196 ComplementaryTherapies in Medicine
physiotherapy as primary management. Three hun-
dred and twenty-three patients, aged 18-60 years,
who had no contralndications to manipulation and
who had not been treated within the previous month
were included in the study. Multiple regression
analysis was used to identify prognostic factors.
Dependent variables were mean Oswestry score and
mean change in Oswestry score at 12 month follow-
up. The multiple regression analysis revealed five
significant (P < 0.001-0.01) prognostic factors;
duration of current episode, Oswestry score at entry,
expectations of treatment, number of localizations,
and well-being. Besides, the regression coefficients
for the significant factors were compared between
the two treatment strategies. No significant differ-
ence in effect or regression coefficients for the prog-
nostic factors were seen between the two treatment
strategies. Twelve per cent of the patients had poor
prognostic factors (duration > or = 1 month, more
than one localization, low expectations of treatment
and low well-being) at entry. These patients had a
mean Oswestry score above 20% at 1 year follow-
up. Clinical decision models for the management of
patients with back pain visiting primary care that
consider prognostic factors need to be implemented
and prospectively evaluated.
Clark ME, Lipe AW, Bilbrey M. Use of music to
decrease aggressive behaviors in people with
dementia. Journal of Gerontological Nursing 1998;
24: 10-17.
The purpose of this study was to examine the effects
of recorded, preferred music in decreasing occur-
rences of aggressive behavior among individuals
with Alzheimer's type dementia during bathing
episodes. Eighteen older adults, age 55-95 years,
with severe levels of cognitive impairment, partici-
pated in the study. They were randomly scheduled
for observation during bath time under either a con-
trol (no music) condition or an experimental condi-
tion in which recorded selections of preferred music
were played via audiotape recorder during the
bathing episode. Following a 2 week (10 episode)
observation period, conditions were reversed. A
total of 20 observations were recorded for each indi-
vidual. Results indicated that during the music con-
dition, decreases occurred in 12 of 15 identified
aggressive behaviors. Decreases were significant (P
< 0.05) for the total number of observed behaviors
and for hitting behaviors. During the music condi-
tion, caregivers frequently reported improved affect
and a general increase in cooperation with the
bathing task. The implications of these findings for
improving the overall quality of care for severely
cognitively impaired older adults are discussed.
Gordon A, Merenstein JH, D'Amico F, Hudgens
D. The effects of therapeutic touch on patients
with osteoarthritis of the knee. Journal of Family
Practice 1998; 47: 271-277.
Background: The purpose of this study was to deter-
mine if therapeutic touch, an alternative medicine
modality, is effective in the treatment of osteoarthri-
tis of the knee. Methods: A single-blinded random-
ized control trial was conducted in a family practice
center of a community hospital family practice resi-
dency program in Pennsylvania. The patients were
between the ages of 40 and 80 had been given a
diagnosis of osteoarthritis of at least one knee, had
not had knee replacement, and had no other connec-
tive tissue disease. The patients were randomized to
therapeutic touch, mock therapeutic touch or stan-
dard care. Main outcome measuJes: Pain and its
impact, general well-being, and health status mea-
sured by standardized, validated instruments, as
well as the qualitative measurement of a depth inter-
view. Results: Twenty-five patients completed the
study. The treatment group had significantly
decreased pain and improved function as compared
with the placebo and control groups. The qualitative
depth interview confirmed this result. Conclusion:
Despite the small numbers, significant differences
were found in improvement in function and pain for
patients receiving therapeutic touch. A larger study
is needed to confirm these results. Alternative thera-
pies can neither be accepted nor rejected without
being subjected to the scientific method.
Hay IC, Jamieson M, Ormerod AD. Randomized
trial of aromatherapy. Successful treatment for
alopecia areata. Archives of Dermatology 1998;
134: 1349-1352.
Objective: To investigate the efficacy of aromather-
apy in the treatment of patients with alopecia areata.
Design: A randomized double-blind, controlled trial
of 7 months' duration, with follow-up at 3 and 7
months. Setting: Dermatology outpatient depart-
ment. Participants: Eighty-six patients diagnosed as
having alopecia areata. Intervention: Eighty-six
patients were randomized into two groups. The
active group massaged essential oils (thyme, rose-
mary lavender, and cedarwood) in a mixture of car-
tier oils (jojoba and grapeseed) into their scalp dally.
The control group used only carrier oils for their
massage, also daily. Main outcome measures:
Treatment success was evaluated on sequential pho-
tographs by two dermatologists (I.C.H. and A.D.O.)
independently. Similarly, the degree of improvement
was measured by two methods: a 6-point scale and
computerized analysis of traced areas of alopecia.
Results: Nineteen (44%) of 43 patients in the active
group showed improvement compared with 6 (15%)
of 41 patients in the control group (P = 0.008). An
alopecia scale was applied by blinded observers on
sequential photographs and was shown to be repro-
ducible with good interobserver agreement (~ =
0.84). The degree of improvement on photographic
assessment was significant (P = 0.05). Demographic
analysis showed that the two groups were well
matched for prognostic factors. Conclusions: The
results show aromatherapy to be a safe and effective
Abstracts
treatment for alopecia areata. Treatment with these
essential oils was significantly more effective than
treatment with the carrier oil alone (P = 0.008 for the
primary outcome measure). We also successfully
applied an evidence-based method to an alternative
therapy.
Deale A, Chalder T, Wessely S. Illness beliefs and
treatment outcome in chronic fatigue syndrome.
Journal of Psychosomatic Research 1998; 45: 77-83.
Longitudinal studies have shown that physical ill-
ness attributions are associated with poor prognosis
in chronic fatigue syndrome (CFS). Speculation
exists over whether such attributions influence
treatment outcome. This study reports the effect of
illness beliefs on outcome in a randomized con-
trolled trial of cognitive-behavior therapy versus
197
relaxation. Causal attributions and beliefs about
exercise, activity, and rest were recorded before and
after treatment in 60 CFS patients recruited to the
trial. Physical illness attributions were widespread,
did not change with treatment, and were not associ-
ated with poor outcome in either the cognitive-
behavior therapy group or the control group. Beliefs
about avoidance of exercise and activity changed in
the cognitive behavior therapy group, but not in the
control group. This change was associated with
improved outcome. These findings suggest that
physical illness attributions are less important in
determining outcome (at least in treatment studies)
than has been previously thought. In this study,
good outcome is associated with change in avoid-
ance behavior, and related beliefs, rather than causal
attributions.