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Jamali Dastjerdi M, Azadvari M, Kordafshari G, Zhao BX, Adel-Mehraban MS, Alipour R, Karimi M, Kazemi AH, Sourani A, Vafaie Sefti A. Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: a randomized clinical trial. Ann Med Surg (Lond) 2024; 86:2729-2738. [PMID: 38694293 PMCID: PMC11060228 DOI: 10.1097/ms9.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/02/2024] [Indexed: 05/04/2024] Open
Abstract
Objective Chronic low back pain (CLBP) imposes considerable financial and social burden with poor response to medical and surgical treatments. Alternatively, acupuncture and venesection(Fasd) are traditionally used to alleviate nociceptive and musculoskeletal pains. This study aimed to evaluate the effectiveness and the safety of acupuncture and venesection on CLBP and patient functionality. Methods The current study was a single-blinded, randomized clinical trial with balanced allocation, conducted in the Department of Physical Medicine & Rehabilitation Medicine, in 2022. One hundred five CLBP patients who had no back pain-attributable structural or major diseases were randomly allocated into three parallel arms and received either physical therapy (PTG), acupuncture (APG), or venesection (VSG). Pain severity and functional aspects were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) during the study. VAS and ODI scores were defined as the primary outcomes. Results Ninety-five patients were reviewed in the final analysis (PTG=33, APG=30, VSG=31). Demographic data showed equal group distribution. Statistical analysis showed all procedures had reduced VAS score immediately after the first session, after the last session, and after follow-up; however, APG and VSG values were significantly lower (P<0.05). Pain reduction results in follow-up period were more sustainable in APG and VSG as compared to PTG (P<0.01). ODI results revealed global improvement after the last session of the treatment in all groups, while APG had more significant results (P<0.05). During the follow-up period, ODI still tended to decrease in VSG, non-significantly increased in APG, and significantly increased in PTG. Only two patients reported fainting after receiving venesection. Conclusion Considering the pain and functional scores, both acupuncture and venesection can reproduce reliable results. Acupuncture and venesection both have sustained effects on pain and daily function of the patients even after treatment termination, while physical therapy had more relapse in pain and functional limitations.
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Affiliation(s)
- Moein Jamali Dastjerdi
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Azadvari
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Kordafshari
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bai-Xiao Zhao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mohammad Sadegh Adel-Mehraban
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
- Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Reihane Alipour
- Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Traditional Medicine, School of Persian medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hooman Kazemi
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
- International School, Beijing University of Chinese Medicine, Beijing, China
| | - Arman Sourani
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Vafaie Sefti
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
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Cathcart-Rake EJ, Tevaarwerk AJ, Haddad TC, D'Andre SD, Ruddy KJ. Advances in the care of breast cancer survivors. BMJ 2023; 382:e071565. [PMID: 37722731 DOI: 10.1136/bmj-2022-071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors' quality of life.
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Foley H, Bugarcic A, Adams J, Wardle J, Leach M, Steel A. Criteria for the selection, evaluation and application of traditional knowledge in contemporary health practice, education, research and policy: A systematic review. Health Info Libr J 2023; 40:233-261. [PMID: 37531012 DOI: 10.1111/hir.12499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Traditional and complementary medicine (T&CM) is highly utilised and draws on traditional knowledge (TK) as evidence, raising a need to explore how TK is currently used. OBJECTIVES Examine criteria used to select, evaluate and apply TK in contemporary health contexts. METHODS Systematic search utilising academic databases (AMED, CINAHL, MEDLINE, EMBASE, SSCI, ProQuest Dissertations Theses Global), Trip clinical database and Google search engine. Citations and reference lists of included articles were searched. Reported use of TK in contemporary settings was mapped against a modified 'Exploration-Preparation-Implementation-Sustainment' (EPIS) implementation framework. RESULTS From the 54 included articles, EPIS mapping found TK is primarily used in the Exploration phase of implementation (n = 54), with little reporting on Preparation (n = 16), Implementation process (n = 6) or Sustainment (n = 4) of TK implementation. Criteria used in selection, evaluation and application of TK commonly involved validation with other scientific/traditional evidence sources, or assessment of factors influencing knowledge translation. DISCUSSION One of the difficulties in validation of TK (as a co-opted treatment) against other evidence sources is comparing like with like as TK often takes a holistic approach. This complicates further planning and evaluation of implementation. CONCLUSION This review identifies important criteria for evaluating current and potential contemporary use of TK, identifying gaps in research and practice for finding, appraising and applying relevant TK studies for clinical care.
