Exploring Outcomes Associated with Acupuncture

Validity and reliability of the measure yourself medical outcome profile 2 (MYMOP2) questionnaire among Turkish patients having anorectal disorders

BACKGROUND/AIMS

Measure Yourself Medical Outcome Profile 2 (MYMOP2) is a patient-generated outcome measure allowing patients to select the problems that are the most important to them and that they want to address, and it measures the effects of the problem from a wide range of health care interventions. This study aimed to translate the questionnaire into Turkish language (Turkish MYMOP-TMYMOP) and add this clinically useful measure to Turkish medical practice by assessing its validity and reliability.

MATERIALS AND METHODS

Fifty volunteers with anorectal disorders were prospectively included into the study. Each patient was enrolled into a pelvic floor training biofeedback program, specific to their anorectal symptomatology. The subjects were administered both the Nottingham Health Profile and the TMYMOP2 questionnaires before the treatment session (initial visit) and at the control follow-up visits (the first and second months, via e-mail or telephone calls).

RESULTS

The TMYMOP2 questionnaire was shown to be moderately valid (the Pearson correlation coefficient score between the total scores of the subgroups of the two questionnaires were 0.335 and 0.642, respectively, p<0.05) and highly reliable (the Cronbach's alfa coefficient score between the total scores of the subgroups of the two questionnaires were 0.77, 0.82, and 0.88 in the beginning and at the first and second month follow-up visits, respectively).

CONCLUSION

The TMYMOP2 was shown to be a low-to-moderately valid and a highly reliable scale. Because it is brief and short to complete, it might be an important and free-to-use tool to measure the diseases, and it can enhance the patient-centered care within the Turkish health care context.

Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand

INTRODUCTION

Clinic-based acupuncturists, midwives, and physiotherapists have reported using acupuncture to treat lumbopelvic pain in pregnancy, a common condition that may affect functioning and quality of life. To contribute to the emerging evidence on treatment outcomes, we collected patient-reported pain reduction data from women treated during pregnancy in a no-pay, hospital-based acupuncture service in New Zealand.

METHODS

Observational study of patient-reported symptom reduction.The main outcome measure was the MYMOP (Measure Your Medical Outcome Profile), a brief, validated self-report instrument. Open-ended questions on treatment experiences and adverse events were included.

RESULTS

Of the 81 women on whom we had complete treatment data, the majority (N = 72, 89%) reported clinically meaningful symptom reduction. Patient-reported adverse events were infrequent and mild.

DISCUSSION

Patient-reported and treatment-related lumbopelvic pain symptom reduction findings provide further evidence that acupuncture in pregnancy is safe and beneficial in a field setting. We discuss this study's unique contributions in providing guidance for clinicians who practice acupuncture in pregnancy, including midwives, physiotherapists, and physicians.

Measuring patient reported outcomes of acupuncture treatment on pain patients' health status

OBJECTIVES

The primary aim of this observational multicenter case series study was to assess patient reported outcome measures of health status following routine acupuncture treatment.

DESIGN

Via the patient reported 'MYMOP2-online' questionnaire 110 pain patients reported three times (baseline, after four weeks, after sixteen weeks) whether changes in health status occurred following un-standardized routine acupuncture treatment.

RESULTS

ANOVA for repeated measures showed that primary pain (-38.8%), secondary pain (-38.4%), limitation to daily functioning (-33.2%), subjective well-being (24.2%), and health status (34.0%) significantly improved between zero and four weeks (p < 0.001). The achieved health benefits persisted over the long term (sixteen weeks). Pain medication usage decreased by 44.5% in four weeks. The changes in health status could not be related to specific aspects of acupuncture treatment.

CONCLUSION

In this observational study pain patients self-reported a statistically significant and clinically relevant long-term improvement in health status following acupuncture treatments in routine practice.

Adjunctive Treatment of Psychotic Disorders with Micronutrients

OBJECTIVE

To evaluate the effect of micronutrients (minerals and vitamins) on adult psychosis when added to conventional medications by using a placebo-controlled randomized design with a 1-month open-label run-in.

