From this we calculated the expected regression-to-the mean effect and compared it to the total change in quality of life, hereby applying Mee and Chua's modified t-test [ 17 ]. Although this study is explanatory by nature confidence intervals and p-values for change scores might be misinterpreted as statistical proof of hypotheses.
We thus adjusted the results for all 12 outcomes 4 outcome measures times 4 time points by applying Holm's procedure [ 18 ]. Standardized mean changes effect sizes were calculated by mean changes divided by standard deviation at baseline. Patients were recruited between September and December For baseline characteristics of the study population see Table 1.
At baseline on average 3. Fifty-seven percent of the patients had five or more complaints at baseline. The most common diagnosis in women was sleep disturbance For the most frequent diagnoses, their severity and duration is shown in Table 2. During the month observation period following the initial interview, patients consulted their physicians an average of 6. Nine patients died during follow-up, the mean survival time was days range 6 to days.
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Twenty patients stopped the homeopathic treatment. During the study period eight patients 9. Each patient received on average 6. Prescriptions were given consecutively following the principles of classical homeopathy. More than half of all prescriptions were covered by 9 homeopathic remedies Figure 1.
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The most frequently prescribed homeopathic potencies were C The strongest clinical improvements of complaints were described by patients in the first three months, after which no further improvement was observed Table 3 , Figure 2. The physicians' assessments of diagnoses showed a more optimistic course for the long term, decreasing from 6. Overall the quality of life remained stable within the 24 months observation period. Table 3. In a prospective multicentre observational study with qualified homeopathic physicians in daily practice, we documented the homeopathic and conventional treatment with its outcome in 83 elderly patients over 24 months.
The study provided information on the course of disease in elderly patients receiving homeopathic treatment, as assessed by both patients and physicians. Patient and physician assessments of the severity of the complaints consistently demonstrated substantial improvements following homeopathic treatment, which were maintained through 24 months of follow up. Overall the quality of life and the number of medicines taken remained stable within the 24 months observation period.
To our knowledge, the present study is the first to systematically evaluate the range of diagnoses and therapies in classical homeopathic medical practices in Germany and Switzerland in patients over 70 years old. A strength of this study is that patients with all diagnoses were included. Therefore, no disease-specific measurement instruments could be used.
To assess the severity of different medical complaints, there is no other generally accepted measuring instrument available. Instead numerical rating scales [ 12 ] were applied, which would allow for the determination of the severity of the complaint in a diagnosis-independent manner.
However, our data may be helpful in the planning of further research on homeopathy including randomized clinical trials on the effectiveness of individually chosen homeopathic remedies. These trials however should include tailored instruments which measure treatment effects more specifically than the rather global measures we employed in this study. Our study was not designed to assess the effectiveness of the homeopathic remedies, therefore the chosen methodology did not include a control group, randomization or blinding and patients could use additional conventional therapies.
Thus, the observed improvement can be attributed to a wide range of possible reasons as it is known for complex interventions. There might be some selection bias because the homeopaths belong to a group using only classical homeopathy. Other forms of homeopathy, for example, clinical homeopathy are more focused on the primary disease symptoms, treat more often acute diseases and have shorter case taking and use a smaller range of homeopathic drugs.
In addition information bias might be possible because we follow the assumption that missing values are per random, this might result in a underestimation or overestimation of effect. A further limitation of our study might be that This might have triggered the therapeutic outcome due to high therapeutic expectations. Physician assessments tended to be more positive than patient assessments.
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This is supported by the fact that patients did not visit the study physicians when they were feeling their worst, but rather after a long waiting period. The interpretation of our quality of life results is difficult.
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The SF baseline values of our homeopathic patients were lower than in the German normal population of the same age group physical component score - difference: 1. In the German population SF values for physical and mental component score decrease with increasing age [ 13 ]. Based on this the absence of a decrease in quality of life in our elderly patients might be interpreted in a positive way. We were unable to confirm the common notion that homeopathy is frequently used for trivial complaints or diseases. The duration of disease in our study patients was very long and their symptoms were, on average, of moderate severity.
If we compare our results for elderly patients with other homeopathic outcome studies [ 9 — 11 , 19 — 21 ] there is a common and clinically relevant improvement of the severity of complaints for most patients over all age-groups within the first few months of homeopathic treatment.
