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Development and validation of a PROM to capture holistic outcomes in traditional, complementary and integrative medicine - The Warwick Holistic Health Questionnaire (WHHQ-18)

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Brough, Nicola, Stewart-Brown, Sarah L., Parsons, Helen and Perera, Chinthana (2021) Development and validation of a PROM to capture holistic outcomes in traditional, complementary and integrative medicine - The Warwick Holistic Health Questionnaire (WHHQ-18). European Journal of Integrative Medicine, 47 . 101375. doi:10.1016/j.eujim.2021.101375 ISSN 1876-3820.

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Official URL: https://doi.org/10.1016/j.eujim.2021.101375

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Abstract

Introduction: Existing patient reported outcome measures (PROMs) do not capture all holistic outcomes observed in Traditional, Complementary and Integrative Medicine (TCIM). This study reports development and validation of a PROM to support research on craniosacral therapy (CST) and other TCIMs.

Methods: Using a conceptual framework and items developed and evaluated with clients and practitioners in a CST setting, a questionnaire was developed and tested using mixed methods approaches. Evaluation included an iterative process. Psychometric tests: structural validity (exploratory factor analysis, EFA), internal consistency (Cronbach's alpha), convergent validity (correlations with Warwick-Edinburgh Mental Wellbeing Scale, Short Form-12v2 (SF-12), Harry Edwards Healing Impact Questionnaire), repeatability and responsiveness (t-tests; intra class coefficients, ICC).

Results: The Warwick Holistic Health Questionnaire (WHHQ-18) was resolved covering mental, physical, emotional and spiritual wellbeing, self-awareness, engaging in life, responsibility for self, living in the moment and satisfaction with life.

EFA revealed four correlated sub-scales. Internal reliability was good (alpha = 0.852). Convergent validity showed strong positive correlation with other wellbeing measures, but no correlation with health-related quality of life (SF-12). Repeatability testing showed good agreement (ICC=0.822) and no differences in scores for test-retest (paired t-test: t = 0.355, p = 0.723). Responsiveness analysis showed significant differences in scores (paired t-test t = 6.15, p < 0.001) with 46% of participants having an effect size of 0.5 or more.

Conclusion: WHHQ-18 is the first PROM developed for CST practice and captures outcomes important to TCIM more broadly. Good internal consistency, test-retest reliability and responsive at individual and group level make this new PROM an attractive resource for evaluators. Lack of convergent validity with SF-12 scales suggests WHHQ-18 be added to rather than replace HRQol measures in clinical studies.

Item Type: Journal Article
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RZ Other systems of medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Outcome assessment (Medical care), Medical care -- Evaluation, Patient satisfaction , Alternative medicine , Integrative medicine, Traditional medicine , Craniosacral therapy , Holistic medicine
Journal or Publication Title: European Journal of Integrative Medicine
Publisher: Urban und Fischer Verlag
ISSN: 1876-3820
Official Date: October 2021
Dates:
DateEvent
October 2021Published
28 August 2021Available
16 August 2021Accepted
Volume: 47
Article Number: 101375
DOI: 10.1016/j.eujim.2021.101375
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Copyright Holders: Elsevier
Date of first compliant deposit: 19 October 2021
Date of first compliant Open Access: 20 October 2021
Funder:
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
Chancellor's Scholarship AwardUniversity of Warwickhttp://dx.doi.org/10.13039/501100000741
UNSPECIFIEDCraniosacral Therapy Association UKhttps://www.craniosacral.co.uk/
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