2.  WHAT CONTRIBUTION CAN
COMPLEMENTARY MEDICINE
MAKE TO PRIMARY HEALTH CARE?
...Continued


2.2.3  Outcome measured by SF36 and other health scales

The SF36 scale proved to be quite a sensitive measure of change, in spite of the variability in the group of patients referred for treatment. There were significant improvements on all dimensions of the scale between referral and completion of treatment, apart from on the general health dimension, with most dimensions showing a continuing improvement at the six month stage. The significance of the change in scores between referral and at six months was rather lower than between referral and completion of treatment, probably due to the smaller number of questionnaires available at this stage (Table 16).

Table 16  Average (mean) SF36 scores
(high scores imply a better level of health and well-being)

Category on SF36 scale	On Referral	At end of treatment	Six months after referral
Physical functioning	68.1	72.9***	74.8
Physical role performance	32.5	49.9***	59.2
Body pain	43.1	53.8***	53.8
General health	58.4	60.9	64.5
General vitality	41.9	48.3**	48.6
Social functioning	62.6	73.6***	75.3
Emotional role performance	53.6	65.1*	73.1
Mental health	59.5	67***	69.3
Total questionnaires	425	224	93

*** The difference between scores on referral and end of treatment significant at .001.
** The difference between scores on referral and end of treatment significant at .005
* The difference between scores on referral and end of treatment significant at .05.

Subgroups of patients were also asked to complete four other tests. Patients with psycho-social problems were asked to complete the Inventory of Interpersonal Problems (HP), and a Beck’s Depression Inventory, and patients with musculo-skeletal problems were asked to complete a Functional Limitation Profile (FLP) and Pain Index. Unfortunately, the numbers of patients with psycho-social problems completing follow-up questionnaires was too small to make analysis of their scores worthwhile. However, for patients with musculo-skeletal problems, scores on the FLP and pain index showed up significant changes on completion of treatment, similar results to those from the SF36 (Table 17), although in this case, six month questionnaires appeared to show a deterioration in condition. However, the small number of questionnaires completed at six months may have influenced this outcome.

Table 17  Mean scores on FLP and Pain Scale

Item on scale	On referral	At six months	On completion of treatment
Ambulation	10.3	6.4*	10.7
Body care	4.9	4.2*	6.1
Mobility	3.1	35*	3.9
Work	14.3	11.2*	15
FLP total	6.5	5.1*	7.3
Main Pain score	5.5	4.8*	4.3
Numbers	100	61	29

* The difference between scores on referral and end of treatment sign significant at .001.

On the whole, the correspondence between the results on these health scales, and patient’s own assessment of the change in their health condition following treatment was often quite poor. For example, the relationship between patients’ self-assessed improvement and changes in their SF36 scores was only a weakly significant one. In part, this was because of the variety of conditions being referred, which meant that different patients were reporting change on different elements of the SF36 scale, When the different groups were separated out, the correspondence between self-reported change and level of change in SF36 scores was a little more significant. There was, for example, a significant relationship (p= .005) between level of improvement recorded on the physical functioning scale and self reported change for patients with musculo-skeletal problems.


2.3  Provision of advice on self management of health problem

In addition to treatment, most of the complementary practitioners gave their patients advice on managing their health problem (Table 18). This was usually advice specifically related to the condition being treated, designed to enable the patient to alleviate the symptoms, or to prevent a worsening of the problem; either through the use of specific exercises, relaxation or stress management techniques, or avoidance of particular foods which might aggravate the problem.

Table 18  Advice received from practitioners

Type of advice received	Number	%
About problem	112	50
Specific exercises	88	39.2
General exercise	64	28.5
Relaxation	61	27.3
Diet	43	19.2
Stress	24	10.7
Smoking	6	2.6
Alcohol	8	3.5
Other	20	8.9
Total	224	-

Although no specific measurement was made of extent to which patients followed such advice, a third of the patients themselves reported making some change to their lifestyle since referral, which the majority found to be helpful (Table 19).

Table 19  Lifestyle changes made

Type of change made	Number	%
More attention to diet	62	27.7
More frequent exercise	82	36.6
More use of relaxation techniques	63	28.1
More use of meditation/prayer	34	15.2

Patients appeared to be appreciative of the help provided by the practitioners in managing their problems, sometimes commenting on the fact that they now felt less helpless in the face of the health problem from which they suffered.

"I found treatment very helpful. [The practitioner] explained exactly what has been going on with my neck and muscle structure and gave me ideas of exercises which are especially useful as I realise that with long ongoing problems such as I have I can’t expect it to all clear up in one go."

"A terrific help: it made me very aware of my tension and I feel I really do need to make changes in my way of life in order to help alleviate the problems"

"The advice over the period of treatment placed the problem in its perspective, alleviating anxiety both as to potential seriousness of the problem and to my ability to control it, ie. with appropriate exercise."

"The herbalist took great pains to explain fully how my condition was being caused how the parts of my body it affected worked, and how different types of food affect it and which foods to avoid"

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