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Affiliation(s)
- Hope Foley
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, New South Wales, Australia
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Andrea Bugarcic
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Jon Adams
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Matthew Leach
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, New South Wales, Australia
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Amie Steel
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, New South Wales, Australia
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Jacobson E, Conboy L, Tsering D, Shields M, McKnight P, Wayne PM, Schnyer R. Experimental Studies of Inter-Rater Agreement in Traditional Chinese Medicine: A Systematic Review. J Altern Complement Med 2019; 25:1085-1096. [PMID: 31730402 PMCID: PMC6864748 DOI: 10.1089/acm.2019.0197] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives: It has been recommended that clinical trials of Traditional Chinese Medicine (TCM) would be more ecologically valid if its characteristic mode of diagnostic reasoning were integrated into their design. In that context, however, it is also widely held that demonstrating a high level of agreement on initial TCM diagnoses is necessary for the replicability that the biomedical paradigm requires for the conclusions from such trials. Our aim was to review, summarize, and critique quantitative experimental studies of inter-rater agreement in TCM, and some of their underlying assumptions. Design: Systematic electronic searches were conducted for articles that reported a quantitative measure of inter-rater agreement across a number of rating choices based on examinations of human subjects in person by TCM practitioners, and published in English language peer-reviewed journals. Publications in languages other than English were not included, nor those appearing in other than peer-reviewed journals. Predefined categories of information were extracted from full texts by two investigators working independently. Each article was scored for methodological quality. Outcome measures: Design features across all studies and levels of inter-rater agreement across studies that reported the same type of outcome statistic were compared. Results: Twenty-one articles met inclusion criteria. Fourteen assessed inter-rater agreement on TCM diagnoses, two on diagnostic signs found upon traditional TCM examination, and five on novel rating schemes derived from TCM theory and practice. Raters were students of TCM colleges or graduates of TCM training programs with 3 or more years experience and licensure. Type of outcome statistic varied. Mean rates of pairwise agreement averaged 57% (median 65, range 19-96) across the 9 studies reporting them. Mean Cohen's kappa averaged 0.34 (median 0.34, range 0.07-0.59) across the seven studies reporting them. Meta-analysis was not possible due to variations in study design and outcome statistics. High risks of bias and confounding, and deficits in statistical reporting were common. Conclusions: With a few exceptions, the levels of agreement were low to moderate. Most studies had significant deficits of both methodology and reporting. Results overall suggest a few design features that might contribute to higher levels of agreement. These should be studied further with better experimental controls and more thorough reporting of outcomes. In addition, methods of complex systems analysis should be explored to more adequately model the relationship between clinical outcomes, and the series of diagnoses and treatments that are the norm in actual TCM practice.
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Affiliation(s)
- Eric Jacobson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Lisa Conboy
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences University, Worcestor, MA
| | | | - Monica Shields
- New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences University, Worcestor, MA
| | | | - Peter M. Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rosa Schnyer
- Department of Adult Health, School of Nursing, University of Texas, Austin, TX
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Birch S. Treating the patient not the symptoms: Acupuncture to improve overall health - Evidence, acceptance and strategies. Integr Med Res 2019; 8:33-41. [PMID: 30949430 PMCID: PMC6428918 DOI: 10.1016/j.imr.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 02/07/2023] Open
Abstract
Documented mechanisms of acupuncture suggest the possibility of whole body effects in addition to local and regional effects. Traditional theories of acupuncture predict whole body effects. Does this permit the possibility of applying treatment to target overall health improvement of the patient rather than the symptom? After introducing the term 'health improvement' this paper explores situations where it might be advantageous to do this, giving examples of how health authorities in some countries have proposed broader treatment approaches that focus on health improvement. It also discusses cases where acupuncture has been recommended as a treatment method in a number of these proposals and gives some clinical examples of this kind of whole body 'health improvement' targeted treatment effects. Given that health authorities have already recognised this potential for the application of acupuncture the author then explores evidence of more whole-body 'health improvement' effects from systematic reviews and examples of health experts recommending acupuncture to take advantage of them. Research strategies and foci are then proposed and explored to develop this evidence. What are the best treatment approaches to create these effects? By what mechanisms can 'health improvement' be produced? How can one measure these effects? It is likely that treatments based on 'pattern identification' (PI) may provide the best strategies for producing 'health improvement', thus PI-based acupuncture treatments are likely to be the best strategy for clinical research investigating these effects.