DESIGN

Longitudinal comparison study following a randomized, controlled trial that had failed because participants declined to undergo randomization. Setting/Locations: Rural primary care and psychiatry clinic in northern New England (town of 16,000 people).

PARTICIPANTS

People older than age 18 years diagnosed with a psychotic disorder who were receiving medications.

INTERVENTION

Fifty consecutive clients seen in 1 month's time were invited to participate; 19 completed a 1-month open-label phase of the addition of a micronutrient to their medication regimen; all 19 then withdrew rather than risk randomization to a placebo. This finding itself was important, so the study was restructured to compare the response of those 19 patients during 24 months of micronutrients + medication to the response of the 31 people who declined participation, enriched by an additional 28 consecutive patients recruited over the second month of the study. This yielded a total of 59 patients who received medication without micronutrients.

OUTCOME MEASURES

All clients were evaluated with the Positive and Negative Symptom Scale and the Clinical Global Impression scale at study baseline and after 3, 6, 9, 12, 15, 18, and 24 months. Psychosis was confirmed with clinical interview by using Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, criteria. All participants had normal physical examinations and laboratory studies.

RESULTS

Outcomes were similar for both groups until 15 months, although the micronutrient group used significantly less antipsychotic medication throughout that time (p < 0.001). At 15 months, the micronutrients + medication group exhibited significantly fewer symptoms than the medication-only group, a difference that was even stronger at 24 months.

CONCLUSIONS

Micronutrients may appear to be a beneficial long-term, adjunctive strategy for people with psychotic disorders, allowing for smaller doses of medication to achieve the same effectiveness with fewer side effects.

Integration of Complementary and Alternative Medicine Therapies into Primary-Care Pain Management for Opiate Reduction in a Rural Setting

BACKGROUND

Opiates are no longer considered the best strategy for the long-term management of chronic pain. Yet, physicians have made many patients dependent on them, and these patients still request treatment. Complementary and alternative medicine (CAM) therapies have been shown to be effective, but are not widely available and are not often covered by insurance or available to the medically underserved.

METHODS

Group medical visits (GMVs) provided education about non-pharmacological methods for pain management and taught mindfulness techniques, movement, guided imagery, relaxation training, yoga, qigong, and t'ai chi. Forty-two patients attending GMVs for at least six months were matched prospectively with patients receiving conventional care.

RESULTS

No one increased their dose of opiates. Seventeen people reduced their dose, and seven people stopped opiates. On a 10-point scale of pain intensity, reductions in pain ratings achieved statistical significance (p = 0.001). The average reduction was 0.19 (95% confidence interval [CI] 0.12-0.60; p = 0.01). The primary symptom improved on average by -0.42 (95% CI -0.31 to -0.93; p = 0.02) on the My Medical Outcome Profile, 2nd version. Improvement in the quality-of-life rating was statistically significant (p = 0.007) with a change of -1.42 (95% CI = -0.59 to -1.62). In conventional care, no patients reduced their opiate use, and 48.5% increased their dose over the two years of the project.

CONCLUSIONS

GMVs that incorporated CAM therapies helped patients reduce opiate use. While some patients found other physicians to give them the opiates they desired, those who persisted in an environment of respect and acceptance significantly reduced opiate consumption compared with patients in conventional care. While resistant to CAM therapies initially, the majority of patients came to accept and to appreciate their usefulness. GMVs were useful for incorporating non-reimbursed CAM therapies into primary medical care.

Critical Review of Data Evaluation in Teaching Clinics of Traditional Chinese Medicine Outside China: Implications for Education

OBJECTIVES

The increasing acceptance of traditional Chinese medicine (TCM) worldwide has highlighted the importance of ensuring the provision of high-quality TCM clinical education. This clinical training should be partly guided by a robust assessment of patient data outcomes in TCM teaching clinics. We undertook a comprehensive literature review to examine the data evaluation in TCM teaching clinics outside China and its implications for TCM education.

