes of delivering a complementary Long Covid support service using psycho-educational and mind-body approaches within a community setting.
Methods
: This study utilised quantitative methods to evaluate the outcomes of implementing a complementary approach to Long Covid support. The service offered a package of care including group sessions combining psychoeducation and mind-body complementary approaches and optional 1:2:1 sessions (physiotherapy and craniosacral therapy (CST)). Screening for the service and health information was obtained using the Covid-19-Yorkshire Rehabilitation Screening tool (C-19 YRS). The impact of the service was assessed using the patient reported outcome measure: Warwick Holistic Health Questionnaire (WHHQ-18), and a survey was designed for general evaluation and feedback about the service from participants.
Results
: N=25 participants engaged with the service. The C-19YRS proved to be a useful tool to screen service users. The WHHQ-18 highlighted a positive group change (n=16) in participants’ mental, physical, emotional, and spiritual wellbeing: mean group score at the start = 33.7 (SD=12.5), mean group score at the follow up = 39.5 (SD=10.8). In the feedback from the service evaluation, participants reported that the service was useful in supporting them with their health challenges because of Long Covid and was delivered to the standard expected.
Conclusion
: In conclusion the psycho-educational and mind-body complementary approaches used within this service were well received and the measures used to evaluate were suitable for a service delivered within a community setting.
... Mild, transient side effects of CST are correspond l to those reported by other trials and reviews. 13,40,41 In patients with preexisting severe pathologies of the spine, the literature reported one serious adverse event. 42 Thus, CST can be considered as safe as other conventional or commentary manual therapies. ...
Background
Patients frequently use treatments complementary to standard primary care. This prospective cohort-study examined the use, benefits, and safety of Craniosacral Therapy (CST).
Methods
Consecutive out-patients utilizing CST from 2015 to 2019 were asked to provide anonymized data on symptom intensity, functional disability, and quality of life before and after treatment using an adapted 11-point numerical rating scale (NRS) version of the Measure Yourself Medical Outcome Profile (MYMOP). Treatment expectations were assessed as were concurrent therapies/medication and safety. Mean differences were analyzed using paired sample t-tests with 95% confidence intervals (CI), predictors of treatment response using linear regression modelling.
Results
CST therapists submitted 220 patient records (71.4% female) including 15.5% infants and toddlers, 7.7% children, and 76.8% adolescents and adults. Patients received on average 7.0 ± 7.3 CST sessions to treat 114 different, acute and chronic conditions. Symptom intensity significantly decreased by -4.38 NRS (95%CI=-4.69/-4.07), disability by -4.41 NRS (95%CI=-4.78/-4.05), and quality of life improved by 2.94 NRS (95%CI = 2.62/3.27). Furthermore, CST enhanced personal resources by 3.10 NRS (95%CI = 1.99/4.21). Independent positive predictors of change in the adapted total MYMOP score included patients’ expectations (p = .001) and therapists’ CST experience (p = .013), negative predictors were symptom duration (p < .002) and patient age (p = .021); a final categorical predictor was CST type (p = .023). Minor but no serious adverse events occurred.
Conclusions
In primary care, patients and parents of underage children use CST for preventive and therapeutic purposes. Considering the design limitations, CST appears to be overall effective and safe in infants, children, and adults.
... Besides releasing myofascial structures, CST intends to normalize sympathetic nerve activity, often increased in chronic pain patients, by modifying craniosacral body rhythms [10,11]. Reducing physiological arousal and switching to the parasympathetic mode [12] has been shown to enhance the body's ability for physiological regulation and tissue relaxation [13][14][15][16][17], and to decrease chronic pain [18,19]. While the specific mechanisms of CST are still understudied, clinical trials have shown preliminary evidence for CST on improving patient-reported outcomes, albeit with often unclear risk of bias due to limited methodological study quality [20][21][22]. ...
Objectives:
To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain.
Methods:
PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool.
Results:
Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups.
Discussion:
In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain.
Protocol registration at prospero:
CRD42018111975.
... Other studies where changes in neurobehavioral function were inferred related to CST being the primary treatment modality include: brain injury [25], chronic pain [26,27], dementia [28], and various pediatric issues [29][30][31]. CST was also shown to have a favorable effect on autonomic nervous activity in patients with subjective complaints [32], positive effects on health [33], and improved quality of life [34]. These and other studies show some improvements and clinical significance but do not stand up to rigorous empirical standards. ...
Objective: Present single case study of a 26 year old female with congenital agenesis of cerebellum and other congenital malformations who achieved fecal continence and measurable mobility improvements following a prolonged series of craniosacral therapy.
Design: Retrospective review of data based on several interviews with the patient’s mother, her primary caregiver and review of the medical record.
Setting: Community based private therapy clinic in the upper Midwest. Interventions: Craniosacral Therapy and minimal use of other therapies.
Results: Craniosacral Therapy over the course of 4 years contributed to unexpected attainment of fecal continence as well as other areas of functional improvements. The patient was 22 years of age at the time this therapy series began and had life-long neurogenic bowel and bladder dysfunction. Gains were indirectly achieved. Treatment had been initiated to address chronic pain from an older spinal surgery and sessions continued long term for health and wellness. Mobility improvements beyond pre-surgery status and fecal continence were a surprise to all parties involved.
Conclusion: Clinical significance of these outcomes stimulates curiosity as to the actual type of stimulation CST actually provides to the central nervous system and its effect upon neuroplasticity.
... 64 Pain relief, decreasing muscles tension, and the experience of deep relaxation and release were also reported by the interviewed patients treated with CST. 65,66 Further described results of CST included the reduction of state and trait anxiety, whereas depression levels were often not influenced significantly. 29,56 Adverse events have been reported only by 1 randomized controlled trial in detail, with temporarily increased symptoms and tiredness occurring most often. ...
Objectives: With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients.