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Affiliation(s)
- Stephen Birch
- Department of Health Sciences, Kristiania University College, Oslo, Norway
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Gadau M, Zhang SP, Yip HY, Yeung WF, Bian ZX, Lu AP, Zaslawski C. Pattern Differentiation of Lateral Elbow Pain in Traditional Chinese Medicine: A Systematic Review. J Altern Complement Med 2016; 22:921-935. [DOI: 10.1089/acm.2016.0098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Marcus Gadau
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Shi-Ping Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Ho-Yin Yip
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Zhao-Xiang Bian
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Ai-Ping Lu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Chris Zaslawski
- College of TCM, University of Technology Sydney, Sydney, Australia
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Chiang PJ, Li TC, Chang CH, Chen LL, Lin JD, Su YC. SEED: the six excesses (Liu Yin) evaluation and diagnosis scale. Chin Med 2015; 10:30. [PMID: 26516343 PMCID: PMC4624590 DOI: 10.1186/s13020-015-0059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/14/2015] [Indexed: 11/27/2022] Open
Abstract
Background Infections such as common colds, influenza, acute upper respiratory infections, bacterial gastroenteritis, and urinary tract infections are usually diagnosed according to patients’ signs and symptoms. This study aims to develop a scale for the diagnosis of infectious diseases based on the six excesses (Liu Yin) etiological theory of Chinese medicine (CM) by the Delphi method. Methods A total of 200 CM-guided diagnostic items measuring signs and symptoms for infectious diseases were compiled from CM literature archives from the Han to Ming dynasties, CM textbooks in both China and Taiwan, and journal articles from the China Knowledge Resource Integrated Database. The items were based on infections and the six excesses (Liu Yin) etiological theory, i.e., Feng Xie (wind excess), Han Xie (coldness excess), Shu Xie (summer heat excess), Shi Xie (dampness excess), Zao Xie (dryness excess), and Huo Xie (fire excess). The items were further classified into the six excess syndromes and reviewed via a Delphi process to reach consensus among CM experts. Results In total, 178 items with a mean or median rating of 7 or above on a scale of 1–9 from a panel of 32 experts were retained. The numbers of diagnostic items in the categories of Feng (wind), Han (coldness), Shu (summer heat), Shi (dampness), Zao (dryness), and Huo (fire) syndromes were 15, 22, 25, 37, 17, and 62, respectively. Conclusions A CM-based six excesses (Liu Yin) evaluation and diagnosis (SEED) scale was developed for the evaluation and diagnosis of infectious diseases based only on signs and symptoms.
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Affiliation(s)
- Pei-Jung Chiang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan ; Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Chih-Hung Chang
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Li-Li Chen
- School of Nursing, China Medical University, Taichung, Taiwan ; Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Jun-Dai Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yi-Chang Su
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan
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Alraek T. Designing clinical studies that take into account traditional East Asian medicine's systems and methods - with focus on pattern identification. Chin J Integr Med 2014; 20:332-5. [PMID: 24788085 DOI: 10.1007/s11655-014-1807-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Indexed: 11/30/2022]
Abstract
This article is based on two presentations held at Chinese medicine conference in Rothenburg (2013), Germany and at the 19th Anniversary of Korean Institute of Oriental Medicine (KIOM) International Symposium of Current Research Trends in Traditional Medicine - Pattern of Identification (2013). In designing clinical studies, it is a research question that leads to appropriate study design. However, they are mostly diagnostic procedures and techniques that are the key points to reflect the application of systems and methods in all forms of medicine - traditional East Asian medicine (TEAM) is no exception. The challenges within TEAM based on research reflect in different systems of medicine/theories such as traditional Japanese acupuncture, traditional Korean acupuncture and traditional Chinese acupuncture. This diversity of medical systems and methods applied in East Asia seems to have been fruitful within the different countries and traditional medicines have found their places within the respective countries health systems. The existing diversity, from a clinician's point of view, may be viewed as a treasure when dealing with patients in the 'real world'. On the other hand, this diversity seems to challenge the scientific mind worldwide, especially when it comes to research. Hence, there is a gap between clinical practice and research.
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Affiliation(s)
- Terje Alraek
- National Research Center in Complementary and Alternative Medicine, NAFKAM should be in brackets i.e. (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT the Arctic University of Norway, 9037, Tromsø, Norway,
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Hua B, Abbas E, Hayes A, Ryan P, Nelson L, O'Brien K. Reliability of Chinese Medicine Diagnostic Variables in the Examination of Patients with Osteoarthritis of the Knee. J Altern Complement Med 2012; 18:1028-37. [PMID: 22897413 DOI: 10.1089/acm.2011.0621] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bin Hua
- School of Biomedical and Health Sciences, Victoria University, Melbourne, Australia
| | - Estelle Abbas
- Registered Chinese Medicine Practitioner, Melbourne, Victoria, Australia
| | - Alan Hayes
- School of Biomedical and Health Sciences, Victoria University, Melbourne, Australia
| | - Peter Ryan
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Centre for Clinical Studies, Nucleus Network, Melbourne, Australia
| | - Lisa Nelson
- Centre for Clinical Studies, Nucleus Network, Melbourne, Australia
| | - Kylie O'Brien
- School of Biomedical and Health Sciences, Victoria University, Melbourne, Australia
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Deakin University, Burwood, Victoria, Australia
