Integrative physiology and traditional naturopathic practice: results of an international observational study

Amie Steel,Joshua Z. Goldenberg,Jason A. Hawrelak,Hope Foley,Sophia Gerontakos,Joanna E. Harnett,Janet Schloss,Rebecca Reid 한국한의학연구원 2020 Integrative Medicine Research Vol.9 No.4

Background: Naturopathy is one of seven distinct traditional medical systems acknowledged by the World Health Organization. Naturopathic principles and philosophies encourage a focus on multiple body systems during case-taking and the design of treatments. Little is known about whether such teaching translates into practice. This study aimed to characterise naturopathic practice as it relates to the identification of multiple physiological systems in the diagnosis and treatment of patients. Methods: A cross sectional study was conducted in collaboration with the World Naturopathic Federation. A survey capturing clinical diagnostic and treatment considerations for up to 20 consecutive patients was administered to naturopaths in 14 countries. Results: Naturopaths (n = 56) were mostly female (62.5%), aged between 36 and 45 years (37.5%), in practice for 5–10 years (44.6%), and consulting between 11 and 20 patients per week (35.7%). Participants completed the survey for 851 patient cases. Naturopaths reported a greater number of physiological systems relevant to clinical cases where the patients were working age (18–65 years) (IRR 1.3, p = .042), elderly (65 years and over) (IRR 1.4, p = .046), or considered by the naturopath to have a chronic health condition (IRR 1.2, p = .003). The digestive system was weakly associated with patients based on chronicity of the health complaint (V = .1149, p = .004), or having a musculoskeletal complaint (V = .1067, p = .002) autoimmune pathophysiology (V = .1681, p < .001), and considered relevant in respiratory (V = .1042, p = .002), endocrine (V = .1023, p = .003), female reproductive (V = .1009, p = .003), and integumentary (V = .1382, p < .001) systems. Conclusion: Naturopaths across the world adopt an integrative physiological approach to the diagnosis and treatment of chronic and complex health care complaints.

Prevalence and predictors of naturopathic practitioners’ self-reported practice behaviours: results of an international survey

Amie Steel,Iva Lloyd,Hope Foley,Matthew J. Leach 한국한의학연구원 2022 Integrative Medicine Research Vol.11 No.4

Background The naturopathic workforce spans over 108 countries and is estimated to provide care to over 5.5 million patients globally per month. Despite such demand, naturopathic practitioners are not well integrated into mainstream health systems, in part due to poor knowledge about naturopathy among policy makers and other health professionals. This study aims to describe naturopathic practitioners’ practice behaviours and examine the characteristics that predict the use of naturopathic treatments and practices around the world. Methods An international cross-sectional online survey was distributed through World Naturopathic Federation membership organisations and social media accounts. Multivariate reverse stepwise logistic regression was undertaken to examine potential predictors of practice behaviours, adjusting for the influence of demographic and practice characteristics Results A response rate of 78.4% was achieved (n=478). Lifestyle modifications, dietary changes, nutritional products and herbal medicines were most consistently prescribed Always or Most of the time. At least one-half of participants discussed nine of the ten health topics during clinical practice Always or Most of the time. More than one-half (55.1%) of participants practiced in a location with statutory regulation/occupational certification. Compared to participants located in countries with voluntary certification/no regulation, those in countries with statutory registration/occupational licensing had higher odds of prescribing nutritional products (adjusted odds ratio (aOR)=2.5) or IV/injection therapies (aOR=18.4). Conclusion The findings of this study provide important insights into contemporary naturopathic practice behaviour, which may help to overcome misconceptions about such practice among other health professionals, policy makers and the community.

Golf Swing Rotational Velocity: The Essential Follow-Through

Katherine M. Steele,Eugene Y. Roh,Gordhan Mahtani,David W. Meister,Amy L. Ladd,Jessica Rose 대한재활의학회 2018 Annals of Rehabilitation Medicine Vol.42 No.5

Objective To evaluate if shoulder and pelvic angular velocities differ at impact or peak magnitude between professional and amateur golfers. Golf swing rotational biomechanics are a key determinant of power generation, driving distance, and injury prevention. We hypothesize that shoulder and pelvic angular velocities would be highly consistent in professionals. Methods Rotational velocities of the upper-torso and pelvis throughout the golf swing and in relation to phases of the golf swing were examined in 11 professionals and compared to 5 amateurs using three-dimensional motion analysis.Results Peak rotational velocities of professionals were highly consistent, demonstrating low variability (coefficient of variation [COV]), particularly upper-torso rotational velocity (COV=0.086) and pelvic rotational velocity (COV=0.079) during down swing. Peak upper-torso rotational velocity and peak X-prime, the relative rotational velocity of upper-torso versus pelvis, occurred after impact in follow-through, were reduced in amateurs compared to professionals (p=0.005 and p=0.005, respectively) and differentiated professionals from most (4/5) amateurs. In contrast, peak pelvic rotational velocity occurred in down swing. Pelvic velocity at impact was reduced in amateurs compared to professionals (p=0.019) and differentiated professionals from most (4/5) amateurs. Conclusion Golf swing rotational velocity of professionals was consistent in pattern and magnitude, offering benchmarks for amateurs. Understanding golf swing rotational biomechanics can guide swing modifications to help optimize performance and prevent injury.

