BACKGROUND: a continuous growth in the publication of research papers means that there is an expanding volume of data available to the systematic reviewer. Sometimes, researchers can become overwhelmed by the sheer volume of data being processed, leading to inefficient data extraction. This paper seeks to address this problem by proposing a modification to the current systematic review methodology. PROPOSED METHOD: This paper details the routine piloting of a systematic review all the way through to evidence-synthesis stage using data from a sample of included papers. RESULTS AND DISCUSSION: the result of piloting a sample of papers through to evidence-synthesis stage is to produce a 'mini systematic review'. Insights from such a pilot review may be used to modify the criteria in the data extraction form. It is proposed that this approach will ensure that in the full review the most useful and relevant information is extracted from all the papers in one phase without needing to re-visit the individual papers at a later stage. CONCLUSIONS: Routine piloting in systematic reviews has been developed in response to advances in information technology and the subsequent increase in rapid access to clinical papers and data. It is proposed that the routine piloting of large systematic reviews will enable themes and meaning in the data to become apparent early in the review process. This, in turn, will facilitate the efficient extraction of data from all the papers in the full review. It is proposed that this approach will result in increased validity of the review, with potential benefits for increasing efficiency.

OBJECTIVE: Limitations in the conventional medical management of osteoarthritis indicate a real need for safe and effective treatment of osteoarthritis patients. Herbal medicines may provide a solution to this problem. The aim of this article was to review systematically all randomized controlled trials on the effectiveness of herbal medicines in the treatment of osteoarthritis. METHODS: Computerized literature searches were carried out on five electronic databases. Trial data were extracted in a standardized, predefined manner and assessed independently. RESULTS: Twelve trials and two systematic reviews fulfilled the inclusion criteria. The authors found promising evidence for the effective use of some herbal preparations in the treatment of osteoarthritis. In addition, evidence suggesting that some herbal preparations reduce consumption of non-steroidal anti-inflammatory drugs was found. The reviewed herbal medicines appear relatively safe. CONCLUSIONS: Some herbal medicines may offer a much-needed alternative for patients with osteoarthritis.

Osteoarthritis is a common rheumatic disease. Limitations of conventional medical management of this condition indicate a real need for safe and effective treatment of osteoarthritic patients. The authors review the clinical evidence for and against the effectiveness of homeopathic medicines in the treatment of patients with osteoarthritis. A systematic review of all randomised controlled clinical trials of homeopathic treatment of patients with this condition is presented. A comprehensive search yielded four trials which are discussed in detail. The authors conclude that the small number of randomised clinical trials conducted to date, although favouring homeopathic treatment, do not allow a firm conclusion as to the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis. The clinical evidence appears promising, however, and more research into this area seems warranted.

UNLABELLED: with the increasing demand and usage of complementary/alternative medicine (CAM) by the general public, it is vital that healthcare professionals can make informed decisions when advising or referring their patients who wish to use CAM. Therefore they might benefit from advice by CAM-providers as to which treatment can be recommended for which condition. AIM: the primary aim of this survey was to determine which complementary therapies are believed by their respective representing professional organizations to be suited for which medical conditions. METHOD: 223 questionnaires were sent out to CAM organizations representing a single CAM therapy. The respondents were asked to list the 15 conditions they felt benefited most from their CAM therapy, the 15 most important contra-indications, the typical costs of initial and any subsequent treatments and the average length of training required to become a fully qualified practitioner. The conditions and contra-indications quoted by responding CAM organizations were recorded and the top five of each were determined. Treatment costs and hours of training were expressed as ranges. RESULTS: of the 223 questionnaires sent out, 66 were completed and returned. Taking undelivered questionnaires into account, the response rate was 34%. Two or more responses were received from CAM organizations representing twelve therapies: aromatherapy, Bach flower remedies, Bowen technique, chiropractic, homoeopathy, hypnotherapy, magnet therapy, massage, nutrition, reflexology, Reiki and yoga. The top seven common conditions deemed to benefit by all twelve therapies, in order of frequency, were: stress/anxiety, headaches/migraine, back pain, respiratory problems (including asthma), insomnia, cardiovascular problems and musculoskeletal problems. Aromatherapy, Bach flower remedies, hypnotherapy, massage, nutrition, reflexology, Reiki and yoga were all recommended as suitable treatments for stress/anxiety. Aromatherapy, Bowen technique, chiropractic, hypnotherapy, massage, nutrition, reflexology, Reiki and yoga were all recommended for headache/migraine. Bowen technique, chiropractic, magnet therapy, massage, reflexology and yoga were recommended for back pain. None of the therapies cost more than ł60 for an initial consultation and treatment. No obvious correlation between length of training and treatment cost was apparent. CONCLUSION: the recommendations by CAM organizations responding to this survey may provide guidance to health care professionals wishing to advise or refer patients interested in using CAM.