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Hua B, Abbas E, Hayes A, Ryan PF, Nelson L, O'Brien K. Reliability of the Eight Guiding Principles and Syndrome Diagnosis in Chinese Medicine Diagnosis of Patients with Knee Osteoarthritis. J Altern Complement Med 2012:120821072912004. [PMID: 22909254 DOI: 10.1089/acm.2011.0726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract Background: A Chinese medicine (CM) "Syndrome" or "pattern of disharmony" is a diagnostic subcategory of a disease/disorder or symptom, characterized by particular symptoms and signs, and indicative of the etiology and the state of pathogenesis at that point in time. In CM, treatment is aimed at addressing the disease/disorder and the underlying CM Syndrome. A few studies have assessed reliability of CM Syndrome diagnosis according to one of the major CM theories, Zang-Fu theory, but only 1 study has investigated the reliability of diagnosis according to a fundamental theory, that of the Eight Guiding Principles. Given that treatment follows diagnosis, if diagnosis is not reliable there will be lower confidence that optimal treatment is received. There have not yet been any reliability studies in osteoarthritis (OA). Little is known about the characteristics or Syndromes of OA with respect to the Eight Guiding Principles and Zang-Fu theory. Objectives: The objectives of this study were to characterize diagnostic subcategories of OA according to the Eight Guiding Principles and Zang-Fu theory and to investigate the inter-rater reliability of CM diagnosis according to these two theories. Methods: An inter-rater reliability study was conducted as a substudy of a clinical trial investigating the treatment of knee OA with Chinese herbal medicine. Two (2) experienced CM practitioners conducted a CM examination separately, within 2 hours of each other, of 40 participants. A CM assessment form was utilized to record the diagnostic data. Cohen's κ coefficient was used as a measure of reliability. Results: Results support the concept that knee OA is more likely a disease with characteristics of Interior, Deficiency, and Yin according to the Eight Guiding Principles. There was no clear agreement on CM Syndromes of knee OA according to Zang-Fu theory. The main Zang Organs involved were broadly agreed on; they were Kidney, Liver, and Spleen. Conclusions: Results lend some empirical evidence to support to the argument that OA of the knee is an Internal disease with the manifestations of Deficient symptoms according to CM theories. To establish if Syndrome diagnosis is reliable, more studies should be conducted for different clinical conditions.
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Affiliation(s)
- Bin Hua
- 1 School of Biomedical and Health Sciences, Victoria University , Melbourne, Australia
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Chen RQ, Wong CM, Lam TH. Construction of a traditional Chinese medicine syndrome-specific outcome measure: the Kidney Deficiency Syndrome Questionnaire (KDSQ). Altern Ther Health Med 2012; 12:73. [PMID: 22672362 PMCID: PMC3479037 DOI: 10.1186/1472-6882-12-73] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 06/06/2012] [Indexed: 12/17/2022]
Abstract
Background Development of Traditional Chinese Medicine (TCM) syndrome-specific outcome measures is needed for the evaluation of TCM syndrome-specific therapies. We constructed a Kidney Deficiency Syndrome Questionnaire (KDSQ) for the evaluation of the common TCM syndromes Kidney-Yin Deficiency Syndrome (KDS-Yin) and Kidney-Yang Deficiency Syndrome (KDS-Yang) in middle-aged women with menopausal symptoms. Methods KDS-Yin and KDS-Yang were traditionally defined by expert opinion were validated by exploratory factor analysis (EFA) and structural equation modeling (SEM). Content validity was tested by EFA on a sample of 236 women from a seminar and SEM on another sample of 321 women from a postal survey. Other psychometric properties were tested on 292 women from the seminar at baseline and two systematically selected sub-samples: 54 who reported no changes in discomforts 11–12 days after the baseline and 31 who reported changes in discomforts 67–74 days after the baseline. All participants completed the KDSQ, the Greene Climacteric Scale and the standard 12-item Short Form Health Survey. Results The EFA and SEM established the measurement models of KDS-Yin and KDS-Yang supporting content validity of the KDSQ. Internal consistency was good (Cronbach’s Alpha >0.70). Construct validity was supported by theoretically-derived levels of correlation with the established external measures. Test–retest reliability was strong (ICCagreement: KDS-Yin, 0.94; KDS-Yang, 0.93). The KDSQ was responsive to changes over time as tested by effect size and longitudinal validity. Conclusions The KDSQ was a valid and reliable measure for KDS-Yin and KDS-Yang in Hong Kong Chinese middle-aged women with menopausal symptoms.
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12
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Chen RQ, Wong CM, Cao KJ, Lam TH. An evidence-based validation of traditional Chinese medicine syndromes. Complement Ther Med 2010; 18:199-205. [PMID: 21056843 DOI: 10.1016/j.ctim.2010.05.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 04/30/2010] [Accepted: 05/22/2010] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES A standard description regarding the diagnosis of traditional Chinese medicine (TCM) syndromes based on validated evidence is needed for education, practice and evaluation of TCM syndrome-specific treatments. We studied whether an evidence-based four-step approach proposed for the validation of TCM syndromes could validate Kidney-Yin deficiency syndrome (KDS-Yin) and Kidney-Yang deficiency syndrome (KDS-Yang) in middle-aged women with menopausal symptoms. METHODS TCM classic and contemporary literature were reviewed for the symptoms and the domain changes of KDS-Yin and KDS-Yang. Factor analysis was used to explore whether these symptoms could be grouped according to their mutual relationships in a sample of women. Latent tree models were constructed based on the factor loadings and justifiability by the theory, and were tested by structural equation modelling on another sample of women. RESULTS The symptoms and domain changes were reviewed from the TCM literature. Exploratory factor analysis (EFA) identified symptom patterns on a sample of 236 women. Based on the findings and the TCM literature, latent tree models of KDS-Yin and KDS-Yang, showing their domain changes and domain symptoms, were constructed and could be confirmed by structural equation modelling on a sample of 323 women. CONCLUSION KDS-Yin and KDS-Yang in middle-aged women with menopausal symptoms were validated and the four-step approach may be used to validate TCM syndromes.
