Trials

[Jo Bowyer]

Interview: Dr Martin Héroux talks about reproducibility of transcranial magnetic stimulation

https://motorimpairment.neura.edu.au...producibility/

Transcranial magnetic stimulation (TMS) is a popular method among neuroscientists to study brain function, because it enables selective activation of certain areas of the brain with a magnetic coil. However, results from TMS studies published in the scientific literature can often not be reproduced. NeuRA’s Dr Martin Héroux talks about findings of a recent survey looking into why this may be and how we can improve the reproducibility of TMS.

[Jo Bowyer]

Accuracy of magnetic resonance imaging in detecting lumbo-sacral nerve root compromise: a systematic literature review

http://bmcmusculoskeletdisord.biomed...891-016-1236-z

Abstract

Background
MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy. There exists controversy among researchers and clinicians regarding the diagnostic utility and accuracy of MRI in detecting nerve root compromise and radiculopathy. This review evaluated 4 primary diagnostic accuracy studies that specifically assessed the accuracy of MRI in detecting nerve root compromise, as established in the current literature.

Methods
Eight electronic data bases were searched for relevant articles from inception until January 2014. All primary diagnostic studies which investigated the accuracy of MRI in diagnosing nerve root compromise among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria.

Results
Four studies qualified for inclusion in this review. The sensitivity of MRI in detecting lumbar nerve root compromise was very low at 0.25 (95 % CI) while the specificity was relatively high at 0.92 (95 % CI).

Conclusions
There is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy. Therefore, clinicians should always correlate the findings of MRI with the patients’ medical history and clinical presentation in clinical decision making.

Keywords

Lumbo-sacral radiculopathy Accuracy MRI Diagnosis

[Jo Bowyer]

Relations Between Brain Alterations and Clinical Pain Measures in Chronic Musculoskeletal Pain: A Systematic Review

http://www.jpain.org/article/S1526-5...ain%20Medicine

Highlights

•Magnetic resonance imaging has shown brain alterations in chronic musculoskeletal pain patients.
•Brain changes are related to clinical pain measures in chronic musculoskeletal pain.
•Structural and functional brain alterations are related to clinical pain measures.
•This systematic review reports preliminary to moderate evidence for these relations.
•Inconclusive results exist regarding the direction of these relations.

Abstract

Compelling evidence has shown chronic widespread and exaggerated pain experience in chronic musculoskeletal pain (MSKP) conditions. In addition, neuroimaging research has revealed morphological and functional brain alterations in these patients. It is hypothesized that brain alterations play a role in the persistent pain complaints of patients with chronic MSKP. Nevertheless, lack of overview exists regarding the relations between brain alterations and clinical measures of pain. The present systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, to investigate the relations between structural or functional brain alterations, using magnetic resonance imaging scans, and clinical pain measures in patients with chronic MSKP. PubMed, Web of Science, Cinahl, and Cochrane databases were searched. First, the obtained articles were screened according to title and abstract. Second, the screening was on the basis of full-text. Risk of bias in included studies was investigated according to the modified Newcastle-Ottawa Scale. Twenty studies met the inclusion criteria. Moderate evidence shows that higher pain intensity and pressure pain sensitivity are related to decreased regional gray matter (GM) volume in brain regions encompassing the cingulate cortex, the insula, and the superior frontal and temporal gyrus. Further, some evidence exists that longer disease duration in fibromyalgia is correlated with decreased total GM volume. Yet, inconclusive evidence exists regarding the association of longer disease duration with decreased or increased regional GM volume in other chronic MSKP conditions. Inconclusive evidence was found regarding the direction of the relation of pain intensity and pressure pain sensitivity with microstructural white matter and functional connectivity alterations. In conclusion, preliminary to moderate evidence demonstrates relations between clinical pain measures, and structural and functional connectivity alterations within brain regions involved in somatosensory, affective, and cognitive processing of pain in chronic MSKP. Nevertheless, inconclusive results exist regarding the direction of these relations. Further research is warranted to unravel whether these brain alterations are positively or negatively correlated to clinical pain measures.