A naturalistic study of herbal medicine for self-reported depression and/or anxiety a protocol

David Casteleijn,Amie Steel,Diana Bowman,Romy Lauche,Jon Wardle 한국한의학연구원 2019 Integrative Medicine Research Vol.8 No.2

Background Mental health conditions including anxiety and depression account for around 8% of the global disease burden. Anxiety and depression often coexist and impose a high individual and social burden. Patients with mental and behavioural conditions may be at increased risk of co-morbidities and are often high health-care utilisers. Herbal medicine is estimated to be used by up to 80% of the worlds population, and by 22% of Australian women seeking care for depression. The holistic and tailored treatment approach offered by practitioners of herbal medicine is difficult to capture in randomised controlled trials and as such there is a paucity of research demonstrating the outcomes of real-life practice. This project aims to address this gap with a whole practice, observational model. Methods The study will employ a naturalistic observational design. Two-hundred patient participants will be recruited to be treated by 15 clinician participants from different naturopathic clinics. The observed changes in anxiety and depression symptoms of patients will be documented across three consultations using validated patient-reported outcome measures (SF-36, DASS-21, GHQ-28 and POMS-2). Discussion Clinical studies investigating the efficacy of individualised herbal medicine treatment as prescribed by a naturopath are rare. Our study attempts to fill this gap with a longitudinal observation of individualised care as practiced by naturopaths in Australia; to offer valuable insights into the effectiveness of individualised herbal medicine practice and provide contextualisation of data currently focused on individual herbal medicines in specific conditions. Trial Registration Australian and New Zealand Clinical Trials Registry: ACTRN12616000010493

A qualitative study of classical Chinese medicine in community health focusing on self-care: practitioner and staff perspectives

Alaia Harvie,Amie Steel,Jon Wardle 한국한의학연구원 2020 Integrative Medicine Research Vol.9 No.1

Background: Classical Chinese medicine (CCM) encompasses many simple lifestyle recommendations which can be adopted into daily routines in support of short and long-term health outcomes. The rise in non-communicable diseases (NCDs) globally in recent decades has led to a need for cost-effective and scalable health care interventions to address lifestyle risk for NCDs in the community. This analysis explores the experience of staff and practitioners delivering a CCM community health care program designed to improve health behaviors in the community in rural Scotland. Methods: A qualitative study employed semi-structured interviews with a sample of program practitioners and staff (n = 7). Informants were asked to share their experience in delivering the CCM program. Emergent themes were identified via analysis using the Framework Approach. Results: Themes emerged from the data in three key areas: Cultural challenges within the local region; Integration with the existing local health care network; and Team dynamics, co-creation and communication integrity. Conclusion: This study highlights the importance of accessibility, integration, networking, secure funding and team unity in the context of community health program delivery, as well as noting a diversity of practice among Chinese medicine practitioners. CCM concepts may hold potential for integration into community health, however, further research is warranted.

Design characteristics of comparative effectiveness trials for the relief of symptomatic dyspepsia: A systematic review

Natalie Elliott,Amie Steel,Bradley Leech,Wenbo Peng 한국한의학연구원 2021 Integrative Medicine Research Vol.10 No.2

Background: Dyspepsia represents a symptom domain rather than a diagnostic condition and covers a wide range of complex, underlying pathophysiologies that are not well understood. The review explores comparative effectiveness interventions for the treatment of symptomatic dyspepsia along a pragmatic-explanatory continuum. The aim is to identify relevant design characteristics applicable to future upper gastrointestinal comparative effectiveness research employing integrative medicine. Methods: Medline, CINAHL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and WHO Clinical Trials were systematically searched until January 2019. Included articles were original research with two or more comparative intervention arms for the primary outcome; relief of symptomatic dyspepsia. Evaluation of the studies was conducted using the pragmatic-explanatory continuum indicator summary (PRECIS-2) tool. Results: Thirty-six articles were included in the review. A total of 68 Patient Reported Outcome Measurements (PROMs), utilizing 50 different formats were deployed across the studies. The appraisal process revealed eligibility, flexibility in adherence, flexibility in delivery and organization domains further aligned towards an explanatory design. Conclusion: This review identified three design characteristics relevant for future comparative effectiveness research for the treatment of upper gastrointestinal disorders in a community setting. Extensive exclusion eligibility criteria limited the generalization of comparative effectiveness study results by removing sub-groups of the target populations more at risk of dyspeptic symptoms. The requirement for entry endoscopy was found to be common and not always pragmatically justifiable. Development of validated PROMs appropriate for a generic application to upper gastrointestinal disorders would be advantageous for future comparative effectiveness research within integrative medicine.

