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Wang J, Zhang CS, Zhang AL, Yu J, Deng H, Chen H, Xue CC, Lu C. Add-on effects of Chinese herbal medicine external application (FZHFZY) to topical urea for mild-to-moderate psoriasis vulgaris: Protocol for a double-blinded randomized controlled pilot trial embedded with a qualitative study. PLoS One 2024; 19:e0297834. [PMID: 38512933 PMCID: PMC10956750 DOI: 10.1371/journal.pone.0297834] [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: 02/25/2023] [Accepted: 01/01/2024] [Indexed: 03/23/2024] Open
Abstract
Psoriasis vulgaris is a chronic dermatological disease with a high global prevalence. It significantly reduces patients' quality of life and is associated with a substantial economic burden. Conventional therapies for mild-to-moderate psoriasis are often associated with insufficient long-term symptomatic relief and side effects. Chinese herbal medicine (CHM) is commonly used for psoriasis management. A CHM formula, namely Fu zheng he fu zhi yang (FZHFZY), has shown promising treatment effects in clinical practice when used as a bath therapy. However, its efficacy and safety has not been evaluated by a rigorous randomized controlled trial (RCT). Therefore, we designed a double-blinded pilot RCT embedded with a qualitative study on CHM formula FZHFZY plus topical urea for mild-to-moderate psoriasis vulgaris to advance the evidence development and practice of CHM external application for psoriasis. This will be a mixed-method design consisting of a pilot RCT and a qualitative study. The pilot RCT is a two-arm, parallel, placebo-controlled, double-blinded trial. Sixty eligible participants will be randomized at a 1:1 ratio to receive eight weeks' treatment of either FZHFZY plus 10% urea cream, or placebo plus 10% urea cream, with 12-week follow-up visits after the treatment phase. The CHM or placebo will be administered externally as a bath therapy. Outcome measures include trial feasibility, efficacy and safety. The primary efficacy outcome will be Psoriasis Area Severity Index (PASI). Secondary efficacy outcomes include Physician Global Assessment, PASI-75, PASI-50, Body Surface Area, Dermatology Life Quality Index, Skindex-16, itch visual analogue scale and relapse. The qualitative study will be conducted to collect participants' feedback on CHM external application and their experience with the pilot RCT. This study will advance the evidence-based clinical practice of using CHM for psoriasis vulgaris and then to support translation of findings into clinical practice in the future. Trial registration number: ChiCTR2200064092.
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Affiliation(s)
- Junyue Wang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Claire Shuiqing Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Jingjie Yu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Hao Deng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Haiming Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Charlie Changli Xue
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Chuanjian Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Sørensen CW, Sonne C, Sacha M, Kristiansen M, Hannemose SZ, Stein DJ, Carlsson J. Potential advantages of combining randomized controlled trials with qualitative research in mood and anxiety disorders - A systematic review. J Affect Disord 2023; 325:701-712. [PMID: 36642313 DOI: 10.1016/j.jad.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Most randomized controlled trials (RCTs) of mood and anxiety disorders employ solely quantitative methods. Supplementing quantitative data with qualitative methods, a so-called mixed-method approach, would seem useful, however this area has not been rigorously reviewed. We undertook a systematic review of RCTs of mood and anxiety disorders that employed concurrent quantitative data collection and qualitative methods exploring the participants' perspective, with the aim of 1. determining the number of such studies, 2. describing study characteristics, and 3. identifying potential advantages of a mixed-method approach. METHODS Following PRISMA guidelines, a systematic literature search for RCTs of mood and anxiety disorders, concurrently applying quantitative and qualitative methods, was conducted using EMBASE, PsycINFO and Pubmed, from their inception to February 2021. Categories of potential advantages of this mixed method approach were developed. RESULTS A total of 45 RCTs were included. The qualitative components typically included 10-40 participants, mostly consisting of interviews after the intervention. The majority of papers did not state a specific rationale for using a mixed method approach. Four categories of advantages emerged: 1. determine acceptability/feasibility, 2. investigate efficacy, 3. inform implementation in clinical practice and 4. generate new hypotheses based on the combination of quantitative and qualitative data. LIMITATIONS Lack of cross-referencing and consistent terminology challenged identification of relevant publications. CONCLUSION There are a number of potential advantages of applying mixed method approaches in RCTs within psychiatric research. Intentional consideration of such advantages early in trial design may increase the likelihood of gaining added value.
