Our Research:

Background This qualitative study was nested within a large, still ongoing clinical trial designed to test for non-specific treatment effects, notably the therapeutic relationship, in western acupuncture patients awaiting surgery for lower limb osteoarthritis. Together the two studies comprise a mixed methods protocol born out of the recommendation for such research whole system methodologies within the field of Complementary and Alternative Medicine (CAM).
Aim The aim of the qualitative study was to investigate the experiences of participants taking part in a randomized controlled trial designed to test for non-specific effects of western acupuncture.
Method Participants in the trial are randomized to one of three treatments (one real and two placebo controls – needle and non needle) delivered with or without empathic intent. The qualitative study, based on grounded theory, involved a combination of post-trial audio taped narrative interviews; post treatment debriefing, participant and non participant observation and personal reflections. Data collection and analysis were conducted using constant comparison. Purposive sampling was used to develop emergent concepts which were tested using progressively focused interview techniques and theoretical sampling.
Findings Data collection is now complete, and the findings are being written up. A substantive theory of participation has emerged and this will be available following the thesis submission in July 2008.

Introduction Kinesiology is a diagnostic and therapeutic complementary therapy utilising subtle change in manual muscle testing results to evaluate the energetic balance of the body and to subsequently select individualised healing modalities.  Anecdotal evidence suggests kinesiology is helpful for a wide range of conditions.  Studies have been conducted in this field, but the last comprehensive critical evaluation of the literature related to publications between 1981 and 1987; we felt it timely to perform an updated review of the kinesiology literature.
Aims and specific research questions
(1)  To ascertain if diagnostic accuracy for any type of kinesiology has been established.
(2)  To ascertain if inter-examiner reliability for any type of kinesiology has been established
(3)  To ascertain if muscles respond to stimuli as suggested by the underlying principles of kinesiology.   
(4)  To review whether there is any evidence for the therapeutic effectiveness of kinesiology
(5)  To assess the quality of reporting of the relevant studies.
Methods Electronic databases and grey literature were searched for studies fulfilling the inclusion criteria.  Diagnostic accuracy studies were analysed for both methodological quality and quality of reporting using the quality assessment tool for studies of diagnostic accuracy included in systematic reviews (QUADAS) and the Standards for Reporting of Diagnostic Studies (STARD).  Clinical studies were analysed for methodological quality using the JADAD scale and for quality of reporting using the Consolidated Standards of Reporting Trials (CONSORT).   These scales were ‘scored’ for each relevant study.
Results A total of 22 original studies were identified as fulfilling the inclusion criterion.  Overall, the studies suffered from poor methodology and reporting standards as indicated by the absence of basic methodological criteria and items deemed by the quality measures to be important.  Items reported on QUADAS (diagnostic studies) scored 1 – 11 out of a possible 14, STARD scores were between 6 – 13 out of 25, JADAD scores were all 0 out of a possible 5 and CONSORT 4 – 6 out of 22: consequently we were unable to answer any of our research questions.
Conclusion There is insufficient evidence for: inter- examiner reliability or diagnostic accuracy within kinesiology; the validity of muscle response to stimuli; the effectiveness of kinesiology as a clinical intervention for any condition.  The standards of reporting were low and efforts should be made to improve both methodology and reporting in future studies.  We recommend that a pragmatic study of the overall effectiveness of kinesiology as a whole system as the most appropriate initial step to determine whether it has any clinical value.

