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Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings
Harald J Hamre, Claudia M Witt, Gunver S Kienle, Christoph Meinecke, Anja Glockmann, Stefan N Willich, Helmut Kiene
BMC Pediatrics , 2009, DOI: 10.1186/1471-2431-9-39
Abstract: In conjunction with a health benefit program, consecutive outpatients starting anthroposophic treatment for any chronic disease participated in a prospective cohort study. Main outcome was disease severity (Disease and Symptom Scores, physicians' and caregivers' assessment on numerical rating scales 0–10). Disease Score was documented after 0, 6, and 12 months, Symptom Score after 0, 3, 6, 12, 18, and 24 months.A total of 435 patients were included. Mean age was 8.2 years (standard deviation 3.3, range 1.0–16.9 years). Most common indications were mental disorders (46.2% of patients; primarily hyperkinetic, emotional, and developmental disorders), respiratory disorders (14.0%), and neurological disorders (5.7%). Median disease duration at baseline was 3.0 years (interquartile range 1.0–5.0 years). The anthroposophic treatment modalities used were medications (69.2% of patients), eurythmy therapy (54.7%), art therapy (11.3%), and rhythmical massage therapy (6.7%). Median number of eurythmy/art/massage therapy sessions was 12 (interquartile range 10–20), median therapy duration was 118 days (interquartile range 78–189 days).From baseline to six-month follow-up, Disease Score improved by average 3.00 points (95% confidence interval 2.76–3.24 points, p < 0.001) and Symptom Score improved by 2.41 points (95% confidence interval 2.16–2.66 points, p < 0.001). These improvements were maintained until the last follow-up. Symptom Score improved similarly in patients not using adjunctive non-anthroposophic therapies within the first six study months.Children under anthroposophic treatment had long-term improvement of chronic disease symptoms. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that anthroposophic therapies may play a beneficial role in the long-term care of children with chronic illness.Chronic illness affects 15%–18% of children [1] and can lead to functional limitation, depe
Outcome of anthroposophic medication therapy in chronic disease: A 12-month prospective cohort study
Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Gunver S Kienle et al
Drug Design, Development and Therapy , 2008, DOI: http://dx.doi.org/10.2147/DDDT.S
Abstract: tcome of anthroposophic medication therapy in chronic disease: A 12-month prospective cohort study (3530) Total Article Views Authors: Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Gunver S Kienle et al Published Date January 2008 Volume 2008:2 Pages 25 - 37 DOI: http://dx.doi.org/10.2147/DDDT.S Harald J Hamre1, Claudia M Witt2, Anja Glockmann1, Renatus Ziegler3, Gunver S Kienle1, Stefan N Willich2, Helmut Kiene1 1Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Society for Cancer Research, Arlesheim, Switzerland Background: Anthroposophic medications (AMED) are prescribed in 56 countries. Objective: To study clinical outcomes in patients prescribed AMED for chronic disease. Design: Prospective cohort study. Setting: 110 medical practices in Germany. Participants: 665 consecutive outpatients aged 1–71 years, prescribed AMED for mental, respiratory, musculoskeletal, neurological, genitourinary, and other chronic diseases. Main outcomes: Disease and Symptom Scores (physicians’ and patients’ assessment, 0–10) and SF-36. Results: During the first six months, an average of 1.5 AMED per patient was used, in total 652 different AMED. Origin of AMED was mineral (8.0% of 652 AMED), botanical (39.0%), zoological (7.2%), chemically defined (13.0%), and mixed (33.0%). From baseline to six-month follow-up, all outcomes improved significantly: Disease Score improved by mean 3.15 points (95% confidence interval 2.97–3.34, p 0.001), Symptom Score by 2.43 points (2.23–2.63, p 0.001), SF-36 Physical Component Summary by 3.04 points (2.16–3.91, p 0.001), and SF-36 Mental Component Summary by 5.75 points (4.59–6.92, p 0.001). All improvements were maintained at 12-month follow-up. Improvements were similar in adult men and women, in children, and in patients not using adjunctive therapies. Conclusion: Outpatients using AMED for chronic disease had long-term reduction of disease severity and improvement of quality of life.
