Multiple interacting factors corresponding to repetitive use of complementary and alternative medicine

Effect of Scraping Therapy on Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

The purpose of this study was to review the literature on the effect of scraping therapy on chronic low back pain (LBP) from randomized controlled trials (RCTs).

METHODS

Three English medical electronic databases (PubMed, Embase, and the Cochrane Library) and 2 Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials related to the effects of scraping therapy on chronic LBP were included in this systematic review. Study selection, data extraction, and validation were conducted independently by 2 reviewers. The methodological quality of the studies was evaluated by the Cochrane risk-of-bias tool. RevMan 5.3 software was applied to perform meta-analysis of the data.

RESULTS

Ten studies comprising 627 participants were included. Overall, the quality of evidence was moderate owing to a lack of blinding and allocation concealment in some studies and unclear risk of selective reporting. Meta-analysis of 9 RCTs indicated that scraping therapy had a statistically significant effect on pain reduction (standard mean difference = -0.66, 95% confidence interval [CI], -0.83 to -0.49, P < .001). However, if only a single scrape treatment was carried out, the results did not show that scraping was superior to the control group regarding pain relief (mean difference = -0.35, 95% CI, -1.23 to 0.53, P = .44). Moreover, the results of 6 RCTs involving 468 participants showed significantly greater improvement in lumbar dysfunction (mean difference = -10.05, 95% CI, -13.52 to -2.32, P < .001). In addition, the results of 5 RCTs involving 393 participants showed a favorably significant effect on the overall efficacy (odds ratio = 4.74, 95% CI, 2.34-9.62, P < .001). As for follow-up effects, meta-analysis of 3 RCTs involving 241 participants showed a promising effect on pain reduction and lumbar function improvement at 1 month and 3 months after the end of treatment, respectively. Only 1 study reported adverse effects, and none were serious.

CONCLUSION

Scraping therapy may have a therapeutic effect for some individuals with chronic LBP. However, due to the limited amount of research and the low methodological quality of the included studies, additional large-scale, multicenter, high-quality RCTs on relieving pain intensity and improving lumbar dysfunction are still necessary.

The Importance of Patient's Experience and Its Impact on Health Care System for People Receiving Traditional Chinese Medicine

Objectives: Health system responsiveness is a complicated issue that guides researchers in determining an efficient methodology to enhance the understanding of health care systems' perspectives. This study examined the relationship between patients' experience profiles and their satisfaction with medical outcomes. Design: The authors used 11 items from the Taiwanese Annual National Health Insurance survey and used latent class analysis (LCA) to develop experience profiles for 2012 Traditional Chinese Medicine (TCM) patients. A logistic regression model was developed to explore differences in patients' satisfaction with their treatment outcome across four groups identified using the LCA, with adjustment for demographic factors. Subjects: Patients' experiences with medical services in TCM in 2015. Outcome measures: Patients' satisfaction with their treatment outcome. Results: Participants (N = 2012) were divided into four groups. Regardless of gender and age, Group 2 (nall) held the lowest satisfaction with treatment outcome relative to those reported by the other three groups (odds ratios with p-value: Group 1 [pall]: 7.40, Group 3 [nComm]: 1.37, Group 4 [Skip]: 2.20, p < 0.001). Respondents with a more favorable patient experience reported higher satisfaction with treatment outcome. Conclusions: An increased favorable treatment experience in TCM (such as positive accessibility and better interpersonal relationships with providers) is associated with higher satisfaction with treatment outcome. The World Health Organization emphasizes that traditional medicine integrated with Western medicine can play an important role in achieving the goal of "Health for All." Health authorities should develop strategies aimed at enhancing patients' experiences in TCM to contribute to a positive care process.

Effects of Gua Sha therapy on perimenopausal syndrome: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

In East Asia, Gua Sha therapy is widely used in patients with perimenopausal syndrome. The goal of this systematic review was to evaluate the available evidence from randomized controlled trials (RCTs) of Gua Sha therapy for the treatment of patients with perimenopausal syndrome.