METHODS

Literature was retrieved via MEDLINE (from 1946 to January 2015), EMBASE (from 1980 to February 2015), and Google Scholar for studies conducted outside China. The search was restricted to English articles reporting empirical findings related to the assessments of patient data in TCM teaching clinics, with implications for TCM education in countries other than China.

RESULTS

Only seven articles from six studies met the inclusion criteria. The characteristics and main symptoms of patients who received any TCM treatment in the context of teaching clinics among all included studies were similar. Symptom relief as well as a high level of patient satisfaction with TCM treatment were found in TCM teaching clinics. Conventional healthcare providers and other complementary practitioners were not the main source of referral to TCM practitioners but rather patients׳ friends/relatives. Patients received acupuncture treatment more frequently than treatments utilizing Chinese herbal medicine in teaching clinics. A standardized and consistent framework for patient records within TCM teaching clinics is currently lacking. There was no robust study which "translated" TCM clinic data evaluation findings into implications for TCM education and clinical training.

CONCLUSIONS

Recognizing that TCM evolves over time and its practice varies in different settings, there is an urgent need to conduct large-scale, rigorous evaluations of TCM clinic data to address the findings of our review, with the purpose of better informing TCM education and clinical training in countries beyond China. Expansions for scientific efforts supporting TCM education are essential to ensure that qualified TCM practitioners are able to provide safe, efficacious, and cost-effective TCM treatment modalities.

Introducing healing circles and talking circles into primary care

We report on the incorporation of a North American aboriginal procedure called "the talking circle" into primary care in areas serving this population. Communication is regulated through the passing of a talking piece (an object of special meaning or symbolism to the circle facilitator, who is usually called the circle keeper). Twelve hundred people participated in talking circles in which 415 attended 4 sessions and completed pre- and postquestionnaires. Outcome measures included baseline and end Measure Your Medical Outcome Profile version 2 forms. Participation in at least 4 talking circles resulted in a statistically significant improvement in reported symptoms and overall quality of life (p < 0.001 and effect sizes ranging from 0.75 to 1.19). The talking circle is a useful tool to use with Native Americans. It may be useful as a means to reduce health care costs by providing other alternative settings to deal with stress-related and other life problems.

Lessons from an acupuncture teaching clinic: patient characteristics and pain management effectiveness

OBJECTIVES

To understand the following about patients using an acupuncture teaching clinic: (1) sociodemographic characteristics and main complaints and (2) self-reported level of patient-centered outcomes regarding pain management.

METHODS/DESIGN

Retrospective chart review.

SUBJECTS

A total of 458 new patients at NESA clinic during October 1, 2009 to July 31, 2010 were enrolled in the study.

INTERVENTIONS

A variety of styles of Oriental medicine, primarily Chinese and Japanese style acupuncture and also heat treatments (MOXA or heat lamps) and Tui Na (Asia bodywork).

RESULTS

Results from Objective 1 were descriptive (n = 421). Objective 2 focused on the 59 patients from the larger sample who completed both an initial and a follow-up Measure Your Medical Outcome Profile (MYMOP) form and who used acupuncture for pain management of (1) diseases of the musculoskeletal system and/or connective tissue or (2) migraine/headache. Both the symptom severity and activity of daily living/well-being scales of the MYMOP showed over 15.8% improvement from baseline to at least six weeks of treatment: 28.6% for Symptom 1, 19.4% for Symptom 2, 35.7% for activities of daily living, and 25.0% for well-being. The relative majority for each sociodemographic trait investigated were as follows: female, about 40 years old, white, not Hispanic or Latino, married, highly educated, and employed. Most patients were confident in acupuncture treatment. Out of the 421 acupuncture patients, 68.2% wanted acupuncture in order to manage pain. Overall, 20.6% of the patients (59, N = 287) who used acupuncture for pain management for diseases of the musculoskeletal system and/or connective tissue or migraine or headache completed the sixth-week follow-up MYMOP form. Of these patients, 57.6% (34, N = 59) returned during week 6 of the semester for acupuncture treatment and reported clinical improvement in at least one MYMOP severity score, and no score got worse.

