Mapping Nutrition Research against ‘Effectiveness Gaps’ in the NHS: A Critical Review of the Evidence

By Clare Grundel

Abstract

Background

The changing landscape of ill-health in the United Kingdom has lead to the emergence of clinical areas recognised as ‘effectiveness gaps’ in the National Health Service. Patients and General Practitioners are turning to Complementary and Alternative Medicine in these circumstances, frequently without supporting scientific evidence. The cross-referencing or ‘mapping’ of nutritional research evidence to effectiveness gap conditions has not been conducted. This information would enable primary care doctors to make informed referrals to nutrition professionals.

 

Aims

The aims of this study were threefold:

  1. to verify the broad clinical areas (e.g. musculo-skeletal) that constitute NHS effectiveness gaps;
  2. to map the evidence in nutrition to specific effectiveness gap conditions (e.g. osteoarthritis) within the most common clinical areas;
  3. to critically appraise the evidence, to provide a basis for initial approaches to NHS primary care practitioners.

 

Methods

A literature search of reasons for Complementary and Alternative Medicine use was conducted to identify a list of effectiveness gaps within primary care. This included review articles, surveys, evaluations, pilot studies and some cross-sectional studies. Nutrition research evidence, in the form of systematic reviews only, from Cochrane, DARE, MEDLINE and EMBASE was then mapped to the five identified effectiveness gap conditions. Each systematic review was critically appraised using CASP and categorized according to the quality of the evidence. Quality findings were then summarized in tabular form.

 

Findings

The existence of clinical areas known as effectiveness gaps were verified through the literature. Nutrition evidence mapping was conducted for osteoarthritis, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome and depression. 58% of the evidence found was deemed of poor quality. However, 42% of the nutrition evidence examined was categorized as moderate or good quality and it is this higher quality evidence that has been presented in a series of summary reference tables for each effectiveness gap condition.

 

Conclusions

Mapping of available nutrition evidence suggests that nutrition could be considered as complementary to other therapies as part of a portfolio of treatments for effectiveness gap conditions. Quality nutrition studies, focusing on efficacy and without biological flaws, are required to move this agenda forward. Whilst the findings in this study are broad and therefore cannot be used to directly inform clinical decisions, they do provide an evidence base for further exploration and discussion. Whilst the findings in this study are broad and therefore cannot be used to directly inform clinic decisions, they do provide an evidence base for further exploration and discussion.