Health-seeking behaviour, views and preferences of adults with suspected increased intestinal permeability: A cross-sectional survey of Australian adults

Leech Bradley,McIntyre Erica,Steel Amie,Sibbritt David 한국한의학연구원 2022 Integrative Medicine Research Vol.11 No.1

Background: The public health consequence of increased intestinal permeability (IP) is currently limited by the lack of patient-centred research. This study aims to describe the health-seeking behaviour of Australian adults with suspected IP. Methods: A cross-sectional survey of 589 Australian adults who have been diagnosed with IP or have suspected (undiagnosed) IP. Results: The majority (56.2%) of participants with suspected IP reported self-diagnosing their condition, with the majority (56.7%) of these participants preferring to be assessed using an accurate method by a general practitioner or naturopath. On average, Australian adults with suspected IP spent 11.1 (95% CI: 9.5, 12.8) years between first suspecting IP and receiving a formal diagnosis. Over the previous 12 months, participants spent an average of $699 on consultation fees, $2176 on dietary supplements for the treatment of IP, and an average of $287 on the assessment of IP. Furthermore, participants who find it difficult to live on their available household income spent significantly more (mean=$2963) on dietary supplements compared to participants who find it easy to live on their available household income ($1918) (p=0.015). Conclusion: The investigation of Australian adults with suspected IP found the majority of participants experienced a considerable length of time between first suspecting IP and receiving a diagnosis of IP. The out-of-pocket expenditure associated with the management of IP suggests a financial burden for people with suspected IP. The results of this study provide novel patient-centred considerations that can be used to inform a clinical practice guideline for the management of IP.

Naturopathic approaches to irritable bowel syndrome: protocol for a prospective observational study in academic teaching clinics

Joshua Z. Goldenberg,Amie Steel,Andrew Day,Christina Yap,Ryan Bradley,Kieran Cooley 한국한의학연구원 2018 Integrative Medicine Research Vol.7 No.3

Background: Irritable bowel syndrome (IBS) is a common functional bowel disorder with a worldwide prevalence estimated between 10% and 20%. It has a significant impact on quality of life and societal expense. While there are pharmaceutical options available, few can be reliably recommended. Many IBS sufferers turn to complementary and alternative medicine including naturopathy. Naturopathic approaches to IBS are poorly studied to date. Methods: We aim to describe naturopathic approaches to IBS as well as establish pilot data on before and after changes in validated IBS instruments. The study will employ a multi-centered, international, prospective, observational, naturalistic design. The uncontrolled before-and-after study will examine the outcomes associated with individualized, whole system naturopathic care as determined by each provider. We will recruit adult patients diagnosed with IBS and presenting to a participating naturopathic academic teaching clinic. Participants’ IBS symptoms will be measured using validated instruments (IBS-SSS and IBS-AR). Quality of life will be measured by using the PROMIS-29 profile. Adverse events will be tracked, as followed for treatment descriptions. Our primary outcomes will be before-and-after differences using week twelve as the primary endpoint. A p values will be set at 0.05, and descriptive and summary data will be presented. Discussion: This study is designed to plug significant evidence gaps and to gather preliminary evidence to guide the design of a follow-up randomized active controlled trial. Australia and New Zealand Clinical Trial Registration Number: ACTRN12617001413314

An examination of naturopathic treatment of non-specific gastrointestinal complaints: comparative analysis of two cases

Tristan Carter,Joshua Z. Goldenberg,Amie Steel 한국한의학연구원 2019 Integrative Medicine Research Vol.8 No.3

Background: Functional gastrointestinal disorders (FGID) affect more than one-third of the general population and contribute a considerable burden on the health and wellbeing of the community and the economy. This study aims to examine the treatment approaches and outcomes of naturopathic management of individuals presenting with a non-specific FGID. Methods: We report a comparison of two clinical case studies of patients being treated by a naturopath for a functional gastrointestinal disorder. The care was provided by two different student practitioners under the supervision of an industry qualified mentor within a multidisciplinary academic clinic at the Endeavour College of Natural Health. A student practitioner and student observer conduct consultations under the supervision of an industry qualified mentor. The outcomes of care were measured by the Gastrointestinal Symptom Rating Scale. Results: Clinical notations partially correlate to Jane’s outcomes measured by gastrointestinal rating scale scores, which remain stable. Significant changes in Rona’s gastrointestinal rating scale scores equate to only generalizable minimal clinical notations. Conclusions: The holistic and individualised approach core to naturopathic medicine practice is also informed by traditional methods, research evidence and the pragmatic needs of the patient. The emphasis within naturopathic treatment approaches on dietary changes and lifestyle prescription alongside other ingestive therapies such as herbal and nutritional medicine underscores the need for clinical research designs which support evaluation of complex interventions in real-world settings.