A comprehensive search string informed by an operational definition of complementary, alternative, and integrative medicine for systematic bibliographic database search strategies.

BACKGROUND: Determining which therapies fall under the umbrella of complementary, alternative, and/or integrative medicine (CAIM) is difficult for several reasons. An operational definition is dynamic, and changes depending on both historical time period and geographical location, with many countries integrating or considering their traditional system(s) of medicine as conventional care. We have previously reported the first operational definition of CAIM informed by a systematic search. In the present study, we have developed a comprehensive search string informed by an operational definition of CAIM for systematic bibliographic database search strategies. METHODS: We developed a single search string for the most common bibliographic databases, including those searchable on the OVID platform (e.g., MEDLINE, EMBASE, PsycINFO, AMED), the EBSCO platform (e.g., ERIC, CINAHL), Scopus, and Web of Science, using the finalised operational definition of CAIM's 604 therapies. We searched the Therapeutic Research Center's "Natural Medicines" database for all 604 therapies, and each item's scientific name and/or synonym was included as a keyword or phrase in the search string. RESULTS: This developed search string provides a standardised list of CAIM terms (i.e., keywords and phrases) that may be searched on bibliographic databases including those found on the OVID platform (e.g., MEDLINE, EMBASE, PsycINFO, AMED), the EBSCO platform (e.g., ERIC, CINAHL), Scopus, and Web of Science. CONCLUSION: Researchers can select relevant terms for their CAIM study and insert the keywords/phrases into these databases to receive all accessible data. This search technique can simply be copied and pasted into the search bar of each database to identify research by keywords, which is the most inclusive, or by words in the article title, which is more selective. Given its versatility across multiple commonly used academic platforms/databases, it is expected that this search string will be of great value to those conducting research on CAIM topics involving systematic search strategies.

Operational definition of complementary, alternative, and integrative medicine derived from a systematic search.

BACKGROUND: Identifying what therapies constitute complementary, alternative, and/or integrative medicine (CAIM) is complex for a multitude of reasons. An operational definition is dynamic, and changes based on both historical time period and geographical location whereby many jurisdictions may integrate or consider their traditional system(s) of medicine as conventional care. To date, only one operational definition of "complementary and alternative medicine" has been proposed, by Cochrane researchers in 2011. This definition is not only over a decade old but also did not use systematic methods to compile the therapies. Furthermore, it did not capture the concept "integrative medicine", which is an increasingly popular aspect of the use of complementary therapies in practice. An updated operational definition reflective of CAIM is warranted given the rapidly increasing body of CAIM research literature published each year. METHODS: Four peer-reviewed or otherwise quality-assessed information resource types were used to inform the development of the operational definition: peer-reviewed articles resulting from searches across seven academic databases (MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, Scopus and Web of Science); the "aims and scope" webpages of peer-reviewed CAIM journals; CAIM entries found in online encyclopedias, and highly-ranked websites identified through searches of CAIM-related terms on HONcode. Screening of eligible resources, and data extraction of CAIM therapies across them, were each conducted independently and in duplicate. CAIM therapies across eligible sources were deduplicated. RESULTS: A total of 101 eligible resources were identified: peer-reviewed articles (n = 19), journal "aims and scope" webpages (n = 22), encyclopedia entries (n = 11), and HONcode-searched websites (n = 49). Six hundred four unique CAIM terms were included in this operational definition. CONCLUSIONS: This updated operational definition is the first to be informed by systematic methods, and could support the harmonization of CAIM-related research through the provision of a standard of classification, as well as support improved collaboration between different research groups.

Evaluation of the quality of online patient information at the intersection of complementary and alternative medicine and hypertension.