CONCLUSIONS

The information about sociodemographic characteristic and patient-centered outcomes of pain management can be used for service provision, future study planning, and marketing. Future studies should address the low follow-up rate, the quality of self-reported clinic data, and the reasons that patients chose acupuncture treatments and teaching clinics.

A brief patient-reported outcome instrument for primary care: German translation and validation of the Measure Yourself Medical Outcome Profile (MYMOP)

BACKGROUND

Measure Yourself Medical Outcome Profile (MYMOP) is a patient-generated outcome instrument capable of measuring effects from a wide range of health care interventions. This paper reports the translation of this instrument into German (MYMOP-D) and the assessment of validity and sensitivity to change for the MYMOP-D. The instrument was piloted in a German primary care context.

METHODS

The translation process was conducted according to international guidelines. Recruited patients of both general practitioners and non-medical Complementary and Alternative Medicine (CAM) practitioners ("Heilpraktiker") in the German state of Baden-Wuerttemberg completed a questionnaire comprised of the MYMOP-D and the EQ-5D. Responses were analysed to assess construct validity. For assessing the instrument's sensitivity to change, patients received the MYMOP-D again after four weeks at which point they were also asked for their subjective views on change of symptoms. Correlation between MYMOP-D and EQ-5D and sensitivity to change as gradient in score change and as standardized response mean (SRM) were calculated.

RESULTS

476 patients from general practices and 91 patients of CAM practitioners were included. Construct validity of the MYMOP-D was given with a correlation of r = .47 with the EQ-5D. Sensitivity to change for subjective change of symptoms could only be analysed for improvement or no change of symptoms, as only 12 patients reported deterioration of symptoms. Results showed the expected smooth gradient with 2.2, 1.3, and 0.5 points of change for large, little improvement and no change, respectively. SRM for MYMOP-D Profile Score was 0.88.

CONCLUSIONS

The MYMOP-D shows excellent construct validity. It is able to detect changes when symptoms in patients improve or remain unchanged. Deterioration of symptoms could not be evaluated due to too few data. With its brevity and simplicity, it might be an important tool for enhancing patient-centred care in the German health care context.

Acupuncture and meditation for military veterans: first steps of quality management and future program development

Veterans of all war eras have a high rate of chronic disease, mental health disorders, and chronic multi-symptom illnesses (CMI).(1-3) Many veterans report symptoms that affect multiple biological systems as opposed to isolated disease states. Standard medical treatments often target isolated disease states such as headaches, insomnia, or back pain and at times may miss the more complex, multisystem dysfunction that has been documented in the veteran population. Research has shown that veterans have complex symptomatology involving physical, cognitive, psychological, and behavioral disturbances, such as difficult to diagnose pain patterns, irritable bowel syndrome, chronic fatigue, anxiety, depression, sleep disturbance, or neurocognitive dysfunction.(2-4) Meditation and acupuncture are each broad-spectrum treatments designed to target multiple biological systems simultaneously, and thus, may be well suited for these complex chronic illnesses. The emerging literature indicates that complementary and integrative medicine (CIM) approaches augment standard medical treatments to enhance positive outcomes for those with chronic disease, mental health disorders, and CMI.(5-12.)

The effectiveness of acupuncture in the treatment of Gulf War Illness

INTRODUCTION

It can be challenging to study complex and novel health states within the parameters of a RCT. This report describes the use of an unblinded Phase II Clinical Trial design to investigate the effectiveness of acupuncture in the treatment of Gulf War Illness (GWI). GWI is a complex illness found among veterans of the first Gulf War, and is characterized by multiple symptoms, including fatigue, sleep and mood disturbances, cognitive dysfunction, and musculoskeletal pain. No published trials of acupuncture for the treatment of GWI exist. This trial is designed to both answer questions of the effectiveness of acupuncture for our entire sample, as well as subgroups with of individual presentations of GWI.

