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Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study.

Hamre HJ, Kiene H, Ziegler R, Tröger W, Meinecke C, Schnürer C, Vögler H, Glockmann A, Kienle GS - Glob Adv Health Med (2014)

Bottom Line: Anthroposophic medicine is a physician-provided complementary therapy system that was founded by Rudolf Steiner and Ita Wegman.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.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.

View Article: PubMed Central - PubMed

Affiliation: Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Freiburg, Germany (Dr Hamre).

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.

No MeSH data available.


Related in: MedlinePlus

Outcome comparisons stratified by diagnoses.Differences between pre-post improvements of Anthroposophic Medicine Outcomes Study (AMOS) cohorts and improvements of corresponding cohorts for all SF-36 scales and summary measures, expressed in effect sizes and ordered in increasing magnitude: for all diagnoses and for individual diagnoses (n = 517 comparisons in total). Positive effect sizes indicate larger pre-post improvement in AMOS cohort than in corresponding cohort.Figure reproduced from Hamre et al.44
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Figure 2: Outcome comparisons stratified by diagnoses.Differences between pre-post improvements of Anthroposophic Medicine Outcomes Study (AMOS) cohorts and improvements of corresponding cohorts for all SF-36 scales and summary measures, expressed in effect sizes and ordered in increasing magnitude: for all diagnoses and for individual diagnoses (n = 517 comparisons in total). Positive effect sizes indicate larger pre-post improvement in AMOS cohort than in corresponding cohort.Figure reproduced from Hamre et al.44

Mentions: In a systematic review, adult AMOS patients with asthma, depression, low back pain, migraine, and neck pain (n = 392 patients) were compared to other patient cohorts with corresponding diagnoses receiving other treatment.44 A total of 63 publications fulfilled all eligibility criteria for the review (see Methods section). These publications reported one or more comparison cohorts with low back pain (n = 24 publications), depression (n = 13), migraine (n = 13), asthma (n = 11), and neck pain (n = 2), comprising 84 comparison cohorts with 16 167 patients. A total of 517 comparisons of 10 different SF-36 scales showed improvements largely of the same order of magnitude in AMOS subgroups and corresponding cohorts (minimal-to-small differences in 80% of the comparisons), with medium-to-large differences favoring AMOS and the corresponding cohorts in 14% and 7% of the comparisons, respectively (Figure 2). Sensitivity analyses had only small effects on the results.44


Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study.

Hamre HJ, Kiene H, Ziegler R, Tröger W, Meinecke C, Schnürer C, Vögler H, Glockmann A, Kienle GS - Glob Adv Health Med (2014)

Outcome comparisons stratified by diagnoses.Differences between pre-post improvements of Anthroposophic Medicine Outcomes Study (AMOS) cohorts and improvements of corresponding cohorts for all SF-36 scales and summary measures, expressed in effect sizes and ordered in increasing magnitude: for all diagnoses and for individual diagnoses (n = 517 comparisons in total). Positive effect sizes indicate larger pre-post improvement in AMOS cohort than in corresponding cohort.Figure reproduced from Hamre et al.44
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3921612&req=5

Figure 2: Outcome comparisons stratified by diagnoses.Differences between pre-post improvements of Anthroposophic Medicine Outcomes Study (AMOS) cohorts and improvements of corresponding cohorts for all SF-36 scales and summary measures, expressed in effect sizes and ordered in increasing magnitude: for all diagnoses and for individual diagnoses (n = 517 comparisons in total). Positive effect sizes indicate larger pre-post improvement in AMOS cohort than in corresponding cohort.Figure reproduced from Hamre et al.44
Mentions: In a systematic review, adult AMOS patients with asthma, depression, low back pain, migraine, and neck pain (n = 392 patients) were compared to other patient cohorts with corresponding diagnoses receiving other treatment.44 A total of 63 publications fulfilled all eligibility criteria for the review (see Methods section). These publications reported one or more comparison cohorts with low back pain (n = 24 publications), depression (n = 13), migraine (n = 13), asthma (n = 11), and neck pain (n = 2), comprising 84 comparison cohorts with 16 167 patients. A total of 517 comparisons of 10 different SF-36 scales showed improvements largely of the same order of magnitude in AMOS subgroups and corresponding cohorts (minimal-to-small differences in 80% of the comparisons), with medium-to-large differences favoring AMOS and the corresponding cohorts in 14% and 7% of the comparisons, respectively (Figure 2). Sensitivity analyses had only small effects on the results.44

Bottom Line: Anthroposophic medicine is a physician-provided complementary therapy system that was founded by Rudolf Steiner and Ita Wegman.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.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.

View Article: PubMed Central - PubMed

Affiliation: Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Freiburg, Germany (Dr Hamre).

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.

No MeSH data available.


Related in: MedlinePlus