Background Data has confirmed that patients receiving homeopathy feel satisfied with their treatment, yet currently no definitive mechanisms to explain how homeopathy works is available. Homeopathy is a complex medical intervention and a “whole systems” approach is necessary to understand the whole treatment process; this involves exploring aspects such as the patient/practitioner relationship. Recent interest in understanding its success is focussed on the patient practitioner dyad however little research has been done into the homeopathic consultation and there is currently no published work that explores the role of the homeopathic practitioner.
Aim This study therefore will focus on the nature of the homeopathic consultation and the role of the homeopathic practitioner with the aim of identifying factors that homeopathic practitioners perceive to be important in promoting therapeutically effective consultations.
Method In keeping with the explorative and emergent nature of this study qualitative methods will be used with a grounded theory approach to data collection and analysis. Grounded theory is an inductive qualitative research methodology designed to develop theory that is grounded in the data, which has been systematically gathered. Theory evolves during the research through a continuous interaction between data collection and analysis and by using constant comparison concepts and categories are formed until saturation of the data is achieved.  A two phase process of data collection and analysis will be used.
Phase 1: Homeopaths will be sampled from the Faculty of Homeopathy and the Society of Homeopaths register and interviewed.  Initially the participants will be purposefully sampled and following preliminary data analysis decisions regarding sampling will be guided by theoretical sampling and snowball sampling.  The number of interviews required will be dependant on obtaining saturation of the categories.  This phase of data collection and analysis will enable theory development and a tentative model of the homeopathic consultation.
Phase 2: the purpose of phase two of the data collection and analysis process is to confirm or refute aspects of the developing theory of the homeopathic consultation. This will entail purposeful sampling of practitioners who took part in phase 1 of the data collection.  In phase 2 observations of consultations will take place and some practitioners will be asked to keep a diary for two weeks focusing on particular aspects of the consultation. 
Results A tentative model of the homeopathic consultation is in development as data collection and analysis is ongoing in this study. The results will be available by November 2008.

Sustained and subtle hyperventilation can result in a wide variety of symptoms, leading to a chronic condition which has been termed hyperventilation syndrome (HVS). Treatment options include physiotherapy, in the form of breathing retraining (BR), but additional approaches aim to reduce the anxiety which is recognised as being a frequent component of this condition.
Objectives: The aim of this study was to evaluate whether acupuncture is an appropriate treatment for HVS to reduce anxiety, and whether a crossover trial is an appropriate study design to evaluate acupuncture in this condition.
Design: A single-blind crossover trial was carried out comparing the effects of 4 weeks (twice weekly) acupuncture and BR on patients with HVS.
Subjects: Ten(10) patients diagnosed with HVS were recruited to the trial and randomised into two groups. Both groups received acupuncture and BR with a washout period of 1 week.
Outcome measures: The primary outcome measure used was the Hospital Anxiety and Depression Scale (HAD). Other outcome measures used were the Nijmegen questionnaire and Medical Research Council Dyspnoea scale.
Results: The results showed statistically significant treatment differences between acupuncture and breathing retraining, in favour of acupuncture. Reductions were found in the HAD A (anxiety) (p = 0.02) and Nijmegen (symptoms) (p = 0.03) scores. There was no statistical evidence of any carryover effects. However, when graphically examining individual anxiety scores, in those who received acupuncture first, there was a reduction in anxiety levels which persisted through the wash out period, suggesting that there may have been some carry over effect from this treatment.
Conclusions: This study suggests that acupuncture may be beneficial in the management of HVS in terms of reducing anxiety levels and symptom severity.  However, there may be some carry over effect, after acupuncture treatment, which went undetected due to the small sample size. This preliminary study provides the basis for a larger, sufficiently powered and methodologically sound trial.

Objectives To assess the effectiveness of oral vanadium supplementation for glycaemic control in type 2 diabetes by conducting a systematic review of the literature.
Research Design and Methods Eligible studies were identified by searching 14 databases using standardised terms. Experts, study authors and manufacturers were also contacted. Hand-searching was not undertaken. Selection criteria for inclusion in the review were controlled human trials of vanadium versus placebo in type 2 diabetic adults of minimum two months duration, and a minimum of ten subjects per arm. Data extraction and the assessment of study quality were undertaken by two independent reviewers.
Results No studies were found that met the inclusion criteria. Revised, less restrictive criteria stipulating any human diabetic trial of vanadium supplementation in the range 30 to 150 mg orally identified only five papers. These demonstrated significant treatment-effects, but due to their poor quality, this cannot be assumed. Treatment with vanadium often results in gastrointestinal side-effects.
Conclusion There is no good evidence that oral vanadium supplementation improves glycaemic control in type 2 diabetes. The routine use of vanadium for this purpose cannot be recommended. A large scale RCT {Damian you haven’t defined the acronym RCT at this point. Its probably better not to use acronyms in the abstract}is needed to address this clinical question.

