Health services research as a framework for expanding a whole systems research agenda in complementary and integrative medicine: The example of intestinal permeability

The Subjective Well-being and Health-Related Quality of Life of Australian Adults with Increased Intestinal Permeability and Associations with Treatment Interventions

Objective: The integrity and function of the gastrointestinal system is important in disease prevention and management. This study aims to describe the management methods used by Australian adults with suspected increased intestinal permeability (IP) and the association with subjective wellbeing (SWB) and health-related quality of life (HRQoL).

Design and Setting: Cross-sectional survey of Australian adults diagnosed with IP or have suspected (undiagnosed) IP.

Outcome Measures: Questionnaire items investigating demographic characteristics, self-reported outcome of IP and treatment methods used to manage IP. Participants' HRQoL and SWB according to the 20-Item Short Form Health Survey (SF-20) and Personal Wellbeing Index-Adult (PWI-A) scale, respectively.

Results: Participants (n = 589) frequently used dietary products (87.9%), dietary supplements (72.9%) and lifestyle therapies (54.6%) for managing IP. Participants had lower (i.e., worse) mean SWB scores for all domains compared to the Australian population (p < 0.001). The number of days IP reported to affect daily living was negatively correlated with SWB and HRQoL (p < 0.001). Participants that reported an improvement in their IP in the previous 12 months were more likely to be treated by a healthcare practitioner (OR = 2.04, p = 0.015), use dietary supplements (OR = 2.66, p = 0.003), participate in vigorous exercise (OR = 2.99, p < 0.001) and employ vagus nerve stimulation (OR = 3.10, p = 0.010). Conversely, they were less likely to consume gluten (OR = 0.35, p < 0.001) or use nonsteroidal anti-inflammatory drugs (OR = 0.35, p = 0.022). Self-reported improvement of IP (β = 10.70, p < 0.001) and use of dietary products (β = 12.12, p = 0.008) were predictors of a higher level of SWB.

Conclusions: Altered IP may pose a greater health burden than previously thought, with poor SWB and HRQoL reported in Australian adults with self-reported IP. Our results highlight the potential clinical relevance and consequence of altered IP, providing the first indication of a possible relationship between altered IP and both SWB and HRQoL.

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.