MATERIALS AND METHODS

Our primary outcome is quality of life as measured by the SF-36. In an effort to better understand this complex disease and its treatment, our multi-level measurement plan examines psychosocial variables, fatigue, sleep quality, pain, and biomarkers of inflammation and immune status. All of the measurement instruments used in this trial show good validity and reliability.

RESULTS

This study is ongoing and clinical results are not available. We have achieved good feasibility of our recruitment, treatment, and data collection procedures.

CONCLUSIONS

Low constraint RCT designs are an appropriate choice when investigating conditions in which the causes and mechanisms of disease are poorly understood. This naturalistic RCT includes individualized protocols, a clinically supported length and dose of treatment, a wait list control arm, and the ethical benefit that all subjects receive treatment during the study.

Use of the measure your medical outcome profile (MYMOP2) and W-BQ12 (Well-Being) outcomes measures to evaluate chiropractic treatment: an observational study

Background

The objective was to assess the use of the Measure Yourself Medical Outcome Profile (MYMOP2) and W-BQ12 well-being questionnaire for measuring clinical change associated with a course of chiropractic treatment.

Methods

Chiropractic care of the patients involved spinal manipulative therapy (SMT), mechanically assisted techniques, soft tissue therapy, and physiological therapeutic devices.

Outcome measures used were MYMOP2 and the Well-Being Questionnaire 12 (W-BQ12).

Results

Statistical and clinical significant changes were demonstrated with W-BQ12 and MYMOP2.

Conclusions

The study demonstrated that MYMOP2 was responsive to change and may be a useful instrument for assessing clinical changes among chiropractic patients who present with a variety of symptoms and clinical conditions.

Research on integrative healthcare: context and priorities

It is important that integrative healthcare research be conducted to optimize the effectiveness, safety, costs, and social and economic impact of prospective, personalized, patient-centered, comprehensive, and holistic healthcare that focuses on well-being as well as disease management, and that the research itself be well understood. The scope of this research extends beyond evaluation of specific therapies, to include evaluations of multimodality whole system intervention, practitioner-patient relationships, patient goals and priorities, promoting self-care and resilience, personalized diagnostic and therapeutic measures, practitioner well-being, the comparative effectiveness of different educational and outreach strategies in improving health and healthcare, and the environmental/social causes and consequence of health and healthcare. In this paper, we describe the state of the science of research on integrative healthcare, research needs, and opportunities offered by cutting-edge research tools. We propose a framework for setting priorities in integrative health research, list areas for discussion, and pose a few questions on a future research agenda.

Using Chinese version of MYMOP in Chinese medicine evaluation: validity, responsiveness and minimally important change

Background

Measure Yourself Medical Outcome Profile (MYMOP) is a patient generated outcome instrument applicable in the evaluation of both allopathic and complementary medicine treatment. This study aims to adapt MYMOP into Chinese, and to assess its validity, responsiveness and minimally important change values in a sample of patients using Chinese medicine (CM) services.

Methods

A Chinese version of MYMOP (CMYMOP) is developed by forward-backward-forward translation strategy, expert panel assessment and pilot testing amongst patients. 272 patients aged 18 or above with subjective symptoms in the past 2 weeks were recruited at a CM clinic, and were invited to complete a set of questionnaire containing CMYMOP and SF-36. Follow ups were performed at 2^nd and 4^th week after consultation, using the same set of questionnaire plus a global rating of change question. Criterion validity of CMYMOP was assessed by its correlation with SF-36 at baseline, and responsiveness was evaluated by calculating the Cohen effect size (ES) of change at two follow ups. Minimally important difference (MID) values were estimated via anchor based method, while minimally detectable difference (MDC) figures were calculated by distribution based method.