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Affiliation(s)
- Carina Winkler Sørensen
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark; Mental Health Centre Copenhagen, Denmark.
| | - Charlotte Sonne
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Maria Sacha
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sigrid Zeuthen Hannemose
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry, South Africa; Neuroscience Institute, University of Cape Town, South Africa
| | - Jessica Carlsson
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Nakamura M, Niimura H, Kitanishi K. A century of Morita therapy: What has and has not changed. Asia Pac Psychiatry 2023; 15:e12511. [PMID: 35403327 PMCID: PMC10078264 DOI: 10.1111/appy.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
We review the history of Morita therapy (MT), which has existed for over 100 years, and examine what has changed over that period and what has not. Classic MT, which was dependent on a highly strict therapeutic approach, gradually lost its pre-eminence, but at the same time, the fundamental theory of MT was refined. This theory came to be applied to current outpatient MT and adapted to inpatient MT. As MT was refined, a standard training system for therapists was established, adaptations to modern conditions were made and expanded, and comparisons to and dialogs with other psychotherapeutic concepts such as mindfulness became possible. To better evaluate MT, further work should be conducted on its effectiveness of from a clinical epidemiological perspective.
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Affiliation(s)
- Mitsuhiro Nakamura
- Department of Psychiatry, Yokohama Camellia Hospital, Yokohama, Kanagawa, Japan.,Shinano Mental Clinic, Yokohama, Kanagawa, Japan
| | - Hidehito Niimura
- Faculty of Human Science, Toyoeiwa University, Yokohama, Kanagawa, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Kitanishi
- Morita Therapy Institute, Tokyo, Japan.,Kitanishi Clinic, Tokyo, Japan
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Assessing the Efficacy of the Early Rehabilitation Pathway in Combination with Morita Therapy after Hip and Knee Arthroplasty. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4285197. [PMID: 35368944 PMCID: PMC8970862 DOI: 10.1155/2022/4285197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective methods for the treatment of end-stage osteoarthritis. Furthermore, rehabilitation training and psychological interventions play significant roles in the recovery of hip and knee joint function after THA and TKA. A total of 46 patients who received hip replacement and knee replacement are equally divided into two groups, with the control group being prescribed routine rehabilitation intervention and the observation group prescribed an early rehabilitation pathway with Morita therapy intervention. According to the results, the observation group displayed a significantly decreased incidence of deep venous thrombosis, while simultaneously reducing the recovery time of lower limb function (P < 0.05), including straight leg raising time, walking time, and vertical knee flexion time. In addition, the treatment program demonstrates a significant ability to improve the joint function score, pain score, quality of life score, and range of motion score (P < 0.05). Moreover, serum D-dimer, fibrin degradation products (FDP), and femoral vein blood flow peak also are significantly reduced (P < 0.05). Therefore, we have determined that an early rehabilitation pathway combined with Morita therapy can effectively reduce stress pain, improve the recovery process of joint motor function, and reduce the incidence of thrombosis. However, an increased sample size would facilitate the confirmation of the safety and efficacy of the program. In addition, the overall financial expenditure and feasibility of the treatment need to be considered.
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Proactive Community Occupational Therapy Service for Social Participation Development of Thai Adults with Depression: A Grounded Theory Study from Occupational Therapists' Perspective. Occup Ther Int 2021; 2021:6695052. [PMID: 34354554 PMCID: PMC8294989 DOI: 10.1155/2021/6695052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/12/2021] [Accepted: 06/30/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Depression in adulthood decreases social participation in the workplace, family, and community, which further results in decreased work performance and cessation and social isolation. There is a high statistic of outpatient consultation and readmission of Thais with depression, yet the mental health support for remission in community life and social participation remains limited and unclear. Further, due to the lack of mental health professional resources, particularly occupational therapists, there is much to be known regarding how such therapists work to support the development of social participation in Thai adults with depression. Objective This research was aimed at understanding the process of how occupational therapists work to redevelop the social participation of community-dwelling Thai adults with depression. Method The grounded theory methodology was used in this study. Data were collected through interviews and nonparticipatory observations of 14 participants who had experience providing mental health care in community services. The constant comparative analysis method was employed. Result Three concepts illustrated a proactive community occupational therapy service for depression (PCOTS-D), namely, integrating depression care in community occupational therapy service (COTS), supporting meaningful participation, and forming collaborative networks. The PCOTS-D supported the reconnection of social participation by leading from proactive depression care service to COTS and then working to support meaningful participation toward the patient's self-management and building collaborative networks with inter- and intraprofessional teams simultaneously. Conclusion The PCOTS-D presented a holistic view of working with community-dwelling Thai adults with depression by considering the importance of the community and researchers' network to redevelop social participation, promote health and recovery, build teams in depression care, and encourage research evidence to enhance the supportive advocacy policy for Thai people with depression.
