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© 2016 Elsevier GmbH Introduction The needle stimulation mat, also known as fakirs mat or acupressure pad has regularly been advertised as an effective means to reduce chronic back pain, however little is known about the effectiveness of such device. This study aimed to test the effects of the needle stimulation pad for chronic or recurrent low back pain. Methods In this prospective, single-armed trial patients with non-specific chronic or recurrent low back pain were selected from a health insurance company database and advised to use the pad daily for two weeks; outcomes were assessed at baseline, weeks 2 and 14. Primary outcome measure was pain intensity at week 2; secondary outcome measures included disability, health-related quality of life, fear avoidance beliefs, analgesic medication and safety. Results 91 patients were included (50 males, 52.3 ± 10.5years). No significant differences were found for pain intensity between weeks 0, 2 and 14, however immediate pain relief was detected after the application (p < 0.001). Significant decreases were found for disability at weeks 2 (−4.6%,95%CI-6.6;−2.6;p < 0.001) and 14 (−4.3,95%CI-6.4;−2.2;p = 0.008). For quality of life the physical component summary, physical functioning and vitality changed significantly. Medication consumption significantly decreased. No further changes were observed. Concerning safety, eight patients perceived the intervention as too painful to continue, and one patient reported transient itching and skin reddening after use. Conclusions The needle stimulation pad provided immediate non-persistent pain relief in patients with chronic low back pain, but nearly 10% of participants reported adverse reactions discouraging them from further use. Further methodologically rigorous trials are warranted.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Objectives: With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients. Materials and Methods: A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20). The primary outcome was the pain intensity on a visual analog scale at week 8; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients' global impression of improvement, and safety. Results: In comparison with sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (-21mm group difference; 95% confidence interval,-32.6 to-9.4; P=0.001; d=1.02) and at week 20 (-16.8mm group difference; 95% confidence interval,-27.5 to-6.1; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% within the CST group, whereas 48% even had substantial clinical benefit. Significant between-group differences at week 20 were also found for pain on movement, functional disability, physical quality of life, anxiety and patients' global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8. No serious adverse events were reported. Discussion: CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.

© 2016 The Author(s). This study aimed to test the efficacy of cupping therapy to improve symptoms and quality of life in patients diagnosed with the fibromyalgia syndrome. Participants were randomly assigned to cupping therapy, sham or usual care. Cupping was administered five times at twice weekly intervals on the upper and lower back. The primary outcome measure was pain intensity at day 18. Secondary outcomes included functional disability, quality of life, fatigue and sleep quality as well as pressure pain sensitivity, satisfaction and safety at day 18 and 6 months. Altogether 141 patients were included in this study (139 females, 55.8 ± 9.1 years). After 18 days patients reported significant less pain after cupping compared to usual care (difference-12.4; 95% CI:-18.9;-5.9, p < 0.001) but not compared to sham (difference-3.0; 95% CI:-9.9, 3.9, p = 0.396). Further effects were found for quality of life compared to usual care. Patients were mildly satisfied with cupping and sham cupping; and only minor side effects were observed. Despite cupping therapy being more effective than usual care to improve pain intensity and quality of life, effects of cupping therapy were small and comparable to those of a sham treatment, and as such cupping cannot be recommended for fibromyalgia at the current time.

© 2015, Springer-Verlag Berlin Heidelberg. Purpose: The aim of this study was to investigate the effects of a mindfulness-based day care clinic group program for cancer survivors on health-related quality of life and mental health; and to investigate which psychological variables are associated with changes in health variables. Methods: One hundred seventeen cancer survivors (91.0 % female; mean age 53.9 ± 10.7 years; 65.0 % breast cancer; mean time since diagnosis 27.2 ± 46.5 months) participated in an 11-week mindfulness-based day care clinic group program, 6 h per week. The intervention incorporated mindfulness-based meditation, yoga, cognitive-behavioral techniques, and lifestyle modification. Outcome measures including health-related quality of life (EORTC QLQ-C30), depression and anxiety (HADS); and psychological variables including life satisfaction (BMLSS), mindfulness (FMI), adaptive coping styles (AKU), spiritual/religious attitudes in dealing with illness (SpREUK), and interpretation of illness (IIQ) were assessed before, after, and 3 months after the intervention. Results: Using mixed linear models, significant improvements in global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning were found. Cancer-related symptoms, including fatigue, pain, insomnia, constipation, anxiety, and depression, also improved significantly. Mindfulness, life satisfaction, health satisfaction, all coping styles, all spiritual/religious attitudes, and interpretation of illness as something of value increased; interpretation of illness as punishment decreased significantly (all p < 0.05). Improved outcomes were associated with increases in psychological variables, mainly life satisfaction, health satisfaction, and trust in medical help (R2 = 7.3–43.6 %). Conclusion: Supportive mindfulness-based interventions can be considered as an effective means to improve cancer survivors’ physical and mental health. F