Objective To determine whether existing psychological scales of holistic health are sensitive to change following CAM treatment.
Design A study investigating change on several outcome measures over a 4 month period during CAM treatment.  Patients attending the Centre for Complementary and Integrated Medicine (CCIM, Southampton, UK) for their first appointment were recruited and completed their baseline forms (T1) at the first consultation. Three further sets of questionnaires (T2, T3 and T4) were posted with SAE to them at monthly intervals and returned to CCIM.
Patients and location People visiting the CCIM and treated with an individualised combination of homeopathy, dietary advice and nutritional supplements for treatment of their chronic benign illness.
Outcome The measures were: (a) symptoms (Measure Yourself Medical Outcome Profile: MYMOP), (b) mood (Positive And Negative Affect Scale; PANAS) and (c) Brief Sense Of Coherence (BASOC).
Results Forty-five patients were recruited and 40 completed the study; MYMOP (p = .001), PANAS negative (p = .025) and BASOC (p = .019) all showed similar patterns of significant improvement over time; PANAS positive showed a non significant trend for improvement (p = .074).  Change on one scale was correlated with change on other scales.
Conclusion Existing psychology scales of holistic health are sensitive to change following CAM treatment.

Use of complementary and alternative medicine (CAM) is substantial in the UK.  This thesis is about why people return to CAM, in other words why people continue to use of adhere to CAM.  Previous research suggests that people who use CMA do so because they hold beliefs about health, treatment and illness which are congruent with CAM, have chronic health problems, and are disillusioned with the experience and outcomes from orthodox medicine.  Working within the self-regulation theoretical framework and combining quantitative and qualitative methods this PhD aimed to identify why people adhere to CAM. 
Two new questionnaire measures were developed.  The CAM beliefs inventory (CAMBI) was developed as a generic measure of treatment beliefs relevant to CAM which can be used in a range of CAM settings.  The Treatment Process Questionnaire (TPQ) was developed as a generic measure of peoples’ experiences of non-pharmacological treatments and can be used in both CAM and non-CAM settings.
Two questionnaire studies were conducted to examine the relative importance of different beliefs in ongoing CMA use.  The cross-sectional study found that beliefs in holistic health were the most important predictors of CAM use across difference CAM treatments.  The prospective questionnaire study examined the relationship between beliefs, experiences of treatment, and adherence to CAM.  This study showed that positive experiences of treatment are the most important predictors of adherence to CAM, compared to illness and treatment beliefs.
A qualitative study using ethnographic and grounded theory techniques was conducted to examine the processes involved in ongoing CAM use.  This study developed a process-oriented model of CAM use which suggested ways in which people experience and evaluate CAM therapies, and highlighted the way in which individuals’ health care decisions are embedded in the socio-cultural context.
Overall this programme of research has provided rigorous and well-validated insights with questionnaire measures and valuable theory-driven processes in a much under-researched and over-debated area.

Objectives To conceptualise how patients use complementary and alternative medicine (CAM) and to examine how patients’ perspectives relate to existing, expert-led taxonomies.
Methods  A qualitative thematic analysis was carried out on semi-structured interviews conducted with 46 people using CAM in the South of England.
Results  CAMs appeared to be used in four different ways; as treats, and as alternative, complementary, and conventional treatments.  Treats were portrayed as personal luxuries, not directed at an identified health need. There were systematic differences in the context, anticipated benefits and implications for financial justification when non-medical therapies were viewed and used as alternative, complementary or conventional treatments.  There was no simple relationship between patients’ ways of using therapies and CAM modality. 
Conclusions  Some people use CAMs as personal luxuries, and not as health care technologies.  This is incongruent with existing expert-led taxonomies.  Physicians and researchers need to be aware that patients’ views of what constitutes CAM can differ radically from their own views. They should choose their terminology carefully in order to initiate meaningful dialogue with their patients and research participants.  