For all patients in our cohort severity of disease decreased significantly from 6.
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Major improvements in quality of life could only be observed in children, but not in adults. In our elderly subgroup we can confirm these results. The findings of our study demonstrate that elderly patients who seek homeopathic treatment are primarily those suffering from long-standing, chronic disease.
The severity of complaints decreased markedly in the first 3 months of treatment. However, the quality of life remained stable.
A meta-analysis of placebo-controlled trials. Das Gesundheitswesen. Again, in children there were no relevant differences between those who stopped homeopathic treatment and those who continued, whereas in those adults who continued treatment we found slightly higher effects. Accordingly, most patients would use homeopathy again and recommend it to friends with similar complaints table 5. From the logistic regression we found that this was more likely in women than in men, and in children than in adults.
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Patients who simultaneously used other treatments conventional or complementary had a smaller chance to improve relevantly, as did those suffering from allergies, allergic rhinitis, or headache. In contrast, a diagnosis of multiple infections was a positive predictor table 6. In our study we extended former results on the course of disease in patients receiving homeopathic treatment, now presenting data from an 8-year follow-up.
These data consistently show substantial health improvements in patients under homeopathic treatment, which persisted through the whole observation period. Improvements were more pronounced in younger patients, females, and those with greater disease severity at baseline. Moreover, our study provides a reasonably representative sample of all patients attending a doctor practicing classical homeopathy in Germany. The subset of patients responding to the 8-year follow up matched fairly well the data of the complete sample: although female adults were slightly overrepresented in this sample, data on age, complaint severity at baseline or duration of disease were nearly identical between those who responded after 8 years and those who did not.
We therefore believe that selection bias is small and that our data are generalisable. Our study was designed to evaluate homeopathic treatment in patients with various multiple diagnoses.
This disallowed the use of disease-specific measurement instruments. Instead we used a numeric rating scale which is validated, often used [ 14 ] and allowed for assessments of a specific complaint as well as for generalization and interpretation across various diagnoses. Using generic QoL questionnaires served the same purpose. As patients were allowed to use conventional therapies and other complementary therapies during the study period, the observed improvements cannot be attributed to homeopathic treatment alone.
The aim of this study, however, was not to test the effectiveness of homeopathic drug treatment, but rather provide an unbiased representation of contemporary homeopathic health care and its outcome in routine care.
The mean change of the severity ratings after 8 years was large. We thus cannot rule out overestimation of the treatment effect. The QoL improvements, on the other hand, may have been greater than recorded: The SF is unlikely to overestimate changes, its mental scales have been found to be less sensitive than the mental und social scales of other instruments such as the Duke Health Profile [ 15 ]. It is most unlikely that regression to the mean accounts for all QoL improvement that we have described: on the physical scale the adults scored even better than the average German population.
Moreover, patients in this study suffered from long-term chronic diseases and nearly all of them were conventionally pretreated [ 10 ]. This strengthens the likelihood that the improvement is not purely due to the natural history of the condition. It is of note that the differences in the outcome between those patients who stopped treatment and those who still continued were small. Moreover, only few diagnoses turned out as a predictive factor for treatment success. This might be taken as an indicator that the difference in outcome was similar for most diagnoses and that diagnosis was not a factor severely confounding our results.
Patients who used additional treatments had a worse outcome than those who did not. This presumably does not reflect the fact that these treatments were ineffective or even harmful, but is more likely a consequence from self-selection: patients who did not benefit from the homeopathic treatment are more likely to seek additional treatment.
To our knowledge, the present study is the first to evaluate systematically health effects under homeopathic treatment for such a long observation period and with a high follow-up rate. In England, Spence et al. Several other investigations from different countries in Europe or America report similar health effects in various diseases within the first year after homeopathic treatment. Our findings demonstrate that patients who seek homeopathic treatment are likely to improve considerably, although this effect must not be attributed to homeopathic treatment alone. These effects persisted for 8 years.
Results from the National Omnibus survey. Journal of public health Oxford, England. Complementary therapies in medicine. Forsch Komplementarmed Klass Naturheilkd.