Materials and Methods: A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20). The primary outcome was the pain intensity on a visual analog scale at week 8; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients’ global impression of improvement, and safety.
Results: In comparison with sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (�21mm group difference; 95% confidence interval, �32.6 to �9.4; P=0.001; d=1.02) and at week 20 (�16.8mm group difference; 95% confidence interval, �27.5 to �6.1; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% within the CST group, whereas 48% even had substantial clinical benefit. Significant between-group differences at week 20 were also found for pain on movement, functional disability, physical quality of life, anxiety and patients’ global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8. No serious adverse events were reported.
Discussion: CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.
Key Words: craniosacral therapy, manual therapies, neck pain, sham treatment, randomized controlled trial
... IM also addresses health as a complex system and treatment may deliver unexpected outcomes or new phenomena. These include a reassessment of presenting symptoms, a new level of health awareness [6] or simply surprises [3]. New levels of health awareness and reassessment of presenting symptoms both mean that the 'box' which the patient ticks to record their level of health at the outset of treatment becomes different with hindsight and ceases to be an appropriate benchmark for change. ...
... 64 Pain relief, decreasing muscles tension, and the experience of deep relaxation and release were also reported by the interviewed patients treated with CST. 65,66 Further described results of CST included the reduction of state and trait anxiety, whereas depression levels were often not influenced significantly. 29,56 Adverse events have been reported only by 1 randomized controlled trial in detail, with temporarily increased symptoms and tiredness occurring most often. ...
Introduction: Existing patient reported outcome measures (PROMs) do not capture all holistic outcomes observed in Traditional, Complementary and Integrative Medicine (TCIM). This study reports development and validation of a PROM to support research on craniosacral therapy (CST) and other TCIMs.
Methods: Using a conceptual framework and items developed and evaluated with clients and practitioners in a CST setting, a questionnaire was developed and tested using mixed methods approaches. Evaluation included an iterative process. Psychometric tests: structural validity (exploratory factor analysis, EFA), internal consistency (Cronbach's alpha), convergent validity (correlations with Warwick-Edinburgh Mental Wellbeing Scale, Short Form-12v2 (SF-12), Harry Edwards Healing Impact Questionnaire), repeatability and responsiveness (t-tests; intra class coefficients, ICC).
Results: The Warwick Holistic Health Questionnaire (WHHQ-18) was resolved covering mental, physical, emotional and spiritual wellbeing, self-awareness, engaging in life, responsibility for self, living in the moment and satisfaction with life.
EFA revealed four correlated sub-scales. Internal reliability was good (alpha=0.852). Convergent validity showed strong positive correlation with other wellbeing measures, but no correlation with health-related quality of life (SF-12). Repeatability testing showed good agreement (ICC=0.822) and no differences in scores for test-retest (paired t-test: t=0.355, p=0.723). Responsiveness analysis showed significant differences in scores (paired t-test t=6.15, p<0.001) with 46% of participants having an effect size of 0.5 or more.
Conclusion: WHHQ-18 is the first PROM developed for CST practice and captures outcomes important to TCIM more broadly. Good internal consistency, test-retest reliability and responsive at individual and group level make this new PROM an attractive resource for evaluators. Lack of convergent validity with SF-12 scales suggests WHHQ-18 be added to rather than replace HRQol measures in clinical studies.
Introduction
: There is no evidence supporting the importance of heart coherence in spiritual leadership, which describes a transformation process for increased adaptability. The study aims to evaluate heart coherence in craniosacral therapy as an indicator of spiritual leadership, determined by an Inner Life and Coherent Interaction among its variables. Heart coherence denotes the degree of order, harmony and stability in numerous physiological rhythms within the human body.
Methods
: A multilevel, quantitative, within-subjects, experimental research design was used in a convenience sample of 11 participants from a low and high experienced study group in craniosacral therapy. Spiritual leadership was measured using a questionnaire, while a heart sensor captured its coherence.
Results
: At the group level, the second group exhibited higher Spiritual Leadership (+18%) and a higher outcome, Spiritual Well-Being (+9%), with similar scores for Coherent Interaction. At the personal level, participants of the same group had higher Spiritual Leadership (+31%), higher Coherent Interaction (+14%), and higher Spiritual Well-Being (+11%). Individual Inner Life was 5% higher for participants of the first group. A repeated measure ANOVA on the pre and post means did not produce any significant difference in heart coherence for both groups.
Conclusion
: Findings support the hypothesis that Inner Life and Coherent Interaction can be usefully deployed to evaluate the emergence of Spiritual Well-being. The study could not provide evidence that heart coherence could be considered as an indicator of spiritual leadership, but results indicate a measurable variation and synchronization of heart coherence among participants during a craniosacral therapy session.
Aim: To investigate the importance of the latest results of scientific work in the suboccipital region regarding the principle of structure-function-relationship of Osteopathy. Also to investigate the meaning of these results for applying manual and osteopathic techniques to the structures of the suboccipital region and to incorporate these results to the daily clinical work.
Studydesign: A narrative review, to investigate the latest outcome of scientific work, related to the suboccipital region and its structures and functions.
Methods: Search for defined keywords in the field of the suboccipital region unseing the onlinelibaries Pubmed, Google-Scholar and the Osteopathic Medical Digital Repository (Ostemed) and narrative description of the results.
Results: The existance of the myodural bridge has been proven in various structures and it has functions, regarding the stabilisation of the cervical dura, its influence on cerebospinal fluid circulation and ist meaning for the pathophysiology of various headache and circulation-dissorders supports the biomechanical (n = 36), circulatory (n = 9) and neurological (n = 17) models of the structure-function-relationship. Also the anatomical connection of the first spinal nerve and the hypoglossal nerve and their common branches to the atlanto-occipital joint fits in to these concepts. It also seems that the manual interventions in the suboccipital region are able to modulate nociceptive input, mobilize restricted structures and influence the static of the craniocervical junction.