Perspective
Structural and functional brain alterations within regions involved in somatosensory, affective, and cognitive pain processing play a crucial role in the persistent pain of chronic MSKP patients. Accordingly, these brain alterations have to be taken into account when assessing and treating patients with chronic MSKP.

via @SimonGandevia who comments "Systematic Review finds little! Field full of publication bias?"

[Jo Bowyer]

Paolo Macchiarini: A surgeon’s downfall

http://www.bbc.co.uk/news/magazine-37311038

Ground-breaking work on synthetic organ transplants made Paolo Macchiarini one of the most famous doctors in the world. But some of his academic research is now seen as misleading, and most of the patients who received his revolutionary treatment have died. What went wrong?

via @NeuroSkeptic

Macchiarini and the bonfire of greed
https://forbetterscience.wordpress.c...fire-of-greed/

Retraction Watch
Meet the filmmakers who cracked open the case against star surgeon Macchiarini
http://retractionwatch.com/2016/09/1...n-macchiarini/

[Jo Bowyer]

Comparison of Dorsal and Volar Percutaneous Approaches in Acute Scaphoid Fractures: A Meta-Analysis

http://journals.plos.org/plosone/art...l.pone.0162779

Abstract

The dorsal approach allows better central screw placement along the long axis of the scaphoid compared with the volar approach in managing acute scaphoid fractures. However, it is unclear whether the dorsal approach leads to better clinical outcomes than the volar approach. This meta-analysis compared clinical outcomes, including the incidence of nonunion, postoperative complications, overall functional outcome, postoperative pain, grip strength, and range of wrist motion, between the dorsal and volar percutaneous approaches for the management of acute scaphoid fractures. Seven studies met the criteria for inclusion in the meta-analysis. The proportion of patients who developed nonunion (OR 0.74, 95% CI: 0.21 to 2.54; P = 0.63) and postoperative complications (OR 1.05, 95% CI: 0.45 to 2.44; P = 0.91) did not differ significantly between the dorsal and volar approaches. Both approaches also led to similar results in terms of overall functional outcome (95% CI: -0.39 to 0.22; P = 0.57), postoperative pain (95% CI: -0.52 to 0.46; P = 0.92), grip strength (95% CI: -4.56 to 1.02; P = 0.21), flexion (95% CI: -2.86 to 1.13; P = 0.40), extension (95% CI: -1.17 to 2.67; P = 0.44), and radial deviation (95% CI: -1.94 to 2.58; P = 0.78). However, ulnar deviation (95% CI: -7.48 to 0.05; P = 0.05) was significantly greater with the volar approach. Thus, orthopedic surgeons need to master both the dorsal and volar percutaneous approaches because not all acute scaphoid fractures can be dealt with completely with one approach.

[Jo Bowyer]

Disrupted Self-Perception in People With Chronic Low Back Pain. Further Evaluation of the Fremantle Back Awareness Questionnaire

http://www.jpain.org/article/S1526-5...ain%20Medicine

Highlights

•The questionnaire appears to be a sound way of assessing altered self-perception of the back.
•The level of altered self-perception is positively correlated with pain intensity and disability.
•Self-perception is also associated with distress, pain related cognitions and sensitivity.
•Self-perception appears a more important determinant of clinical severity than these factors.

Abstract

Several lines of evidence suggest that body perception is altered in people with chronic back pain. Maladaptive perceptual awareness of the back might contribute to the pain experience as well as serve as a target for treatment. The Fremantle Back Awareness Questionnaire (FreBAQ) is a simple questionnaire recently developed to assess back-specific altered self-perception. The aims of this study were to present the outcomes of a comprehensive evaluation of the questionnaire's psychometric properties and explore the potential relationships between body perception, nociceptive sensitivity, distress, and beliefs about back pain and the contribution these factors might play in explaining pain and disability. Two hundred fifty-one people with chronic back pain completed the questionnaire as well as a battery of clinical tests. The Rasch model was used to explore the questionnaires' psychometric properties and correlation and multiple linear regression analyses were used to explore the relationship between altered body perception and clinical status. The FreBAQ appears unidimensional with no redundant items, has minimal ceiling and floor effects, acceptable internal consistency, was functional on the category rating scale, and was not biased by demographic or clinical variables. FreBAQ scores were correlated with sensitivity, distress, and beliefs and were uniquely associated with pain and disability.