Anthroposophic Therapy for Anxiety Disorders: A Two-year Prospective Cohort Study in Routine Outpatient Settings
Harald J. Hamre, Claudia M. Witt, Gunver S. Kienle, Anja Glockmann, Renatus Ziegler, Stefan N. Willich and Helmut Kiene
Clinical Medicine Insights: Psychiatry , 2012,
Abstract: Background and Methods: Anthroposophic treatment for anxiety disorders includes special artistic and physical therapies and special medications. We conducted a prospective cohort study of 64 consecutive adult outpatients starting anthroposophic treatment for anxiety disorders under routine conditions. Main outcomes were Anxiety Severity (physician and patient ratings 0–10), Self-rating Anxiety Scale (0–100), Center for Epidemiological Studies Depression Scale, German version (CES-D, 0–60), and SF-36 Mental Component Summary. Results: Mean age was 42.3 years. Most frequent diagnoses were generalized anxiety disorder (44% of patients, n = 28/64) and panic disorder (39%). Median disease duration was 4.5 years. The anthroposophic treatment modalities used were medications (56% of patients), eurythmy therapy (41%), art therapy (30%), and rhythmical massage therapy (3%). Median number of eurythmy/art/massage sessions was 12, median therapy duration was 120 days. From baseline to six-month follow-up, all outcomes improved significantly; average improvements were: Physician-rated Anxiety Severity 3.60 points (95% confidence interval 2.97–4.22, p < 0.001), patient-rated Anxiety Severity 3.50 (2.88–4.12, p < 0.001), Self-rating Anxiety Scale 11.88 (7.70–16.05, p < 0.001), CES-D 8.79 (5.61–11.98, p < 0.001), and SF-36 Mental Component 9.53 (5.98–13.08, p < 0.001). All improvements were maintained until last follow-up after 24 months. Conclusions: Patients with anxiety disorders under anthroposophic treatment had long-term improvements of symptoms and quality of life.
Anthroposophic medical therapy in chronic disease: a four-year prospective cohort study
Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Stefan N Willich, Helmut Kiene
BMC Complementary and Alternative Medicine , 2007, DOI: 10.1186/1472-6882-7-10
Abstract: In conjunction with a health benefit program in Germany, 233 outpatients aged 1–74 years, treated by 72 anthroposophic physicians after a consultation of at least 30 min participated in a prospective cohort study. Main outcomes were disease severity (Disease and Symptom Scores, physicians' and patients' assessment on numerical rating scales 0–10) and quality of life (adults: SF-36, children aged 8–16: KINDL, children 1–7: KITA). Disease Score was documented after 0, 6 and 12 months, other outcomes after 0, 3, 6, 12, 18, 24, and (Symptom Score and SF-36) 48 months.Most common indications were mental disorders (17.6% of patients; primarily depression and fatigue), respiratory diseases (15.5%), and musculoskeletal diseases (11.6%). Median disease duration at baseline was 3.0 years (interquartile range 0.5–9.8 years). The consultation leading to study enrolment lasted 30–60 min in 51.5% (120/233) of patients and > 60 min in 48.5%. During the following year, patients had a median of 3.0 (interquartile range 1.0–7.0) prolonged consultations with their anthroposophic physicians, 86.1% (167/194) of patients used anthroposophic medication.All outcomes except KITA Daily Life subscale and KINDL showed significant improvement between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: Disease Score from mean (standard deviation) 5.95 (1.74) to 2.31 (2.29) (p < 0.001), Symptom Score from 5.74 (1.81) to 3.04 (2.16) (p < 0.001), SF-36 Physical Component Summary from 44.01 (10.92) to 47.99 (10.43) (p < 0.001), SF-36 Mental Component Summary from 42.34 (11.98) to 46.84 (10.47) (p < 0.001), and KITA Psychosoma subscale from 62.23 (19.76) to 76.44 (13.62) (p = 0.001). All these improvements were maintained until the last follow-up. Improvements were similar in patients not using diagnosis-related adjunctive therapies within the first six study months.Patients treated by anthroposophic physicians after an initial prolonged consultation had long-term re
Anthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings
Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al
Journal of Asthma and Allergy , 2009, DOI: http://dx.doi.org/10.2147/JAA.S7184