It has been suggested that people are attracted to and use complementary and alternative medicines (CAM) because they hold beliefs that are congruent with CAM.  This article collates, examines and synthesises the evidence surrounding this hypothesis.  The majority of studies are cross-sectional and focus on a limited number of beliefs.  The small number of multivariate analyses suggest that beliefs related to control and participation, perceptions of illness, holism and natural treatments, and general philosophies of life predict CAM use when controlling for demographic and clinical factors.  Further research is required to establish the robustness of these findings in different illness groups, whether pro-CAM beliefs are held prior to CAM use and to examine the role of such beliefs in the initiation and maintenance of CAM use over time.

This study investigated associations between complementary medicine use and treatment and illness beliefs.  Previously validated questionnaire measures of treatment beliefs, illness beliefs, and complementary medicine use were presented and advertised online.  Completed questionnaires were received from 247 participants.  Logistic regression analysis showed that demographic characteristics, treatment beliefs and illness beliefs accounted for approximately 36% of the variance in complementary medicine use (χ2 (25) = 75.33, p <.01).  Separate analyses were conducted to predict use of different types of complementary medicine.  The strength of associations between beliefs and complementary medicine use was related to the type of complementary medicine used.  The results suggest that people use complementary medicine because they are attracted to it rather than because they are disillusioned with orthodox medicine, and that both treatment and illness beliefs have an important role in explaining why people use complementary medicine. 

Objectives  The study aimed to develop a comprehensive generic measure of treatment beliefs, the Complementary and Alternative Medicine Beliefs Inventory (CAMBI), and to identify distinct dimensions of CAM-related beliefs.
Methods  The CAMBI and other measures were presented and advertised online. 
Results  328 completed questionnaires were received.  Factor analysis indicated three dimensions of beliefs could be identified.  Subscales of the CAMBI were developed measuring beliefs in natural treatment, participation in treatment and holistic health.  The subscales all had satisfactory reliability and were significantly correlated with CAM use (Spearman’s rho = .18, .47 and .22 for natural treatments, holistic health and participation in treatment respectively).
Conclusions  The CAMBI measures three distinct dimensions of treatment beliefs, all of which are related to CAM use. 

Complementary and alternative medicine (CAM) consists of a wide range of often disparate approaches to health, illness and wellbeing. 
This paper outlines why CAM use is of interest to health psychology, the current state of knowledge about why people use CAM, and future directions for health psychology research into CAM use.

The aims with this thesis are to explore why parents bring their children to homeopaths and to investigate the effect of homeopathic treatment for prevention of upper respiratory tract infections (URTI) in children. The reason for doing studies on this is that there has been a nearly threefold increase in the proportion of children among patients visiting Norwegian homeopaths. This raised the question of why it is so. Furthermore, recurrent respiratory complaints are a main reason why child patients consult homeopaths. This raised the question of the effect of homeopathic treatment in this patient group, because there is very little research on this. The thesis builds on four different studies conducted between August 2002 and June 2004.

Parents of nine children that recently had been to a homeopath for the first time were interviewed to explore why parents take their children to homeopaths. All parents had been to a medical doctor before consulting the homeopath. It was the experiences with conventional medical treatment that led the parents to look for alternatives. The reasons were that 1) the parents did not want to give the medication prescribed by the doctor, 2) they wanted treatment while waiting for a problem to be assessed, 3) they did not want to continue to use the prescribed medication, 4) they stopped taking conventional medication due to side effects or 5) they were not offered any treatment by the medical doctor. The parents would consult a medical doctor if they felt insecure about the health conditions of the child and would visit a homeopath when they felt that situation was clarified. There are parents who take their child to homeopaths despite not understanding or having belief in how ultramolecular homeopathic medicines can have effects.