Perspective
Several lines of evidence suggest that body perception might be disturbed in people with chronic low back pain, possibly contributing to the condition and offering a potential target for treatment. The FreBAQ was developed as a quick and simple way of measuring back-specific body perception in people with chronic low back pain. The questionnaire appears to be a psychometrically sound way of assessing altered self-perception. The level of altered self-perception is positively correlated with pain intensity and disability as well as showing associations with psychological distress, pain catastrophization, fear avoidance beliefs, and lumbar pressure pain threshold. In this sample, it appears that altered self-perception might be a more important determinant of clinical severity than psychological distress, pain catastrophization, fear avoidance beliefs, or lumbar pressure pain threshold.

Key words:
Chronic low back pain, psychometrics, Rasch analysis, body image

via @ SimonGandevia

[Jo Bowyer]

Minimal important improvement thresholds for the six-minute walk test in a knee arthroplasty cohort: triangulation of anchor- and distribution-based methods

http://bmcmusculoskeletdisord.biomed...891-016-1249-7

Abstract

Background
The 6-minute walk test (6MWT) is a commonly used metric for measuring change in mobility after knee arthroplasty, however, what is considered an improvement after surgery has not been defined. The determination of important change in an outcome assessment tool is controversial and may require more than one approach. This study, nested within a combined randomised and observational trial, aimed to define a minimal important improvement threshold for the 6MWT in a knee arthroplasty cohort through a triangulation of methods including patient-perceived anchor-based thresholds and distribution-based thresholds.

Methods
Individuals with osteoarthritis performed a 6MWT pre-arthroplasty then at 10 and 26 weeks post-surgery. Each rated their perceived improvement in mobility post-surgery on a 7-point transition scale anchored from “much better” to “much worse”. Based on these responses the cohort was dichotomised into ‘improved’ and ‘not improved’. The thresholds for patient-perceived improvements were then identified using two receiver operating curve methods producing sensitivity and specificity indices. Distribution-based change thresholds were determined using two methods utilising effect size (ES). Agreement between the anchor- and distribution-based methods was assessed using kappa.

Results
One hundred fifty-eight from 166 participants in the randomised cohort and 222 from 243 in the combined randomised and observational cohort were included at 10 and 26 weeks, respectively. The slightly or more patient-perceived improvement threshold at 26 weeks (an absolute improvement of 26 m) was the only one to demonstrate sensitivity and specificity results both better than chance. At 10- and 26-weeks, the ES based on the mean change score divided by the baseline standard deviation (SD), was an absolute change of 24.5 and 37.9 m, respectively. The threshold based on a moderate ES (a 0.5 SD of the baseline score) was a change of 55.0 and 55.4 m at 10- and 26-weeks, respectively. The level of agreement between the 26-week anchor-based and distribution-based minimal absolute changes was very good (k = 0.88 (95 % CI 0.81 0.95)).

Conclusion
A valid threshold of improvement for the 6MWT can only be proposed for changes identified from baseline to 26 weeks post-surgery. The level of agreement between anchor- and distribution-based methods indicates that a true minimal or more threshold of meaningful improvement following surgery is likely within the ranges proposed by the triangulation of all four methods, that is, 26 to 55 m.

Keywords

Arthroplasty, knee Arthroplasty Six-minute walk test Mobility test Clinimetric

[Jo Bowyer]

Systematic Review of the Empirical Evidence of Study Publication Bias and Outcome Reporting Bias

http://journals.plos.org/plosone/art...ampaign=buffer

Abstract

Background

The increased use of meta-analysis in systematic reviews of healthcare interventions has highlighted several types of bias that can arise during the completion of a randomised controlled trial. Study publication bias has been recognised as a potential threat to the validity of meta-analysis and can make the readily available evidence unreliable for decision making. Until recently, outcome reporting bias has received less attention.

Methodology/Principal Findings

We review and summarise the evidence from a series of cohort studies that have assessed study publication bias and outcome reporting bias in randomised controlled trials. Sixteen studies were eligible of which only two followed the cohort all the way through from protocol approval to information regarding publication of outcomes. Eleven of the studies investigated study publication bias and five investigated outcome reporting bias. Three studies have found that statistically significant outcomes had a higher odds of being fully reported compared to non-significant outcomes (range of odds ratios: 2.2 to 4.7). In comparing trial publications to protocols, we found that 40–62% of studies had at least one primary outcome that was changed, introduced, or omitted. We decided not to undertake meta-analysis due to the differences between studies.

