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New multimodal intervention to reduce irritable bowel syndrome (IBS) severity symptoms-Pilot study with a 12 month follow-up. PLoS One 2022; 17:e0277880. [PMID: 36409730 PMCID: PMC9678296 DOI: 10.1371/journal.pone.0277880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is characterized by patients' high level of suffering. Up to 60% of patients with IBS have symptoms of anxiety or depression and only little attention has been paid to their specific requirements. Anthroposophical multimodal therapy (AMT) has been shown to significantly improve health-related quality of life of patients with high symptomatic burden. OBJECTIVE The aim of this pilot study was to find out whether AMT meets the needs of IBS patients and the interactions of AMT with IBS, depression and anxiety. METHODS Patients with diagnosed IBS were included in a feasibility study and received 12 sessions of AMT over 8 weeks (drks.de, DRKS00016890). The primary endpoint was the change of the IBS severity score (IBS-SSS) and changes were calculated by linear mixed effects analyses. The secondary endpoints were changes of self-reported PHQ-9 and GAD-7 for mental comorbidity as well as self-valued effectiveness and satisfaction of AMT. RESULTS Thirty-six patients, 89% female, were included in the study. AMT was successfully applied to IBS patients (-45 points in the IBS-SSS, p < .05). AMT had a large positive effect (-84 points in IBS-SSS, p < .003) on patients without anxiety or depression. Over time, patients with higher anxiety scores worsened with regard to their IBS compared to patients with depression and without mental comorbidity. The AMT effect was maintained at a 12 month follow up and both mentally affected and unaffected patients, had even lower IBS severity than shortly after AMT. AMT modules were rated by IBS patients as very effective. CONCLUSION Our findings suggest that an 8-week program of AMT improves the severity of IBS with an ongoing effect at a 12 month follow-up. Especially for patients without psychological comorbidities, AMT is very successful. Future IBS therapies should incorporate a modified multimodal concept with stronger psychological therapy modules in parallel for patients with depression and anxiety.
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Skop M, Darewych OH, Root J, Mason J. Exploring intimate partner violence survivors’ experiences with group art therapy. INTERNATIONAL JOURNAL OF ART THERAPY 2022. [DOI: 10.1080/17454832.2022.2124298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michelle Skop
- Faculty of Social Work, Wilfrid Laurier University, Brantford, Canada
| | - Olena Helen Darewych
- Department of Spiritual Care and Psychotherapy, Martin Luther University College, Wilfrid Laurier University, Waterloo, Canada
| | - Jennifer Root
- Faculty of Social Work, Wilfrid Laurier University, Brantford, Canada
| | - Julie Mason
- Faculty of Social Work, Wilfrid Laurier University, Brantford, Canada
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Baars EW, Kienle GS, Heusser P, Pedersen PA, van Wietmarschen HA, Kiene H, von Schoen-Angerer T, Hamre HJ. Anthroposophic Medicinal Products: A Literature Review of Features, Similarities and Differences to Conventional Medicinal Products, Scientific and Regulatory Assessment. Glob Adv Health Med 2022; 11:21649561211073079. [PMID: 35281956 PMCID: PMC8915225 DOI: 10.1177/21649561211073079] [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: 05/03/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Regulatory assessment of anthroposophic medicinal products (AMPs) can be challenging due to their specific features. Objective The aim of this paper is therefore to provide adequate scientific information on AMPs for regulatory purposes. Methods A literature review was executed with database searches in PubMed, Cinahl, Merkurstab, Anthromedics, and https://iaap-pharma.org/. Search terms were: anthroposophic medicinal products, anthroposophic medicines, anthroposophic pharmacy. There was no language restriction; searches were executed from onset until June 11, 2020. In addition, experts were invited to suggest relevant literature. Results Eighty-seven of 660 identified publications were included. The system of anthroposophic medicine (AM) with its conceptual background and various aspects of AMPs was described: definition, pharmaceutical properties, an example of AMP development, use in clinical practice, similarities with and differences to conventional medicinal products, societal aspects, scientific and regulatory assessment. Conclusion AMPs are part of the integrative whole medical system of AM. AMPs are manufactured according to Good Manufacturing Practice and national drug regulations and have an excellent safety status; the limited available evidence suggests clinical benefits. Current drug regulation of AMPs in the EU and most European countries does not take the special properties of AMPs into account. Future research should focus on appropriate methodologies for the evaluation of effects of AMPs as part of the AM whole medical system, the scientific quality of its non-atomistic holistic ontological position, and the integration of AM and conventional medicine in clinical practice. Future policies should focus on appropriate ways of addressing regulatory challenges to AMPs.
