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Kroenke K, Corrigan JD, Ralston RK, Zafonte R, Brunner RC, Giacino JT, Hoffman JM, Esterov D, Cifu DX, Mellick DC, Bell K, Scott SG, Sander AM, Hammond FM. Effectiveness of care models for chronic disease management: A scoping review of systematic reviews. PM R 2024; 16:174-189. [PMID: 37329557 DOI: 10.1002/pmrj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). METHODS Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. DATA Target diseases, model components used (n = 11), and six outcomes (disease-specific, generic health-related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). SYNTHESIS Narrative synthesis, including proportion of reviews documenting outcome benefits. RESULTS More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes (n = 22), depression (n = 16), heart disease (n = 12), aging (n = 11), and kidney disease (n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease-specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. CONCLUSIONS Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Rick K Ralston
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Steven G Scott
- Center of Innovation on Disability & Rehab Research (CINDRR), James A Haley Veterans' Hospital, Tampa, Florida, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Mata R, Bankole AO, Barnhill J, Roth I. A descriptive exploration of younger and older adults' experiences of Integrative Medical Group Visits for Long COVID. AGING AND HEALTH RESEARCH 2023; 3:100137. [PMID: 37799164 PMCID: PMC10554753 DOI: 10.1016/j.ahr.2023.100137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Introduction Long COVID disproportionately affects older adults. Individuals with Long COVID (LC) often experience symptoms that severely impact quality of life, and treatment approaches are still evolving. The Integrative Medical Group Visit (IMGV) model is an evidence-based approach that may be useful to treat patients with LC; however, there is limited evidence describing the experience and/or feasibility of using IMGV for LC treatment, especially among the older adult population. The purpose of this study is to describe older and younger adults' experiences of both having LC and participating in a virtually delivered IMGV for LC. Methods This is a secondary analysis of qualitative data from a parent study examining the experiences of participants in a virtually delivered IMGV for patients with LC. Patients participated in semi-structured interviews before and after 8 weekly IMGV sessions. Thematic analysis was used to analyze interview data. Results Overall, 21 pre-interviews and 17 post-interviews were collected. Thematic analysis of patient interviews by age group resulted in three themes that each contained similarities and differences between the younger and older adult participants. These themes included: (1) experiences of LC (2) feelings about the future (3) experiences of the pilot IMGV on LC. Conclusion This study provides critical context for clinicians who treat older adults with LC. Results support virtually delivered IMGVs as a potentially feasible option for both older and younger adults who want to apply an integrative approach to their LC treatment. Findings from this study will inform future research on IMGV for LC treatment.
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Affiliation(s)
- Raveena Mata
- The Ohio State University, College of Medicine, USA
- University of North Carolina, Chapel Hill, USA
| | | | | | - Isabel Roth
- University of North Carolina, Chapel Hill, USA
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3
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Binda DD, Weinberg JM, Nguyen T, Morone NE. Characterizing Interprofessional Collaboration and Referral to Mindfulness-Based Stress Reduction Programs. Glob Adv Health Med 2022; 11:2164957X221126484. [PMID: 36118601 PMCID: PMC9478712 DOI: 10.1177/2164957x221126484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background In 2017, the American College of Physicians (ACP) designated Mindfulness-Based Stress Reduction (MBSR), an eight-week group program, as first-line non-pharmacological treatment for chronic low back pain. However, interprofessional collaboration between mindfulness instructors and Primary Care Providers (PCP) remains largely unknown. Objective We developed a survey to assess communication between mindfulness instructors and PCPs, identify predictors of referral to MBSR, and determine areas where interventions could increase patient access to MBSR. Methods The 25-question survey was sent via email to PCPs at the Division of General Internal Medicine, University of Pittsburgh, PA, the Piedmont Health Services Family Medicine Section, Chapel Hill, NC, the Boston Medical Center General Internal Medicine and Family Medicine Sections, Boston, MA, and the UMass Memorial Medical Center Family Medicine Section, Worcester, MA. We used descriptive statistics and logistic regression to analyze the data. Results Among 118 eligible respondents, 85 (72.0%) were female PCPs, mean age was approximately 41.5±10.1, and the majority (65.2%) had been in medical practice ≤10 years. Of these PCPs, 83 (70.1%) reported familiarity with MBSR (95% CI: 62.1, 78.5), and 49 (59.0%) of them referred patients at least yearly. Of those who referred, 8 (16.3%) reported collaboration with mindfulness instructors. PCPs who were quite a bit or very much familiar with MBSR had 5.10 (1.10, 22.50) times the odds (P=.03), and those who were 50 years or younger had 3.30 times the odds (P=.04) of referring patients to MBSR. Frequency of PCPs' personal practice of mindfulness was not significantly associated with referrals (P=.30). Conclusion This is the first study to assess interprofessional collaboration between mindfulness instructors and PCPs. Suggestions for a potential integrative health care model are included; further studies on methods to augment communication and education are warranted to improve the referral process and ultimately increase accessibility and utilization of mindfulness-based programs.