Conclusion: The results are supporting the biomechanical, circulatory and neurological models of the structure-function-relationship. There is only poor research regarding the biopsychosocial or bioenergetic model. It seems that manual and ostepathic techniques are able to treat the dysfunctions of the described structures and the results may support craniosacral concepts just like the neurodynamic and sacro-occipital concepts of physiotherapists or chiropractors.
Keywords: Suboccipital area, suboccipital muscles, craniocervical junction, atlanto-axial joint, atlanto-occipital joint, myodural bridge, craniosacral osteopathy
The Healing Warriors Program is a non-profit organization aiming to improve the quality of life for veterans suffering from Post-Traumatic Stress Disorder and Traumatic Brain Injury through alternative healing modalities. This article describes how various hypotheses were tested using data consisting of 3387 observations gathered on pre-treatment and post-treatment anxiety, pain, and emotion to determine significant differences in these quality of life metrics. After grouping clients by treatment number and modality, hypothess testing determined short-term improvement across all modalities. Meanwhile, a regression analysis showed varied long-term effect on quality of life metrics.
Introduction: Craniosacral Therapy (CST) is a 'body based' complementary or alternative medical practice which aims to support natural healing mechanisms. There is limited evidence regarding its effectiveness or mechanisms of action. Methods: Qualitative study based on constant comparative methods informed by grounded theory. Semi-structured interviews explored 29 participants' experiences with CST. Inductive thematic analysis resulted in themes, concepts and illustrative quotes. Results: Participants consulted for pain relief, emotional and psychological issues and help with rehabilitation. All but four participants reported improvement in at least two of the three dimensions of holistic wellbeing: body, mind and spirit, others in one. Experiences during CST included altered perceptual states and other specific sensations and emotions. The importance of the therapeutic relationship was emphasized. Theory emerging from this study regarding CST and the ways in which healing can be enabled holistically suggests that the establishment of a trusting therapeutic relationship enables CST to take clients into altered perceptual states; these in turn facilitate a new level of awareness regarding the interrelatedness of body, mind and spirit, together with an enhanced capacity to care for self and manage health problems. Conclusion: All participants in this study observed positive changes in their health status and most attributed these to CST; these changes were frequently accompanied by new levels of health awareness which enhanced participants' capacity to self-care. Interviewees were self-selected users of CST and the data are therefore subject to certain methodological biases.
The goal of this research was to provide insight into the full range of meaningful outcomes experienced by patients who participate in clinical trials of complementary and alternative medicine (CAM) therapies.
Data for this study were assembled from five randomized trials evaluating six different CAM treatments for back pain. A conventional qualitative content analysis was conducted on responses to open-ended questions asked at the end of telephone interviews assessing treatment outcomes.
A total of 884 study participants who received CAM therapies completed post-treatment interviews. Of these, 327 provided qualitative data used in the analyses.
Our analysis identified a range of positive outcomes that participants in CAM trials considered important but were not captured by standard quantitative outcome measures. Positive outcome themes included increased options and hope, increased ability to relax, positive changes in emotional states, increased body awareness, changes in thinking that increased the ability to cope with back pain, increased sense of well-being, improvement in physical conditions unrelated to back pain, increased energy, increased patient activation, and dramatic improvements in health or well-being. The first five of these themes were mentioned for all of the CAM treatments, while others tended to be more treatment specific. A small fraction of these effects were considered life transforming.
Our findings suggest that standard measures used to assess the outcomes of CAM treatments fail to capture the full range of outcomes that are important to patients. In order to capture the full impact of CAM therapies, future trials should include a broader range of outcomes measures.
Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately.
From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation.
The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains.
This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews.
We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire.
The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience.
We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide an innovative model for the development of truly patient-centered outcome measures. Although this instrument was designed and tested in a CAM-specific population, it may be useful in assessing multi-dimensional shifts in well-being across a broader patient population.
Spiritual healing, probably the oldest documented paramedical intervention, is a neglected area of research. In order to conduct further research into the effects of healing, a valid and reliable outcome measure is needed that captures the experience of individuals receiving healing (healees) and is not burdensome to complete. We aimed to develop such a measure.
A mixed methods design was used. Focus groups and cognitive interviews were used to generate and refine questionnaire items grounded in the experiences and language of healees (Study 1). The resulting questionnaire was tested and its formal psychometric properties were evaluated (Study 2). Participants were recruited from a spiritual healing sanctuary and via individual healers (including registered spiritual healers, Reiki practitioners, healers affiliated with churches).
In Study 1, 24 participants took part in 7 focus groups and 6 cognitive interviews. 29 common effects were identified and grouped into 7 discrete dimensions that appeared to characterize potentially sustainable effects reported by participants following their experiences of spiritual healing. In Study 2, 393 participants returned completed baseline questionnaires, 243 of whom completed the questionnaire again 1-6 weeks later. Exploratory factor analysis generated 5 subscales, based on 20 of the items: outlook, energy, health, relationships and emotional balance. These subscales demonstrated acceptable internal consistency, convergent validity and test-retest reliability. Three of the subscales and the whole questionnaire demonstrated good sensitivity to change.
We have produced a psychometrically sound healing impact questionnaire that is acceptable to healees, healers and researchers for use in future evaluations of spiritual healing.
The goal of this research was to provide insight into the full range of meaningful outcomes experienced by patients who participate in clinical trials of complementary and alternative medicine (CAM) therapies.
Data for this study were assembled from five randomized trials evaluating six different CAM treatments for back pain. A conventional qualitative content analysis was conducted on responses to open-ended questions asked at the end of telephone interviews assessing treatment outcomes.
A total of 884 study participants who received CAM therapies completed post-treatment interviews. Of these, 327 provided qualitative data used in the analyses.