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Affiliation(s)
- Erik W Baars
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands.,Faculty of Healthcare, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Gunver S Kienle
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.,Faculty of Medicine, Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Heusser
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Peter A Pedersen
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Independent Pharmaceutical Consultant, Søborg, Denmark
| | - Herman A van Wietmarschen
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | | | - Harald J Hamre
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
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Mehl A, Brauer D, Didwiszus A, Gelin-Kröz B, Pranga D, Zerm R, Gutenbrunner C, Reif M, Kröz M. The Anthroposophic Art Therapy Assessment Paint (AART-ASSESS-P): A peer-report instrument to assess patients' pictorial expression during Anthroposophic Painting Therapy. Explore (NY) 2020; 17:541-548. [PMID: 32843248 DOI: 10.1016/j.explore.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Anthroposophic painting therapy (APT) is a specific form of art therapy that aims to activate self-healing capacities through painting aquarelles. METHODS The Anthroposophic Art Therapy Assessment-Paint' (AART-ASSESS-P) was developed to measure pictorial expression and validated in the framework of a comprehensive cohort design study. The validation study examined 68 breast cancer patients with fatigue. Art therapists made pre- and post-assessments of spontaneously drawn water-color paintings with a preliminary version of the AART-ASSESS-P (58 items). Inter-rater reliability (IRR) for the items was examined with Cohen's weighted Kappa (κw). Additionally, a reliability- and factor analysis (FA) were conducted. Convergence criteria were patients' self-report measures: the Satisfaction with Painting Therapy, Inner Correspondence with Painting Therapy and the Self-Regulation Questionnaire. RESULTS IRR for the items was heterogeneous (κw= 0.09-0.89, Mean κw= 0.40, SD = 0.17). Thirty-six items were excluded due to insufficient IRR and item-total correlation (κw= < 0.30, ρitem-total< 0.30). A FA with 22 items revealed 5 subscales: Shape Development (6 items), Shape Arrangement (6 items), Order and Symmetry (5 items), Color Application (3 items), and Color Quality (2 items) explaining 61% of total variance. Psychometric properties for the AART-ASSESS-P were satisfying with Cronbach's alpha coefficients (rα = 0.60-0.81) across subscales. Due to weak inter-subscale correlations (r = 0.18-0.48, p < 0.05) and the ambiguity of face validity a sum-score was not formed. Correlations between subscales and self-reports were small (all p < 0.05). CONCLUSION The AART-ASSESS-P is the first reliable instrument to measure pictorial expression during APT.
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Affiliation(s)
- A Mehl
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany.
| | - D Brauer
- Medical Section, School of Spiritual Science/Goetheanum, 4134Dornach, Switzerland
| | - A Didwiszus
- Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089Berlin, Germany
| | - B Gelin-Kröz
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany
| | - D Pranga
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany
| | - R Zerm
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany; Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089Berlin, Germany
| | - C Gutenbrunner
- Clinic for Rehabilitative Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625Hannover, Germany
| | - M Reif
- Society for Clinical Research, Hardenbergstraße 20, 10623Berlin, Germany
| | - M Kröz
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany; Institute for Integrative Medicine, University Witten/Herdecke, Gerhard Kienle Weg 8, 58313Herdecke, Germany; Hospital Arlesheim, Research Department, Pfeffinger Weg 1, 4144Arlesheim, Switzerland
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Anthroposophic Medicine: A multimodal medical system integrating complementary therapies into mainstream medicine. Complement Ther Med 2019; 47:102151. [DOI: 10.1016/j.ctim.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Kröz M, Mehl A, Didwiszus A, Gelin-Kröz B, Reif M, Berger B, Ten Brink F, Zerm R, Girke M, Gutenbrunner C, Büssing A. Reliability and first validity of the inner correspondence questionnaire for painting therapy (ICPTh) in a sample of breast cancer patients. Complement Ther Med 2019; 42:355-360. [PMID: 30670266 DOI: 10.1016/j.ctim.2018.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 01/31/2023] Open
Abstract