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Affiliation(s)
- Dhanesh D. Binda
- Dhanesh D. Binda, Boston University School of
Medicine, 72E Concord St, Boston, MA 02118, USA.
| | - Janice M. Weinberg
- Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA
| | - Tra Nguyen
- Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA
- Boston University School of Medicine and
Boston Medical Center, Boston, MA, USA
| | - Natalia E. Morone
- Boston University School of Medicine and
Boston Medical Center, Boston, MA, USA
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4
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Oorschot T, Adams J, Sibbritt D. Is mental health co-morbidity an influencing factor in the health service utilisation of women with diabetes mellitus? PLoS One 2022; 17:e0272041. [PMID: 35939485 PMCID: PMC9359580 DOI: 10.1371/journal.pone.0272041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 07/13/2022] [Indexed: 11/19/2022] Open
Abstract
Diabetes Mellitus, affecting nearly half a billion people worldwide, is a substantial global public health issue. Although diabetes predominantly affects men, women with diabetes have specific risks and self-management characteristics. Women have a higher risk of either presenting with or developing depression or anxiety, as well as being high users of complementary medicine which can create clinical governance issues. In spite of these known gender differences, limited research has explored gender-specific diabetes care, especially health service use patterns. As increasing attention has turned to supporting people with diabetes to successfully self-manage their diabetes, it is important that we understand how women with diabetes are using health services, and if their specific risk profile is influencing their health care choices. Our study sought to examine the relationship between mental health status and the patterns of conventional and complementary medicine health service use by women diagnosed with diabetes mellitus. Our results showed that women with diabetes and any mental health co-morbidity were more likely to visit their general practitioner more frequently or use herbal medicine than those without a mental health co-morbidity. Women with depression and anxiety were also less likely to consult a physiotherapist and those with anxiety less likely to consult a podiatrist over time when compared to the other mental health groups.
