Balens 2017 CPD Event Warwick Holistic Health Questionnaire (WHHQ) - PowerPoint PPT Presentation

Balens 2017 CPD Event Warwick Holistic Health Questionnaire (WHHQ) Nicola Brough – MPhil, RCST, Warwick University, Body worker and energetic practitioner

The Warwick Holistic Health Questionnaire: Developing and evaluating a patient reported outcome measure for Craniosacral Therapy. By Nicola Brough (MPhil, RCST).

About me Background • Degree in business; worked in a management training company involved in psychometric profiling for training and recruitment in AUS. • Interested in CAM during burnout and emotional breakdown (late 90’s) • Started CAM training in 2001 in AUS • CST Training in 2004-2006 in UK • In private practice in Staffordshire • Use various modalities of work depending on needs of client, yet most www.nicolabrough.com of practice is orientated around CST. • Interested in research since 2009 • Undertaken 2 studies so far … 3

Overview Craniosacral Therapy CST and The Craniosacral Therapy Association • Explored outcomes of CST with CST users • The current situation • Lack of suitable Patient Reported Outcome (PRO) measures for CAM • PRO assessment is in its infancy in CST and in CAM more generally Future prospects Enable more robust studies of the effectiveness of CST to be undertaken and • in the future may influence provision of CST in health services

What is CST? CST has developed from clinical experience within the field of • osteopathy. CST is a ‘hands on’ therapy which is thought to assist the body's • natural capacity to self-repair. Practitioners rely on their perceptions, not limited to a specific • sensory organ but encompass their entire being. Being able to stay ‘present’ with clients is an important catalyst for • the mechanisms of action. CST is not widely practised in the NHS . • There is not yet a method to measure the phenomenon of CST. •

What happens during a CST session? If you were to have a session of CST • you would be fully clothed and usually lie on a treatment table. The practitioner would make light • contact on the body, see Figure 1. The head and the sacrum are the two • main contact points allowing direct contact with the craniosacral system. Figure.1. Occipital hold Sessions can take between 40 • minutes to one hour.

Craniosacral Therapy Association (CSTA) CST is not currently regulated, but practitioners can voluntarily join • associations that provide professional foundations for the practice of CST. CSTA – established in 1989, has a membership of approximately 600, • the number of non-member practitioners is unknown. Members undertake 2 year training from an accredited school, adhere to • the CSTA code of ethics, participate in regular continuing professional development and hold professional indemnity insurance(www.craniosacral.co.uk).

CST Literature – 3 systematic reviews

Exploratory work to understand users’ perspectives A qualitative study (Brough et al ., 2015) explored clients’ experiences and categorised the outcomes they reported. Changes were identified in three aspects: • • mind • body • spirit Changes in health status were reported as: • • recovery • reduction of symptoms • reassessment of problems

New levels of awareness in six domains Medium of awareness is fundamental to the perceived impact of CST on health. coping self concept strategies new levels of psycho/ interpersonal awareness relationships emotional understanding self care mind-body-spirit links

CST process and mechanisms Two aspects of importance were evident in the data: The therapeutic relationship Feeling cared for • Altered sensory perception Changes in perceptual awareness • Developing a sense of • partnership with practitioner, Of seeing colours creating a balance of power • Imagery Attention given to the ambiance • • of the environment in creating a safe space New sensations in the body • The importance of their • practitioners model of health, lack of expectation in terms of outcomes to treatment

Review of existing outcome measures • Systematic review of the literature to identify candidate measures to assess changes in people having CST. • Identified 3 candidate measures: – Harry Edwards Healing Impact Questionnaire 2 (HEHIQ) – Short Form-12 v2 Health Survey 3 (SF-12) – Warwick-Edinburgh Mental Wellbeing Scale 4 (WEMWBS) • None of these measures capture all the changes clients report as a result of CST • Need to develop a CST specific measure. 12

Aim of PhD • To design and evaluate a Patient Reported Outcome Measure (PROM) to assess change in those having CST. 13

Methods • International guidelines 1 for the development of a new PROM have been followed. – Create conceptual framework – Generate item long list – Refine longlist to create provisional measure – Test provisional measure 14

Evaluating the conceptual framework Focus group participants: • – Practitioners (two groups: 4 and 3 participants) – Patients (one group: 3 participants) Discussion in the focus groups included: • – Content of conceptual framework – Relationship between domains and subdomains – Language used – Comprehension – Design and layout 15

Designing a questionnaire Using semi-structured interviews, 5 verbatim representative statements were identified Develop an appropriate name: Use further qualitative methods to construct questionnaire:  Consulted with a group of 16 practitioners  Semi-structured interviews with 6 patients Refine questionnaire. 16

Study 1: Testing the WHHQ • Two global questions – Why participants had come for session? – How they rated their wellbeing on day of completion? • Draft Warwick Holistic Health Questionnaire – 52 statements (9 reverse coded) • Tested in a sample of CST users – Scale reliability – Identify redundant items – Assess content and structural validity 17

Challenges when measuring wellbeing Wellbeing and health related quality of life is subjective. • People’s assessment of their health and the way in which they ‘adapt’ to • illness changes over time. Response shift (Sprangers and Schwartz, 1999) a valuable strategy for • coping with chronic disease • shift of internal standards of measurement (recalibration) • shift of respondents’ values (reprioritisation) • reconceptualisation of target construct Currently - a bias to be adjusted for during analysis and reporting. • ‘Response shift’ may be the AIM of intervention.

What next? • Analysis in progress – External/convergent validity – Confirmatory factor analysis – Data be analysed in relation to response shift • Evaluating acceptability of an electronic version of WHHQ 19

References [1] US Department of Health & Human Services (2009) FDA: Patient reported outcome measures: Use in medical product development to support labelling claims. MD: S Department of Health & Human Services Food & Drug Administration. [2] Bishop, F., Barlow, J. Walker, C. McDermott and G.T. Lewith (2010) “The Development and Validation of an outcome measure for spiritual healing: A mixed method study.” Psychotherapy and Psychosomatics 253: 1-13. [3] Ware, J. E. Jr.,Kosinski, M., Keller, S. D. (1996) “A 12-Item Short-Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity. “ Medical Care. 34:3. 220-233 [4] Tennant, R., L. Hiller, R. Fishwick, S. Platt, S. Joseph, S. Weich, J. Parkinson, J. Secker and S. Stewart-Brown (2007). “The Warwick-Edinburgh Mental Well-being Scale (WEWBS): development and UK validation.” Health and Quality of Life Outcomes. 5 (1). [5] Brough et al., (2015) “Perspectives on the effects and mechanisms of craniosacral therapy: A qualitative study of users’ views.” EuJIM, Volume 7, Issue 2, Pages 172–183 20

Supervisors Dr Helen Parsons Professor Sarah Stewart-Brown Funders Warwick Graduate School Chancellors’ Scholarship Award Craniosacral Therapy Association UK

• Thank you for listening. • Any questions? • Contact:n.brough@warwick.ac.uk 22