Our analysis identified a range of positive outcomes that participants in CAM trials considered important but were not captured by standard quantitative outcome measures. Positive outcome themes included increased options and hope, increased ability to relax, positive changes in emotional states, increased body awareness, changes in thinking that increased the ability to cope with back pain, increased sense of well-being, improvement in physical conditions unrelated to back pain, increased energy, increased patient activation, and dramatic improvements in health or well-being. The first five of these themes were mentioned for all of the CAM treatments, while others tended to be more treatment specific. A small fraction of these effects were considered life transforming.
Our findings suggest that standard measures used to assess the outcomes of CAM treatments fail to capture the full range of outcomes that are important to patients. In order to capture the full impact of CAM therapies, future trials should include a broader range of outcomes measures.
For 3 years, children between 18 months and 12 years of age with and without recognized neurologic deficits were studied at the Osteopathic Center for Children. Their response to 6 to 12 osteopathic manipulative treatments directed to all areas of impaired inherent physiologic motion was estimated from changes in three sensory and three motor areas of performance. Houle's Profile of Development was used to compare neurologic with chronologic age and rate of development, and scores were age-adjusted. Results in children after treatment were compared with those following a waiting period without treatment. Neurologic performance significantly improved after treatment in children with diagnosed neurologic problems and to a lesser degree in children with medical or structural diagnoses. The advances in neurologic development continued over a several months' interval. The results support the use of osteopathic manipulative treatment as part of pediatric healthcare based on osteopathic medical philosophy and principles.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
A review of the extensive work by dentists Fonder and Smith to resolve temporomandibular joint (TMJ) syndrome shows awareness of the unity of the body and the effect of TMJ dysfunction on all body systems. However, the role of the craniosacral mechanism has not been appreciated sufficiently. Results of a retrospective study of 130 TMJ patients evaluated for craniosacral dysfunction over a 9-year-period are reported. More than 57 percent of the patients had a history of trauma. The number of upper cervical restrictions was also impressive. A viscerosomatic reflex is postulated as a mechanism for the association of cervical and cranial restriction of cervical and cranial restrictions and TMJ dysfunction. Osteopathic cranial treatment will assist resolution of TMJ symptoms and improve results with the dental splint. The benefits of a team approach by dentists and physicians are discussed.
Craniosacral findings were recorded for all patients with traumatic brain injury entering an outpatient rehabilitation program between 1978 and 1992. The average cranial rhythmic impulse was low in all 55 patients (average, 7.2 c/min). At least one cranial strain pattern was exhibited by 95%, and 87% had one or more bony motion restrictions. Sacral findings were similar to those in patients with low back pain. Although craniosacral manipulation has been found empirically useful in patients with traumatic brain injury, three cases of iatrogenesis occurred. The incidence rate is low (5%), but the practitioner must be prepared to deal with the possibility of adverse reactions.
Many people with chronic disease seek acupuncture treatment, despite it being largely excluded from Western state-funded health care systems. What benefits and problems do such people perceive and experience as important? To what extent do three subjective health questionnaires encompass and measure these treatment effects?
A longitudinal qualitative study, using a constant comparative method, informed by grounded theory. Each person was interviewed three times over 6 months and before each interview participants completed three health status questionnaires, EuroQol, COOP-WONCA charts, and MYMOP2. Semistructured interviews used open-ended questions to explore peoples' experiences of illness and treatment, and then used the cognitive interview technique to discuss their questionnaire responses.
Eight professional acupuncturists in seven different settings publicized the study to their patients. We interviewed a maximum variation sample of 23 people with chronic illness, who were having acupuncture for the first time.
In addition to changes in their presenting symptoms people experienced whole-person effects that were characterized by changes in strength and energy, and changes in personal and social identity. These effects were distinct but not divisible because of their interdependence and their complex and individual development over time. The health status questionnaires varied in their ability to reflect and measure these changes, and the whole person effects were often missed. After 6 months some people had changed their treatment goals and some individuals were still seeing health improvement. One person found that acupuncture exacerbated her symptoms.
Knowledge of the range, individuality, and varied temporal patterns of treatment outcomes can guide potential patients, clinicians, health care providers, and researchers. Qualitative methods have highlighted the strengths and weaknesses of different outcome questionnaires, and the importance of long-term follow-up. We plan to do further work on appropriate outcome questionnaire selection and development.
The present study investigated the experiences of users of complementary and alternative medicine (CAM) using a qualitative approach. In-depth interviews were conducted with 11 frequent users and analysed using interpretative phenomenological analysis (IPA). Results indicated that the patient-practitioner relationship and explanatory frameworks provided by CAM were perceived as important components of the therapeutic process, irrespective of treatment efficacy. CAM served a variety of functions beyond the explicit relief of symptoms by increasing energy and relaxation, facilitating coping and enhancing self/other awareness. It is therefore important that these wider effects are taken into account when evaluating complementary medicine in order to reflect patients' experiences accurately.
Evaluation of integrative health care (IHC) models is becoming increasingly important. One of the areas that requires further attention is the development of an appropriate set of outcome measures. The purpose of this study was: (1) to identify how cancer patients phrase and frame the beneficial outcomes they experienced from IHC, and (2) to develop recommendations for an appropriate outcome measures package for evaluation of IHC.
This study involved two different parts: (1) a secondary analysis of qualitative data consisting of transcripts from 42 personal interviews and three focus groups from previous studies related to IHC use by cancer patients; and (2) a content analysis of goal-setting data collected from patients attending an IHC clinic to categorize the type and range of their treatment goals.
Six types of benefits were identified: physical well-being, change in physiological indicators, improved emotional well-being, personal transformation, feeling connected, global state of well-being, and cure. Types of goals identified by patients confirmed these benefits and include: to improve state of being, to be cancer free, to have more energy, more effective pain management, and improved quality of life.