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Affiliation(s)
- Tracey Oorschot
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jon Adams
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Sibbritt
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
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5
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Developing a needs-based integrative service delivery model to deliver best practice care for chronic nonspecific low back pain. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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McIntyre E, Oorschot T, Steel A, Leach MJ, Adams J, Harnett J. Conventional and complementary health care use and out-of-pocket expenses among Australians with a self-reported mental health diagnosis: a cross-sectional survey. BMC Health Serv Res 2021; 21:1266. [PMID: 34814916 PMCID: PMC8611990 DOI: 10.1186/s12913-021-07162-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Mental health disorders are a global health concern. In Australia, numerous national reports have found that the current mental healthcare system does not adequately meet the needs of Australians with mental illness. Consequently, a greater understanding of how people with a mental health disorder are using the broader healthcare system is needed. The aim of this paper is to explore conventional and complementary health care use and expenditure among Australian adults reporting a mental health disorder diagnosis. Methods A cross-sectional online survey of 2,019 Australian adults examined socio-demographic characteristics, complementary and conventional health care use and the health status of participants. Results 32 % (n = 641) of the total sample (N = 2019) reported a mental health disorder in the previous 3 years. Of these, 96 % reported consulting a general practitioner, 90.6 % reported using prescription medicines, 42.4 % consulted a complementary medicine practitioner, 56.9 % used a complementary medicine product and 23 % used a complementary medicine practice. The estimated 12-month out-of-pocket health care expenditure among Australians with a mental health disorder was AUD$ 4,568,267,421 (US$ 3,398,293,672) for conventional health care practitioners and medicines, and AUD$ 1,183,752,486 (US$ 880,729,891) for complementary medicine practitioners, products and practices. Older people (50–59 and 60 and over) were less likely to consult a CM practitioner (OR = 0.538, 95% CI [0.373, 0.775]; OR = 0.398, 95% CI [0.273, 0.581] respectively) or a psychologist/counsellor (OR = 0.394, 95% CI [0.243, 0.639]; OR = 0.267, 95% CI [0.160, 0.447] respectively). People either looking for work or not in the workforce were less likely to visit a CM practitioner (OR = 0.298, 95% CI [0.194, 0.458]; OR = 0.476, 95% CI [0.353, 0.642], respectively). Conclusions A substantial proportion of Australian adults living with a mental health disorder pay for both complementary and conventional health care directly out-of-pocket. This finding suggests improved coordination of healthcare services is needed for individuals living with a mental health disorder. Research examining the redesign of primary health care provision should also consider whether complementary medicine practitioners and/or integrative health care service delivery models could play a role in addressing risks associated with complementary medicine use and the unmet needs of people living with a mental health disorder.
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Affiliation(s)
- Erica McIntyre
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia. .,Institute for Sustainable Futures, University of Technology Sydney, PO Box 123, 2007, Ultimo, NSW, Australia.
| | - Tracey Oorschot
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia
| | - Matthew J Leach
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia.,National Centre for Naturopathic Medicine, Southern Cross University, NSW, 2480, Lismore, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia
| | - Joanna Harnett
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney School of Pharmacy, 2006, Sydney, NSW, Australia
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Granata N, Traversoni S, Kardas P, Kurczewska-Michalak M, Costa E, Midão L, Giardini A. Methodological features of quantitative studies on medication adherence in older patients with chronic morbidity: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2132-2141. [PMID: 32402488 DOI: 10.1016/j.pec.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/07/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The growing number of chronic, multimorbid older adults encourages healthcare systems to cope with polypharmacy and non-adherence. However, methodology on how to provide effective interventions to enhance medication adherence is still object of debate. METHODS To describe methodological features of quantitative studies concerning older adults' medication adherence, by means of a PRISMA systematic review (Scopus, PubMed, Medline). A specific focus was devoted to theoretical models and to the ABC Taxonomy model, as stated by the EMERGE guidelines. RESULTS 55 papers were included. Most of the studies were conducted using randomized control trials (63.6%) and focused on a single disease only (72.7%). Most of the interventions were provided by a single professional figure (70.9%). Medication adherence was mainly evaluated by means of questionnaires (61.8%) and by clinical records (30.9%). Sixteen studies considered a theoretical model in the intervention framework. The Initiation phase (ABC Taxonomy) was the most neglected. CONCLUSIONS Future studies upon medication adherence should account real-life challenges such as multimorbidity, polypharmacy and interdisciplinarity, analyzing adherence as a complex, holistic process. PRACTICE IMPLICATIONS Theoretical models may be useful to enhance the soundness of the results, to ease their comparability, to calibrate tailored strategies and to plan patient-centered interventions.
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Affiliation(s)
- Nicolò Granata
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy
| | - Silvia Traversoni
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy
| | - Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | | | - Elísio Costa
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, Portugal
| | - Luís Midão
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, Portugal
| | - Anna Giardini
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy.
