This article outlines NAFKAM's understanding of and system for quality assurance.
Last updated: Sept 9, 2022
The fact sheets in NAFKAM's net lexicon on various forms for complementary and alternative medicine (CAM) are based on evidence from summarized research from recognized, international and independent research databases. To ensure that research results are referred both correctly and understandable for non-professionals, an interdisciplinary team consisting of at least one senior researcher and one information advisor analyzes the evidence, before it is reported on the website.
Reviewing the evidence follows a common procedure. An initial point for the team is considering whether the systematic review (SR) complies with evidence level 1a according to the Oxford criteria: This means that a SR ) must be based on at least two relevant studies (RCTs) of the therapies, in order for it to be included in the basis for what we write about efficacy. In line with the Oxford criteria, we do not require that the included studies's data are combined into a meta-analysis (MA).
The studies included in these SRs are quality checked by the authors as well as peer-reviewers before they are published. Thus, the methods used and the execution of the treatment have been evaluated.
Research does not always distinguish between CAM and standard care provided by the official Norwegian health care system. Thus, an SR may include studies where the treatment is provided by other types of practitioners than first come to mind in a Norwegian context. An example of this could be studies of classical/Swedish massage, where the provider is a licensed physiotherapist and not a massage therapist (CAM provider). Another example would be research on a homeopathic remedy not available in Norway.
Other criteria that must be met, are that the SRs must be written in English. They must also have a clear conclusion about the therapy's efficacy, compared to waiting list, placebo control or standard treatment of the specific health problem/ outcome.
If the team is then left with multiple relevant SRs of one therapy for the same outcome, they will refer the most recently published SR. If the team cannot find any SRs of the therapy in question, their conclusion is that we do not have sufficient documentation to state whether the treatment works or not. In cases of doubt, final decisions are made by the senior researcher.
Structure of the fact sheets
The fact sheets are written according to a common template. This provides guidelines for which topics will be covered, and which sources should be consulted for the presentation of a therapy's effect and safety. Thus, answers to relevant questions are ensured, presented from a common and solid basis.
Does it work?
The "Does it work"-sections of the fact sheets cover what we can state from science about the therapy's efficacy. This is based on systematic reviews from the following international and independent research databases:
- CAM Cancer (for cancer-related outcomes)
- The Cochrane Library (subscription required)
- EMBASE (subscription required)
- Web of Science (subscription required)
The "Does it work"-sections also aim to present how the providers describe that the therapy works (mechanism of action), compared to generally accepted knowledge about the human body, illness and health.
Is it safe?
The "Is it safe"-sections of the fact sheets cover what we can say from science about the safety, risk and adverse effects associated with the therapies. E.g, if it is proven or suspected that the therapy causes new symptoms, or alters a medicine's effect.
This is based on information from several levels of evidence, with PubMed, Natural Medicines, and the Drugs and Lactation Database (LactMed) as main sources. We also inform you of any warnings issued, advice on usage and the like from official authorities in Norway and abroad.
A brief description of general advice on safe use of CAM is also referred in this chapter, with links to further reading on this topic.
Background, Sources and Read More
Further information about a therapy's origin, historical development, understanding of illness and health, therapy-specific theories about the mechanism of action, or provider's guidelines for administration of the therapy is presented in the Background secions of the fact sheets.
The fact sheets also contain a sections where the sources used are listed and linked (if possible). These also indicate when the information was obtained. In addition to research and public sources of health information, this chapter may contain names of and hyperlinks to CAM entities (providers' associations or individual providers) when such are used as a source to information.
The "Read more" section presents links to other, potential relevant literature.
NAFKAM answers questions from patients, health care professionals, CAM providers, media, researchers etc.Answers to questions about the effectiveness and safety regarding CAM therapies are based on searches and systematic reviews found in at least one of the above-mentioned research libraries. Answers are quality-checked by a colleague before it is sent.
All questions received and answers given are anonymised after answering, and stored internally for possible later use for educationa purposes and/ or in the website's Q&A-section.
We advise not to send us specific health information, as this is sensitive information that in e-mail format could easily go astray. NAFKAM offers neither examination nor treatment of patients' health, advice on their use of treatment or help in finding CAM providers.