A patient's perspective is crucial in understanding the process and outcomes of intentional selfhealing. Assessing self-identified goals suggests the need for patient empowerment through participation in outcome evaluation. We present recommendations for an appropriate outcomes package that is relevant, practical, and based on patient experiences.
Changes in self-concept are an important potential outcome for many interventions for people with long-term conditions. This study sought to identify and evaluate outcome questionnaires suitable for quantifying changes in self-concept in people with long-term conditions, in the context of treatment with acupuncture and Chinese medicine.
A literature search was followed by an evaluation of three questionnaires: The Wellbeing Questionnaire W-BQ12, the Patient Enablement Instrument (PEI), and the Arizona Integrative Outcome Scale (AIOS). A convenience sample of 23 people completed the questionnaires on two occasions and were interviewed about their experience and their questionnaire responses. All acupuncturists were interviewed.
Changes in self-concept were common and emerged over time. The three questionnaires had different strengths and weaknesses in relation to measuring changes in self-concept. The generic AIOS had face validity and was sensitive to changes in self-concept over time, but it lacked specificity. The PEI was sensitive and specific in measuring these changes but had lower acceptability. The sensitivity of the W-BQ12 was affected by initial high scores (ceiling effect) and a shorter timescale but was acceptable and is suitable for repeated administration. The PEI and W-BQ12 questionnaires worked well in combination.
Changes in self-concept are important outcomes of complex interventions for people with long-term illness and their measurement requires carefully evaluated tools and long-term follow-up. The literature review and the analysis of the strengths and weaknesses of the questionnaires is a resource for other researchers. The W-BQ12 and the PEI both proved useful for this population and a larger quantitative study is planned.
This chapter concerns the philosophy underlying the Biodynamic model of osteopathy in the cranial field (BOCF). To do this we employ a Hegelian dialectic, a weave of BOCF principles with BOCF science, presented within an historical context. We will compare biomechanical OCF with Biodynamic OCF, or "left-brained versus right-brained cranial" as Fred Mitchell likes to quip. No treatment methods will be described here. Note that certain words in this article will be capitalized, indicating the usage of a defined BOCF meaning, not a standard dictionary sense. BOCF's legacy extends back to Hippocrates, as reflected in the Hippocratic Oath's axiom "do no harm," and its concern for our triune (body-mind-spirit) integrity. Threads of Paracelcus-style empiricism and Avicennian experimentalism colour the BOCF tapestry. The foundation of BOCF, however, is firmly grounded in the philosophy and practice of three osteopathic teacher-physicians, evolving from three lifetimes spent in general medical practice, working alongside the self-balancing, self-healing principles present in their patients. The first of these teacher-physicians is Andrew Taylor Still (1828-1917), who founded osteopathy in 1874. Dr. Still sought "the Health" in his patients, which was always present no matter how sick his patients presented. This concept was fundamental to Still's hands-on approach to care. "I love my patients," he declared, "I see God in their faces and their form" (Still 1908). The physician's task, Still always reminded his students, was to remove with gentleness all perceived mechanical obstructions to the free-flowing rivers of life (blood, lymph, and cerebro-spinal fluid). Nature would then do the rest. Still formulated innovative concepts regarding the cranium, the cranial nerves, and he famously proclaimed, "the cerebrospinal fluid [CSF] is the highest known element that is contained in the human body" (Still 1899). His treatment techniques included gentle pressure on cranial bones, for example in the treatment of pterygium (Still 1910). The second of these teacher-physicians is William Garner Sutherland (1873-1954), who founded Osteopathy in the Cranial Field (OCF). Dr. Sutherland was a student of Still and became imbued with Still's thinking, methods, and practice. Sutherland formulated his first cranial hypothesis as a student in 1899 while examining a temporal bone from a disarticulated skull. The thought struck him that its edges were bevelled like the gills of a fish, as if part of a respiratory system. Sutherland's 1899 revelation initiated a life-long evolution of thought, described in subsequent sections of this chapter. The third teacher-physician is James S. Jealous (1943-) whose Biodynamic Model of OCF (BOCF) has attracted great interest and controversy within the profession. Jealous adapted the term Biodynamic from his study of the German embryologist Erich Blechschmidt, and not from the Swiss philosopher Rudolf Steiner, although Steiner's Biodynamic concepts resonate with BOCF principles. For over 30 years Dr. Jealous has compiled oral histories from Sutherland's students, and he continues to research Sutherland's writings (both published and unpublished). This "work with the elders" enabled Jealous to compile an authoritative chronology of Sutherland's journey. Thus BOCF dedicates itself to the perceptual odyssey where Sutherland left off at the end of his life.
Central to the development of a sound evidence base for Complementary and Alternative Medicine (CAM) interventions is the need for valid, reliable and relevant outcome measures to assess whether the interventions work. We assessed the specific needs for a database that would cover a wide range of outcomes measures for CAM research and considered a framework for such a database.
The study was a survey of CAM researchers, practitioners and students. An online questionnaire was emailed to the members of the Canadian Interdisciplinary Network for CAM Research (IN-CAM) and the CAM Education and Research Network of Alberta (CAMera). The majority of survey questions were open-ended and asked about outcome measures currently used, outcome measures' assessment criteria, sources of information, perceived barriers to finding outcome measures and outcome domains of importance. Descriptive quantitative analysis and qualitative content analysis were used.
One hundred and sixty-four completed surveys were received. Of these, 62 respondents reported using outcome measures in their CAM research and identified 92 different specific outcomes. The most important barriers were the fact that, for many health concepts, outcome measures do not yet exist, as well as issues related to accessibility of instruments. Important outcome domains identified included physical, psychological, social, spiritual, quality of life and holistic measures. Participants also mentioned the importance of individualized measures that assess unique patient-centered outcomes for each research participant, and measures to assess the context of healing and the process of healing.