Objectives Art therapy (ArT) such as mindfulness-oriented painting therapy is increasingly used in psychosomatic, oncological integrative and rehabilitative medicine. Though it remains unknown how ArT works, we hypothesize that an engaged participation with painting ('Inner-Correspondence') contributes to improved symptom scores. In the context of a comprehensive cohort study for breast cancer survivors with cancer-related fatigue, we developed a patient-reported outcome measure to assess 'Inner Correspondence' with painting therapy and conducted a first validation study. Design A 24-item questionnaire on 'Inner Correspondence' (ICPTh) was administered after ten weeks of intervention and at six month followup together with concurrent scales (Inner Correspondence and Peaceful Harmony, Cancer Fatigue Scale, Hospital Anxiety and Depression Scale, Internal Coherence Scale). Statistical assessment included reliability- and factor analyses. Results A total of n = 68 BC (mean age, 58.2 years, SD = 8.7) participated in the preliminary validation study. Exploratory factor analysis revealed a robust 22-item scale with an unambiguous four-factor solution explaining 78% of total variance and the following subsales: 1) therapy congruence and relaxation (11 items), 2) inner development and mood (6 items), 3) artistic skill (3 items) and 4) task congruence (2 items). The 22-item ICPTh yielded high reliability (Cronbach's alpha = .966, item-total correlation = .497 - .883, test-retest reliability = .888). Conclusions We present a reliable instrument to measure 'Inner Correspondence' with painting therapy. Due to the small sample size and sample selection further validation studies are indicated.
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Affiliation(s)
- M Kröz
- Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089 Berlin, Germany; Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany; Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany; Institute of Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - A Mehl
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - A Didwiszus
- Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089 Berlin, Germany; Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - B Gelin-Kröz
- Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089 Berlin, Germany; Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - M Reif
- Society for Clinical Research, Hardenbergstraße 19, 10623, Berlin, Germany.
| | - B Berger
- Institute of Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - F Ten Brink
- Clinic for Rehabilitative Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - R Zerm
- Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089 Berlin, Germany; Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - M Girke
- Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089 Berlin, Germany; Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - C Gutenbrunner
- Clinic for Rehabilitative Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - A Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
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A collaborative model of integrative care: Synergy between Anthroposophic music therapy, acupuncture, and spiritual care in two patients with breast cancer. Complement Ther Med 2018; 40:195-197. [DOI: 10.1016/j.ctim.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/30/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022] Open
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Hamre HJ, Pham VN, Kern C, Rau R, Klasen J, Schendel U, Gerlach L, Drabik A, Simon L. A 4-year non-randomized comparative phase-IV study of early rheumatoid arthritis: integrative anthroposophic medicine for patients with preference against DMARDs versus conventional therapy including DMARDs for patients without preference. Patient Prefer Adherence 2018; 12:375-397. [PMID: 29588576 PMCID: PMC5859899 DOI: 10.2147/ppa.s145221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND While disease-modifying antirheumatic drugs (DMARDs) are a mainstay of therapy for rheumatoid arthritis (RA), some patients with early RA refuse DMARDs. In anthroposophic medicine (AM), a treatment strategy for early RA without DMARDs has been developed. Preliminary data suggest that RA symptoms and inflammatory markers can be reduced under AM, without DMARDs. PATIENTS AND METHODS Two hundred and fifty-one self-selected patients aged 16-70 years, starting treatment for RA of <3 years duration, without prior DMARD therapy, participated in a prospective, non-randomized, comparative Phase IV study. C-patients were treated in clinics offering conventional therapy including DMARDs, while A-patients had chosen treatment in anthroposophic clinics, without DMARDs. Both groups received corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). Primary outcomes were intensity of RA symptoms measured by self-rating on visual analog scales, C-reactive protein, radiological progression, study withdrawals, serious adverse events (SAE), and adverse drug reactions in months 0-48. RESULTS The groups were similar in most baseline characteristics, while A-patients had longer disease duration (mean 15.1 vs 10.8 months, p<0.0001), slightly more bone destruction, and a much higher proportion of women (94.6% vs 69.7%, p<0.0001). In months 0-12, corticosteroids were used by 45.7% and 81.6% (p<0.0001) and NSAIDs by 52.8% and 68.5% (p=0.0191) of A- and C-patients, respectively. During follow-up, both groups not only had marked reduction of RA symptoms and C-reactive protein, but also some radiological disease progression. Also, 6.2% of A-patients needed DMARDs. Apart from adverse drug reactions (50.4% and 69.7% of A- and C-patients, respectively, p=0.0020), none of the primary outcomes showed any significant between-group difference. CONCLUSION Study results suggest that for most patients preferring anthroposophic treatment, satisfactory results can be achieved without use of DMARDs and with less use of corticosteroids and NSAIDs than in conventional care. LIMITATION Because of the non-randomized study design, with A-patients choosing anthroposophic treatment, one cannot infer how this treatment would have worked for C-patients.