Conclusions

Recent work provides direct empirical evidence for the existence of study publication bias and outcome reporting bias. There is strong evidence of an association between significant results and publication; studies that report positive or significant results are more likely to be published and outcomes that are statistically significant have higher odds of being fully reported. Publications have been found to be inconsistent with their protocols. Researchers need to be aware of the problems of both types of bias and efforts should be concentrated on improving the reporting of trials.

[Jo Bowyer]

Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain? A randomized controlled trial

http://bmcmusculoskeletdisord.biomed...891-016-1263-9

Abstract

Background
The evidence for the effect of treatments of neck pain is modest. In the absence of causal treatments, a possibility is to tailor the treatment to the individuals’ functional limitations and symptoms. The aim was to evaluate treatment effects of a tailored treatment versus a non-tailored treatment. Our hypothesis was that tailored treatment (TT) would have better effect on pain intensity and disability than either non-tailored treatment (NTT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that TT and NTT would both have better effect than TAU.

Method
One hundred twenty working women with subacute and chronic non-specific neck pain were allocated to 11 weeks of either TT, NTT or TAU in a randomized controlled trial with follow-ups at 3, 9 and 15 months. The TT was designed from a decision model based on assessment of function and symptoms with defined cut-off levels for the following categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, impaired eye-head-neck control, trapezius myalgia and cervicogenic headache. Primary outcomes were pain and disability. Secondary outcomes were symptoms, general improvement, work productivity, and pressure pain threshold of m. trapezius.

Results
Linear mixed models analysis showed no differences between TT and NTT besides work productivity favoring TT at 9- and 15-months follow-ups. TT and NTT improved significantly more than TAU on pain, disability and symptoms at 3-month follow-up. General improvement also favored TT and NTT over TAU at all follow-ups.

Conclusion
Tailored treatment according to our proposed decision model was not more effective than non-tailored treatment in women with subacute and chronic neck pain. Both tailored and non-tailored treatments had better short-term effects than treatment-as-usual, supporting active and specific exercise therapy, although therapist-patient interaction was not controlled for. Better understanding of the importance of functional impairments for pain and disability, in combination with a more precise tailoring of specific treatment components, is needed to progress.

Keywords

Neck-shoulder pain Trapezius Individualized treatment Rehabilitation Physiotherapy Cut-off

[Jo Bowyer]

Triangulating meta-analyses: the example of the serotonin transporter gene, stressful life events and major depression

http://bmcpsychology.biomedcentral.c...ource=Teradata

Abstract

Background
Meta-analysis is intended as a tool for the objective synthesis of evidence across a literature, in order to obtain the best evidence as to whether or not an association or effect is robust. However, as the use of meta-analysis has proliferated it has become increasingly clear that the results of a meta-analysis can be critically sensitive to methodological and analytical choices, so that different meta-analyses on the same topic can arrive at quite different conclusions.

Results
We demonstrate the variability in results of different meta-analyses on the same topic, using the example of the literature on the putative moderating effect of 5-HTTLPR genotype on the association between stressful life events and major depression. We also extend on previous work by including a P-curve analysis of studies from this literature, drawn from a previous meta-analysis, in an attempt to resolve the discrepant conclusions arrived at by previous meta-analyses.

Conclusions
We highlight the divergent conclusions that can be reached when different methodological and analytical choices are taken, and argue that triangulating evidence using multiple evidence synthesis methods is preferable where possible, and that every effort should be made for meta-analyses to be as unbiased as possible (e.g., conducted by methodologists or as part of an adversarial collaboration between authors from opposing camps).

