Evidence review informs latest Australian Government Natural Therapies Report and Recommendations
The Australian Government recently released the Natural Therapies Review 2024—the culmination of a five-year effort to assess the evidence on the effects of 16 natural therapies not currently eligible for the Private Health Insurance Rebate. The review recommends the re-inclusion of several therapies.
The Natural Therapies Review, led by Prof Michael Kidd, is an update of a similar undertaking from 2015 that found insufficient evidence to draw definite conclusions regarding the clinical effectiveness of these therapies.
NHMRC contracted several synthesis groups in Australia to conduct the independent evidence evaluations of individual therapies (for any health condition). Cochrane Australia evaluated seven of the natural therapies under consideration (Alexander Technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, kinesiology, reflexology), with other groups responsible for evaluating homeopathy, iridology, naturopathy, Pilates, Rolfing, shiatsu, tai chi, Western herbal medicine, and yoga.
The comprehensive evaluations used Cochrane methods for evidence synthesis and the GRADE approach to assess the certainty of the body of evidence for each therapy. Given the reporting and study design limitations prevalent across the evaluations, high certainty evidence was lacking.
In his letter to the Minister for Health and Aged Care, Prof Kidd recommended the re-inclusion of therapies for the Private Health Insurance Rebate for which there was moderate certainty evidence of their clinical effectiveness for at least one health outcome in one health condition. Seven natural therapies fell into this category—Alexander Technique, naturopathy, Pilates, shiatsu, tai chi, Western herbal medicine, and yoga. The remaining nine therapies were not recommended for re-inclusion due to low or very low certainty evidence which meant it was not possible to interpret the effects of the therapies with confidence.
The evaluations conducted by Cochrane Australia included therapies with substantial bodies of evidence—over 320 and 170 studies respectively for aromatherapy and reflexology of which 300 could be included in meta-analysis. In spite of this, it was not possible to draw conclusions about the effects of these therapies with confidence for any condition or outcome. Of the other therapies Cochrane Australia evaluated, Alexander Technique was the only therapy to include moderate certainty evidence of an effect (improved physical function in people with chronic musculoskeletal pain).
"Although the process was more arduous than any of us anticipated, ultimately the outcome of the review highlights the value in applying a systematic and rigorous approach to evaluating the evidence," says Dr Sue Brennan, who led the evaluations for Cochrane Australia. "Given the widespread use of natural therapies in Australia, the outcome of this review could significantly impact how Australians access these natural therapies through their health insurance."
The Department of Health and Aged Care has published the outcomes of the review, including the final report, recommendations, and evaluations of individual therapies. The Minister for Health and Aged Care will now consider these recommendations before making any changes to the Private Health Insurance Rebate eligibility criteria.
