Developing a multi-modality complementary medicine practice-based research network: The PRACI project

Characteristics of bowen therapy practitioners and practice in Australia: An exploratorysecondary analysis of the practitioner research and collaboration initiative (PRACI) practice-based research network

INTRODUCTION

Bowen Therapy (BT) is a non-invasive manual therapy used to treat muscle pain and discomfort, poor flexibility and imbalances in the body's tissues. Globally, the BT profession comprises a small, but widely dispersed, network of practitioners. While a small pool of preliminary clinical research has begun to investigate the effectiveness of BT for a range of conditions, the investigation of the practice of BT remains extremely limited.

METHODS

This study employs secondary analysis of a national cross-sectional workforce survey of complementary medicine practitioners, to describe the characteristics of BT professionals and their practices in Australia. The study sampled data collected from individuals with qualifications in Bowen Therapy involved in the Practitioner Research and Collaboration Initiative (PRACI). Data were analysed using descriptive statistics.

RESULTS

Study participants (n = 80), primarily female (71.3%) and with a mean age of 52.9 years, reported commonly using a range of assessment tools, discussing a range of health topics with their clients, and using diverse manual therapy techniques in their practice. Participants most commonly reported consulting with clients reporting stress (84.9%), neck pain (75.0%) and sciatica (66.0%). Participants reported treating middle aged (93.4%) and older people (63.3%) most frequently.

DISCUSSION AND CONCLUSION

BTs provide care to a range of clients experiencing a number of conditions and symptoms. Further research should explore the rich details and establish the outcomes of BTs' care with a view to helping inform safe, effective, coordinated patient care across the wider primary care team.

Use of Practice-Based Research Networks in Massage Therapy Research

Massage therapy is a profession, not simply an intervention, and pathways are needed to connect all key massage therapy profession components-clinicians, patient/clients, and the work-to the scholarship and research that describes, investigates, and shapes practice. While the volume of massage-related research has grown over the past few decades, much of the growing massage evidence base is not reflective of real-world massage therapy, nor is research typically conducted through the clinical lens of the massage therapy discipline. This situation reflects the unfortunate disconnect between massage therapy research and massage therapy practice, while magnifying a key research infrastructure deficiency within the massage therapy discipline: the who and where research is conducted is disconnected from the who and where massage therapy is practiced. Practice-based research networks (PBRNs) are a staple of primary care and other health professions research reflecting real life, discipline-focused practice that seeks to address the needs of the discipline's practitioners and patients. The PBRN model fits well with the directional need of massage therapy research. This paper presents a commentary on the use of PBRNs in massage therapy research, and the current state of PBRN research within the field of massage therapy, namely the recently launched MassageNet PBRN.

Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review

BACKGROUND

Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM.

METHODS

The scoping review was undertaken using the Arksey and O'Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data.

RESULTS

Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers.

CONCLUSIONS

While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

Practice-Based Research Networks and Massage Therapy: a Scoping Review

BACKGROUND

Practice-based research networks (PBRNs) are means to connect practitioners with researchers and increase the body of rigorous research. PBRNs have been used in medicine for decades, but efforts to create PBRNs in massage therapy (MT) are limited.

PURPOSE

Examine and describe the amount of and nature of MT-related publications derived from PBRN-supported endeavors.

PUBLICATION SELECTION

Databases: Scopus, CINAHL, PubMed, ClinicalKey, EMBASE, Google Scholar. Keywords: massage, massage therapy, practice-based research network, PBRN. Key items: publication year, operating PBRN, article type, study design, general theme, massage therapist involvement/MT application. Inclusion Criteria: studies conducted through a PBRN using MT/massage therapists as an investigated factor; articles/editorials focused on PBRN-related MT research.

RESULTS

Initial database search resulted in 444 records; 40 articles included in analysis from database search, PBRN website access, and PBRN staff contacts. Publication dates ranged from 2005 to 2019, with nearly all published since 2013. Nine PBRNs published 29 articles based on 20 studies and sub-studies as research papers (n=21) or poster/oral presentation abstracts (n=8), and articles discussing the need for PBRNs in MT (n=8). Most research studies were conducted as surveys (n=21), examining practice characteristics (n=9) and patient perspectives/utilization (n=7). Three articles discussing PBRNs in MT were not connected to any specific PBRN.

CONCLUSION

The PBRN model holds promise to further the field of MT, but implementation needs significant development. Promoting the creation and growth of massage-specific PBRNs should be a focus of professional associations and research institutions to expand the body of scientific evidence supporting MT. While the United States has had the most PBRN-related research efforts, a sustainable implementation model is not evident as highlighted by inactivity from US-based PBRNs after initial productivity. An Australian PBRN may serve as a needed sustainability model for massage-related PBRNs in the US if their productivity trajectory continues.