Background: Coping with the complex nature of fibromyalgia symptoms (FMS) still remains a challenge for patients. Taking into account the possible adverse events of pharmacological treatments patients often seek additional treatments for the management of fibromyalgia and turn towards complementary and alternative medicine (CAM). Objective: In this review, we aimed to investigate the current state of literature of homeopathy in the treatment of FMS. Methods: We searched Medline, the Cochrane Register of Controlled Trials, Embase, AMED, PsycInfo and CAMbase for the terms "fibromyalgia AND homeopath$" through February 2013. In addition we searched Google Scholar, the library of the Carstens Foundation and that of the Deutsche Homöopathische Union (DHU). Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated and meta-analyzed using the generic inverse variance method. Results: We found 10 case-reports, 3 observational studies, 1 non-randomized and 4 randomized controlled trials (RCTs) on homeopathy for fibromyalgia. Both case reports and observational studies are naturally predominated by the use of qualitative and not validated outcome measures. Meta-analyses of CCTs revealed effects of homeopathy on tender point count (SMD. = -0.42; 95%CI -0.78, -0.05; P= 0.03), pain intensity (SMD. = -0.54; 95%CI -0.97, -0.10; P= 0.02), and fatigue (SMD. = -0.47; 95%CI -0.90, -0.05; P= 0.03) compared to placebo. Conclusion: The results of the studies as well as the case reports define a sufficient basis for discussing the possible benefits of homeopathy for patients suffering from fibromyalgia syndrome although any conclusions based on the results of this review have to be regarded as preliminary. © 2014 Elsevier Ltd.

© 2014 Elsevier Ltd. Objectives: Determining efficacy in complementary medicine research requires valid placebo/sham control groups that are credible to patients and ensure successful blinding. Within the scope of this study, a light touch sham-control intervention for trials of Craniosacral Therapy (CST) was developed and tested for its credibility. Methods: Patients of a randomized controlled trial on chronic non-specific neck pain (. NCT01526447) obtained the Credibility/Expectancy Questionnaire and the Helping Alliance/Satisfaction Questionnaire. Treatment and sham group respectively received 8 weekly sessions of CST or light touch. Data without (. N=. 50) and with multiple imputation (. N=. 54) were analyzed separately using logistic regression models. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated to assess whether group outcome could be predicted from patients' credibility ratings. An additional t-test for analysis of the overall compliance/attendance was conducted. Results: Patients' ratings of treatment expectancy, credibility and therapeutic alliance were not found to have significant power for classifying patients into CST or sham group (. p≥.05). Only satisfaction with treatment revealed a significant impact (AOR: 6.83; 95% CI: [1.54|30.24]; p=.011) in the non-imputed analysis, but not in the multiple imputation analysis (AOR: 4.09; 95% CI: [0.94|17.76]; p=.060). Compliance of both groups was not significantly different (. p>.05) as were reasons for non-attendance. No serious adverse events were reported. Conclusions: Patients' expectancy, credibility and therapeutic alliance did not appear to affect study outcomes, blinding patients to group allocation was possible, and sham intervention was tolerable and safe. The design can therefore be recommended as control for non-specific treatment effects in future CST clinical trials.