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Affiliation(s)
- Run Qiu Chen
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Yuan J, Purepong N, Hunter RF, Kerr DP, Park J, Bradbury I, McDonough S. Different frequencies of acupuncture treatment for chronic low back pain: an assessor-blinded pilot randomised controlled trial. Complement Ther Med 2009; 17:131-40. [PMID: 19398066 DOI: 10.1016/j.ctim.2008.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 10/21/2008] [Accepted: 10/22/2008] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine the feasibility of a main RCT to compare the effectiveness of two frequencies (2 versus 5 times/week) of acupuncture treatment for chronic low back pain (LBP). METHODS Participants (n=30) with chronic LBP were randomised into two groups to receive 10 acupuncture treatments: Low Frequency Group, 2 times/week for five weeks (n=15); High Frequency Group, 5 times/week for two weeks (n=15). The following outcomes were measured blindly at baseline, 2 weeks, 5 weeks, 3 months and 1 year: pain on a VAS, functional disability using the RMDQ, quality of life using the Measure Yourself Medical Outcome Profile (MYMOP-2), psychological impact with the Coping Strategies Questionnaire (CSQ) and Pain Locus of Control (PLC) questionnaire. Two objective outcomes, the Shuttle Walk Test (SWT) and Lateral Trunk Flexibility (LTF), were also measured. RESULTS The compliance rate was 100% for each group. Some of the measurements were shown to be sensitive (VAS, RMDQ, MYMOP-2 Wellbeing). 66-330 participants would be required for a fully powered non-inferiority trial. The groups were balanced at baseline for LBP and demographic characteristics. There were no significant differences between the groups in terms of any of the outcomes, at each follow-up time point. It was notable however that the clinically important improvement in terms of pain, functional disability, quality of life, and SWT in both groups was achieved within the first two weeks, which was maintained at one year follow-up. CONCLUSIONS It is feasible to conduct a main RCT, to compare different frequencies of acupuncture for LBP, using sensitive measurements. Also the trend for early clinically important improvement within a minimum of four measurements is worthy of further study.
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Affiliation(s)
- Jing Yuan
- School of Health Sciences, University of Ulster, Co Antrim, United Kingdom
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Guangyi X, Chongsuvivatwong V, Geater A, Ming L, Yun Z. Application of Delphi Technique in Identification of Appropriate Screening Questions for Chronic Low Back Pain from Traditional Chinese Medicine Experts' Opinions. J Altern Complement Med 2009; 15:47-52. [DOI: 10.1089/acm.2008.0230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiong Guangyi
- Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, People's Republic of China
| | | | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Li Ming
- Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, People's Republic of China
| | - Zhang Yun
- Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, People's Republic of China
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15
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Yuan J, Kerr D, Park J, Liu XH, McDonough S. Treatment regimens of acupuncture for low back pain—A systematic review. Complement Ther Med 2008; 16:295-304. [PMID: 19186345 DOI: 10.1016/j.ctim.2008.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Yuan
- School of Health Sciences, University of Ulster, Shore Road, Co Antrim BT37 0QB, United Kingdom
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16
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Zhang GG, Singh B, Lee W, Handwerger B, Lao L, Berman B. Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: effect of training. J Altern Complement Med 2008; 14:381-6. [PMID: 18576921 DOI: 10.1089/acm.2007.0712] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate whether a training process that focused on consensus on Traditional Chinese Medicine (TCM) diagnostic criteria will improve the agreement of TCM diagnosis on patients with rheumatoid arthritis (RA). DESIGN The design was a prospective survey. SETTING The study was conducted at the General Clinical Research Center, University of Maryland Hospital System, Baltimore, MD. SUBJECTS The participants were 42 patients with RA. PRACTITIONERS: The practitioners included 3 licensed acupuncturists with a minimum of 5 years' licensure and education in Chinese herbs. METHODS A training session of TCM diagnostic procedures was conducted with an open case discussion and "real time" practice. After the training, 3 TCM practitioners examined the same 42 patients with RA separately. Patients filled out a questionnaire to serve as the data for the "Inquiry" component while physical examinations, including observations of tongue and palpation of radial pulse, were conducted by the 3 practitioners. Each practitioner provided a TCM diagnosis based upon the examination results. These diagnoses were then examined with respect to the rate of agreement among the 3 practitioners. RESULTS The average agreement with respect to the TCM diagnoses among the 3 pairs of TCM practitioners was 73% (64.3%-85.7%). Statistically significant differences were found between this study and the two previous studies (p < 0.001). CONCLUSIONS After training focused on consensus on TCM diagnostic criteria, we found that these 3 same TCM practitioners who were used in phase II of the study produced a significantly higher agreement when compared to study phase I or phase II. Our study suggests that improved consensus on TCM diagnostic criteria results in increased agreement of diagnosis.