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Affiliation(s)
- Harald J Hamre
- Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Freiburg, Germany
- Correspondence: Harald J Hamre, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg, Germany, Tel +49 761 1560 307, Fax +49 761 6125 6125, Email
| | - Van N Pham
- Institute of Statistics in Medicine, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Christian Kern
- Department of Integrative Medicine, Asklepios Westklinikum, Hamburg, Germany
| | - Rolf Rau
- Department of Rheumatology, Evangelisches Fachkrankenhaus Ratingen, Ratingen, Germany
| | - Jörn Klasen
- Department of Integrative Medicine, Asklepios Westklinikum, Hamburg, Germany
| | - Ute Schendel
- Department of Rheumatology, m&i-Fachklinik Bad Pyrmont, Bad Pyrmont, Germany
| | - Lars Gerlach
- Department of Internal Medicine and Gastroenterology, Filderklinik, Filderstadt, Germany
| | - Attyla Drabik
- Institute of Statistics in Medicine, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ludger Simon
- Department of Internal Medicine and Gastroenterology, Filderklinik, Filderstadt, Germany
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Lees J. The emerging therapeutic landscape of psychotherapy in the twenty-first century and the contribution of anthroposophic psychotherapy. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2017. [DOI: 10.1080/13642537.2017.1312476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- John Lees
- School of Healthcare, The University of Leeds, Leeds, UK
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Hamre HJ, Kiene H, Ziegler R, Tröger W, Meinecke C, Schnürer C, Vögler H, Glockmann A, Kienle GS. Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study. Glob Adv Health Med 2014; 3:54-70. [PMID: 24753995 PMCID: PMC3921612 DOI: 10.7453/gahmj.2013.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Anthroposophic medicine is a physician-provided complementary therapy system that was founded by Rudolf Steiner and Ita Wegman. Anthroposophic therapy includes special medicinal products, artistic therapies, eurythmy movement exercises, and special physical therapies. The Anthroposophic Medicine Outcomes Study (AMOS) was a prospective observational multicenter study of 1631 outpatients starting anthroposophic therapy for anxiety disorders, asthma, attention deficit hyperactivity disorder, depression, low back pain, migraine, and other chronic indications under routine conditions in Germany. AMOS incorporated two features proposed for the evaluation of integrative therapy systems: (1) a sequential approach, starting with the whole therapy system (use, safety, outcomes, perceived benefit), addressing comparative effectiveness and proceeding to the major system components (physician counseling, anthroposophic medicinal products, art therapy, eurythmy therapy, rhythmical massage therapy) and (2) a mix of different research methods to build an information synthesis, including pre-post analyses, prospective comparative analyses, economic analyses, and safety analyses of individual patient data. AMOS fostered two methodological innovations for the analysis of single-arm therapy studies (combined bias suppression, systematic outcome comparison with corresponding cohorts in other studies) and the first depression cost analysis worldwide comparing primary care patients treated for depression vs depressed patients treated for another disorder vs nondepressed patients. A total of 21 peer-reviewed publications from AMOS have resulted. This article provides an overview of the main research questions, methods, and findings from these publications: anthroposophic treatment was safe and was associated with clinically relevant improvements in symptoms and quality of life without cost increase; improvements were found in all age, diagnosis, and therapy modality groups and were retained at 48-month follow-up; nonrespondent bias, natural recovery, regression to the mean, and adjunctive therapies together could explain a maximum of 37% of the improvement.