Abstract: nthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings Original Research (5763) Total Article Views Authors: Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al Published Date November 2009 Volume 2009:2 Pages 111 - 128 DOI: http://dx.doi.org/10.2147/JAA.S7184 Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christof Schnürer3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene1 1Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Internal Medicine Practice, A Fraenkel Centrum, Badenweiler, Germany; 4Society for Cancer Research, Arlesheim, Switzerland Background: Anthroposophic treatment for asthma includes special artistic and physical therapies and special medications. Methods: We studied consecutive outpatients starting anthroposophic treatment for asthma under routine conditions in Germany. Main outcomes were average asthma severity (0–10, primary outcome); symptoms (1–4); and asthma-related quality of life at 12-month follow-up (Asthma Quality of Life Questionnaire [AQLQ] overall score, 1–7, for adults; KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, asthma module, 0–100, for children) at 12-month follow-up. Results: Ninety patients (54 adults, 36 children) were included. Anthroposophic treatment modalities used were medications (88% of patients, n = 79/90); eurythmy therapy (22%); art therapy (10%); and rhythmical massage therapy (1%). Median number of eurythmy/art/massage sessions was 12 (interquartile range 10–20), median therapy duration was 120 days (84–184). From baseline to 12-month follow-up, all outcomes improved significantly (P < 0.001 for all comparisons). Average improvements were: average asthma severity 2.61 points (95% confidence interval CI: 1.90–3.32); cough 0.93 (95% CI: 0.60–1.25); dyspnea 0.92 (95% CI: 0.56–1.28); exertion-induced symptoms 0.95 (95% CI: 0.64–1.25); frequency of asthma attacks 0.78 (95% CI:0.41–1.14); awakening from asthma 0.90 (95% CI: 0.58–1.21); AQLQ overall score 1.44 (95% CI:0.97–1.92); and KINDL asthma module 14.74 (95% CI: 9.70–19.78). All improvements were maintained until last follow-up after 24 months. Conclusions: Patients with asthma under anthroposophic treatment had long-term improvements of symptoms and quality of life.
Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study
Elke Jeschke, Thomas Ostermann, Manuela Tabali, Horst C Vollmar, Matthias Kr?z, Angelina Bockelbrink, Claudia M Witt, Stefan N Willich, Harald Matthes
BMC Geriatrics , 2010, DOI: 10.1186/1471-2318-10-48
Abstract: Twenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions.In 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female) were included. The most frequent diagnoses were hypertension (11.1%), breast cancer (3.5%), and heart failure (3.0%). In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic). The adjusted odds ratio (AOR) for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79), treatment by an internist (AOR = 1.49; CI: 1.40-1.58), female patients (AOR = 1.35; CI: 1.27-1.43), cancer (AOR = 4.54; CI: 4.12-4.99), arthropathies (AOR = 1.36; CI: 1.19-1.55), or dorsopathies (AOR = 1.34; CI: 1.16-1.55) and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98). The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39), diabetes mellitus (AOR = 0.17; CI: 0.14-0.22), or metabolic disorders (AOR = 0.17; CI: 0.13-0.22).The present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.With average life expectancy increasing and birth rates declining, the proportion of elderly people expands in almost every
Predictors of outcome after 6 and 12 months following anthroposophic therapy for adult outpatients with chronic disease: a secondary analysis from a prospective observational study
Harald J Hamre, Claudia M Witt, Gunver S Kienle, Anja Glockmann, Stefan N Willich, Helmut Kiene
BMC Research Notes , 2010, DOI: 10.1186/1756-0500-3-218