Keywords

Meta-analysis Gene x environment interaction 5-HTTLPR Stressful life events Depression

[Jo Bowyer]

Decreased Pain Perception by Unconscious Emotional Pictures

http://journal.frontiersin.org/artic...016.01636/full

Pain perception arises from a complex interaction between a nociceptive stimulus and different emotional and cognitive factors, which appear to be mediated by both automatic and controlled systems. Previous evidence has shown that whereas conscious processing of unpleasant stimuli enhances pain perception, emotional influences on pain under unaware conditions are much less known. The aim of the present study was to investigate the modulation of pain perception by unconscious emotional pictures through an emotional masking paradigm. Two kinds of both somatosensory (painful and non-painful) and emotional stimulation (negative and neutral pictures) were employed. Fifty pain-free participants were asked to rate the perception of pain they were feeling in response to laser-induced somatosensory stimuli as faster as they can. Data from pain intensity and reaction times were measured. Statistical analyses revealed a significant effect for the interaction between pain and emotional stimulation, but surprisingly this relationship was opposite to expected. In particular, lower pain intensity scores and longer reaction times were found in response to negative images being strengthened this effect for painful stimulation. Present findings suggest a clear pain perception modulation by unconscious emotional contexts. Attentional capture mechanisms triggered by unaware negative stimulation could explain this phenomenon leading to a withdrawal of processing resources from pain.

[Jo Bowyer]

Citizen science or scientific citizenship? Disentangling the uses of public engagement rhetoric in national research initiatives

https://bmcmedethics.biomedcentral.c...ource=Teradata

Abstract

Background
The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists. Originally, these labels were invoked by volunteer research efforts propelled by amateurs outside of traditional research institutions and aimed at appealing to those looking for more “democratic,” “patient-centric,” or “lay” alternatives to the professional science establishment. As mainstream translational biomedical research requires increasingly larger participant pools, however, corporate, academic and governmental research programs are embracing this populist rhetoric to encourage wider public participation.

Discussion
We examine the ethical and social implications of this recruitment strategy. We begin by surveying examples of “citizen science” outside of biomedicine, as paradigmatic of the aspirations this democratizing rhetoric was originally meant to embody. Next, we discuss the ways these aspirations become articulated in the biomedical context, with a view to drawing out the multiple and potentially conflicting meanings of “public engagement” when citizens are also the subjects of the science. We then illustrate two uses of public engagement rhetoric to gain public support for national biomedical research efforts: its post-hoc use in the “care.data” project of the National Health Service in England, and its proactive uses in the “Precision Medicine Initiative” of the United States White House. These examples will serve as the basis for a normative analysis, discussing the potential ethical and social ramifications of this rhetoric.

Summary
We pay particular attention to the implications of government strategies that cultivate the idea that members of the public have a civic duty to participate in government-sponsored research initiatives. We argue that such initiatives should draw from policy frameworks that support normative analysis of the role of citizenry. And, we conclude it is imperative to make visible and clear the full spectrum of meanings of “citizen science,” the contexts in which it is used, and its demands with respect to participation, engagement, and governance.

Keywords

Care.data Citizenship Citizen science Crowdsourcing Big data National health research Participant centric initiatives Precision medicine Public engagement Recruitment

[Jo Bowyer]

Attitudes towards assisted dying are influenced by question wording and order: a survey experiment

https://bmcmedethics.biomedcentral.c...ource=Teradata

Abstract

Background
Surveys on attitudes towards assisted dying play an important role in informing public debate, policy and legislation. Unfortunately, surveys are often designed with insufficient attention to framing effects; that is, effects on the respondents’ stated attitudes caused by question wording and context. The purpose of this study was to demonstrate and measure such framing effects.

Methods
Survey experiment in which an eight-question survey on attitudes towards assisted dying was distributed to Norwegian citizens through a web-based panel. Two variations of question wording as well as two variations of question order were employed. Respondents were randomized to receive one of four questionnaire versions.

Results
Three thousand and fifty responses were received. There were moderate to large question wording and question order effects. A majority of Norwegian citizens favour the legalization of assisted dying for patients with terminal or chronic disease.

Conclusions
Stakeholders in the assisted dying debate need to acknowledge potential framing effects, and accordingly should interpret survey results with caution. The same holds for researchers who conduct attitude surveys in the field of bioethics.