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Sugg HVR, Frost J, Richards DA. Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy. Trials 2020; 21:41. [PMID: 31915064 PMCID: PMC6950935 DOI: 10.1186/s13063-019-3788-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 10/05/2019] [Indexed: 11/11/2022] Open
Abstract
Background Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients’ perspectives in depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita therapy recipients’ views on treatment acceptability explain their adherence and response to treatment. Methods The Morita trial incorporated a pilot randomised controlled trial of Morita therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from general practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants’ views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology. Results We demonstrated that (1) participants who could identify with the principles of Morita therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita therapy did not respond to treatment, again regardless of treatment adherence and (2) participants whose personal circumstances impeded their opportunity to engage in Morita therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them. Conclusions We identified new potential relationships between “orientation” and outcomes, and “opportunity” and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials. Trial registration Current Controlled Trials, ISRCTN17544090. Registered on 23 July 2015.
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Affiliation(s)
- Holly Victoria Rose Sugg
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
| | - Julia Frost
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - David A Richards
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
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Richards DA, Bazeley P, Borglin G, Craig P, Emsley R, Frost J, Hill J, Horwood J, Hutchings HA, Jinks C, Montgomery A, Moore G, Plano Clark VL, Tonkin-Crine S, Wade J, Warren FC, Wyke S, Young B, O'Cathain A. Integrating quantitative and qualitative data and findings when undertaking randomised controlled trials. BMJ Open 2019; 9:e032081. [PMID: 31772096 PMCID: PMC6886933 DOI: 10.1136/bmjopen-2019-032081] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
It is common to undertake qualitative research alongside randomised controlled trials (RCTs) when evaluating complex interventions. Researchers tend to analyse these datasets one by one and then consider their findings separately within the discussion section of the final report, rarely integrating quantitative and qualitative data or findings, and missing opportunities to combine data in order to add rigour, enabling thorough and more complete analysis, provide credibility to results, and generate further important insights about the intervention under evaluation. This paper reports on a 2 day expert meeting funded by the United Kingdom Medical Research Council Hubs for Trials Methodology Research with the aims to identify current strengths and weaknesses in the integration of quantitative and qualitative methods in clinical trials, establish the next steps required to provide the trials community with guidance on the integration of mixed methods in RCTs and set-up a network of individuals, groups and organisations willing to collaborate on related methodological activity. We summarise integration techniques and go beyond previous publications by highlighting the potential value of integration using three examples that are specific to RCTs. We suggest that applying mixed methods integration techniques to data or findings from studies involving both RCTs and qualitative research can yield insights that might be useful for understanding variation in outcomes, the mechanism by which interventions have an impact, and identifying ways of tailoring therapy to patient preference and type. Given a general lack of examples and knowledge of these techniques, researchers and funders will need future guidance on how to undertake and appraise them.
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Affiliation(s)
- David A Richards
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Patricia Bazeley
- Transitional Research and Social Innovation Group, Western Sydney University, Penrith South, New South Wales, Australia
| | - Gunilla Borglin
- Department of Care Science, Malmo University, Malmo, Skåne, Sweden
- Department of Nursing Education, Lovisenberg Diaconal University College, Oslo, Akershus, Norway
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Julia Frost
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Jacqueline Hill
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Jeremy Horwood
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | | | - Clare Jinks
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Vicki L Plano Clark
- School of Education, University of Cincinnati College of Education Criminal Justice and Human Services, Cincinnati, Ohio, USA
| | - Sarah Tonkin-Crine
- Department of Primary Care Health Sciences, and NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, Oxfordshire, UK
| | - Julia Wade
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Fiona C Warren
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Glasgow, UK
| | - Bridget Young
- Institute of Population Health Sciences, University of Liverpool, Liverpool, Merseyside, UK
| | - Alicia O'Cathain
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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