BACKGROUND: Hypertension impacts 1.1 billion people globally; many patients seek complementary and alternative medicine (CAM), as a result of adverse side effects from antihypertensive medications or because they believe natural options are safer. The internet is increasingly playing a role in patient health information-seeking behavior, however, the variability of information quality across websites is unclear. Thus, the purpose of this study was to assess the quality of websites providing consumer health information at the intersection of hypertension and CAM. METHODS: Four unique terms were searched on Google, across Australia, Canada, the US, and the UK. The first 20 webpages resulting from each search were screened for eligibility, and were included if they contained consumer health information relating to CAM therapies for the treatment/management of hypertension. To assess the quality of health information on eligible websites, we used the DISCERN instrument, a standardized quality index of consumer health information. RESULTS: Of 90 unique webpages, 40 websites were deemed eligible and quality assessed. The 40 eligible websites were classified into seven categories: professional (n = 15), news (n = 11), non-profit (n = 5), health portal (n = 3), commercial (n = 2), government (n = 1), and other (n = 3). The mean summed DISCERN score was 52.34 (standard deviation [SD] = 10.69) out of 75 and the mean overall score was 3.49 (SD = 0.08) out of 5. A total of 10 websites had a total DISCERN score of 60.00 and above with an average rating of 4.33. Among these, Medicine Net (69.00) and WebMD (69.00) were determined to have the highest quality information. Websites generally scored well with respect to providing their aims, identifying treatment benefits and options, and discussing shared-decision making; websites generally lacked references and provided inadequate information surrounding treatment risks and impact on quality of life. CONCLUSIONS: While some websites provided high-quality consumer health information, many others provided information of suboptimal quality. A need exists to better educate patients about identifying misinformation online. Healthcare providers should also inquire about their patients' health information-seeking behavior, and provide them with the guidance necessary to identify high-quality resources which they can use to inform shared-decision making.

The quality of online consumer health information at the intersection of complementary and alternative medicine and arthritis.

BACKGROUND: Complementary and alternative medicine (CAM) use is prevalent among patients living with arthritis. Such patients often seek information online, for the purpose of gaining a second opinion to their healthcare provider or even self-medication. Little is known about the quality of web-based consumer health information at the intersection of CAM and arthritis; thus, investigating the quality of websites containing this information was the purpose of this study. METHODS: Four unique search terms were searched on Google across four English-speaking countries. We assessed the first 20 results of each search, including them if they contained CAM consumer health information for the treatment and/or management of arthritis. Eligible websites were assessed in duplicate using the DISCERN instrument, which consists of 16-items designed to assess quality. RESULTS: Of total of 320 webpages, 239 were duplicates, and a total of 38 unique websites were deemed eligible and assessed using the DISCERN instrument. The mean summed  DISCERN scores across all websites was 55.53 (SD = 9.37). The mean score of the overall quality of each website was 3.71 (SD = 0.63), thus the majority of websites are ranked as slightly above 'fair' quality. CONCLUSION: Eligible websites generally received scores better than 'moderate' in terms of overall quality. Several shortcomings included a lack of transparency surrounding references used and underreporting of risks associated with treatment options. These results suggest that health providers should be vigilant of the variable quality of information their patients may be accessing online and educate them on how to identify high quality resources.

The quality of online consumer health information at the intersection of complementary and alternative medicine and arthritis

Abstract Background: Complementary and alternative medicine (CAM) use is prevalent among patients living with arthritis. Such patients often seek information online, for the purpose of gaining a second opinion to their healthcare provider or even self-medication. Little is known about the quality of web-based consumer health information at the intersection of CAM and arthritis; thus, investigating the quality of websites containing this information was the purpose of this study. Methods: Four unique search terms were searched on Google across four English-speaking countries. We assessed the first 20 results of each search, including them if they contained CAM consumer health information for the treatment and/or management of arthritis. Eligible websites were assessed in duplicate using the DISCERN instrument, which consists of 16-items designed to assess quality. Results: Of total of 320 webpages, 239 were duplicates, and a total of 38 unique websites were deemed eligible and assessed using the DISCERN instrument. The mean summed DISCERN scores across all websites was 55.53 (SD = 9.37). The mean score of the overall quality of each website was 3.71 (SD = 0.63), thus the majority of websites are ranked as slightly above 'fair' quality. Conclusion: Eligible websites generally received scores better than 'moderate' in terms of overall quality. Several shortcomings included a lack of transparency surrounding references used and underreporting of risks associated with treatment options. These results suggest that health providers should be vigilant of the variable quality of information their patients may be accessing online and educate them on how to identify high quality resources.(AU)