We have developed a preliminary framework that includes all components of health-related outcomes. The framework provides a foundation for a larger, comprehensive collection of CAM outcomes. It fits very well in a whole systems perspective, which requires an expanded set of outcome measures, such as individualized and holistic measures, with attention to issues of process and context.
Introduction: Craniosacral Therapy (CST) is a 'body based' complementary or alternative medical practice which aims to support natural healing mechanisms. There is limited evidence regarding its effectiveness or mechanisms of action. Methods: Qualitative study based on constant comparative methods informed by grounded theory. Semi-structured interviews explored 29 participants' experiences with CST. Inductive thematic analysis resulted in themes, concepts and illustrative quotes. Results: Participants consulted for pain relief, emotional and psychological issues and help with rehabilitation. All but four participants reported improvement in at least two of the three dimensions of holistic wellbeing: body, mind and spirit, others in one. Experiences during CST included altered perceptual states and other specific sensations and emotions. The importance of the therapeutic relationship was emphasized. Theory emerging from this study regarding CST and the ways in which healing can be enabled holistically suggests that the establishment of a trusting therapeutic relationship enables CST to take clients into altered perceptual states; these in turn facilitate a new level of awareness regarding the interrelatedness of body, mind and spirit, together with an enhanced capacity to care for self and manage health problems. Conclusion: All participants in this study observed positive changes in their health status and most attributed these to CST; these changes were frequently accompanied by new levels of health awareness which enhanced participants' capacity to self-care. Interviewees were self-selected users of CST and the data are therefore subject to certain methodological biases.
Whilst much research into alternative and complementary medicine use indicates that these practices enable experiences of control, agency and empowerment, few theoretically informed answers have been given to why and how consultations with alternative and complementary health practitioners facilitate experiences that are felt to be ‘healing’.This article utilizes theories of recognition in order to reflect on the healing experiences of women seeking health and wellbeing through varied forms of alternative and complementary medicine. I analyse the empowering and agency-giving aspects of alternative and complementary medicines, in particular in relation to wider societal conceptualizations of the self. This article is based on qualitative interviews with both practitioners and clients of varying alternative and complementary medicines.
This paper introduces the concept of treatment via the craniosacral system. It defines the components of the craniosacral system and the importance of viewing the body as a single entity. It attempts to show how the concept can be applied to many conditions treated by physiotherapy but in a non-invasive way.
A mixed methodology was used to explore the effects of craniosacral still point technique (CSPT) in 9 older adults with dementia. Participants were monitored at baseline (3 weeks), intervention (6 weeks), and postintervention (3 weeks) using the modified Cohen-Mansfield Agitation Inventory (M-CMAI). CSPT was implemented daily for 6 weeks by a certified craniosacral therapist. Findings indicated a statistically significant reduction in M-CMAI total and subscale scores during the intervention period. This reduction continued during postintervention for subscale scores of physical nonaggression and verbal agitation. Staff and family interviews provided convergent validity to the quantitative findings. Participants were also more cooperative during caregiving activities and displayed meaningful interactions.
Caring about others is a virtuous act but is it compatible, or indeed advisable, in academic research? This article considers the locus of ethical responsibility for work‐based practitioners, and considers ethics for researchers undertaking research within their own organisations. The authors argue that, as practitioner researchers, they are insiders who have insider knowledge not only of systems but also of the individuals they designate, for the purpose of the research, as subjects, and this creates for them a different ethical position than, say, for researchers able to research and then leave the context of their research space. It is argued that this context is one where an ‘ethics of care’ ought to prevail. The issue is raised of whether the ethical considerations practitioner researchers have to reflect upon ensure that, as researchers, they sufficiently take account of their position within the researched community and how an ‘ethics of care’ could be invoked to safeguard these personal and moral relations to others. The authors use the work of research students in the UK and Cyprus who have undertaken research for a professional doctorate as a case to illustrate these points.
Craniosacral therapy (CST) is an alternative treatment approach, aiming to release restrictions around the spinal cord and brain and subsequently restore body function. A previously conducted systematic review did not obtain valid scientific evidence that CST was beneficial to patients. The aim of this review was to identify and critically evaluate the available literature regarding CST and to determine the clinical benefit of CST in the treatment of patients with a variety of clinical conditions.
Computerised literature searches were performed in Embase/Medline, Medline(®) In-Process, The Cochrane library, CINAHL, and AMED from database start to April 2011. Studies were identified according to pre-defined eligibility criteria. This included studies describing observational or randomised controlled trials (RCTs) in which CST as the only treatment method was used, and studies published in the English language. The methodological quality of the trials was assessed using the Downs and Black checklist.
Only seven studies met the inclusion criteria, of which three studies were RCTs and four were of observational study design. Positive clinical outcomes were reported for pain reduction and improvement in general well-being of patients. Methodological Downs and Black quality scores ranged from 2 to 22 points out of a theoretical maximum of 27 points, with RCTs showing the highest overall scores.
This review revealed the paucity of CST research in patients with different clinical pathologies. CST assessment is feasible in RCTs and has the potential of providing valuable outcomes to further support clinical decision making. However, due to the current moderate methodological quality of the included studies, further research is needed.
Gastroesophageal reflux (GER) in infants can be a frustrating experience for caregivers. The cause of GER is often unknown. Traditional treatment approaches include positioning, formula changes, medications, and surgery, which often are unsuccessful or have undesirable side effects. This case study presents an effective, non-traditional treatment approach called CranioSacral Therapy.
(C)1996Aspen Publishers, Inc.
Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.
Abstract This article explores the relationship between connectedness and spiritual health. Three forms of connectedness are discussed: connecting with oneself, with others, and with a larger meaning or purpose. Eight connectedness skills are suggested. Combined, these skills may lead to an enhanced sense of spiritual well-being.
This study describes patients presenting for CranioSacral treatment, the conditions they present with, and the impact of treatment on both their symptoms and lives.