Australian massage therapists' views and practices related to preconception, pregnancy and the early postpartum period

BACKGROUND AND PURPOSE

Massage is commonly used by the Australian public and is often sought by expectant mothers. Despite its popularity there is no regulatory body to enforce minimum educational standards, guidelines or evidence-based best practice for massage therapists. The aim of this paper is to critically examine the views and practices of massage therapists who offer preconception, antenatal or postnatal massage.

MATERIALS AND METHODS

An online survey was administered to Australian massage therapists who provide massage in the preconception, antenatal or postnatal periods.

RESULTS

Ninety-nine therapists completed the survey. The majority of respondents had received training in pregnancy massage (n = 72; 72.7%) only. The most confident respondents were those that had both training and experience.

CONCLUSION

There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage.

The naturopathic profession in Australia: A secondary analysis of the Practitioner Research and Collaboration Initiative (PRACI)

INTRODUCTION

This study provides the most detailed empirical examination of the naturopathic profession and naturopathic practice in Australia.

METHODS

Naturopaths from the Practitioner Research And Collaboration Initiative (PRACI) were invited to participate in an online workforce survey.

RESULTS

The baseline survey was completed by 281 naturopaths and 155 (55.2%) completed the second survey. Respondents were predominantly female (86.7%), with a mean age of 45.5 years (SD 10.4). A diverse range of clinical interest topics were disclosed; most frequent were digestive (84.0%) and women's (79.4%) health. Diet/nutrition (91.1%), sleep (90.2%), stress management (85.3%) and physical activity/fitness (79.4%) were commonly discussed during consultation.

CONCLUSION

Although respondents reported a varied scope of practice, there was a notable emphasis on lifestyle prescriptions. Given lifestyle diseases are the leading cause of death in Australia, a more in-depth examination of the preparedness of the naturopathy workforce to integrate into community-based health care teams is now warranted.

Introducing national osteopathy practice-based research networks in Australia and New Zealand: an overview to inform future osteopathic research

Both the Osteopathic Research Innovation Network (ORION) and the Osteopathy Research Connect-New Zealand (ORC-NZ) are practice-based research networks (PBRNs) recently established in Australia and New Zealand. This paper highlights the profile of the osteopaths participating in each PBRN in order to encourage and facilitate further related research in osteopathy. All registered osteopaths in Australia and New Zealand were invited to participate in the ORION and ORC-NZ PBRNs, respectively. This paper presents practice and sociodemographic characteristics of the osteopaths that elected to join the PBRN in their country. A total of 253 registered osteopaths in New Zealand (48.7%) agreed to join ORC-NZ while 992 registered osteopaths in Australia (44.5%) joined ORION. Membership of both PBRNs reflect national geographical spread, and diverse personal and practice characteristics. Combined membership of both PBRNs represents 45.3% of all registered osteopaths in Australasia and 7.7% of the global osteopathic profession. The PBRNs, independently and in combination, hold much potential to advance the evidence-base and capacity of osteopathy research. Both ORION and ORC-NZ PBRNs are powerful, innovative resources available to other interested parties to help conduct further osteopathy research in Australia and New Zealand.

Treatment Interventions for the Management of Intestinal Permeability: A Cross-Sectional Survey of Complementary and Integrative Medicine Practitioners

Objectives: This study aims to explore the treatment interventions complementary and integrative medicine (CIM) practitioners use in the management of an emerging health condition, increased intestinal permeability (IP), and the association these methods have on the observed time to resolve this condition. Design and setting: A cross-sectional survey of Australian naturopaths, nutritionists, and Western herbal medicine practitioners was undertaken (n = 227) through the Practitioner Research and Collaboration Initiative (PRACI) network. Outcome measures: Frequencies and percentages of the treatment methods, including chi-square analysis to examine the associations between treatment methods and observed time to resolve IP. Results: Thirty-six CIM practitioners responded to the survey (response rate 15.9%). CIM practitioners were found to use a multimodal approach in the management of IP with 92.6% of respondents using three or more categories of treatment interventions (nutritional, herbal, dietary, and lifestyle) with a mean total of 43.0 ± 24.89 single treatment interventions frequently prescribed. The main treatments prescribed in the management of IP were zinc (85.2%), probiotics: multistrain (77.8%), vitamin D (75.0%), glutamine (73.1%), Curcuma longa (73.1%), and Saccharomyces boulardii (70.4%). CIM practitioners also advocate patients with IP to reduce alcohol (96.3%), gluten (85.2%), and dairy (75.0%) consumption. Evaluation of antibiotics (75.0%) and nonsteroidal anti-inflammatory drugs (73.1%) prescriptions were frequently advised by CIM practitioners. A longer observed time to resolve IP was seen in CIM practitioners who did not reduce intense exercise in the management of IP (p = 0.02). Conclusions: This study represents the first survey of the treatments prescribed by CIM practitioners for IP and suggests that CIM practitioners use numerous integrative treatment methods for the management of IP. The treatment interventions frequently prescribed by CIM practitioners align with preclinical research, suggesting that CIM practitioners prescribe in accordance with the published literature. The findings of this study contribute to the implementation of clinical research in the management of IP, which considers multiple concurrent treatments.

