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354 Oral Presentations / European Journal

n Alexander Technique (AT) service in a hospital pain clinic.he BISCUIT study focused on the economic evaluation of theristol Homeopathic Hospital. The aim was to reflect on thesepproaches to economic evaluation used in these two studies,ompare their usefulness and present results.

Methods: The SEAT study recruited 43 service users via theospital pain clinic who attended weekly Alexander Techniqueessons over six consecutive weeks. They self-reported personalnd NHS costs at the first session, six weeks and 3 monthsfter baseline. As part of the BISCUIT study, 15 case partic-pants who attended the Bristol Homeopathic Hospital and 19ommunity control participants were matched for GP practice,ondition, age and sex and reported personal and NHS costs atve time points over 15 months. In addition, GP medical recordata was extracted on NHS resource use and sick notes for all4 BISCUIT participants. SEAT and BISCUIT data were pricedsing a variety of different sources (i.e. NHS reference costs,ritish National Formulary, Unit Costs of Health and Socialare). SEAT data were analysed for NHS and personal costshereby standard weekly costs were calculated at three timeoints and compared. BISCUIT data were analysed from a NHSost and societal cost perspective whereby annual costs for casesnd controls were compared.

Results: For the SEAT study total costs for AT service usersid not decrease between baseline and three months (baselineean £55.53, 3 month mean £61.19, p = 0.815). However NHS

nd personal costs associated specifically with pain reducedy over half (baseline mean £27.43, 3 month mean £11.68,= 0.004). Results for the BISCUIT study are still undergoingnalysis. For both the SEAT and BISCUIT studies there wasubstantial variability.

Conclusions: The SEAT and BISCUIT studies are break-ng new ground in finding commissioner friendly approaches toosting NHS complementary therapy services. Dissemination ofhe learning is important so that future evaluators of NHS com-lementary therapy services can incorporate cost analyses intoheir research design. This would be of key interest to healthcareommissioners considering the funding of NHS complementaryherapy services in the future.

ttp://dx.doi.org/10.1016/j.eujim.2012.06.006

ction research, critical realism and new knowledge forelivering integrative medicine: Sharing research results

argaret Welch

Northern College of Acupuncture, York

Background: This research focussed on the interpersonalynamics embedded in Integrative Medicine (IM), the placehere conventional biomedicine and complementary medicine

nterface. In this research, the methodology of Action ResearchAR) and the ontological underpinning of Critical Realism (CR)ere combined to show the ‘bigger picture’ when studying IM.

his is arguably a methodological approach that offers new

nsights for those interested in finding solutions to barriers facedy IM.

ciS

egrative Medicine 4 (2012) e353–e357

Methods: Action research transforms reflective practice intoigorous qualitative research and allows all stakeholders to haveignificant input. This ‘naturalistic approach’ means that thehenomenon of IM could be studied without overburdening thectivities of the clinic. By combining AR with a critical realistnterpretation, the phenomenon of IM has been examined ‘inction’ and in its social context. Possible ‘generative mecha-isms’ were identified as social forces behind the rhetoric andhe barriers that can thwart successful, sustainable IM.

Findings: There is little experiential and in-depth researchrom the point of view of a CAM therapist. By working collabo-atively in two primary care settings, a partnership with GPs andlinic staff engendered reflexive cycles of learning which weresed to illuminate our multiple stakeholder viewpoints, raisingnd solving clinical problems and building working relation-hips. By adding a critical realists interpretation to this process,hree strong themes led to recommendations for the success ofM.

‘Transformative practice’ in the clinic (sharing knowledge;ooperative approaches) was identified as an achievable goalithin the clinic, underscoring real opportunities of for IM.A structurally defined place within the clinic for comple-

entary therapists (job description, line manager, etc) wereotably lacking, leaving the relationships between conventionalnd complementary care providers lopsided and difficult to sus-ain. This can put CAM providers in danger of becoming merelyappended’ services.

A commitment to dialogue between professions, particu-arly when engaging with Allied Health Professionals, was alsoacking. This meant that mistrust and misunderstanding couldrise. Without dialogue, disagreements regarding scope of prac-ice and other professionalisation issues could easily underminehe building of solid, mutually respectful relationships.

Conclusions: Using the participative and reflective toolsvailable in AR, Integrative Medicine in primary care clinicshowed great promise. However, a critical realists’ interpreta-ion to the data highlights the underlying social and structuralorces that may inhibit the survival of some attempts at IM.ttention to the macro-management issues of ‘structures’ and

dialogue’ to support IM should greatly increase its chances ofuccess in the Primary Care Clinic.

ttp://dx.doi.org/10.1016/j.eujim.2012.06.007

he use of warm needle technique produces greatermprovement in symptoms for patients with osteoarthritisf the knee than using acupuncture needling without moxi-ustion (a protocol in development)

an Appleyard, Nicola Crichton, Nicola Robinson

London South Bank University

Background: Approximately 20% of adults 45–64 years ofge have osteoarthritic pain in the knee. It is a condition that

auses impaired mobility and consequently impacts on the qual-ty of life. Pharmacological treatment commonly involves Nonteroidal Anti Inflammatory Drugs (NSAIDS) the effectiveness