The records of 157 patients treated with Upledger CranioSacral Therapy (UCST) were reviewed. Seventy-three (73) patients had been treated by 10 different practitioners working independently and 84 patients were treated by a single practitioner working within the National Health Service.
Patients' ages ranged from neonates to 68 years. Seventy-four percent (74%) of patients reported a valuable improvement in their presenting problem. Sixty-seven percent (67%) also reported a valuable improvement in their general well-being and/or a second health problem. Outcome by diagnostic groups suggested that UCST is particularly effective for patients with headaches and migraine, neck and back pain, anxiety and depression, and unsettled babies. Seventy percent (70%) of patients on medication decreased or discontinued it, and patients' average general practitioner consultation rate fell by 60% in the 6 months following treatment.
The study suggests that further research into UCST as a treatment modality would be valuable for the abovementioned problems in particular.
In many countries, recent data on the use of complementary and alternative medicine (CAM) are available. However, in England, there is a paucity of such data. We sought to determine the prevalence and predictors of CAM use in England.
Data were obtained from the Health Survey for England 2005, a national household survey that included questions on CAM use. We used binary logistic regression modelling to explore whether demographic, health and lifestyle factors predict CAM use.
Data were available for 7630 respondents (household response rate 71%). Lifetime and 12-month prevalence of CAM use were 44.0% and 26.3% respectively; 12.1% had consulted a practitioner in the preceding 12 months. Massage, aromatherapy and acupuncture were the most commonly used therapies. Twenty-nine percent of respondents taking prescription drugs had used CAM in the last 12 months. Women (OR 0.491, 95% CI: 0.419, 0.577), university educated respondents (OR 1.296, 95% CI: 1.088, 1.544), those suffering from anxiety or depression (OR 1.341, 95% CI: 1.074, 1.674), people with poorer mental health (on GHQ: OR 1.062, 95% CI 1.026, 1.100) and lower levels of perceived social support (1.047, 95% CI: 1.008, 1.088), people consuming ≥ 5 portions of fruit and vegetables a day (OR 1.327, 95% CI: 1.124, 1.567) were significantly more likely to use CAM.
Complementary and alternative medicine use in England remains substantial, even amongst those taking prescription drugs. These data serve as a valuable reminder to medical practitioners to ask patients about CAM use and should be routinely collected to facilitate prioritisation of the research agenda in CAM.
Since the 1960s, in Western societies, there has been a striking growth of consumer interest in complementary or alternative medicine (CAM). In order to make this increased popularity intelligible this paper challenges stereotypical images of users' motives and the results of clinical studies of CAM by exploring bodily experiences of acupuncture, reflexology treatments, and mindfulness training. The study draws on 138 in-depth interviews with 46 clients, client diaries and observations of 92 clinical treatments in order to identify bodily experiences of health and care: experiences that are contested between forces of mastery, control and resistance. We discuss why clients continue to use CAM even when the treatments do not help or even after they have been relieved of their physiological or mental problems. The encounter between the client and CAM produces derivative benefits such as a fresh and sustained sense of bodily responsibility that induces new health practices.
To examine whether craniosacral therapy improves lower urinary tract symptoms of multiple sclerosis (MS) patients. A prospective cohort study. Out-patient clinic of multiple sclerosis center in a referral medical center. Hands on craniosacral therapy (CST). Change in lower urinary tract symptoms, post voiding residual volume and quality of life. Patients from our multiple sclerosis clinic were assessed before and after craniosacral therapy. Evaluation included neurological examination, disability status determination, ultrasonographic post voiding residual volume estimation and questionnaires regarding lower urinary tract symptoms and quality of life. Twenty eight patients met eligibility criteria and were included in this study. Comparison of post voiding residual volume, lower urinary tract symptoms and quality of life before and after craniosacral therapy revealed a significant improvement (0.001>p>0.0001). CST was found to be an effective means for treating lower urinary tract symptoms and improving quality of life in MS patients.
To determine whether the addition of chiropractic care including craniosacral therapy to a regimen of standard obstetric pregnancy results in fewer obstetric interventions during labor and delivery.
Retrospective, case-matched, static-group comparison.
The study group was obtained from a college faculty-based clinic and received chiropractic care in addition to their routine obstetrical care. The setting for the comparison group was unkown, but the care rendered was presumed to be primary medical obstetric care only.
A consecutive sample of 63 pregnant women who sought chiropractic care within the period under study. The reason for seeking care was not necessarily related to the pregnancy. The sample was primarily between 18 and 35 yr, non-Hispanic caucasian and primiparous. After selection and matching criteria, 35 patients remained in the study group.
Chiropractic care and craniosacral therapy delivered during pregnancy vs. unknown care within the same county.
Obstetric interventions during labor and delivery as reported by the birth attendant on the certificate of live birth.
No statistical differences were detected in the rates of obstetric interventions used during labor or delivery between the two samples. Approximate large-sample 95% confidence intervals are provided.
Because of the limitations in the design of the project, this study provides no evidence that the addition of chiropractic care and craniosacral therapy during pregnancy results in any observable benefit or detriment with regard to obstetric interventions used during labor and delivery and that chiropractic care for pregnancy-related neuromusculoskeletal disorders should not complicate labor or delivery.
To assess the sensitivity to within person change over time of an outcome measure for practitioners in primary care that is applicable to a wide range of illness.
Comparison of a new patient generated instrument, the measure yourself medical outcome profile (MYMOP), with the SF-36 health profile and a five point change score; all scales were completed during the consultation with' practitioners and repeated after four weeks. 103 patients were followed up for 16 weeks and their results charted; seven practitioners were interviewed.
Established practice of the four NHS general practitioners and four of the private complementary practitioners working in one medical centre.
Systematic sample of 218 patients from general practice and all 47 patients of complementary practitioners; patients had had symptoms for more than seven days.