Lessons from Outside and Within: Exploring Advancements in Methodology for Naturopathic Medicine Clinical Research

INTRODUCTION

Naturopathy is a mixture of both traditional and complementary medicine. It incorporates a broad set of health care practices that may or may not be traditional to that country or conventional medicine and are not fully integrated into the dominant health care system. Research required to evaluate or substantiate naturopathic medicine may not fall under the testing of randomized clinical trials, which opens up discussions on what is the best practice for research in naturopathic medicine.

DISCUSSION

Not only do advances in health research methodology offer important opportunities to progress naturopathic research, there are also areas where the unique characteristics of naturopathic philosophy and practice can impact other areas of health research. Some of the new advances in health research methodology involve whole-system research, pragmatic trials, template for intervention description and replication protocols for complex interventions, patient-centered care models, and the pragmatic-explanatory continuum indicator summary tool for designing pragmatic trials. Discussion and critique of these health-related methodologies shows that these research methods are more suited for the philosophy and treatment options that naturopathy is based on.

CONCLUSIONS

Successful implementation of naturopathic research methodologies, and translation and dissemination of research will require a substantial paradigm shift in which naturopathic practitioners adopt a greater level of responsibility for developing an evidence base for naturopathic medicine.

The Australian Complementary Medicine Workforce: A Profile of 1,306 Practitioners from the PRACI Study

OBJECTIVES

This study aims to describe the Australian complementary medicine (CM) workforce, including practice and professional characteristics.

DESIGN

National cross-sectional survey.

SETTINGS/LOCATION

Australia.

SUBJECTS

Any individual who self-identified as a practitioner qualified in any one of 14 CM professions and working in any state or territory of Australia was eligible to participate in the survey.

INTERVENTIONS

A 19-item online survey was developed following a review of existing CM workforce data and in alignment with other CM workforce survey projects in progress at the time. The survey items were presented under three main constructs: demographic characteristics, professional characteristics, and practice characteristics.

STATISTICAL ANALYSIS

Descriptive statistical analysis, including frequencies and percentages, of multiple choice survey items was used. Open response items were analyzed to determine the mean, standard deviation (SD), minimum, and maximum. The demographic data were evaluated for representativeness based on previously reported CM workforce figures.

RESULTS

The survey was completed by 1306 CM practitioners and was found to be nationally representative compared with the most recent registrant data from the Chinese Medicine Board of Australia. Participants primarily practiced in the most populous Australian states and worked in at least one urban clinical location. Most participants held an Advanced Diploma qualification or lower, obtained their qualification ten more years ago, and practiced in a clinical environment alongside at least one other practitioner from another health profession. Participants reported diverse clinical practice specialties and occupational roles. Per week, participants worked an average of 3.7 days and treated 23.6 clients.

CONCLUSIONS

The results from this survey of practitioners from most complementary professions in Australia provide new insights into the national complementary medicine workforce. Further exploration of the CM workforce is warranted to inform all who provide patient care and develop health policy for better patient and public health outcomes.

An Overview of the Practitioner Research and Collaboration Initiative (PRACI): a practice-based research network for complementary medicine

Background

The Practitioner Research and Collaboration Initiative (PRACI) is an innovative, multi-modality practice-based research network (PBRN) that represents fourteen complementary medicine (CM) professions across Australia. It is the largest known PBRN for complementary healthcare in the world and was launched in 2015. The purpose of this paper is to provide an update on the progress of the PRACI project, including a description of the characteristics of PRACI members in order to facilitate further sub-studies through the PRACI PBRN.

Methods

A CM workforce survey was distributed electronically to CM practitioners across fourteen disciplines, throughout Australia. Practitioners electing to become a member of PRACI were registered on the PBRN database. The database was interrogated and the data analysed to described sociodemographic characteristics, practice characteristics, professional qualification and practice interest of PRACI members.

Results

Foundational members of PRACI were found to be predominately female (76.2%) and middle-aged (82.5%). Members were primarily located in urban settings (82.5%) across the Eastern seaboard of Australia (82.5%), with few working remotely. The main modalities represented include massage therapists (58.5%), naturopaths (26.4%) and nutritionists (14.4%). The primary area of clinical interest for PRACI members were general health and well-being (75.4%), musculoskeletal complaints (72%) and pain management (62.6%).

Conclusions

PRACI provides an important infrastructure for complementary healthcare research in Australia and its success relies on CM practitioners being involved in the research being conducted through the PBRN. The aim of this database is to ensure that the research conducted through PRACI is rigorous, robust, clinically relevant and reflects the diversity of clinical practice amongst CM practitioners in Australia.