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Affiliation(s)
- Grant G Zhang
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD 21207, USA.
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17
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Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Irnich D, Hummelsberger J, Hammes M, Pach D, Melchart D, Willich SN. Interventions and Physician Characteristics in a Randomized Multicenter Trial of Acupuncture in Patients with Low-Back Pain. J Altern Complement Med 2006; 12:649-57. [PMID: 16970535 DOI: 10.1089/acm.2006.12.649] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Descriptions of the interventions used in acupuncture studies are often incomplete. The aim of this paper is to describe participating trial physicians and interventions in a randomised trial of acupuncture for low back pain. DESIGN Three-armed, randomized, controlled multicenter trial with 1-year follow-up. A total of 301 patients with low-back pain were randomized to 12 sessions of semistandardized acupuncture (at least six local and two distant points needled bilaterally from a selection of predefined points, but individual choice of additional body or ear acupuncture points possible), minimal acupuncture (superficial needling of at least 6 of 10 predefined, bilateral, distant nonacupuncture points), or a waiting list control (2 months no acupuncture followed by semistandardised acupuncture described above). OUTCOME MEASURES Participating trial physicians and interventions. RESULTS Forty-five (45) physicians specializing in acupuncture (mean age 44 +/- 7.8 years, 23 (51%) female) in 30 outpatient centers in Germany provided the interventions. The median duration of acupuncture training of trial physicians was 350 hours (range 140-2508). The most frequently reported Chinese diagnosis was Kidney deficiency (39%), followed by qi and Blood stagnation (24%), and bi syndrome (20%). The total number of needles used was 17.3 +/- 4.2 in the acupuncture group compared to 12.3 +/- 1.2 in the minimal acupuncture group. In total, 40 physicians (89%) stated that they would have treated patients similarly or in exactly the same way outside of the trial, whereas 5 (11%) stated that they would have treated patients differently. CONCLUSIONS For most trial physicians, the semistandardized acupuncture strategy used in this trial was an acceptable compromise for an efficacy study. However, a relevant minority of participating trial physicians stated that they would have treated patients differently outside of the trial.
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Affiliation(s)
- Benno Brinkhaus
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany.
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18
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Tsai YF, Tsai HH, Lai YH, Chu TL. Pain prevalence, experiences and management strategies among the elderly in taiwanese nursing homes. J Pain Symptom Manage 2004; 28:579-84. [PMID: 15589082 DOI: 10.1016/j.jpainsymman.2004.03.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2004] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among elderly residents of nursing homes in Taiwan. Stratified random sampling was used to recruit participants (n=150). In these elderly nursing home residents, pain prevalence was 65.3% and the average number of pain sites was 3.24 (SD=2.59). The mean pain intensity was 3.86 (SD=1.90) and pain interference was 4.30 (SD=2.28). "Aching" was the word most commonly used (77.6%) to describe pain. Most participants (54.21%) took prescribed medications for dealing with pain; doctors were the main information source for this self-care strategy. Although participants reported severe bouts of pain, they used limited self-care pain management strategies. Since health care providers play an important role in helping the elderly to manage pain, the authors recommend training nursing home staff to perform regular pain assessments and providing current knowledge about pain assessment and management strategies.
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Affiliation(s)
- Yun-Fang Tsai
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan
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19
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Birch S. Clinical Research on Acupuncture: Part 2. Controlled Clinical Trials, an Overview of Their Methods. J Altern Complement Med 2004; 10:481-98. [PMID: 15253852 DOI: 10.1089/1075553041323911] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is almost universal agreement that the quality of clinical trials of acupuncture is poor. There is an urgent need to improve their quality. The author develops here a list of 45 criteria important in the design, implementation, and writing up of controlled clinical acupuncture trials. This list has been compiled after examining the quality assessment criteria used in meta-analyses and systematic reviews of acupuncture, general publications on clinical trial designs and methodological considerations specific to acupuncture trials. Each criterion is discussed with recommendations about use and implementation. Additionally, each criterion is discussed relative to their importance in three types of acupuncture trial, acupuncture versus sham acupuncture, acupuncture versus standard therapy and acupuncture versus no treatment or wait-list. It is hoped that this exploration and systematic presentation of the 45 criteria will contribute to improving the quality of clinical trials of acupuncture. Improved trial quality will lead to greater ease interpreting the results of trials, especially in systematic reviews.
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Affiliation(s)
- Stephen Birch
- Foundation for the Study of Traditional East Asian Medicine, Amsterdam, The Netherlands.
