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Assessing the impact of complementary therapy on health status: a service evaluation of the benefits of acupuncture, homoeopathy and osteopathy using the SF-36 health survey and a waiting list control group

Journal: Unpublished PhD thesis King's College London, Date: 1999/12, Pages: 512, type of study: controlled clinical trial

Free full text   (https://kclpure.kcl.ac.uk/portal/en/studentTheses/assessing-the-impact-of-complementary-therapy-on-health-status-a-)

Keywords:

controlled clinical trial [283]
health status [15]
OMT [2951]
osteopathic manipulative treatment [2973]

Abstract:

This thesis charts the background, establishment and evaluation of a complementary therapy service providing acupuncture, homoeopathy and osteopathy within the National Health Service. The detailed service evaluation used patients on the waiting list as a control group, and examined the effectiveness of the treatments using the SF-36 Health Survey as an outcome measure. Statistical procedures were used to assess potential biasing effects in the absence of randomisation and in the context of non-equivalent groups. The results demonstrated that patients who had treatment experienced significant improvements in health status as measured by the eight scales of the SF-36 and the transition question. Patients in the waiting list control group experienced no change, other than getting worse on one SF-3 6 scale. With the exception of the physical functioning scale significant differences were found between treatment and control groups at outcome. Extensive sensitivity analyses were carried out to assess how nonresponders would have needed to behave in order to achieve non-significant findings. Sub-group analysis provides examples of how more detailed analyses can be undertaken on a specific therapy (acupuncture) and presenting problem (pain). Overall, the results suggest that patients were satisfied with the service and experienced some benefit. A qualitative approach was used to explore patient expectations and perceptions of the service in greater depth. The quality of evidence for the effectiveness of acupuncture, homoeopathy and osteopathy was examined in a detailed systematic review and critical appraisal of primary studies and reviews of trials. The limitations of the research in complementary therapy are discussed, together with the results of the current study and the wider implications for the delivery and evaluation of such therapies. The thesis also examines issues pertinent to the provision of new services in the context of health technology assessment and evidence-based practice, and presents a general model for service development.


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