[Reduction of endogenous regulation in internal medicine patients]

The questionnaire on autonomic regulation: a useful concept for integrative medicine?

The concept of autonomic regulation (aR) reflects the relevance of the function of different autonomic systems for health. aR can be captured by questionnaires. We differentiate between a trait or constitutional aR questionnaire version including 12 (short-version) or 18 items, respectively, with three subscales (orthostatic-circulatory, rest/activity and digestive regulation), and an 18-item state aR questionnaire on the preceding week with four subscales (rest/activity, orthostatic-circulatory, thermo- and digestive regulation). The validated questionnaires show satisfying to good reliability and robust validity with clear construct validity. In this article, we summarized the actually available literature on aR and the use of aR questionnaires in clinical and observational studies. We described the relationship of high aR with health and in case of low aR or loss of regulation with disease and functional disorder in the three (four) different subscales and functional systems, such as rest/activity, orthostatic-circulatory or digestive regulation (thermoregulation) with the consecutive therapeutic need. Finally, we gave perspectives of its further application in clinical research.

Effects of eurythmy therapy in the treatment of essential arterial hypertension: a pilot study

Introduction:

Although eurythmy therapy (ET) has been used in the context of anthroposophic medicine (AM) for the treatment of, among other conditions, arterial hypertension (AH) for more than 80 years, there are as yet no studies on its effectiveness on disease entity. However, it has been shown that ET can increase heart rate variability comparably to ergometer training.

Objective:

To determine whether a 10-week course of ET has an impact on AH and if so, to determine the strength of the effect. The impact of ET on state-autonomic regulation, self-regulation, internal coherence, and quality of life is also explored.

Methods:

Consecutive inclusion of 9 subjects (6 female, 3 male, mean age of 64 years, SD 8.26) with AH diagnosed by their general practitioners. Inclusion criteria: no or unchanged antihypertensive medication from 4 weeks prior to the start of the study until the end of the study. ET was carried out with weekly instruction along with a daily, home-based program for 10 weeks with specific exercises. Twenty-four–hour blood pressure (BP) measuring was carried out, and the questionnaires were administered before and after the intervention. In addition, after a further 6 months during which 8 of the 9 patients carried on with the exercises of their own accord, the aforementioned parameters were assessed for a third time.

Results:

Parameters of the 24-hour BP measurements show a moderate, but not significant, improvement immediately after the intervention and 6 months after the intervention. After the 10-week intervention, we saw an improvement of the State-autonomic Regulation questionnaire, the subscale on “Rest/Activity regulation,” of the Self-regulation questionnaire, and the subscale “Initiative and Interest” of the Herdecke Quality of Life Questionnaire (HLQ) (all P < .045). After the 6-month post-study observation period, the aforementioned parameters improved further still, and an additional, significant improvement was seen for the Trait-autonomic Regulation subscale “Rest/Activity regulation,” the HLQ-sum score, and the HLQ subscales “social interaction,” “mental balance,” and “physical ability.”

Conclusion:

A 10-week course of ET does not result in a significant improvement in BP. The average BP measurements improved post-intervention by an absolute 3.2/2.0 mmHg and after 6 months of independent continuation of ET by 6.3/4.4 mmHg (systolic/diastolic). Despite the small group size, the regulation and quality-of-life parameters improved significantly after the intervention and further still after the 6-month observation period. The results need to be validated with larger patient collectives and control groups.

Validation of the State Version Questionnaire on Autonomic Regulation (State-aR) for cancer patients

Objectives

Current quality of life inventories used in oncology mainly measure the effects of chemo- or radiotherapy alongside functional and role scales. A new approach is to measure the autonomic state of regulation with the trait-inventory of autonomic regulation (Trait-aR). Loss of Trait-aR has been shown in different medical conditions such as breast cancer (BC) but not in colorectal cancer patients (CRC). In this paper we report the validation of a new state autonomic regulation scale (State-aR) of the last week.

