Quality assurance

This article outlines NAFKAM's understanding of and system for quality assurance.

Last updated: Sept 9, 2022

NAFKAM's fact sheets in the 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 summarized research complies with evidence level 1a according to the Oxford criteria: This means that a systematic review (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 summaries are quality checked by the researchers. They evaluate the methods used and the execution of the treatment.

Research does not necessarily distinguish between alternative and conventional treatment, as we find in Norwegian legislation. A summary may have included studies where the treatment is provided by other types of practitioners than first come to mind. An example of this would be studies of classical/Swedish massage, where the therapist is a physiotherapist and not a massage therapist. Another example is research on homeopathic remedies, which are not allowed to market in Norway.

Other criteria that must be met, are that summaries 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 health problem.

If the team is then left with multiple relevant systematic reviews of one therapy for the same outcome, they will refer the most recently published summary. If the team cannot find any summaries of the therapy in question, their conclusion is that we do not have solid enough documentation to support whether the treatment works or not. In cases of doubt, final decisions are made by the senior researcher. 

The basis in NAFKAM's routines for quality assurance is the use of reputable, international research databases, and that we base our information about effect and efficacy of complementary and alternative medicine (CAM)  on systematic reviews (SRs).  The assessments we make of the research is quality assured by senior researchers at NAFKAM.

We are revising our fact sheets to make it easier for the public to find relevant content based on diseases and symptoms. When finished, we will check our databases for new summaries every third year and update the articles if necessary. 

Structure of fact sheets

The fact sheets about CAM therapies 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; how it is typically administered; its history, alleged mechanism of action etc. 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 reserach databases: 

The "Does it work"-sections also aims to present how the providers of the therapy describe that the therapy works (mechanism of action), compared to what 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.

Q&A

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.

NAFKAM -

Norway's National Research Center in Complementary and Alternative Medicine

We work to give you facts about complementary and alternative medicine, so that you can make safer choices for your health.

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