IMPLICATIONS AND CONCLUSIONS
Much variation exists in the evidence supporting the
use of CAM therapies for OA. It’s clear that symptom management should be multimodal and include nonpharmacologic
therapies along with routine pharmacological
treatment. Focusing on comorbid symptoms
is also critical to improving function and overall quality
of life. CAM therapies and other nonpharmacologic
approaches play roles in managing pain and
perhaps the insomnia, depression, and anxiety that
can result.6, 59, 64-70 Effective therapies for these comorbid symptoms are essential for the holistic management
of OA. Thus, one may conclude that further
study is needed, as are clear and consistent definitions
of the therapies considered to be complementary
or alternative.
Consistency across studies is necessary for comparison
and will ultimately provide clearer answers
on whether a therapy’s use is supported. Data are needed on appropriate dosing for the various CAM
therapies and the resultant outcomes. In addition,
it’s essential that researchers use standardized treatments, even though this may contradict the essence of some holistic practices. Comparison of studies on
yoga, for example, becomes complicated when different
yoga practices and traditions are used, which
limits the strength of findings. It’s also essential to consider using new methodologies for CAM study
such as Whole Systems Research, which addresses the complexities of CAM interventions, many of which
come from whole systems of care such as traditional Chinese medicine. Because there might be synergistic
effects with concomitantly used therapies within
these systems, a mixed-methods research approach
is needed. This should include qualitative as well as
quantitative analyses to capture the effects of CAM
therapies.71 Also evident in CAM studies, particularly
in the extensive glucosamine trials, is a tendency toward
not comparing like to like. Differences in product
formulation, CAM practices, and provider services
may affect study results. As data increase, it will become
possible to include proven CAM therapies in
the multimodal management of OA
IMPLICATIONS AND CONCLUSIONSMuch variation exists in the evidence supporting theuse of CAM therapies for OA. It’s clear that symptom management should be multimodal and include nonpharmacologictherapies along with routine pharmacologicaltreatment. Focusing on comorbid symptomsis also critical to improving function and overall qualityof life. CAM therapies and other nonpharmacologicapproaches play roles in managing pain andperhaps the insomnia, depression, and anxiety thatcan result.6, 59, 64-70 Effective therapies for these comorbid symptoms are essential for the holistic managementof OA. Thus, one may conclude that furtherstudy is needed, as are clear and consistent definitionsof the therapies considered to be complementaryor alternative.Consistency across studies is necessary for comparisonand will ultimately provide clearer answerson whether a therapy’s use is supported. Data are needed on appropriate dosing for the various CAMtherapies and the resultant outcomes. In addition,it’s essential that researchers use standardized treatments, even though this may contradict the essence of some holistic practices. Comparison of studies onyoga, for example, becomes complicated when differentyoga practices and traditions are used, whichlimits the strength of findings. It’s also essential to consider using new methodologies for CAM studysuch as Whole Systems Research, which addresses the complexities of CAM interventions, many of whichcome from whole systems of care such as traditional Chinese medicine. Because there might be synergistic
effects with concomitantly used therapies within
these systems, a mixed-methods research approach
is needed. This should include qualitative as well as
quantitative analyses to capture the effects of CAM
therapies.71 Also evident in CAM studies, particularly
in the extensive glucosamine trials, is a tendency toward
not comparing like to like. Differences in product
formulation, CAM practices, and provider services
may affect study results. As data increase, it will become
possible to include proven CAM therapies in
the multimodal management of OA
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