While most qualitative and quantitative clinical and epidemiological research methods are applicable to the evaluation of naturopathic medicine, some models and refinements are being developed specifically for the context of naturopathic healthcare. The studies listed here are reflective of these developments.
Altern Ther Health Med. 2006 Jul-Aug;12(4):20-8.
A method for describing and evaluating naturopathic whole practice.
Herman PM, Sherman KJ, Erro JH, Cherkin DC, Milliman B, Adams LA.
Department of Psychology, University of Arizona, Tucson.
CONTEXT: Even though complementary and alternative medicine (CAM) is generally practiced as distinct systems of medicine, almost all CAM research has focused on single therapies. In order to more adequately evaluate the effectiveness of these medical systems, studies that evaluate the outcome of intact whole systems are needed. One challenge lies in defining the whole medical system (and any medical system it is compared to) in a way that ensures treatment fidelity. OBJECTIVE: This paper presents a proposed method to measure treatment fidelity (treatment criteria) in studies of the naturopathic medical system. DESIGN: Illustrative example of the theory-based development and post-hoc "testing" of treatment criteria against an existing database of actual treatments prescribed by a random sample of naturopathic physicians. MAIN OUTCOME MEASURES: Treatment criteria for 3 conditions--menopausal symptoms, bowel dysfunction, and fatigue/fibromyalgia--and their comparison to actual treatments prescribed. RESULTS: A set of meaningful, measurable treatment criteria based on the naturopathic practice principles were defined that could have generated the majority (82%-93%) of treatment prescriptions given at visits for these conditions. Several of the treatment criteria components are common across the 3 conditions studied, and might be appropriate for all visits to doctors of naturopathy (NDs). Others are specific to each condition. In addition to ensuring model validity, these criteria help identify critical components of care, enable study replication, provide a measure of quality of care, and are one step toward allowing CAM to be studied as it is generally practiced-as distinct systems of medicine. SETTING: Work was performed at Bastyr University and the University of Arizona.
PMID: 16862739
Altern Ther Health Med. 2005 Jan-Feb;11(1):52-6.
Development of an integrative patient history intake tool: a Delphi study.
Lindahl MG, Barrett R, Peterson D, Zheng L, Nedrow A.
Benton County Health Department in Corvallis, Ore, USA.
OBJECTIVE: To identify patient history intake questions common to four fields of medicine--allopathic, naturopathic, chiropractic, and Traditional Chinese Medicine for potential development of an Integrative Patient History Intake Tool. DESIGN: A two-round modified Delphi technique was utilized to generate expert consensus among Oregon healthcare practitioners on the importance of specific patient history intake questions. A panel of faculty members from Oregon Health & Sciences University (OHSU), the National College of Naturopathic Medicine (NCNM), the Oregon College of Oriental Medicine (OCOM), and Western States Chiropractic College (WSCC) identified 321 patient history intake questions, which then were distributed to 106 Oregon healthcare practitioners. The healthcare practitioners were asked to rate the importance of each question through a series of two surveys over the period of 11 weeks. Suggestions for additional intake questions also were invited. RESULTS: The Delphi process resulted in the original 321 initial questions plus 150 additional suggested questions being reduced to 52 intake questions (11% total similarity) for the potential development of the Integrative Patient History Intake Tool. There was a 63% response rate to SURVEY I, and a 73% response rate for SURVEY II. CONCLUSION: The concept of attempting to develop an integrative patient history intake tool is important to improve communication between practitioners of allopathic, naturopathic, chiropractic, and Traditional Chinese Medicine. This study revealed insight into the difficulties faced with such a tool due to the lack of similarity in priorities of questions between these different disciplines. This may also reveal a component of why communication remains difficult between these fields, but should not deter efforts to increase communication in the interest of optimal patient care.
PMID: 15712766
J Altern Complement Med. 2004; 10(3): 506- 513.
Implementation of outcome measures in a complementary and alternative medicine clinic: evidence of decreased pain and improved quality of life.
Secor ER, Blumberg JH, Markow MJ, MacKenzie J, Thrall RS.
Objectives: The purpose of this study was twofold: (1) to design and implement a practical data collection sys- tem capable of obtaining pain and quality-of-life outcome measures in a complementary and alternative medicine (CAM) outpatient clinic and (2) to evaluate changes in patient status over time using these objective measures.
Design: A prospective study was carried out in an outpatient practice based setting. Scannable forms were designed utilizing Cardiff's TELEform® system (Cardiff Software, Inc., Vista, CA) for data collection. Setting/location: This study was conducted at Special Care Holistic Wellness Connection, an urban-based, hospital-affiliated, CAM clinic in Connecticut. Subjects: Inclusion criteria consisted of: a starting pain level of 2 or more, subjects receiving 3 or more treatments in a specific modality, and a completed SF-12v2® Health Survey (Quality Metric Inc., Lincoln, RI). A total of 94 subjects were evaluated for acupuncture, chiropractic, or naturopathy. Outcome measures: The Numeric Pain Analogue Scale and SF-12v2® Health Survey were used for subject evaluations and were compared from the first to the last treatments. International Classification of Disease codes were utilized to correlate and track the diagnosis. Results: An outcome measures data management system was successfully implemented into a CAM outpatient clinical setting. Significant decreases in pain were observed in subjects receiving acupuncture, chiropractic, or naturopathy. In addition, improvements in various subscales of the SF-12v2® Physical and Mental Health categories were observed for each CAM treatment modality studied. Conclusions: This study established that a practical data collection system could be implemented in a CAM clinic utilizing several treatment modalities. In addition, outcome measures demonstrated both a significant reduction in pain and improvement in quality of life for subjects who utilized acupuncture, chiropractic, or naturopathy treatments.
PMID: 15253855
