Background & Aim: Osteoarthritis (OA) sufferers frequently turn to complementary and alternative medicine (CAM), of which the most common are acupuncture and homeopathy, to improve manageability of their condition. However, there is little extant evidence of effectiveness for these treatments for OA, particularly for homeopathy. One criticism of homeopathic studies is that treatment protocols do not reflect true homeopathy. The nature of true homeopathy is not documented in extant literature. In the current study a mixed methods approach was used to investigate the use of homeopathy for osteoarthritis using a survey, conducted with a parallel acupuncture survey for comparison, follow up interviews with homeopaths and a patient-centred study in a homeopathic department offering treatment on the NHS, in order to inform future studies. Method: The current study involved three phases; (1) A descriptive survey conducted on n=362 medical and non-medical homeopaths and acupuncturists, was used to , investigate practice of the therapies (2) Follow up interview of n=28 of the homeopathic practitioners. (3) A patient-centred study of n=11 patients with OA receiving homeopathy in the primary care setting. Results: (1) Most commonly encountered conditions were chronic diseases. Medical and non-medical acupuncturists practised very different forms of acupuncture particularly in terms of diagnostic techniques used and theoretical underpinning. Homeopathic practitioners used individualised treatments, abiding by classical homeopathy. Differences between medical and non-medical homeopaths included time spent in the consultation (p= 0.01), strength of confidence in homeopathy for asthma (p=0.01), musculo-skeletal (p=0.046) and acute conditions (p=0.01)., and confidence in conventional medicine (p=0.01). There was a belief amongst acupuncturists and homeopaths that the treatments may work on electrodynamic fields in the body. (2) A similar approach was taken by participants during a detailed initial consultation. However, irrespective of medical status, varied approaches were used to identify the remedy, potency, and remedy f6mi, and the source of remedy also varied. Main themes regarding the modus operandi of homeopathy included stimulation of self healing mechanisms and identifying in detail events at the point where the initial health imbalance occurred. Identification of this point together with the patient was considered a potential trigger for the healing process to begin, adding a particular importance to the role of the consultation. (3) OA patients in the primary care setting identified pain or stiffness as the most common primary complaint., with an emotional factor such as anxiety and limitations caused by their condition as a secondary complaint. A desire to reduce their medication or to improve the manageability of their condition was a common theme for interest in receiving homeopathy, with access to NHS homeopathic treatment and perceived safety of receiving treatment from medical doctors being important factors. Following 6 months of' homeopathic treatment, most participants reported an improvement in the manageability of their condition. This, however was not supported by results from VAS pain, VAS stiffness, MYCAW scores or SF36 subscore, or salivary concentration of substance P results which were not found to be significant. Few correlations were found between outcome measures. Substance P level was strongly correlated with the functional limitations sub-score of the SF36 (p=0.01), indicating a potential role for this biochemical measure in future studies. Conclusion: Findings from the current study can inform future studies on how to enhance the evidence base for homeopathic and acupuncture treatment, and inform the integration debate. Future advances in the understanding of subtle processes in the body, the placebo response, and the nature of cure may add to our understanding of' CAM treatments. However, it is likely that in order to advance the evidence base on the effectiveness of homeopathy for OA, more effective tools that are sensitive to changes in biopsychosocial dimensions of health will be necessary. Future research on combination therapies is also warranted.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:521105 |
| Date | January 2009 |
| Creators | Majumdar, Anne J. |
| Publisher | Liverpool John Moores University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://researchonline.ljmu.ac.uk/5978/ |
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