Keywords

Assisted dying Euthanasia Opinion poll Physician-assisted suicide Survey experiment

[Jo Bowyer]

A 3D printed knee brace to improve symptoms, biomechanics and daily life among medial knee osteoarthritis patients

http://www.isrctn.com/ISRCTN43076496...ource=Teradata

Plain English Summary
Background and study aims
Osteoarthritis is the 'wear and tear' form of arthritis affecting the joints. Around 250 million people in the world (3.8%) have knee osteoarthritis. Due to aging and increasing obesity, the prevalence of knee osteoarthritis is expected to increase in developed countries in the next 20 years. Knee osteoarthritis decreases patients' quality of life through chronic pain, joint stiffness, and reduced social activity, which influence emotional wellness as well. Knee osteoarthritis can also lead to or increase misalignment of the thighbone and shinbone and increase the force on the knee joint, leading patients into a vicious circle by increasing knee pain, decreasing activities, increasing weight and progressing the disease. A knee brace is a brace worn to strengthen the knee and is a recommended treatment for knee osteoarthritis. It aims to reduce misalignment of the limb. However, the main issue is patients' poor compliance to the treatment because of lack of effectiveness, more drawbacks than benefits, discomfort, bad fitting, movement of the brace, bulkiness, appearance, skin irritation, blisters and too much pressure on the knee. By its freedom in design, 3D printing may resolve most of these complaints. This study aims to compare the effectiveness and comfort of a knee brace made by 3D printing and a conventional knee brace.

Who can participate?
Patients aged 40 to 70 with medial knee osteoarthritis

What does the study involve?
Participants are in the study for 10 weeks. During this period, they wear two different knee braces for two weeks each with a 1-week period without a knee brace in between. Participants attend Glasgow Caledonian University for five visits: once for leg measurement to make the knee braces and four times to fill in questionnaires and perform gait (walking) analysis. Participants also wear activity monitors for three non-consecutive weeks.

What are the possible benefits and risks of participating?
By participating in this study, participants may benefit from pain relief, symptom reduction and improvement in daily life activities. Besides, participants keep the knee brace of their choice at the end of the study. Wearing knee braces may sometimes lead to a rash, allergic skin irritations, and knee lock. However, these risks are minors and reversible.

Where is the study run from?
The Institute for Applied Health Research of Glasgow Caledonian University (UK)

When is the study starting and how long is it expected to run for?
October 2016 to March 2017

Who is funding the study?
EU Seventh Framework Programme

Who is the main contact?
Dr Yoann Dessery
yoann.dessery@peacocks.net

This looks promising.

I have had a certain amount of anecdotal success over the years with bespoke knee braces before the advent of 3D printing. They gave my patients confidence to move and load with less fear that their knee would give way. The cost of self funding was prohibitive to most though and I advised anyone considering it to optimise their BMI before incurring the expense of a brace.

[Jo Bowyer]

Use of Complementary and Alternative Medicine (CAM) as Part of the Oncological Treatment: Survey about Patients’ Attitude towards CAM in a University-Based Oncology Center in Germany

http://journals.plos.org/plosone/art...l.pone.0165801

Abstract

Introduction

To understand if and which patients would be open-minded to Complementary and Alternative Medicine (CAM) use parallel to their oncological treatment. Moreover, we sought to determine which methods are most accepted and which are the primary motivators to use CAM.

Methods

We developed and anonymously conducted a questionnaire for patients in the oncology center (TU Munich). Questions focus on different CAM methods, previous experiences, and willingness to apply or use CAM when offered in a university-based setting.

Results

A total of 171 of 376 patients (37.4% women, 62.0% men, 0.6% unknown) participated. This corresponds to a return rate of 45%. Median age was 64 years (17–87 years). Of all participants, 15.2% used CAM during their oncological therapy; 32.7% have used it in the past. The majority (81.9%) was not using CAM during therapy; 55.5% have not used CAM in the past respectively. The analysis revealed a significant correlation between education and CAM use during therapy (r = 0.18; p = 0.02), and CAM use in the past (r = 0.17; p = 0.04). Of all patients using CAM during therapy, favored methods were food supplements (42.3%), vitamins/minerals (42.3%), massage (34.6%). Motivations are especially the reduction of side effect and stress, the positive effect of certain CAM-treatments on the immune system and tumor therapy. Results showed no difference between women and men. Most patients not having had any experience with CAM complain about the deficiency of information by their treating oncologist (31.4%) as well as missing treatment possibilities (54.3%).

