Integrative medicine for musculoskeletal disorders : a mixed methods study

Abstract

The rising prevalence and burden of musculoskeletal disorders (MSDs) is a major health concern, affecting quality of life and causing an economic burden to the individual as well as society as a whole. Integrative medicine (IM), a complex intervention which includes complementary and alternative medicine (CAM) and conventional medicine, emphasising a holistic approach and patient-practitioner relationship, is a popular option for people with MSDs. The Medical Research Council’s (MRC) framework for evaluating complex interventions was used to explore IM for MSDs and to provide future guidance. The aims of this research study were to develop a theoretical understanding of IM; and to determine the feasibility of carrying out a mixed methods study of IM for MSDs in the UK. For the initial development stage of the MRC framework, a mixed methods review consisting of a mapping review, a systematic review, and a narrative review was performed to develop a theoretical understanding of IM for MSDs. There was promising evidence for integrative treatments provided for low back pain and patients perceived benefits in receiving CAM for their MSDs. However, the components identified in the review as essential in IM were rarely discussed or reported in research. The lack of a standard definition of IM and an absence of guidelines for reporting IM has hindered the process of developing its evidence base. Identification of authentic IM research was challenging, and evidence on IM for MSDs remains inadequate. In particular, no research studies explored IM as a package of care for MSDs in a secondary National Health Service (NHS) setting in the United Kingdom (UK). As part of the second stage of the MRC framework, the feasibility stage, a mixed methods research study was conducted to assess the feasibility of evaluating IM for MSDs at the Royal London Hospital for Integrated Medicine (RLHIM). The results of this mixed methods study of 60 patients followed up over 12 months suggested that the approach was generally feasible. Feasibility was reflected in four aspects: 1). Integrative treatments potentially produced moderate pain relief and improved health related quality of life (HRQoL) at four months which was sustained at 12 months, 2). Patients’ general acceptability of treatment was good, 3). Patients demanded integrative treatment, and 4). Overall research design was feasible with patients reporting positive experiences by participating in the research study. Issues and challenges were identified in the research procedure, including difficulties identifying and recruiting eligible patients, working with busy NHS practitioners, and failure of accessing unit cost data from the hospital. These issues need to be considered in future IM research. In addition, patients suggested particular outcome measures, and a narrative approach was preferred. An IM model was hypothesised from the findings of this research study which represented patients’ perception of good IM care. This research study is the first step in evaluating IM for MSDs. It has provided essential information needed to move the evidence base for IM; and provided original data on the feasibility and practicality of conducting the study. Following the next stage of the MRC framework, future research evaluating IM effectiveness, exploring the potential interaction between the components of the model, and whether these components were associated with the overall effects of IM, using a mixed methods design under a pragmatic approach is warranted. III