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The way forward
Sound practice based on sound evidence and research
Basing your practice on sound evidence in the form of research is not as difficult as it seems. Research-based practice can be anything from reading a reputable journal or book, searching the internet, attending conferences, to sharing knowledge with colleagues. In its simplest form, evidence-based practice may just involved being critical of your own practice and getting appropriate feedback from your client. The main component of good practice however, is being critical about the evidence and research methods you are reading and the methods you are using - sound practice has to be based on accurate information, something which is often difficult to obtain in the aromatherapy world for reasons discussed later. The more information you have, the more sound the evidence is, and the more sound your own skills will be.
Conducting your own research again is not as difficult as it seems.
Good research will ask a question, then use a method to obtain an answer to the
original question. All the method needs to be is a good treatment plan
which is well documented, with an evaluation of success (or none success).
A simple example may be a question such as "is eucalyptus globulus
effective in reliving sinus congestion?". Your method will include a
treatment plan, followed with an evaluation of effectiveness from the
client. The question needs to be simple enough to be answered, the
method appropriate for the condition, and simple enough not to be affected by
other factors that could adversely affect the outcome (such as the addition of
other oils in your blend, or failing to record the oil profile and source used). Your treatment plan needs to be unambiguous and
detailed enough to duplicate the outcome again, and for other therapists to be
able to use your notes to repeat the same treatment. An effective and
simple way to
evaluate treatment is to ask the client to grade the severity of their symptoms
on a scale of 1 to 10, before and after treatment.
Your research does not have to prove anything outright (often very difficult in
complementary therapy), but suggest a positive (or negative) outcome that
supports (or disproves) your hypothesis in order to move forwards towards more
effective treatment.
Different types of research
There are many different types of research available which provide the evidence on which to base our practice. While clinical trials and laboratory-based studies may be out of reach to many, access to their findings should be of interest to every practitioner concerned with improving the practice of aromatherapy as a whole. This means that the serious therapist should have access to up-to-date information and news about current trends in practice - usually available through complementary therapy journals, conferences, the various aromatherapy federations, courses, and the most recent reputable books.
Clinical trials and laboratory-based studies - probably one the most
conclusive methods to support a hypothesis, but therapists need to be aware of
the difference between 'good' and 'poor' research. An example of this is
the trial reporting to 'prove' that essential oils can be absorbed by the
skin. Blood test taken after a massage treatment showing a significant
amount of essential oil in the blood sample. But researchers failing to
account for any of the essential oil being inhaled during the treatment, finding
its way in to the blood supply via the respiratory system.
Multi trials - a collection of co-ordinated trials working on the same
hypothesis.
Case studies - can be single case studies, or a collection of separate
studies, supporting the same outcome.
Surveys - can be large or small scale, and can include simply asking
several therapists the most effective way to treat a specific condition.
Systematic reviews - collates results from several sources (clinical as
well as anecdotal) and can be done by anyone with access to published research
material. A good way to research the properties of a specific essential
oil to use in your own practice. Systematic reviews of clinical trials are
probably the most effective way of supporting a hypothesis.
Type of evidence
Anecdotal - always subjective and opinion-based.
Qualitative - again, opinion based, often depending on subjective
analysis and comparisons.
Quantitative - evaluations using statistics, numerical comparisons,
actual measurements and scales, assessment tools and methods which are quantifiable.
Case reports - a more formal way of representing evidence.
Cohort studies - following a group of people receiving the same treatment
over time.
Clinical trials - usually with at least one treatment group and a control
group.
Randomised control trial - with the random allocation of patients to the
treatment group and the control group.
Double-blind trial - where patients and practitioners do not know who has
received the real treatment, and who has received the placebo (difficult to do
in complementary therapy)
Influencing factors
Other variables - other factors which could have an influence on the
results, e.g.: another essential oil included in the blend, a different
variation or chemotype or source of essential oil, the therapeutic
properties of the carrier oil, conventional medication or other remedy being used by the client,
changes in lifestyle, diet, environment etc.
Limiting illness - client would have got better on their own.
The placebo effect - the expectation of getting better making the client
(and therapist) believe the treatment is working.
Ambiguity in documentation - many trials which appear conclusive often
fail to list species and variants of essential oil. This is a common fault
in many clinical trials and aromatherapy texts even by some of the most reputable
authors (Tisserand, Lawless, Worwood to name a few), denying the reader the
ability to duplicate success and improve the reputation of the profession.
Ambiguity in essential oil labelling -some essential oil labels omitting
species variation or chemotype which may be relevant to the use of an essential
oil to a particular condition. Often oils are bought which may be from a
variety of sources adding further difficulty if results of a trial or treatment
regime need to be duplicated.
Important things to remember
 | If someone says it works, ask why? and be critical about the way the evidence is obtained and all other possible variables. |
| If a treatment doesn't work, don't regard it as failure, use it as a positive opportunity to improve your own practice. |
| Be aware than some sources of information are more informed than others. |
Further information on effective web-searching