Results

Criterion validity of CMYMOP was demonstrated by negative correlation between CMYMOP Profile scores and all SF-36 domain and summary scores at baseline. For responsiveness between baseline and 4^th week follow up, ES of CMYMOP Symptom 1, Activity and Profile reached the moderate change threshold (ES>0.5), while Symptom 2 and Wellbeing reached the weak change threshold (ES>0.2). None of the SF-36 scores reached the moderate change threshold, implying CMYMOP's stronger responsiveness in CM setting. At 2^nd week follow up, MID values for Symptom 1, Symptom 2, Wellbeing and Profile items were 0.894, 0.580, 0.263 and 0.516 respectively. For Activity item, MDC figure of 0.808 was adopted to estimate MID.

Conclusions

The findings support the validity and responsiveness of CMYMOP for capturing patient centred clinical changes within 2 weeks in a CM clinical setting. Further researches are warranted (1) to estimate Activity item MID, (2) to assess the test-retest reliability of CMYMOP, and (3) to perform further MID evaluation using multiple, item specific anchor questions.

The development of a prospective data collection process in a traditional Chinese medicine teaching clinic

OBJECTIVE

There is a growing need for students and practitioners of Traditional Chinese Medicine to gain experience with standardized data collection, patient outcomes measurement, and practice-based research. The purpose of this paper is to describe the development of a process for standardized data collection that could eventually be adopted for clinical, research, and quality assurance purposes.

SETTINGS/LOCATION

The setting for this study was an acupuncture and Oriental medicine teaching clinic in Bloomington, Minnesota.

METHODS

Four (4) aspects of data collection were assessed and improved, including intake and post-treatment questionnaires, follow-up with patients, integration of data collection into clinic flow, and commitment of resources to the project.

OUTCOME MEASURES

The outcomes measures were data collection and missing data rates, burden on patients and clinic staff, and efficiency of data entry.

RESULTS

Revision to the data collection process resulted in decreased burden to patients and staff, more detailed and aggressive follow-up protocols, enhanced training for clinic staff, and increased personnel and data-related resources.

CONCLUSIONS

The systematic collection of descriptive and clinical characteristics can be accomplished in a teaching clinic with thoughtful attention paid to data collection protocols, dedicated resources, and the involvement of all relevant personnel.

Patient outcomes at a traditional Chinese medicine teaching clinic: a prospective data collection project

OBJECTIVE

The purpose of this study was to describe patients who seek treatment at an acupuncture and Oriental medicine teaching clinic in the United States, and to systematically measure and describe patients' responses after treatment using a prospective study design.

DESIGN

This is a prospective survey of clinic patients at intake and one month following the initial treatment. SETTINGS AND LOCATION: Data were collected in an acupuncture and Oriental medicine teaching clinic located in Bloomington, Minnesota.

SUBJECTS

Of 661 new patients who met eligibility criteria, 485 consented to participate.

INTERVENTIONS

Patients were administered two self-report questionnaires: one prior to their initial treatment, and a second sent by mail one month later.

OUTCOME MEASURES

Data collected at intake included demographics such as age, gender, race, ethnicity, education, and employment, as well as main presenting complaint and chronicity. Patients were also asked at intake whether they had consulted with another health care provider, if they were under continued care, and if they had previous experience with Traditional Chinese Medicine (TCM) treatment. Outcome measures included severity, improvement, and satisfaction. Patients were additionally asked if they continued with TCM care for their presenting condition.

RESULTS

Demographics of patients presenting to this teaching clinic were similar to those reported in other outpatient TCM settings. The majority of patients had no previous experience with TCM, and a large percentage was referred by students. Pain was the most common presenting condition, followed closely by wellness care. One month following treatment, most patients reported improvement and satisfaction with care.

CONCLUSIONS

Standardized data collection and follow-up resulted in a description of patients and outcomes in an acupuncture and Oriental medicine teaching clinic, which can be used for research, educational, quality assurance, and marketing purposes.