One hundred and sixty-one children who had been diagnosed with an URTI by a medical doctor were recruited to participate in a trial on the effect of treatment by homeopaths for prevention of URTI in children. The children were randomly allocated to two groups. One group received an appointment immediately with one of five homeopaths who treated the patients as they do in their everyday practice. The other group got such treatment after three months. The occurrence of URTI judged by the parents were significantly lower among those treated immediately by homeopaths (median 8 days in three months) compared to the other group who used self-selected conventional health care (median 13 days) (p=0.006).

Homeopathic medicines are frequently used for self-treatment (over the counter-OTC). It is not known if the choice of the patient is the same, as a homeopath would have prescribed.  A study was therefore conducted to explore if it can be developed indications for homeopathic medicines that facilitate that parents can chose the same medicine as a homeopath would prescribe for children with URTI. Firstly, data from a survey was used to find three medicines Calcarea carb, Pulsatilla and Sulphur that accounted for 60% of all prescription made by Norwegian homeopaths for children with URTI. Simplified constitutional indications for these medicines were developed and tested  by comparing the choices of 70 parents with the prescription of eleven homeopaths. The parents were able to choose the same homeopathic medicine as homeopaths prescribed for 55% of children the children.

Two hundred and fifty-nine children who had been diagnosed with an URTI by a medical doctor were recruited to participate in a trial on the effect of one of three self-selected ultramolecular homeopathic medicines for prevention of URTI in children. The indications  developed were used. The children was randomly allocated to receive either ultramolecular homeopathic medicine (C-30) or placebo. There was no difference in the occurrence of URTI judged by the parents among getting ultramolecular homeopathic medicine (median 9 days in three months) compared to those getting placebo (median 9 days) (p=0.531).

Objectives To develop simplified constitutional indications for homeopathic medicines so that parents of children with recurrent upper respiratory tract infection (URTI) could choose homeopathic medicines for their children more “accurately”, and to subsequently evaluate if these choices match the prescriptions of trained homeopaths.
Design and setting To initially select the most commonly used homeopathic medicines for URTI, data from a survey of 1097 patients visiting 80 different Norwegian homeopaths were used. A simplified constitutional indication was then developed for the three homeopathic medicines most frequently prescribed for recurrent URTI and otitis media. The constitutional indications were developed by a group of five homeopaths and were then sent to 20 homeopaths for further evaluation. To evaluate the parents’ choice of homeopathic medicines compared to the prescription by trained homeopaths, a group of 11 randomly selected homeopaths were asked to participate. They recruited parents of 70 child patients.
Result By using simplified constitutional indications for the three most commonly prescribed remedies, Calcarea carb, Pulsatilla and Sulphur, parents were able to choose the same homeopathic medicine as homeopaths’ prescribed for 55% (95% CI 43–67) of children with URTI. There was excellent agreement between parents’ choice and homeopaths’ prescription for the three medicines (Kappa of 0.77, p < 0.001).
Conclusion Simplified constitutional indications can be used to improve the quality of the choice of homeopathic medicines purchased over the counter (OTC) for self-treatment.

This paper examines some of the problems specifically associated with conducting research into acupuncture and how this can lead to further problems with subsequent systematic reviews. Studies for the treatment of chronic neck pain have been used as examples of how presented information can be misleading to an acupuncture naive reader and how researchers must be sensitive to these problems when compiling their inclusion and exclusion criteria. The problems associated with scoring trials are discussed and further work to increase the scope of scoring mechanisms is recommended in order to produce meaningful systematic reviews in the future.

Study Design Patients enrolled onto a randomised controlled trial were asked to complete various questionnaires which were then compared to establish validity for a new neck pain questionnaire.

