Defining integrative medicine in narrative and systematic reviews : a suggested checklist for reporting

Introduction: The use of the term integrative medicine (IM) is evolving over time but its exact definition remains imprecise. In this paper we use IM to mean complementary and alternative medicine (CAM) provided holistically and in conjunction with conventional medicine. Drawing from the experience of experts in different geographical areas (USA, UK, Australia, and China), this review aimed to identify key elements which could be used to define IM in order to develop a potential guide for reporting IM in clinical research. Method: A total of 54 sources were searched (including websites of governments, key authorities, representative clinical sites, academic journals, relevant textbooks) to identify definitions of IM from the four countries from 1990 to 2014. Key elements characterizing IM were extracted and categorized using a thematic approach in order to identify the key items to consider when reporting IM in research studies. Results: Seventeen definitions were identified and extracted from 17 sources. The remaining 37 sources did not provide a definition of IM. The most common key elements which defined IM were: using aspects of both CAM and conventional medicine; goals of health and healing; holistic approach; optimum treatment; and the body's innate healing response. Integration was also defined at three levels: theoretical, diagnostic and therapeutic. A potential checklist of items is proposed for reporting IM in clinical studies. Conclusion: This paper identifies the key elements which define IM and provides a potential reporting guide for IM clinical trials and which could be used in narrative/systematic reviews. Further debate, discussion and input is now needed from the research and clinical IM communities to further advance this agenda.