Abstract: 913 adult outpatients from Germany participated in a prospective cohort study. Patients were starting anthroposophic treatment for mental (30.4% of patients, n = 278/913), musculoskeletal (20.2%), neurological (7.6%), genitourinary (7.4%) or respiratory disorders (7.2%) or other chronic indications. Stepwise multiple linear regression analysis was performed with the improvement of Symptom Score (patients' assessment, 0: not present, 10: worst possible) after 6 and 12 months as dependent variables. 61 independent variables pertaining to socio-demographics, life style, disease status, co-morbidity, health status (SF-36), depression, and therapy factors were analysed.Compared to baseline, Symptom Score improved by average 2.53 points (95% confidence interval 2.39-2.68, p < 0.001) after six months and by 2.49 points (2.32-2.65, p < 0.001) after 12 months. The strongest predictor for improvement after six months was baseline Symptom Score, which alone accounted for 25% of the variance (total model 32%). Improvement after six months was also positively predicted by better physical function, better general health, shorter disease duration, higher education level, a diagnosis of respiratory disorders, and by a higher therapy goal documented by the physician at baseline; and negatively predicted by the number of physiotherapy sessions in the pre-study year and by a diagnosis of genitourinary disorders. Seven of these nine variables (not the two diagnoses) also predicted improvement after 12 months. When repeating the 0-6 month analysis on two random subsamples of the original sample, three variables (baseline Symptom Score, physical function, general health) remained significant predictors in both analyses, and three further variables (education level, respiratory disorders, therapy goal) were significant in one analysis.In adult outpatients receiving anthroposophic treatment for chronic diseases, symptom improvement after 6 and 12 months was predicted by baseline symptoms,
Health costs in anthroposophic therapy users: a two-year prospective cohort study
Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Stefan N Willich, Helmut Kiene
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-65
Abstract: 717 consecutive outpatients from 134 medical practices in Germany, starting anthroposophic therapies for chronic diseases, participated in a prospective cohort study. We analysed direct health costs (anthroposophic therapies, physician and dentist consultations, psychotherapy, medication, physiotherapy, ergotherapy, hospital treatment, rehabilitation) and indirect costs (sick leave compensation) in the pre-study year and the first two study years. Costs were calculated from resource utilisation, documented by patient self-reporting. Data were collected from January 1999 to April 2003.Total health costs in the first study year (bootstrap mean 3,297 Euro; 95% confidence interval 95%-CI 3,157 Euro to 3,923 Euro) did not differ significantly from the pre-study year (3,186 Euro; 95%-CI 3,037 Euro to 3,711 Euro), whereas in the second year, costs (2,771 Euro; 95%-CI 2,647 Euro to 3,256 Euro) were significantly reduced by 416 Euro (95%-CI 264 Euro to 960 Euro) compared to the pre-study year. In each period hospitalisation and sick-leave together amounted to more than half of the total health costs. Anthroposophic therapies and medication amounted to 3%, 15%, and 8% of total health costs in the pre-study year, first year, and second study year, respectively. The cost reduction in the second year was largely accounted for by a decrease of inpatient hospitalisation, leading to a hospital cost reduction of 519 Euro (95%-CI 377 Euro to 904 Euro) compared to the pre-study year.In patients starting anthroposophic therapies for chronic disease, total health costs did not increase in the first year, and were reduced in the second year. This reduction was largely explained by a decrease of inpatient hospitalisation. Within the limits of a pre-post design, study findings suggest that anthroposophic therapies are not associated with a relevant increase in total health costs.Complementary therapies are popular and extensively used. In Germany and Switzerland some complementary therapie
Anthroposophic therapy for chronic depression: a four-year prospective cohort study
Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Stefan N Willich, Helmut Kiene
BMC Psychiatry , 2006, DOI: 10.1186/1471-244x-6-57
