Alison Benbow is a member of CNHC’s Profession Specific Board (PSB) for Nutritional Therapy. She has co-published a research paper with fellow CNHC Registrant Miranda D Harris that substantiates the evidence base for the efficacy of Nutritional Therapy.
The authors recently shared the results of their research with BANT members. BANT have very kindly let us reproduce this article which first appeared in their May members e-newsletter:
Evaluating the effectiveness of Nutritional Therapy in the McClelland teaching clinic at the University of Worcester
Research by Miranda D Harris MSc MBANT FHEA and Alison Benbow MSc FBANT FHEA
The authors are delighted to share their recently published research with members of BANT to substantiate the evidence base for the efficacy of Nutritional Therapy (NT) and encourage larger scale projects, which will support the work of BANT in developing the profession. A link to the full paper is here, where you will find all the science, statistics and references.
About the authors
First though, a few words about the study background and the two authors:
Alison was a practitioner for many years, is a member of the Nutritional Therapy Education Commission (NTEC) board, has worked with NTEC since accreditation started, supporting the development of the profession including curriculum development for NT training providers. Alison represents the profession as a Profession Specific Board (PSB) member for CNHC, is Course Leader for the NT Masters at the University of Worcester (UoW) and a BANT Fellow.
Miranda has been a practitioner for over ten years, with a special interest in sports nutrition and behaviour change strategies. Miranda is a senior lecturer on the NT Masters at UoW and since 2013, has taught widely across the course, assesses in clinic and leads the research methods and MSc dissertation modules with a special interest in quantitative research and system reviews with meta-analysis. So, between the two of them, they know quite a lot about NT, evidence-based practice, research and the NT profession, which as most of you know has been ongoing since the 1980’s. Development of the NT profession has included educational provision, practice standards and accredited qualifications. All of which aim to generate safe, evidenced, effective and legal practitioners. However, the evidence for the efficacy of NT, which encompasses Functional Medicine (FM) has been a work in progress for many years and as everyone knows there is little published research.
The pilot project
This pilot project, which took place in the NT teaching clinic at UoW was inspired by a paper Alison came across by Harris et al. (2010). It encompasses the two themes considered integral to NT practice; one is successful clinical outcomes and the other, on which the first depends, is the therapeutic relationship. Harris et al. evaluated the relationship between therapist and client, using the Working Alliance Inventory (WAI), while examining the effectiveness of aromatherapy, massage and reflexology in clinical practice in a student clinic using Measure Yourself Medical Outcome Profile 2 (MYMOP2), a Patient Reported Outcome Measure (PROM). They concluded that the symptoms, activity and wellbeing were associated with a positive working therapeutic alliance, although this did not achieve statistically significant. As there were no similar studies in NT, it was decided to develop this study using similar validated instruments, namely WAI-Short Revised Therapist and WAI- Short Revised Client (WAISRT and WAI-SRC respectively), and MYMOP2, with the overall aim of measuring and evaluating the effectiveness of NT in a teaching clinic and adding to the evidence base for the efficacy of the profession.
Practitioners will be familiar with MYMOP2 as it is commonly used in clinical practice to measure client outcomes in relation to NT. However therapeutic efficacy may also depend on establishing a quality relationship between the therapist and client based on mutual respect, communication and understanding of roles and responsibilities. A recent evidenced-based update of the Core Curriculum for NT (Benbow et al. 2017) suggested the profession may benefit further from improved educational provision to develop the therapist-client relationship, which includes behaviour change theory and strategies to support, motivate, and empower clients in making nutritional and lifestyle changes. Further exploration of this therapeutic relationship, to encompass the establishment of health goals and the prerequisite actions, as well as the readiness to change behaviour may result in improved client outcomes.
Evidence has shown that this therapeutic relationship, also known as the therapeutic, alliance or bond, has repeatedly shown to be an effective outcome predictor for success. There is no single definition of the term, but the core tenets suggest the alliance is a helping, collaborative relationship which is dynamic, may involve mutual trust, confidence and commitment, with goals that relate to a shared sense of purpose. The two questionnaires WAI-SRT and WAI-SRC assess three key elements.:
- agreement between therapist and client on the goals of therapy
- consensus on the tasks of therapy to address the issues identified by the client
- the development of an effective bond between the two parties.
MYMOP2 is a client-centred outcome measure, which was originally designed by Primary Care practitioners and since used in complementary healthcare including NT. This objective measure, which is quick and easy to complete in a consultation, enables the client to focus on aspects of their health and identify factors for change, thus facilitating a more client-focused relationship. The client identifies two specific health complaints or symptoms, which have been present over the past week, one activity limited by the symptoms and a general wellbeing score. The client repeats this process at follow-up using MYMOP Follow Up (FU), without sight of the previous scores of MYMOP2. MYMOP2 profile scores are calculated by averaging the four item scores, which can be compared over subsequent consultations with the items measured remaining the same. A medication question is included, which gives an option to express the importance of reducing or ceasing this medication.
The participating students were recruited from the McClelland clinic and clients were recruited from UoW and the general public. All participants were 18 or over and recruited between October 2017 and July 2018. The project had full ethical approval before students and clients were invited to take part and permissions were granted to use all instruments. A total of 55 clients took part and 22 students. The mean client age was 44.2 years ranging from 19-72 with 48 female and 7 males. Clients presented with a range of symptoms with the most common being digestion issues and low energy and the length of time reported for symptom 1 ranging from four to twelve weeks to over five years with the greatest number reporting symptoms for over five years. The activities affected by symptoms ranged from social activities, general activity and exercise performance, and of the twelve taking medication, six wanted to reduce this. Measures were taken at initial and follow up.
Results found a statistically significant improvement between initial and follow-up in WAISRT and WAI-SRC, as well as symptoms and wellbeing, and an improvement in activity scores although this was not significant. Strong positive relationships were found between the two WAI-SR scores at initial and follow-up, suggesting a robust therapist and client working alliance. Positive relationships were found between WAI-SRT and differences in MYMOP2 symptoms at initial and follow-up, as well as between WAI-SRC and differences in MYMOP2 symptoms. So, these results suggest NT is effective in reducing symptoms, improving health and activity and this may be facilitated by a strong therapeutic working alliance. Both working alliance instruments maybe helpful in determining the predictability of the therapeutic relationship on outcomes of NT.
Moving forwards, the possibility of larger scale studies using these or similar instruments would be a beneficial step for the profession and further add to the evidence base for NT.
For more information contact either Alison at firstname.lastname@example.org or Miranda: at email@example.com. You can write to them at University of Worcester, School of Allied Health and Community, St. Johns Campus, Henwick Grove, Worcester WR2 6AJ.