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Asahi MG, Briganti D, Cam E, Seffinger MA. The Role of Musculoskeletal Disorders in Chronic Disease: A Narrative Review. J Osteopath Med 2020; 120:665-670. [PMID: 32936865 DOI: 10.7556/jaoa.2020.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chronic diseases and musculoskeletal conditions are responsible for a significant portion of the global disease burden and are frequently comorbid, such as with low back pain in patients who also have chronic organ disease. Low back pain is the leading cause of long-term disability and is the most common reason adults seek adjunctive treatment, including osteopathic manipulative treatment (OMT). OMT has been shown to be effective in relieving low back pain and improving back-specific functioning. In this narrative review, the authors summarize literature published in the last decade and analyze the relationship between musculoskeletal disorders and systemic medical conditions such as diabetes mellitus; they also discuss the efficacy and cost-effectiveness of OMT in managing somatic dysfunction in patients with chronic diseases.
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9
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Danell JAB. Integrative oncology from a bibliometric point of view. Complement Ther Med 2020; 52:102477. [PMID: 32951727 DOI: 10.1016/j.ctim.2020.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The aim of this article is to analyze the development of integrative oncology from a bibliometric point of view. The publication and citation patterns of publications are analyzed and their contents mapped. DESIGN This study is based on bibliometric methods. The data sets consist of 7 025 respectively 4 990 publications over the time period 1966-2016, shown in PubMed and Web of Science. RESULTS The expansion of the numbers of these publications took place in the late 1990s/early 2000s. Research is dominated by authors located in the USA, China and Germany who are working at well-established research universities and university hospitals. The clinical share of publications is relatively small, and few studies are classified according to clinical phase. Content analysis revealed that much of the clinical research is based on surveys, and that content reflects the intersection of complementary therapies and cancer research. The latter aspect is less obvious in pre-clinical research. The most frequent journals in the material show a focus on complementary and alternative therapies or on integrative oncology, although journals focused on oncology or general/internal medicine were well-represented in the material as a whole. The most-cited publications were review articles and surveys. CONCLUSIONS Integrative oncology has been established as a small, but distinct, research domain. There are several signs of specialization in integrative oncology, but also in its integration into general medical and oncological research.
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10
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Steel A, Rickwood C, Bradley R, Foley H, Harnett JE. Australian Naturopaths' Approach to Caring for People with Cardiovascular Disease and Associated Risk Factors: A Qualitative Study of the Providers' Perspective. J Altern Complement Med 2020; 26:902-910. [PMID: 32721211 DOI: 10.1089/acm.2020.0095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: To date, no formal research has evaluated how naturopathic practitioners approach the care of people living with CVD and associated CVD risk factors. The primary aim of this research was to collect qualitative data from Australian Naturopathic practitioners about their clinical practices for CVD. Design: Semi-structured interviews were conducted, recorded, transcribed, and ultimately coded by three independent researchers using the Framework Approach. Subjects: 10 Australian Naturopathic practitioners. Results: The key emergent themes from the responses of naturopathic practitioners embodied the elements of patient-centered care (PCC). Numerous factors, including regulation, barriers to service access, and interprofessional communication, were cited as hurdles to additional effectiveness as PCC practitioners. Conclusion: Future research should assess whether the principles of PCC are reported directly from the patients who utilize naturopathy for CVD to determine if their experience mirrors the reports by practitioners.