Objectives To validate a new and brief outcome measure for use with patients with mechanical neck pain

Summary of Background Data Neck pain is a very common problem and one which clinicians will be required to treat with some regularity. In today’s climate of evidence based practice and the need to quantify and justify clinical intervention, a quick and easy method to evaluate progress is required. Such a measure has already been produced for those suffering with back pain but as yet there is no such measure for neck pain and this needs to be addressed.

Methods The back pain measure was adapted to enable its use with neck pain patients. Repeatability was assessed by using a one week, test re-test on 104 patients who were enrolled onto a neck pain trial. Validity was assessed by comparing the new questionnaire against other already well validated measures i.e. the Neck Disability Index and a Visual Analogue Scale for pain, with 133 patients.

Results The test re-test showed excellent repeatability with high Intraclass correlations and p values <0.001 for each question tested. The Core Neck Pain Questionnaire also showed good validity, giving close agreement to the other comparison measures.

Conclusion The short Core Neck Pain Questionnaire has been demonstrated to be repeatable and valid as a brief outcome measure for use with patients with mechanical neck pain.

Background. Despite large increases in popularity and use, the efficacy of acupuncture for chronic mechanical neck pain remains unproven.
Objective. To determine if ‘western’ acupuncture treatment is superior to placebo intervention for this condition.
Design. A randomised, single blind, placebo controlled, parallel arm trial with follow-up over 1 year post-treatment.
Setting. Subjects were referred from rheumatologists, family physicians or physiotherapy waiting lists between 1999 and 2001 and attended the outpatient departments of 2 major U.K hospitals.
Patients. Patients aged 18 to 80 years, with chronic mechanical neck pain and with pain > 3/10 on Visual Analogue Scale (VAS). 458 subjects were referred onto the trial and 135 were randomised for treatment. 11 subjects withdrew from treatment, thus 124 reached the primary end point.
Interventions. Patients received 8 treatments (20 minutes duration). The acupuncture group receiving largely individualised treatment with an average of 6 needles each session. The placebo group received mock electrical stimulation to acupuncture points using a decommissioned electro acupuncture stimulation unit via TENS electrodes.
Prime outcome. This was comparison of group mean pain at 1-week post treatment using a VAS.
Results. Both groups significantly improved from baseline. A statistically significant difference between groups was observed but examination of the confidence intervals suggests that is real terms, this difference was negligible but no significant difference was found between the groups (p=0.106). Secondary outcomes showed a similar pattern.
Conclusion. Western style acupuncture was shown to be effective at reducing neck pain in the short and long term, but performed no better than the placebo. Improvements in outcomes are therefore probably due to the non-specific effects of treatment rather than the process of needling.

Objective To investigate the efficacy of acupuncture on stroke recovery compared to an inert placebo.
Design Placebo-controlled, randomised, clinical trial.
Setting Post-stroke rehabilitation wards in five NHS hospitals in the UK.
Subjects Patients between 4 and 10 days after their first stroke.
Interventions and outcome measures  The patients received 12 acupuncture or placebo treatments over four weeks,
Acupuncture with electrical stimulation was compared with mock TENS, and assessments continued for 12 months after entry. Primary outcome was the Barthel Index, (BI). Secondary outcomes were muscle power, Motricity Index (MI), mood, Nottingham Health Profile (NHP) and treatment credibility.
Results 92 patients completed data sets.  Data were analysed using both t tests and a structural equation based on longitudinal analysis of both BI and MI, using generalised estimating equations with an exchangeable correlation structure.
While both acupuncture and placebo (mock TENS) appeared to have had an equal effect on stroke recovery, there is no significant difference between the two interventions at 12 (p=0.737, 95% CI -2.00 to 2.81) and 52 weeks (p=0.371, 95% CI -3.48 to1.32).
An apparently accelerated improvement in the MI scores in the acupuncture group at 3 weeks, (p= 0.009, 95% CI 1.55 to 10.77), is interesting.
Conclusions Acupuncture did not demonstrate specific efficacy over placebo and both groups did as well as normally expected with this condition.