Conclusion

Since many patients believe in study results demonstrating the efficacy of CAM, it stresses our task to develop innovative study protocols to investigate the outcomes of certain CAM on symptom reduction or other endpoints. Thus, prospective trials and innovative evidence-based treatment concepts to include CAM into high-end oncology is what patients demand and what a modern oncology center should offer.

In our study, the most preferred methods of CAM were food supplements (42.3%) and vitamins/minerals (42.3%) as well as massage (34.6%) and physiotherapy/manual medicine (26.9%) followed by homeopathy (23.1%) and herbs/plants (23.1%). This is in line with the literature: Abdallah and colleagues described a frequent utilization of vitamins/minerals as well as herbs in a group of women with gynecological malignancies [25]; Nazik et al. reported 90.2% of all patients in their study favoring herbal therapy [44]. For the subgroup of head-and-neck cancer patients, Molassiotis et al. showed that 47.1% of all patients chose herbal medicine, followed by medicinal teas (23.5%) or vitamins/minerals (11.8%) [5]. Within the large European study on 956 patients with various diagnoses also homeopathy, medicinal teas, and vitamins/minerals were the most frequently used CAM methods [6].

Some of the above are considered to be mainstream rather than CAM in the UK.

UK Oncologists are often sympathetic towards patients who wish to incorporate CAM, but ask that they divulge their use in order that CAM does not cause unwanted reactions with the prescribed course of treatment.




Changes in the use practitioner-based complementary and alternative medicine over time in Canada: Cohort and period effects

http://journals.plos.org/plosone/art...l.pone.0177307

Abstract

Background

The use of complementary and alternative medicine (CAM) is growing. However the factors contributing to changes over time and to birth cohort differences in CAM use are not well understood.

Setting

We used data from 10186 participants, who were aged 20–69 years at the first cycle of data collection in the longitudinal component of the Canadian National Population Health Survey (1994/95-2010/11). We examined chiropractic and other practitioner-based CAM use with a focus on five birth cohorts: pre-World War II (born 1925–1934); World War II (born 1935–1944); older baby boomers (born 1945–1954); younger baby boomers (born 1955–1964); and Gen Xers (born 1965–1974). The survey collected data every two years on predisposing (e.g., sex, education), enabling (e.g., income), behavior-related factors (e.g., obesity), need (e.g., chronic conditions), and use of conventional care (primary care and specialists).

Results

The findings suggest that, at corresponding ages, more recent cohorts reported greater CAM (OR = 25.9, 95% CI: 20.0; 33.6 for Gen Xers vs. pre-World War) and chiropractic use than their predecessors (OR = 2.2, 95% CI: 1.7; 2.8 for Gen Xers vs. pre-World War). There was also a secular trend of increasing CAM use, but not chiropractic use, over time (period effect) across all ages. Factors associated with cohort differences were different for CAM and chiropractic use. Cohort differences in CAM use were partially related to a period effect of increasing CAM use over time across all ages while cohort differences in chiropractic use were related to the higher prevalence of chronic conditions among recent cohorts. The use of conventional care was positively related to greater CAM use (OR = 1.8, 95% CI: 1.6; 2.0) and chiropractic use (OR = 1.2, 95% CI: 1.1; 1.4) but did not contribute to changes over time or to cohort differences in CAM and chiropractic use.

Conclusion

The higher CAM use over time and in recent cohorts could reflect how recent generations are approaching their healthcare needs by expanding conventional care to include CAM therapies and practice for treatment and health promotion. The findings also underscore the importance of doctors discussing CAM use with their patients.

Introduction

Conventional or mainstream medicine continues to be the main source of healthcare in Canada and elsewhere. However, a significant number of people choose complementary and alternative medicine (CAM) for wellness and/or treatment [1, 2]. The increasing demand for CAM may reflect a diversification of preferences for different types of healthcare services and an increasing emphasis on health promotion and self-care by the public [3]. For example, studies show that while many adults use CAM therapies to treat specific symptoms such as chronic pain, others also report using CAM for general health maintenance [4–6]. Therefore, the growing interest in CAM raises questions about the patterns of CAM use over time in the context of use of conventional medicine in the population. Understanding the changes in patterns of CAM and conventional care use has important implications for planning and improving the healthcare system as well as for medical education.

Update 13/05/2017