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Affiliation(s)
- Amie Steel
- Australian Research Centre of Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - Ryan Bradley
- Australian Research Centre of Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Hope Foley
- Australian Research Centre of Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - Joanna E Harnett
- Australian Research Centre of Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia.,School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Shi J, Hu H, Harnett J, Zheng X, Liang Z, Wang YT, Ung COL. An evaluation of randomized controlled trials on nutraceuticals containing traditional Chinese medicines for diabetes management: a systematic review. Chin Med 2019; 14:54. [PMID: 31798675 PMCID: PMC6884840 DOI: 10.1186/s13020-019-0276-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/07/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Nutraceuticals containing traditional Chinese medicine (TCM) are promoted for use in the management of diabetes. The evidence to support such use is largely unknown. This study aimed to summarise and evaluate the literature reporting the results of randomized controlled trials (RCTs) investigating the effects of nutraceuticals in people living with diabetes. METHODS Literature from four electronic databases (PubMed, Scopus, CINAHL and Web of Science) was searched following PRISMA guidelines to yield RCT publications on nutraceutical for diabetes management published since 2009. The quality of reporting was assessed using the CONSORT 2010 checklist statement. Risk-of-bias for each study was assessed using the Cochrane risk of bias tool. RESULTS Out of 1978 records identified in the initial search, 24 randomized, double/triple-blinded, controlled trials that investigated the effect of nutraceuticals covering 17 different TCM herbs for diabetes management were selected. Participants included people who were diabetic (n = 16), pre-diabetic (n = 3) or predisposed to diabetes (n = 5). Sample sizes ranged between 23 and 117 for 2 arms, or 99-165 for 3 arms. Comparisons were made against placebo (n = 22), conventional medicine (n = 1), or regular diet (n = 1) for a duration between 4 and 24 weeks. All but one study tested the effect on fasting blood glucose levels (n = 23) or glycated haemoglobin levels (n = 18), and/or postprandial 2-h blood glucose levels (n = 4) as the primary outcomes. Nineteen studies reported some statistically significant reductions in the respective measures while 5 studies showed no effect on primary or secondary outcomes. None of the included studies met all the criteria for the CONSORT guidelines. Incomplete reporting about randomization and blinding, and a lack of ancillary analyses to explore other influential factors and potential harms associated with the use were repeatedly noted. Based on the Cochrane risk-of-bias tool, 19 studies were deemed to have a high risk of bias mainly attributed to sponsor bias. CONCLUSIONS There is some evidence to suggest positive clinical outcomes in response to the administration of a range of nutraceuticals containing TCM in the management of diabetes. However, these results must be interpreted with caution due to the overall low quality of the trials.
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Affiliation(s)
- Junnan Shi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Joanna Harnett
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Xiaoting Zheng
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Zuanji Liang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Yi-Tao Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Clyne A, Yang AWH, Li M, Fei Y, May BH. Traditional medicines for asthma in children and adults: A systematic review of placebo-controlled studies. Int J Clin Pract 2019; 73:e13433. [PMID: 31610072 DOI: 10.1111/ijcp.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Traditional medicines (TMs) adjunctive to conventional medications are widely used for asthma in east-Asia and have gained popularity in western countries. OBJECTIVE To assess the efficacy and safety of TMs for asthma in children and adults based on placebo-controlled trials in order to inform physicians and assist them in discussions with patients. METHODS Seventeen electronic databases were searched. Participants had acute or chronic asthma. Interventions included orally administered traditional medicines used in east-Asia. Outcomes included lung function, symptoms, quality of life, exacerbations, medication use and safety. RevMan 5.3 (random effect model) was used for meta-analysis. Baseline values were assessed for balance and asthma severity. Within-group changes were calculated to assess minimal clinically important difference (MCID). RESULTS Eighteen studies (2080 participants) were included. All combined TMs with conventional medicines. The single study of acute asthma (n = 300) showed an improvement. For chronic asthma, severity at baseline ranged from very mild to severe. When asthma was mild, significant differences in lung function (FEV1%, PEF/R) were not detectable. When participants had moderate and/or severe asthma at baseline improvements were more evident. For measures of lung function, improvements within the TM groups tended to be greater when the asthma was more severe. Some studies showed MCIDs. No serious adverse events or interactions were reported but safety data were incomplete. CONCLUSIONS The application of certain traditional herbal medicines used in east-Asia as adjuncts to conventional medications improved outcomes in acute and chronic asthma, but most evidence was based on single trials. Therefore, no single TM could be recommended. Effect sizes varied according to asthma severity at baseline. Future studies should consider baseline severity when enrolling participants.
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Affiliation(s)
- Allison Clyne
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic., Australia
| | - Angela Wei Hong Yang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic., Australia
| | - Mingdi Li
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic., Australia
| | - Yutong Fei
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Chaoyang, China
| | - Brian H May
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic., Australia
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