Abstract: 97 outpatients from 42 medical practices in Germany participated in a prospective cohort study. Patients were aged 20–69 years and were referred to anthroposophic therapies (art, eurythmy movement exercises, or rhythmical massage) or started physician-provided anthroposophic therapy (counselling, medication) for depression: depressed mood, at least two of six further depressive symptoms, minimum duration six months, Center for Epidemiological Studies Depression Scale, German version (CES-D, range 0–60 points) of at least 24 points. Outcomes were CES-D (primary outcome) and SF-36 after 3, 6, 12, 18, 24, and 48 months. Data were collected from July 1998 to March 2005.Median number of art/eurythmy/massage sessions was 14 (interquartile range 12–22), median therapy duration was 137 (91–212) days. All outcomes improved significantly between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: CES-D from mean (standard deviation) 34.77 (8.21) to 19.55 (13.12) (p < 0.001), SF-36 Mental Component Summary from 26.11 (7.98) to 39.15 (12.08) (p < 0.001), and SF-36 Physical Component Summary from 43.78 (9.46) to 48.79 (9.00) (p < 0.001). All these improvements were maintained until last follow-up. At 12-month follow-up and later, 52%–56% of evaluable patients (35%–42% of all patients) were improved by at least 50% of baseline CES-D scores. CES-D improved similarly in patients not using antidepressants or psychotherapy during the first six study months (55% of patients).In outpatients with chronic depression, anthroposophic therapies were followed by long-term clinical improvement. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that the anthroposophic approach, with its recourse to non-verbal and artistic exercising therapies can be useful for patients motivated for such therapies.Depressive disorders are a major health problem, affecting one-fourth to one-t
Anthroposophic therapy for attention deficit hyperactivity: A two-year prospective study in outpatients
Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al
International Journal of General Medicine , 2010, DOI: http://dx.doi.org/10.2147/IJGM.S11725
Abstract: nthroposophic therapy for attention deficit hyperactivity: A two-year prospective study in outpatients Original Research (3843) Total Article Views Authors: Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al Published Date August 2010 Volume 2010:3 Pages 239 - 253 DOI: http://dx.doi.org/10.2147/IJGM.S11725 Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christoph Meinecke3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene1 1Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Pediatric Consultant, Community Hospital Havelh he, Berlin, Germany; 4Society for Cancer Research, Arlesheim, Switzerland Background: Anthroposophic treatment for attention deficit hyperactivity disorder (ADHD) includes special artistic and physical therapies and special medications. Methods: We studied 61 consecutive children starting anthroposophic treatment for ADHD symptoms under routine outpatient conditions. Primary outcome was FBB-HKS (a parents’ questionnaire for ADHD core symptoms, 0–3), and secondary outcomes were disease and symptom scores (physicians’ and parents’ assessment, 0–10) and quality of life (KINDL total score, 0–100). Results: A total of 67% of patients fulfilled the DSM-IV criteria for ADHD, 15% had an exclusion diagnosis such as pervasive developmental disorders, while 18% did not fulfill ADHD criteria for another reason. Anthroposophic treatment modalities used were eurythmy therapy (in 56% of patients), art therapy (20%), rhythmical massage therapy (8%), and medications (51%). From baseline to six-month follow-up, all outcomes improved significantly; average improvements were FBB-HKS total score 0.30 points (95% confidence interval [CI]: 0.18–0.43; P < 0.001), FBB-HKS inattention 0.36 (95% CI: 0.21–0.50; P < 0.001), FBB-HKS hyperactivity 0.29 (95% CI: 0.14–0.44; P < 0.001), FBB-HKS impulsivity 0.22 (95% CI: 0.03–0.40; P < 0.001), disease score 2.33 (95% CI: 1.84–2.82; P < 0.001), symptom score 1.66 (95% CI: 1.17–2.16; P < 0.001), and KINDL 5.37 (95% CI: 2.27–8.47; P = 0.001). Improvements were similar in patients not using stimulants (90% of patients at months 0–6) and were maintained until last follow-up after 24 months. Conclusion: Children with ADHD symptoms receiving anthroposophic treatment had -long-term improvement of symptoms and quality of life.
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