Background. Breast cancer is one of the most common types of cancer. However, only a few trials assess the effects of arts therapies. Material and Methods. We searched the Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar from their start date to January 2012. We handsearched reference lists and contacted experts. All randomized controlled trials, quasi-randomized trials, and controlled clinical trials of art interventions in breast cancer patients were included. Data were extracted and risk of bias was assessed. Meta-analyses were performed using standardized mean differences. Results. Thirteen trials with a total of 606 patients were included. Arts therapies comprised music therapy interventions, various types of art therapy, and dance/movement therapies. The methodological quality ranged from poor to high quality with the majority scoring 3 of 4 points on the Jadad scale. Results suggest that arts therapies seem to positively affect patients' anxiety (standardized mean difference: -1.10; 95%, confidence interval: -1.40 to -0.80) but not depression or quality of life. No conclusion could be drawn regarding the effects of arts therapy on pain, functional assessment, coping, and mood states. Discussion. Our review indicates that arts interventions may have beneficial effects on anxiety in patients with breast cancer. © 2014 Katja Boehm et al.

Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments. Copyright © 2012 Andrea D. Furlan et al.

Aims: Changes within the German Higher Education Framework act increasingly attract notice to the fact that the debate on different methods of selecting students lies in the responsibility of german medical schools. For more than 20 years the University of Witten/Herdecke has adhered to its own concept and procedure relating to its choice of students. Since 2005 this application procedure consists of a written and an oral application phase (assessment center). Within this study a retrospective classification of all applicants in the year 2005 was conducted, with the objective of finding academic and non-academic predictors for acceptance at Witten/Herdecke. Methods: All 172 applicants of the assessment center received a questionnaire asking for: age, gender, high school graduation mark, type of school, main school subjects, intended career, attendance at open house, parent graduation and profession. All duly completed questionnaires were classified according to the QUEST model from the viewpoint of acceptance versus refusal to medical studies at Witten/Herdecke. Outcomes: The QUEST model classifies the items of the questionnaire in sequence of declining power and in coherence to the targeted variable (acceptance). Affiliated with an increased probability of acceptance were: high school mark = 1.3, Steiner and Montessori schools, absence at open house, intended career as researcher and natural/social sciences and languages as main school subjects. Predictor sensitivity was 0.53, specificity reached 0.92. The positive predictive value accounted for 0.77, whereas the negative predictive value was 0.83. Conclusions: The high school graduation mark shows to be of high significance for the admission process at the University of Witten/Herdecke. Furthermore factors such as type of school, intended career and main school subjects play a major role. The high negative predictive value points out that the QUEST analysis is not suitable for replacing the existing admission proc, Zielsetzung: Die Auseinandersetzung mit unterschiedlichen Verfahren der Studierendenauswahl rückt durch die Novellierung des Hochschulrahmengesetzes zunehmend in den Verantwortungsbereich deutscher Fakultäten. Als private Universität führt die Universität Witten/Herdecke (UWH) seit 20 Jahren universitätseigene Auswahlverfahren durch. Seit 2005 besteht dieses aus einer schriftlichen ersten Phase und einem zweitägigen Assessment-Center. In der vorliegenden Untersuchung fand eine retrospektive Klassifizierung der Studierendenbewerber 2005 statt. Ziel war es, existierende schulische und nicht-schulische Prädiktoren für die Studienplatzzusage an der UWH zu identifizieren. Methodik: Allen Bewerber/innen der Phase des Assessment-Centers (n=172) wurde ein Fragebogen mit den Items: Alter, Geschlecht, Abiturnote, Leistungskurse, Schulform, Berufsziel, Teilnahme am Tag der offenen Tür, Beruf- und Bildungsabschluss der Eltern vorgelegt. Das Einschlusskriterium war ein vollständig ausgefüllter Fragebogen (n=155). Nach deskriptiver Datenauswertung erfolgte die weitere Klassifizierung auf der Basis der QUEST-Analyse unter dem Gesichtspunkt "Zusage versus Absage" eines Studienplatzes. Ergebnis: Die QUEST-Analyse klassifiziert, in welcher Reihenfolge abnehmender Stärke die Kriterien des Fragebogens im Zusammenhang mit der Zielvariablen "Zusage" stehen. Mit einer erhöhten Zusagewahrscheinlichkeit waren ein Abitur = 1,3, die Schulform Waldorfschule/Montessorischule, die Abwesenheit am Tag der offenen Tür, das Berufsziel "Forschung" und die Leistungskurskombination rein naturwissenschaftlich bzw. Sprache/Gesellschaftswissenschaft verbunden. Die Sensitivität der Prädiktorkombination betrug 0,53, die Spezifität 0,92. Der positiv-prädiktiver Wert lag bei 0,77, der negativ-prädiktive Wert ergab 0,83. Schlussfolgerung: Für das Auswahlverfahren der UWH scheint auch die Abiturnote retrospektiv einen übergeordneten Stellenwert zu besitzen. Darüber hinaus spielen Faktoren wie Schulform, Berufsz

