Die Entwicklung von Messinstrumenten für komplementäre Behandlungsmethoden

Um die Wirksamkeit von Behandlungsmethoden zu erfassen – und dies ist ein wichtiger Aspekt für die Bewertung und letztlich Anerkennung von alternativen und komplementären Behandlungsmethoden (CAM) – ist es wichtig, dass entsprechende Messinstrumente zur Verfügung stehen, die die relevanten Kriterien erfassen. Die Auswahl der Untersuchungskriterien, ihre Gewichtung und wie sie erfasst werden, sind von grundlegender Bedeutung für die Untersuchungsergebnisse – und letztlich dafür, ob sich eine untersuchte Methode als wirksam erweist oder nicht.

Die Studie “Developing a tool to measure holistic practice: a missing dimension in outcomes measurement within complementary therapies” von A. F. Long, G. Mercer und K. Hughes^[1]A.F. Long, G. Mercer & K. Hughes: “Developing a tool to measure holistic practice: a missing dimension in outcomes measurement within complementary therapies”. In: Complementary … weiterlesen geht dieser Fragestellung nach:

“Approaches to outcome measurement within conventional medicine have recently raised the importance of querying whose definition of a ‘successful’ outcome or ‘effective’ intervention is being measured. The need to give greater primacy to the desired outcomes of service users and their informal carers, and effects over the longer term, is becoming increasingly acknowledged. In contrast, within complementary therapies, the importance of measuring the subjective experience of therapy users and the need to look for effects in the longer term has been well recognized. Outcomes have long been assessed in terms of emotional well-being, a healthier lifestyle and more satisfying personal relationships. Indeed, within practice, central interest lies in the user’s own perception of their needs and the ‘problem’, and the extent to which these are addressed … Central to the philosophy and practice of complementary and alternative medicine (CAM) is the notion of holism. This is associated with treating the whole person, body, mind and spirit, within their context of their environment. It further presumes a participatory relationship between practitioner and client which generates a renewed context of hope and empowerment. However, with a growth in the number of therapies that lay claim to holistic practice, these has been increasing variation in its meaning across therapies. It is an empirical question how practitioners use the term, whether the implementation of such an holistic approach is achieved and whether it varies between therapies or practitioners in the same therapy.” (Seite 26f)

Bislang aber, so die Autoren, gibt es darüber wenig Forschungsansätze innerhalb der alternativen und komplementären Behandlungsmethoden. Die meisten Forschungsansätze haben lediglich Kriterien wie Schmerzintensität oder Lebensqualität als Maßstäbe verwendet:

“Left unmeasured are key features of the interaction between therapist and therapy user, and the underlying philosophy of health and healing of CAM. Indeed, survey evidence suggests this is an important factor in the reasons why users come to complementary therapists for treatment. In consequence, the measured effects of CAM treatments may be credited with a lesser effect than is achieved in reality. In short, the range of dimensions of effect is not being adequately measured” (Seite 27).

“This approach is quite different to that within the SF-36 or other similar health status measures. Holism is rather perceived conceptually and empirically as comprising features of health and healing within die CAM philosophy and the way these are interpreted in the interaction, treatment and care provided by the therapist. Interest lies in the approach taken by the practitioner to the problem, the relationship with the practitioner and its educative and empowering nature in clarifying causes and bringing the mind and body into harmony” (Seite 29).

Die Autoren berichten über eine einjährige explorative und qualitative Studie, in der zehn “complementary therapy practitioners”, sechs “NHI practitioners who also provided complementary therapy treatment” und zwölf Konsumenten von komplementärtherapeutischen Behandlungen interviewt wurden, um folgende vier Themenbereiche zu erfassen:

• Perceptions of the philosophy of health and healing
• Features of the therapeutic intervention which could be identified as holistic
• Criteria for success of the therapy
• Factors that enhanced or inhibited the success of the therapist’s interventions

In der zweiten Phase der Studie wurden die erhobenen Daten ausgewertet und ein Set von Aussagen herausgefiltert für einen Fragebogen, der im Bereich ganzheitlicher Methoden verwendet werden kann (HPQ – holistic practice questionnaire). Die Fragen des HPQ wurden dabei so nahe wie möglich an die Ausdrucksweise der PraktikerInnen angepasst. In der dritten Phase der Studie wurde der HPQ dann erstmals erprobt.

Erfassung der Ganzheitlichkeit in der Behandlung

Die grundlegenden Kategorien für die Erfassung der ganzheitlichen Praxis komplementärer Behandlungsangebote, die sich aus der Analyse der Daten ergaben:

• Health (as perceived by the individual; the individual’s own responsibility for health and disease)
• Healing (wanting to get well; empowering the process of self-healing; gaining control; getting in balance)
• Illness (finding out the real problem; looking at the whole individual within their life and social context)
• Therapy/treatment (targets the individual; negotiated;an ongoing process)
• Relationship of the therapist and user (working in partnership; user is encouraged to talk and therapist to listen; trust, confidence and supportive therapist)
• Individual responsibility (re-educating the body and self; developing coping strategies)
• Encouraging movement and change (changing attitudes (to health) and behaviour (Iifestyle); the healing process needs time to occur; learning for coping in the long term)

Auszüge aus dem Fragebogen

Zu Beginn der Behandlungen:

• Have you been to a complementary therapist before?
• How long ago did you use the last therapy?
• How did the last therapy you used work out?
• What would be the best possible result of this therapy for you?
• You have to believe that whatever will be given to you is going to work? 
• Being healthy is when you can live life as fully as possible What do you want to do when you get better?

Zum Abschluss der Behandlungen:

• Talking with the therapist can help the Person find out what the problems are I think complementary therapy is good because it treats the whole person, not just the condition
• The complementary therapy has helped me to become more responsible for my own health
• After the treatment I had more energy
• The complementary therapy has taught me how to help myself get better
• I am able to take my time when I speak to the complementary therapist which helped me feel better
• My body was mending itself
• What can you do now that you didn’t feel able to before the complementary therapy?

Zusammenfassung und Ausblick

Zusammenfassend führen die Autoren aus:

“The qualitative interviews in which the measure is grounded provide substantive evidence for the picture of complementary therapy, treatments and its effects as a process of ongoing change on and with the therapy user. This dynamic aspect needs to be reflected within a measuring instrument. Only in this way can the effects of the complementary therapy arising from the interpretation of its philosophy be expected to emerge. Omitting to measure features of the user-therapy practitioner interaction provides only a partial view” (Seite 30).

Und abschließend:

“However, much further work remains to be done. Within the small pilot study, the measure was seen as relevant and comprehensive. Further funding is currently being sought to validate the instrument and to explore its potential as an outcome measure. A key area for exploration is the way the information contained in the HPQ, and the OMT more generally, is used and found useful by the therapy user and practitioners in monitoring the process of treatment and care” (Seite 31).