Standardised response mean and index of responsiveness; view of practitioners.
The index of responsiveness, relating to the minimal clinically important difference, was high for MYMOP: 1.4 for the first symptom, 1.33 for activity, and 0.85 for the profile compared with < 0.45 for SF-36. MYMOP's validity was supported by significant correlation between the change score and the change in the MYMOP score and the ability of this instrument to detect more improvement in acute than in chronic conditions. Practitioners found that MYMOP was practical and applicable to all patients with symptoms and that its use increased their awareness of patients' priorities.
MYMOP shows promise as an outcome measure for primary care and for complementary treatment. It is more sensitive to change than the SF-36 and has the added bonus of improving patient-practitioner communication.
While a limited amount of data describe who seeks Chinese medicine care and for what conditions, there have been few attempts to explain what users think the care does for them, or why they value and "like" the care. This article presents such data via an analysis of a sample of 460 handwritten stories collected as part of a mixed quantitative qualitative survey of 6 acupuncture clinics in 5 states.
Quantitative data collected in this survey (Part I) showed that respondents were highly satisfied with their Chinese medicine care. The qualitative analysis found that respondents valued relief of presenting complaints as well as expanded effects of care including improvements in physiological and psychosocial adaptivity. In addition, respondents reported enjoying a close relationship with their Chinese medicine practitioner, learning new things, and feeling more able to guide their own lives and care for themselves. While these factors mesh well with Chinese medicine theory, respondents did not reveal familiarity with that theory. Instead, their language and experiences indicate familiarity with an holistic model of healthcare--and they seem to have experienced Chinese medicine care as holistic care.
This finding matters because it shows that respondents are not seeking an 'exotic' kind of healthcare, but are utilizing a homegrown, if nonmainstream, model of healthcare. The finding also matters because it shows that an holistic health delivery model is not only feasible, but currently exists in the United States: how Chinese medicine practitioners are trained, and how they subsequently deliver their care, could serve as a model for American healthcare reform.
The objective of this research was to review critically the scientific basis of craniosacral therapy as a therapeutic intervention.
A systematic search for and critical appraisal of research on craniosacral therapy was conducted. Medline, Embase, Healthstar, Mantis, Allied and Alternative Medicine, Scisearch and Biosis were searched from their start date to February 1999.
A three-dimensional evaluative framework with related appraisal criteria: (A) craniosacral interventions and health outcomes; (B) validity of craniosacral assessment; and (C) pathophysiology of the craniosacral system.
The available research on craniosacral treatment effectiveness constitutes low-grade evidence conducted using inadequate research protocols. One study reported negative side effects in outpatients with traumatic brain injury. Low inter-rater reliability ratings were found.
This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.
To examine satisfaction with complementary therapy among patients receiving treatment funded within the National Health Service (NHS).
Semi-structured interviews using a critical incident approach (n =49).
8 sites across England providing complementary therapy services within primary care.
Complementary therapies are experienced as ameliorating and curing conditions, including chronic problems. Patients also perceive complementary practitioners as being caring and value the development of a therapeutic relationship within which they are encouraged to take an active part in looking after their health. Positive experiences of complementary therapy use were contrasted with either a failure of orthodox medicine or a dislike of the orthodox treatments available to them. Very few negative aspects were reported.
Patient satisfaction was consistent across settings and type of therapy received. The findings reinforce messages from studies of users in the private sector, but also suggest that for NHS users commitment to treatment develops largely as a result of positive experience rather than prior beliefs. Implications of the findings for research and policy are considered.
In this keynote address, the author discusses perception of the body in the context of chronic illness compared with that of health. She describes changes that occur in illness with respect to time, space, morality, aesthetics, morality, technology, information, and interpersonal relationships using examples from her research, and explores the construction of illness and health identities.
A brief history of the word placebo was presented and the placebo effect was defined. Characteristic examples of prescientific medical treatment were described. The following conclusions were reached: The normative history of medical treatment until relatively recently is the history of the placebo effect. Although physicians prescribed what we now know to be useless and often dangerous medications and procedures for thousands of years, they maintained their positions of honor and respect throughout history because they did help their patients. This was possible because of the potent placebo effect. The placebo effect is related to the doctor-Patient relationship and a number of other factors derived from this relationship. The placebo effect is maximized by the closeness of the doctor-patient relationship in psychiatric treatment. Therapeutic efficacy should be studied and evaluated in the light of the methodological principles stemming from this knowledge.
Our understanding of acupuncture and Chinese medicine is limited by a lack of inquiry into the dynamics of the process. We used a longitudinal research design to investigate how the experience, and the effects, of a course of acupuncture evolved over time.
This was a longitudinal qualitative study, using a constant comparative method, informed by grounded theory. Each person was interviewed three times over 6 months. Semistructured interviews explored people's experiences of illness and treatment. Across-case and within-case analysis resulted in themes and individual vignettes.
Eight (8) professional acupuncturists in seven different settings informed their patients about the study. We interviewed a consecutive sample of 23 people with chronic illness, who were having acupuncture for the first time.
People described their experience of acupuncture in terms of the acupuncturist's diagnostic and needling skills; the therapeutic relationship; and a new understanding of the body and self as a whole being. All three of these components were imbued with holistic ideology. Treatment effects were perceived as changes in symptoms, changes in energy, and changes in personal and social identity. The vignettes showed the complexity and the individuality of the experience of acupuncture treatment. The process and outcome components were distinct but not divisible, because they were linked by complex connections. The paper depicts these results as a diagrammatic model that illustrates the components and their interconnections and the cyclical reinforcement, both positive and negative, that can occur over time.
The holistic model of acupuncture treatment, in which "the whole being greater than the sum of the parts," has implications for service provision and for research trial design. Research trials that evaluate the needling technique, isolated from other aspects of process, will interfere with treatment outcomes. The model requires testing in different service and research settings.