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20
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MacPherson H, Thorpe L, Thomas K, Campbell M. Acupuncture for low back pain: traditional diagnosis and treatment of 148 patients in a clinical trial. Complement Ther Med 2004; 12:38-44. [PMID: 15130570 DOI: 10.1016/s0965-2299(03)00125-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AIMS To assess patterns of diagnosis, including concordance, and treatment within a clinical trial of traditional acupuncture for low back pain. SETTING In a pragmatic randomised controlled clinical trial, 148 patients with low back pain, of between 4 weeks and 12 months duration, were randomised to the offer of individualised acupuncture and received up to 10 treatments. METHODS Standardised diagnosis and treatment records were completed by practitioners for 148 patients. The diagnosis was based on three pre-defined low back pain syndromes. For a subgroup of patients, one of the six practitioners then independently re-examined the patients, blind to the original diagnosis. The diagnostic inter-rater reliability was assessed in terms of percentage congruent classifications and Cohen's Kappa. Structured interviews of practitioners established further details about practice styles. RESULTS The most commonly diagnosed syndrome associated with low back pain was Qi and Blood Stagnation (88% of patients), followed by Kidney Deficiency (53%) and Bi Syndrome (28%), with more than one syndrome being identified for 65% of patients. For the subgroup examined twice, practitioner concordance was reasonable: between 47 and 80% of classifications were congruent, while Kappa values lay between 0 ("the same as chance") and 0.67 ("good"). Practitioners provided 1269 treatments in total, using 177 different acupuncture points. Most commonly used channels were Bladder and Gall Bladder, and the commonest points were BL-23 and the two lowest Huatuojiaji points. Auxiliary treatments were utilised by all practitioners to varying degrees. CONCLUSIONS Diagnostic concordance among practitioners was reasonable, and clear themes emerged for treatment. Further research is required to develop a flexible trial protocol with scope for individualised treatment.
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Affiliation(s)
- Hugh MacPherson
- Foundation for Traditional Chinese Medicine, York YO10 5DD, UK.
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21
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22
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Birch S. Developing a research strategy for the acupuncture profession: research questions, resources necessary to answer them and guidelines for matching resources to types of research. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1461-1449(02)00068-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Zaslawski C. Clinical reasoning in traditional Chinese medicine: implications for clinical research. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1461-1449(03)00044-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hsieh RL, Lee WC. One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects. Am J Phys Med Rehabil 2002; 81:838-43. [PMID: 12394995 DOI: 10.1097/00002060-200211000-00006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the therapeutic effects of one shot of low-frequency percutaneous electrical nerve stimulation one shot of transcutaneous electrical nerve stimulation in patients with low back pain. DESIGN In total, 133 low back pain patients were recruited for this randomized, control study. Group 1 patients received medication only. Group 2 patients received medication plus one shot of percutaneous electrical nerve stimulation. Group 3 patients received medication plus one shot of transcutaneous electrical nerve stimulation. Therapeutic effects were measured using a visual analog scale, body surface score, pain pressure threshold, and the Quebec Back Pain Disability Scale. RESULTS Immediately after one-shot treatment, the visual analog scale improved 1.53 units and the body surface score improved 3.06 units in the percutaneous electrical nerve stimulation group. In the transcutaneous electrical nerve stimulation group, the visual analog scale improved 1.50 units and the body surface score improved 3.98 units. The improvements did not differ between the two groups. There were no differences in improvement at 3 days or 1 wk after the treatment among the three groups. CONCLUSIONS Simple one-shot treatment with percutaneous electrical nerve stimulation or transcutaneous electrical nerve stimulation provided immediate pain relief for low back pain patients. One-shot transcutaneous electrical nerve stimulation treatment is recommended due to the rarity of side effects and its convenient application.
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Affiliation(s)
- Ru-Lan Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wo Ho-Su Memorial Hospital, Shih Lin District, Taipei, Taiwan, Republic of China
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Sherman KJ, Cherkin DC, Hogeboom CJ. The diagnosis and treatment of patients with chronic low-back pain by traditional Chinese medical acupuncturists. J Altern Complement Med 2001; 7:641-50. [PMID: 11822612 DOI: 10.1089/10755530152755199] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The selection of appropriate treatments in clinical trials of acupuncture requires understanding how acupuncturists diagnose and treat specific conditions. We examined the Traditional Chinese Medical (TCM) diagnoses and treatments for patients with chronic low-back pain using two separate sets of treatment records. Information from more than 150 initial visits was available for analysis. A diagnosis of Qi and Blood Stagnation or Qi Stagnation was made for 85% of patients. A diagnosis of kidney deficiency (or one of its three subtypes) was made for 33%-51% of patients. Other specific diagnoses were made for less than 20% of the patients. An average of 12-13 needles was used in each treatment. Although more than 85 different acupoints were used in each data set, only 5 or 6 acupoints were used in more than 20 of the treatments in each data set. Only two of those acupoints (UB23, UB40) were the same for both sources of data. More than half of the patients received adjunctive treatments, including heat (36%-67%), and cupping (16%-21%). There was substantial variability in treatments among providers. Such diversity will make it challenging to select a single treatment that has wide applicability. We recommend that researchers attempt to develop a treatment that is considered credible by expert acupuncturists and has broad features characteristic of patterns of common clinical practice.