Background: The University of Witten/Herdecke was founded in 1983 as the first private university in Germany to teach medicine. The University is not part of the centralized state system of medical placement distribution but rather has its own concept and procedure relating to its choice of students. In order to evaluate reliability and validity of the process of selecting medical students at the University of Witten/Herdecke, the first step was to analyse the interview selection process. Material and methods: The basic foundation of this examination were the results of the interview period of of the admission process from 1999 to 2000. In order to test inter-rater-reliability of the interviewers, a modified Cohen Kappa coefficient for multiple nominal scaled variables was used with regards to the group as a whole and also individually for the subgroups gender, admission year, age-groups and A Level results. Results: With Kappa-values ranging from 0.70 in 2000 to 0.88 in 1999 the reliability of the interviewer-process is obvious. However there are clear differences in the two years examined with regards to agreement in the decisions of interviewers. In the subgroup analysis with regards to gender no differences in the Kappa values were seen (male: 0,81; female: 0.8). Slightly less agreement can be seen with regards to subgroup analyses of A Level results of applicants ranging from 0.76 to 0.82. Discussion: In summary, this study shows that the application selection procedure for medicine at the medical faculty of the University of Witten/Herdecke is a reliable instrument with a high inter-rater reliability. This remains the case even though the interviewers do not seem to have standardized decision making criteria. Whether individual criteria/constellations were decisive with regards to the decision making process will be the subject of a further study., Hintergrund: Die Universität Witten/Herdecke wurde 1983 als erste deutsche Hochschule in privater Trägerschaft gegründet. Sie ist die einzige nichtstaatliche Universität in Deutschland, die einen Studiengang Humanmedizin anbietet. Als nichtstaatliche Hochschule ist sie nicht an das staatliche Vergabeverfahren durch die Zentralstelle für die Vergabe von Studienplätzen gebunden und hat im Zuge ihrer Autonomie ein eigenes Aufnahmeverfahren entwickelt. Um die Validität und Reliabilität des Auswahlverfahren zu untersuchen, wurde in einem ersten Schritt der Interviewprozess einer Evaluation unterzogen.Material und Methoden: Grundlage der vorliegenden Untersuchung sind die Ergebnisse der Interviewperioden 1999 und 2000. Zur Überprüfung der Inter-Rater-Reliabilität wurde der Kappa-Koeffizient nach Cohen für mehrstufige nominalskalierte Variablen modifiziert nach Fleiss benutzt. Die Überprüfung von Unterschieden und Übereinstimmungen in den Beurteilungen der Bewerber wurde neben der Gesamtstichprobe separat für die Subgruppen Jahrgang, Altersgruppe, Abiturnote und Geschlecht durchgeführt.Ergebnisse: Die Reliabilität ist mit Kappa-Werten zwischen 0,70 (Jahrgang 2000) und 0,88 (Jahrgang 1999) durchgängig als hoch zu bewerten. Zwischen den Jahrgängen zeigen sich allerdings deutliche Unterschiede in Bezug auf die Übereinstimmung der Interviewer. Es finden sich keine Unterschiede bei einer geschlechtsbezogenen Betrachtung (männlich: k=0,81; weiblich: k=0.8). Eine Tendenz zu einer geringeren Übereinstimmung kann bei der Subgruppenanalyse in Bezug auf die Abiturnote festgestellt werden, die mit Kappa Werten zwischen k=0.76 und k=0.82 schwankte.Diskussion: Die Untersuchung zeigt, dass mit dem Aufnahmeverfahren zum Studium der Humanmedizin an der Fakultät für Medizin der Universität Witten/Herdecke ein reliables Instrument mit einer hohe Inter-Rater Reliabilität vorliegt, obwohl den beteiligten Interviewern keine einheitlichen Entscheidungskriterien und deren Gewichtung vorgegeben we