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Affiliation(s)
- Harald Johan Hamre
- Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Freiburg, Germany (Dr Hamre)
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Freiburg, Germany (Dr Kienle)
| | - Renatus Ziegler
- Institute Hiscia, Society for Cancer Research, Arlesheim, Switzerland (Dr Ziegler)
| | | | | | | | - Hendrik Vögler
- Ita Wegman Therapeutikum, Dortmund, Germany (Dr Vögler). Dr Vögler was the contact person for the Anthroposophic Medicine Outcomes Study (AMOS) in the Physicians' Association for Anthroposophical Medicine in Germany
| | - Anja Glockmann
- Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Freiburg, Germany (Ms Glockmann)
| | - Gunver Sophia Kienle
- Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Freiburg, Germany (Dr Kiene)
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Kienle GS, Albonico HU, Baars E, Hamre HJ, Zimmermann P, Kiene H. Anthroposophic medicine: an integrative medical system originating in europe. Glob Adv Health Med 2013; 2:20-31. [PMID: 24416705 PMCID: PMC3865373 DOI: 10.7453/gahmj.2012.087] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Anthroposophic medicine is an integrative multimodal treatment system based on a holistic understanding of man and nature and of disease and treatment. It builds on a concept of four levels of formative forces and on the model of a three-fold human constitution. Anthroposophic medicine is integrated with conventional medicine in large hospitals and medical practices. It applies medicines derived from plants, minerals, and animals; art therapy, eurythmy therapy, and rhythmical massage; counseling; psychotherapy; and specific nursing techniques such as external embrocation. Anthroposophic healthcare is provided by medical doctors, therapists, and nurses. A Health-Technology Assessment Report and its recent update identified 265 clinical studies on the efficacy and effectiveness of anthroposophic medicine. The outcomes were described as predominantly positive. These studies as well as a variety of specific safety studies found no major risk but good tolerability. Economic analyses found a favorable cost structure. Patients report high satisfaction with anthroposophic healthcare.
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Affiliation(s)
- Gunver S Kienle
- Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke, Germany
| | | | - Erik Baars
- European Scientific Cooperative on Anthroposophic Medicinal Products (ESCAMP), Freiburg, Germany
| | - Harald J Hamre
- Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke, Germany, Norway
| | - Peter Zimmermann
- Department of Gynecology, Plusterveys, Nastola Medical Center, Finland
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke, Germany
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Hamre HJ, Kiene H, Glockmann A, Ziegler R, Kienle GS. Long-term outcomes of anthroposophic treatment for chronic disease: a four-year follow-up analysis of 1510 patients from a prospective observational study in routine outpatient settings. BMC Res Notes 2013; 6:269. [PMID: 23849335 PMCID: PMC3711832 DOI: 10.1186/1756-0500-6-269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 06/25/2013] [Indexed: 11/23/2022] Open
Abstract
Background Anthroposophic treatment includes special artistic and physical therapies and special medications. We here report an update to a previously published study of anthroposophic treatment for chronic diseases, including more patients and a longer follow up. The Anthroposophic Medicine Outcomes Study (AMOS) was a prospective observational cohort study of anthroposophic treatment for chronic indications in routine outpatient settings in Germany. Anthroposophic treatment was associated with improvements of symptoms and quality of life. Previous follow-up-analyses have been performed after 24 months or, in subgroups of patients enrolled in the period 1999-2001, after 48 months. We conducted a 48-month follow-up analysis of all patients enrolled in AMOS in the period 1999-2005. Methods 1,510 outpatients aged 1-75 years, starting anthroposophic treatment for chronic conditions in routine German outpatient settings, participated in a prospective cohort study. Main outcomes were Symptom Score (primary outcome, mean symptom severity on numerical rating scales), SF-36 Physical and Mental Component scores in adults, and disease-specific outcomes in the six most common diagnosis groups: asthma, anxiety disorders and migraine (numerical rating scales), depression (Center for Epidemiological Studies Depression Scale), attention deficit hyperactivity symptoms (FBB-HKS Total score), and low back pain (Hanover Functional Ability Questionnaire, Low Back Pain Rating Scale). Results Median disease duration at baseline was 3.5 years. From baseline to 48-month follow-up all ten outcomes improved significantly (p < 0.001 for all pre-post comparisons). Standardised Response Mean effect sizes were large (range 0.84-1.24 standard deviations) for seven comparisons, medium for two comparisons (SF-36 Mental Component: 0.60, Low Back Pain Rating Scale: 0.55), and small for one comparison (SF-36 Physical Component: 0.39). Symptom Score improved significantly with large effect sizes in adults and children, and in the four main anthroposophic therapy modality groups (art therapy, eurythmy therapy, rhythmical massage therapy, medical therapy). Conclusions This 48-month follow-up analysis confirmed previous analyses from the AMOS study. Outpatients receiving anthroposophic treatment for chronic indications had sustained, clinically relevant improvements of symptoms and quality of life.