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Affiliation(s)
- K J Sherman
- Northwest Institute of Acupuncture and Oriental Medicine, Seattle, WA, USA.
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Hogeboom CJ, Sherman KJ, Cherkin DC. Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists. Complement Ther Med 2001; 9:154-66. [PMID: 11926429 DOI: 10.1054/ctim.2001.0457] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess interrater reliability of Traditional Chinese Medicine (TCM) diagnosis and treatment of chronic low back pain. DESIGN Under a Latin square design, six TCM acupuncturists evaluated the same six patients on the same day. SETTING Northwest Institute of Acupuncture and Oriental Medicine, Seattle, Washington. INTERVENTIONS Assessment only. OUTCOME MEASURES TCM diagnosis, acupoint prescriptions, auxiliary treatment recommendations. RESULTS Twenty diagnoses and 65 acupoints were used at least once. The diagnosis of Qi/Blood Stagnation with Kidney Deficiency and the acupoint UB23 were used for every patient by most acupuncturists. However, consistency across acupuncturists regarding diagnostic details and other acupoints was poor. No diagnoses, and only one acupoint, were used preferentially for a subgroup of patients. Some diagnoses and treatment recommendations were dependent more on the practitioner than on the patient. Fine-grained diagnoses and most acupoints were unrelated to either patient or practitioner. CONCLUSIONS TCM diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely across practitioners. Acupuncture clinical trials using an individualized treatment arm may be difficult to replicate or evaluate because of low concordance among acupuncturists. Comparison of individualized treatment with a thoughtfully developed standardized approach is warranted to determine which, if either, is superior.
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Affiliation(s)
- C J Hogeboom
- Department of Epidemiology & Biostatistics, University of California-San Francisco, 94118, USA.
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Sherman KJ, Hogeboom CJ, Cherkin DC. How traditional Chinese medicine acupuncturists would diagnose and treat chronic low back pain: results of a survey of licensed acupuncturists in Washington State. Complement Ther Med 2001; 9:146-53. [PMID: 11926428 DOI: 10.1054/ctim.2001.0458] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This survey was undertaken to learn how Traditional Chinese Medicine acupuncturists' diagnose and treat patients with chronic low back pain in order to develop a standardized treatment for a clinical trial of that condition. DESIGN We surveyed a randomly selected group of 56 acupuncturists in Washington State, USA about styles of acupuncture they used for treating chronic low back pain, diagnoses made, and key features of treatment for this condition. RESULTS While substantial variability existed among practitioners, there was agreement on several broad features of treatment including: the use of local and distal acupuncture points (86% of practitioners), the use of acupuncture points on the meridians traversing the back (especially the UB meridian, 90%) the use of acupoints determined by palpation (82%), the importance of eliciting de qi (60%), and of providing up to eight treatments for achieving therapeutic results (79%). CONCLUSION The use of practitioner surveys can enhance the systematic development of acupuncture treatment protocols and should be part of this process in future clinical trials of common conditions.
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Affiliation(s)
- K J Sherman
- Northwest Institute of Acupuncture and Oriental Medicine, Seattle, Washington, USA.
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Alraek T, Aune A, Baerheim A. Traditional Chinese medicine syndromes in women with frequently recurring cystitis: frequencies of syndromes and symptoms. Complement Ther Med 2000; 8:260-5. [PMID: 11098202 DOI: 10.1054/ctim.2000.0399] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Frequently recurrent acute cystitis in adult women is common in Western medicine. In prophylactic treatment, women are treated between attacks of acute cystitis to prevent recurrences. A recent study has shown that acupuncture seems effective for prophylaxis. OBJECTIVES To describe the frequency of traditional Chinese medicine (TCM) syndromes found in females vulnerable to recurrent cystitis, and which symptoms most often form the basis for TCM diagnoses made in this condition. METHODS A descriptive study based on TCM diagnostic methods as used by experienced acupuncturists, and a questionnaire of symptoms used in TCM diagnostics. RESULTS Of 61 women with frequently recurring cystitis, 90% were diagnosed as having either a Spleen/Kidney yang xu/qi xu (54%), or a Liver qi stagnation (36%). Only 10% fell in other diagnostic groups. Of all symptoms noted, only three differed in frequency between the two main diagnostic groups: feeling cold (29/33 vs. 13/22, P<0.05), feeling tired (25/33 vs. 4/22, P<0.001), and having a preference for sweets (10/33 vs. 2/22, P<0.05). CONCLUSION Our findings have implications for TCM-based diagnostic work in females with recurrent cystitis, and also indicate that recurrent cystitis may be used as a case for further TCM research.
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Affiliation(s)
- T Alraek
- Bryggen Medical Centre, Bergen, Norway.
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