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Review
. 2014 Jan;3(1):54-70.
doi: 10.7453/gahmj.2013.010.

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

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Free PMC article
Review

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

Harald Johan Hamre et al. Glob Adv Health Med. .
Free PMC article

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.

人智医学是一个由 Rudolf Steiner 和 Ita Wegman 建立、由医生提供 的补充治疗系统。 人智治疗包括特 殊医药产品、艺术疗法、音语舞运 动锻炼和特殊物理疗法。 人智医学 结果研究 (AMOS) 是一项预期的、 多中心观察研究,参与者为 1631 名德国门诊患者,他们因焦虑症、 哮喘、注意缺陷多动障碍、抑郁 症、腰疼、偏头痛和其他常见疾病 的慢性迹象而开始接受人智治疗。AMOS 整合了拟定用于评价综合性 治疗系统的两项特征: (1) 采用 顺序的方法,从整个治疗系统开始 (使用、安全性、结果、感知益 处),到比较疗效,再到重要系统 组件(医生咨询、人智医药产品、 艺术疗法、音语舞疗法、节律性按 摩疗法),并 (2) 融合了不同的 研究方法,建立了一个信息综合 体,包括对单个患者数据进行的治 疗前后分析、预期比较分析、经济 分析和安全性分析。 AMOS 促进了 单组治疗研究分析方面的两项方法 学创新(组合式偏差避免,与其他 研究中相应人群进行的系统性结果 比较),并且首次在全世界范围内 进行了抑郁症成本分析,即对接受 抑郁症治疗的基础护理患者、就另 一项疾病接受治疗的抑郁症患者和 非抑郁症患者进行了比较。AMOS 共发表了 21 个经同行评审 的出版物。 本文概述了这些出版 物的主要研究问题、方法和发现 结果:人智治疗非常安全,可在 不增加费用的情况下在症状和生 活质量方面产生临床相关改善; 这种改善见于所有年龄、诊断和 治疗模式小组的人群之中,并且 保持 48 个月的跟进期;存在无应 答偏差、自然恢复、趋均数回归 和附加治疗这些现象,因而至多 改善 37%。

La medicina antroposófica es un sistema terapéutico complementario proporcionado por el médico que fue fundada por Rudolf Steiner e Ita Wegman. La terapia antroposófica incluye productos medicinales especiales, terapias artísticas, ejercicios de movimiento eurítmico y terapias físicas especiales. El estudio de los resultados de la medicina antroposófica (Anthroposophic Medicine Outcomes Study, AMOS) consistió en un estudio prospectivo observacional multicéntrico de 1631 pacientes ambulatorios que comenzaban la terapia antroposófica para trastornos de ansiedad, asma, trastorno de hiperactividad y déficit de atención, depresión, dolor lumbar, migraña y otras indicaciones crónicas bajo condiciones rutinarias en Alemania.AMOS incorporaba dos características propuestas para la evaluación de sistemas terapéuticos integrales: (1) un enfoque secuencial, comenzando con el sistema terapéutico completo (uso, seguridad, resultados, ventaja percibida), que aborda la eficacia comparativa y continúa con los componentes principales del sistema (asesoramiento del médico, productos medicinales antroposóficos, terapia artística, terapia eurítmica, terapia de masaje rítmico) y (2) una combinación de diferentes métodos de investigación para crear una síntesis de información, que incluye análisis previos y posteriores, análisis comparativos prospectivos, análisis económicos y análisis de la seguridad de los datos del paciente individual. AMOS fomentaba dos innovaciones metodológicas para el análisis de los estudios terapéuticos de un grupo único (supresión del sesgo combinado, comparación sistemática de resultados con las cohortes correspondientes en otros estudios) y el primer análisis a nivel mundial del coste de la depresión comparando pacientes de atención primaria tratados de depresión frente a pacientes deprimidos tratados por otro trastorno frente a pacientes no deprimidos.Ha resultado en un total de 21 publicaciones revisadas por expertos de AMOS. Este artículo proporciona una visión general de las principales cuestiones de investigación, métodos y los resultados de estas publicaciones: el tratamiento antroposófico era seguro y se asociaba a mejoras clínicamente relevantes en los síntomas y la calidad de vida sin aumento de los costes; se observaron mejoras en todos los grupos de edad, diagnóstico y modalidad de terapia y se mantuvieron en el seguimiento de 48 meses; el sesgo ajeno a los entrevistados, la recuperación natural, la regresión a la media y las terapias adyuvantes juntos podían explicar un máximo del 37 % de la mejoría.

Keywords: Anthroposophic medicine; art therapy; drug therapy; eurythmy therapy; observational studies; review; rhythmical massage therapy; whole system evaluation.

Figures

Figure 1
Figure 1
Symptom Score stratified by therapy modality group. Range: 0 (not present) to 10 (worst possible). Patients aged 1-75 years, enrolled 1999-2001, n = 810. Data summarized from references –.
Figure 2
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.
Figure 3
Figure 3
Disease score without and with combined bias suppression. Patients aged 1-75 years, enrolled 1999–2001 with disease score available at baseline, n = 887. Figure reproduced from Hamre et al.
Figure 4
Figure 4
Health costs. Patients aged 1–75 years, enrolled 1999–2001 with available data for ≥3 of 5 follow-ups, n = 717. Figure reproduced from Hamre et al. Abbreviation: AM, anthroposophic medicine.

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