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Use of Complementary and Alternative Medicine in Treating Individuals with Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0019-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kröz M, Fink M, Reif M, Grobbecker S, Zerm R, Quetz M, Frühwirth M, Brinkhaus B, Bartsch C, Girke M, Gutenbrunner C. Multimodal Therapy Concept and Aerobic Training in Breast Cancer Patients With Chronic Cancer-Related Fatigue. Integr Cancer Ther 2012; 12:301-11. [DOI: 10.1177/1534735412464552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hypothese: Cancer-related fatigue (CRF) and sleep disorders are some of the most wearing and common symptoms in disease-free breast cancer patients (BC). Aerobic training (AT) is the treatment with the best available evidence, even though it seems to be insufficient with regards to improvements in cognitive fatigue. We introduced a new multimodal therapy concept (MM) consisting of psycho-, sleep-education and new approaches based on anthroposophic medicine such as eurythmy and painting therapy. Study design: This pilot study will test the implementation of MM and yield first results of the MM and AE in our centres. Methods: 31 out of 34 patients suffering from BC and CRF were fully assessed in a ten-week intervention study. 21 patients chose MM and 10 decided on AT. CRF was measured with the help of the Cancer Fatigue Scale (CFS-D), and the global quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI). We also captured autonomic regulation (aR) and patients’ satisfaction with questionnaires. Statistical analysis was done with SAS 9.1.3 for windows. Results: The new MM therapy can be implemented with high satisfaction among patients. Significant improvements were found in the MM group with regards to CFS-D, global quality of sleep, sleep efficiency (PSQI), aR and rest/activity regulation compared to baseline (all p<0.05). In the AT group aR orthostatic-circulatory and rest/activity regulation improved significantly (p<0.05), too. However, no improvement in cognitive fatigue was seen in either group. Conclusion: The multimodal therapy concept was feasible and improved cancer fatigue, sleep quality, autonomic and rest-/activity regulation in breast cancer patients. It may therefore constitute a valuable treatment option in addition to aerobic training for BC patients with CRF. A further study with larger sample size needs to be carried out to assess the efficacy of combined multimodal-aerobic therapy.
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Affiliation(s)
- Matthias Kröz
- Research Institute Havelhöhe (FIH), Berlin, Germany
- Community Hospital Havelhöhe (GKH), Berlin, Germany
- Charité University Medicine, Berlin, Germany
| | | | - Marcus Reif
- Institute for Clinical Research (IKF), Berlin, Germany
| | | | - Roland Zerm
- Research Institute Havelhöhe (FIH), Berlin, Germany
- Community Hospital Havelhöhe (GKH), Berlin, Germany
| | | | | | | | | | - Matthias Girke
- Research Institute Havelhöhe (FIH), Berlin, Germany
- Community Hospital Havelhöhe (GKH), Berlin, Germany
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Galitesi CRL, Andrade FBD, Borges AFS. Pain and disease according to integral anthroposophical dentistry. Braz Oral Res 2012; 26 Suppl 1:57-63. [DOI: 10.1590/s1806-83242012000700009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/08/2012] [Indexed: 11/22/2022] Open
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Kienle GS, Glockmann A, Grugel R, Hamre HJ, Kiene H. [Clinical research on anthroposophic medicine:update of a health technology assessment report and status quo]. Complement Med Res 2011; 18:269-82. [PMID: 22105040 DOI: 10.1159/000331812] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE In 2005 a Health Technology Assessment (HTA) report analyzed efficacy, effectiveness, safety, utilization and costs of Anthroposophic Medicine (AM). After a recent referendum of the ‘Swiss Population pro Complementary Medicine’ (May 2009) this HTA report was updated. DESIGN Update of the HTA report by a systematic review. METHODS Methods corresponded to the existing HTA report and the guidelines of the Swiss Federal Office of Public Health. For clinical studies four databases and a specialized journal were searched, and extensive expert consultations were used. Studies were selected according to predefined inclusion criteria, data were extracted, and methodological quality was assessed individually. RESULTS 70 new clinical studies were found. Altogether, 265 clinical studies investigated efficacy and effectiveness of AM: 38 randomized controlled trials, 36 prospective and 49 retrospective non-randomized controlled trials as well as 90 prospective and 52 retrospective trials without control groups. They investigated a wide spectrum of AM treatments in a multitude of diseases; the whole AM system in 38 trials, non-pharmacological therapies in 10 trials, AM mistletoe products in cancer therapy in 133 trials, and other AM medication treatments in 84 trials. Most studies showed a positive result for AM. Methodological quality differed substantially; some studies showed major limitations, others were reasonably well conducted. Trials with better quality still showed a positive result. External validity was usually high. Side effects or other risks were rare and usually described to be mild or moderate. Studies regarding safety showed a good tolerability altogether. CONCLUSION Trials of varying design and quality in a variety of diseases predominantly describe good clinical outcomes for AM, only marginal side effects, high satisfaction of patients with regard to results and safety and presumably slightly less costs. Further high-quality evaluations are desirable.
