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Research Directions in Complementary, Integrative & Alternative Medicine: Modeling Clinical Research

Information on clinical evidence models and new approaches for conducting CAM research.

Modeling Research

The relationship of research evidence to clinical practice can be conceptualized in various ways. Variations of the hierarchical "evidence pyramid" are most common, as in this representation:

Thank you to the University of Michigan Library for this image, Creative Commons Attribution License 4.0. Modified from: Haynes RB. Of studies, syntheses, synopses, summaries and systems: the “5S" evolution of services for evidence-based health care decisions. ACP J Club. 2006 Nov-Dec;145(3):A8-9. 

Holistic Evidence Models

Awareness evolves, and practitioners have increasingly recognized the limitations of the hierarchical model, especially in relation to complementary/integrative clinical practice:

"The evidence hierarchy is too simplistic for much of medicine and for the complex interventions in many CAM practices. As every clinician knows, patients recover for complex and interacting reasons, many of which are not additive and cannot be isolated in controlled environments.” 

Jonas WB. (2005). Forschende Komplementärmedizin Und Klassische Naturheilkunde = Research in Complementary Medicine; 12 (3): 163. Note: Wayne B. Jonas, MD, was the founding director of NCCAM (now National Center for Complementary & Integrative Health) at the National Institutes of Health.

This recognition prompted the development of more inclusive models, such as the Evidence Circle and the Evidence Funnel. Here are links to articles or abstracts discussing these models.

 

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