Methods

Study 1 included 114 participants: (41 women/16 men with cancer and 57 age- and gender-matched healthy people) to conduct a reliability-, factor- and validity-analysis. Concurrent and convergent validity was evaluated with Trait-aR, Fatigue-Numeri-cal-Scale, Hospital Anxiety and Depression Scale (HADS-D) and the self-regulation scale, 65 participants were retested. Study 2 completed 42 participants: 17 with BC and 25 with CRC receiving chemotherapy. The State-aR was administered prior, during and after chemotherapy for measuring responsiveness.

Results

The factor analysis loaded to four subscales of State-aR (rest-activity, orthostatic-circulatory, thermosweating and digestive regulation) with a: Cronbach-α r_α = 0.77-0.83 and a test-retest-reliability r_rt = 0.60-0.80. The sum- and sub scales correlated with their concurrent subscales in the Trait-aR (0.48-0.74) and with the sum-scale moderately with all convergent criteria (r = 0.41 --0.44; p < 0.001). During chemotherapy the State-aR-sum and rest-activity-scale decreased significantly compared to the change in the Trait-aR (p < 0.05).

Conclusions

These findings support that the state autonomic regulation scale has satisfactory to good reliability, good validity and acceptable responsiveness in the context of chemotherapy treatment.

Validation of a questionnaire measuring the regulation of autonomic function

BACKGROUND

To broaden the range of outcomes that we can measure for patients undergoing treatment for oncological and other chronic conditions, we aimed to validate a questionnaire measuring self-reported autonomic regulation (aR), i.e. to characterise a subject's autonomic functioning by questions on sleeping and waking, vertigo, morningness-eveningness, thermoregulation, perspiration, bowel movements and digestion.

METHODS

We administered the questionnaire to 440 participants (female symbol: N = 316, male symbol: N = 124): 95 patients with breast cancer, 49 with colorectal cancer, 60 with diabetes mellitus, 39 with coronary heart disease, 28 with rheumatological conditions, 32 with Hashimoto's disease, 22 with multiple morbidities and 115 healthy people. We administered the questionnaire a second time to 50.2% of the participants. External convergence criteria included the German version of the Hospital Anxiety and Depression Scale (HADS-D), a short questionnaire on morningness-eveningness, the Herdecke Quality of Life Questionnaire (HLQ) and a short version questionnaire on self-regulation.

RESULTS

A principal component analysis yielded a three dimensional 18-item inventory of aR. The subscales orthostatic-circulatory, rest/activity and digestive regulation had internal consistency (Cronbach-alpha: ralpha = 0.65 - 0.75) and test-retest reliability (rrt = 0.70 - 85). AR was negatively associated with anxiety, depression, and dysmenorrhoea but positively correlated to HLQ, self-regulation and in part to morningness (except digestive aR) (0.49 - 0.13, all p < 0.05).

CONCLUSION

An internal validation of the long-version scale of aR yielded consistent relationships with health versus illness, quality of life and personality. Further studies are required to clarify the issues of external validity, clinical and physiological relevance.

Validation of the German version of the Cancer Fatigue Scale (CFS-D)

Fatigue is a very important factor determining the quality of life in patients with malignancies. Cancer fatigue occurs with anaemia, during and after chemo- or radiotherapy and in patients with advanced tumours. The Cancer Fatigue Scale (CFS) is a three-dimensional inventory with 15 items which was originally developed in Japan. We present the results of a validation study of the German version (CFS-D) of this instrument. The CFS-D was administered to 114 participants in a matched-pair study. In total, 57 (41 women) of the participants had malignant conditions, and 57 (41 women) were healthy volunteers. The Fatigue Numerical Scale was used to test convergence. The physical and performance status of the cancer patients was assessed by the Karnofsky-Index. Criteria for testing multidimensionality were the Hospital Anxiety and Depression Scale, and the questionnaire on autonomic regulation. We generated a three-dimensional inventory of the CFS-D with the subscales physical fatigue/vitality, cognitive and affective fatigue. The reliability results for the complete scale: Cronbach's alpha: r(alpha) = 0.94, retest reliability: r(rt) = 0.82. The convergence criteria correlate between r = 0.44-0.65 (all P < 0.001). The CFS-D is highly reliable and has construct validity in relation to other measures.