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Affiliation(s)
- Gunver Sophia Kienle
- Institut für angewandte Erkenntnistheorie und medizinische Methodologie e.V. (IFAEMM), Freiburg i.Br., Deutschland
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“The piano is a wooden box with false teeth” – Perspectives in anthroposophical music therapy as revealed through interviews with two expert practitioners. ARTS IN PSYCHOTHERAPY 2010. [DOI: 10.1016/j.aip.2010.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Predictors of outcome after 6 and 12 months following anthroposophic therapy for adult outpatients with chronic disease: a secondary analysis from a prospective observational study. BMC Res Notes 2010; 3:218. [PMID: 20682028 PMCID: PMC3161369 DOI: 10.1186/1756-0500-3-218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 08/03/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anthroposophic medicine is a physician-provided complementary therapy system involving counselling, artistic and physical therapies, and special medications. The purpose of this analysis was to identify predictors of symptom improvement in patients receiving anthroposophic treatment for chronic diseases. METHODS 913 adult outpatients from Germany participated in a prospective cohort study. Patients were starting anthroposophic treatment for mental (30.4% of patients, n = 278/913), musculoskeletal (20.2%), neurological (7.6%), genitourinary (7.4%) or respiratory disorders (7.2%) or other chronic indications. Stepwise multiple linear regression analysis was performed with the improvement of Symptom Score (patients' assessment, 0: not present, 10: worst possible) after 6 and 12 months as dependent variables. 61 independent variables pertaining to socio-demographics, life style, disease status, co-morbidity, health status (SF-36), depression, and therapy factors were analysed. RESULTS Compared to baseline, Symptom Score improved by average 2.53 points (95% confidence interval 2.39-2.68, p < 0.001) after six months and by 2.49 points (2.32-2.65, p < 0.001) after 12 months. The strongest predictor for improvement after six months was baseline Symptom Score, which alone accounted for 25% of the variance (total model 32%). Improvement after six months was also positively predicted by better physical function, better general health, shorter disease duration, higher education level, a diagnosis of respiratory disorders, and by a higher therapy goal documented by the physician at baseline; and negatively predicted by the number of physiotherapy sessions in the pre-study year and by a diagnosis of genitourinary disorders. Seven of these nine variables (not the two diagnoses) also predicted improvement after 12 months. When repeating the 0-6 month analysis on two random subsamples of the original sample, three variables (baseline Symptom Score, physical function, general health) remained significant predictors in both analyses, and three further variables (education level, respiratory disorders, therapy goal) were significant in one analysis. CONCLUSION In adult outpatients receiving anthroposophic treatment for chronic diseases, symptom improvement after 6 and 12 months was predicted by baseline symptoms, health status, disease duration, education, and therapy goal. Other variables were not associated with the outcome. This secondary predictor analysis of data from a pre-post study does not allow for causal conclusions; the results are hypothesis generating and need verification in subsequent studies.
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Jeschke E, Ostermann T, Tabali M, Vollmar HC, Kröz M, Bockelbrink A, Witt CM, Willich SN, Matthes H. Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study. BMC Geriatr 2010; 10:48. [PMID: 20663129 PMCID: PMC2916899 DOI: 10.1186/1471-2318-10-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/21/2010] [Indexed: 01/12/2023] Open
Abstract
Background Pharmacotherapy in the older adult is a complex field involving several different medical professionals. The evidence base for pharmacotherapy in elderly patients in primary care relies on only a few clinical trials, thus documentation must be improved, particularly in the field of complementary and alternative medicine (CAM) like phytotherapy, homoeopathy, and anthroposophic medicine. This study describes diagnoses and therapies observed in elderly patients treated with anthroposophic medicine in usual care. Methods Twenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions. Results In 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female) were included. The most frequent diagnoses were hypertension (11.1%), breast cancer (3.5%), and heart failure (3.0%). In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic). The adjusted odds ratio (AOR) for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79), treatment by an internist (AOR = 1.49; CI: 1.40-1.58), female patients (AOR = 1.35; CI: 1.27-1.43), cancer (AOR = 4.54; CI: 4.12-4.99), arthropathies (AOR = 1.36; CI: 1.19-1.55), or dorsopathies (AOR = 1.34; CI: 1.16-1.55) and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98). The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39), diabetes mellitus (AOR = 0.17; CI: 0.14-0.22), or metabolic disorders (AOR = 0.17; CI: 0.13-0.22). Conclusion The present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.