METHODS

Databases searched from inception until June 2017 included: PubMed, Embase, the Cochrane Central Register of Controlled Trials and four Chinese databases [WanFang Med Database, Chinese BioMedical Database, Chinese WeiPu Database, and the China National Knowledge Infrastructure (CNKI)]. Only the RCTs related to the effects of Gua Sha therapy on perimenopausal syndrome were included in this systematic review. A quantitative analysis of RCTs was employed using RevMan 5.3 software. Study selection, data extraction, and validation were performed by two independent reviewers. Cochrane criteria for risk-of-bias were used to evaluate the methodological quality of the trials.

RESULTS

A total of 6 RCTs met the inclusion criteria, and most were of low methodological quality. When compared with Western medicine therapy alone, meta-analysis of 5 RCTs indicated favorable statistically significant effects of Gua Sha therapy plus Western medicine on the Kupperman Menopausal Index (KMI) Score [mean difference (MD) = -4.57, 95% confidence interval (CI) (-5.37, -3.77), p < 0.01; heterogeneity: Chi² = 29.57 p < 0.01, I² = 86%]. Moreover, study participants who received Gua Sha therapy plus Western medicine therapy showed significantly greater improvements in serum levels of follicle-stimulating hormone (FSH) [MD = -5.00, 95% CI (-9.60, -0.40), p = 0.03], luteinizing hormone (LH) [MD = -4.00, 95% CI (-7.67, -0.33), p = 0.03], and E₂ [MD = -6.60, 95% CI (-12.32, -0.88), p = 0.02] compared to participants in the Western medicine therapy group, with a low heterogeneity (Chi² = 0.12, p = 0.94, I² = 0% in FSH; Chi² = 0.19 p = 0.91, I² = 0% in LH; Chi² = 0.93, p = 0.63, I² = 0% in E₂). In addition, the pooled results displayed favorable significant effects of Gua Sha therapy plus the Western medicine therapy on the MENQOL scale when compared with the Western medicine therapy alone [MD = -5.13, 95% CI (-7.45, -2.81), p < 0.01] with low heterogeneity (Chi² = 0.66, p = 0.42, I² = 0%).

CONCLUSION

Preliminary evidence supported the hypothesis that Gua Sha therapy effectively improved the treatment efficacy in patients with perimenopausal syndrome. Additional studies will be required to elucidate optimal frequency and dosage of Gua Sha.

Cancer Impact, Complementary/Alternative Medicine Beliefs, and Quality of Life in Cancer Patients

OBJECTIVES

The purpose of this study was to explore the relationships among cancer impact, belief in complementary and alternative medicine (CAM), CAM use, and quality of life (QOL).

DESIGN

The study used a cross-sectional, descriptive correlational design with convenience sampling. A total of 122 cancer patients participated. Data were collected at a medical center in Chunghua, Taiwan. The questionnaires included the Chinese version of the Cancer Problem in Living Scale (CPILS), Complementary and Alternative Medicine Belief Inventory (CAMBI), Complementary and Alternative Medicine scale, and Chinese versions of QOL scales, including the Functional Assessment of Cancer Therapy-General (FACT-G).

RESULTS

The mean age was 56.5 years, and most participants were male (n = 69, 56.6%), had completed high school or above (n = 56, 45.9%), and were married (n = 109, 89.3%). The most common type of cancer was oral (n = 17, 13.9%), followed by esophageal (n = 15, 12.3%) and colorectal (n = 13, 10.7%). Cancer patients, on average, use one or two types of CAM. The impact of cancer is significantly related to age (F = 7.12, p < 0.05), and income is related to QOL (F = 3.61, p < 0.05). Pearson correlations showed that the use of CAM was positively associated with belief in CAM (CAMBI) (r = 0.26, p = 0.01), and the impact of cancer was highly negatively associated with QOL (r = -0.71, p = 0.001). The predictors of QOL were the impact of cancer and use of CAM, and the impact of cancer accounted for 51% of the variance in QOL.