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Perruzza N, Kinsella EA. Creative Arts Occupations in Therapeutic Practice: A Review of the Literature. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12759925468943] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to conduct a matrix method literature review of published research on the use of creative arts occupations in therapeutic practice. Peer-reviewed original research articles, published between the years 2000 and 2008, were included in the review. The research articles studied creative arts occupations as a therapeutic medium. Twenty-three articles, located through multiple electronic searches, were identified as meeting the criteria of the review. Data analysis included quantitative analysis and qualitative analysis. The findings suggest that the use of creative arts occupations in therapeutic practice may have important qualitative value related to health and wellbeing. Six predominant outcomes were most frequently identified across the studies: enhanced perceived control, building a sense of self, expression, transforming the illness experience, gaining a sense of purpose and building social support. The results suggest that qualitative research may well be the methodology of choice for the study of this topic and raise questions about the paucity of research in this area. Further research into the use of creative arts occupations as a therapeutic approach in occupational therapy and other health and social care disciplines is warranted.
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Hamre HJ, Glockmann A, Tröger W, Kienle GS, Kiene H. Assessing the order of magnitude of outcomes in single-arm cohorts through systematic comparison with corresponding cohorts: an example from the AMOS study. BMC Med Res Methodol 2008; 8:11. [PMID: 18366683 PMCID: PMC2323398 DOI: 10.1186/1471-2288-8-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 03/19/2008] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND When a therapy has been evaluated in the first clinical study, the outcome is often compared descriptively to outcomes in corresponding cohorts receiving other treatments. Such comparisons are often limited to selected studies, and often mix different outcomes and follow-up periods. Here we give an example of a systematic comparison to all cohorts with identical outcomes and follow-up periods. METHODS The therapy to be compared (anthroposophic medicine, a complementary therapy system) had been evaluated in one single-arm cohort study: the Anthroposophic Medicine Outcomes Study (AMOS). The five largest AMOS diagnosis groups (A-cohorts: asthma, depression, low back pain, migraine, neck pain) were compared to all retrievable corresponding cohorts (C-cohorts) receiving other therapies with identical outcomes (SF-36 scales or summary measures) and identical follow-up periods (3, 6 or 12 months). Between-group differences (pre-post difference in an A-cohort minus pre-post difference in the respective C-cohort) were divided with the standard deviation (SD) of the baseline score of the A-cohort. RESULTS A-cohorts (5 cohorts with 392 patients) were similar to C-cohorts (84 cohorts with 16,167 patients) regarding age, disease duration, baseline affection and follow-up rates. A-cohorts had > or = 0.50 SD larger improvements than C-cohorts in 13.5% (70/517) of comparisons; improvements of the same order of magnitude (small or minimal differences: -0.49 to 0.49 SD) were found in 80.1% of comparisons; and C-cohorts had > or = 0.50 SD larger improvements than A-cohorts in 6.4% of comparisons. Analyses stratified by diagnosis had similar results. Sensitivity analyses, restricting the comparisons to C-cohorts with similar study design (observational studies), setting (primary care) or interventions (drugs, physical therapies, mixed), or restricting comparisons to SF-36 scales with small baseline differences between A- and C-cohorts (-0.49 to 0.49 SD) also had similar results. CONCLUSION In this descriptive analysis, anthroposophic therapy was associated with SF-36 improvements largely of the same order of magnitude as improvements following other treatments. Although these non-concurrent comparisons cannot assess comparative effectiveness, they suggest that improvements in health status following anthroposophic therapy can be clinically meaningful. The analysis also demonstrates the value of a systematic approach when comparing a therapy cohort to corresponding therapy cohorts.
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Affiliation(s)
- Harald J Hamre
- Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany.
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