CONCLUSION

This study supports research on the impact of cancer, belief in CAM, and use of CAM as related to QOL in cancer patients. These results can be used to provide options to clinicians and cancer patients.

Self-Administered Mind-Body Practices for Reducing Health Disparities: An Interprofessional Opinion and Call to Action

Health disparities (HD) continue to persist in the United States which underscores the importance of using low-cost, accessible, evidence-based strategies that can improve health outcomes, especially for chronic conditions that are prevalent among underserved minority populations. Complementary/integrative health modalities, particularly self-administered mind-body practices (MBP), can be extremely useful in reducing HD because they are intrinsically patient-centered and they empower patients to actively engage in self-care of health and self-management of symptoms. Interprofessional healthcare providers and patients can engage in powerful partnerships that encompass self-administered MBP to improve health. This is a call to action for interprofessional researchers to engage in high-quality research regarding efficacy and cost-effectiveness of self-administered MBP, for practitioners to engage patients in self-administered MBP for health promotion, disease prevention, and symptom management, and for healthcare institutions to integrate self-administered MBP into conventional health practices to reduce HD in their communities.

Ethnopharmacological survey of native remedies commonly used against infectious diseases in the tropical island of Mauritius

ETHNOPHARMACOLOGICAL RELEVANCE

Infectious diseases (IDs) still remain a major cause of mortality and morbidity worldwide. This study has been geared to gather primary ethnopharmacological information on common native remedies (NRs) used to treat and/or manage common infectious diseases from different regions of Mauritius, a tropical multicultural island in the Indian Ocean. Given the dearth of updated information on traditional medicine of Mauritius, this work can provide an opportunity to establish valuable primary information on the different NRs used by the local people and hence open new perspectives for further pharmacological research.

AIM OF THE STUDY

To collect, preserve and document primary ethnopharmacological data from the local population concerning NRs commonly used against IDs in the tropical island of Mauritius.

MATERIALS AND METHODS

Face to face interviews were conducted with Mauritians and herbalists (n=307) using a semi-structured questionnaire. Quantitative ethnobotany parameters such as informant consensus factor (F(IC)), fidelity level (FL), use value (UV) and variety of use (VU) were used for herbal and animal products. Statistical analysis such as Pearson correlation and Chi-squared test were performed to delineate any association.

RESULTS

It was found that 94.8% of the local people claimed that managing IDs with NRs was part of their culture and have been using it since childhood. A total of 39 plant species belonging to 24 families and 9 animal species were reported to be traditionally used in the formulation of herbal remedies and animal products, respectively. Sociodemographic characteristics (gender, age, place of residence and income) had a significant (p<0.01) impact on the use of these NRs. The most relevant family contributing much to the medicinal flora was Zingiberaceae (No of citation=301). The average F(IC) for all ailments for medicinal plants and animal products were 0.963 and 0.972, respectively. Acalypha indica L. had the highest FL (0.83) for skin and subcutaneous tissue problems. Panoply of animal products (Anguilla japonica, Periplaneta americana and Helix aspersa) were culturally used, whereby products from Bos taurus, (42.0%) were the most utilized zootherapy. Other remedies used in concurrence with herbal and animal products involved cultural rituals and prayers that were never reported in previous studies. Therapeutic properties of some herbal remedies reported correlated to some extent with those of previous studies while others have open potential perspectives for further research as their chemistry and pharmacology have not been published.

CONCLUSIONS

Given the plethora of novel information obtained from the present survey, it is obvious that the indigenous population still relies to a great extent on NRs which need to be preserved and used sustainably. Nonetheless, further research is needed to probe the possible active constituents that could be the basis of an evidence based investigation to discover new drugs.