Parental attitudes toward acupuncture in a community sample

Barriers and Facilitators to Integrating Acupuncture into the U.S. Health Care System: A Scoping Review

Background: Acupuncture is a widely practiced complementary and integrative health modality that has multiple clinical applications. The use of acupuncture in the United States is rapidly increasing. Although studies have shown the efficacy and effectiveness of acupuncture for various ailments, the integration of acupuncture into the U.S. health care system remains a challenge. Little is known about the factors affecting this integration. Objective: To provide a systematic review of the barriers and facilitators affecting the integration of acupuncture into the U.S. health care system. Methods: Four electronic databases were searched. Three independent reviewers were involved in the screening and data charting processes. Findings were synthesized and categorized into four levels based on the Social Ecological Model. Results: A total of 22 studies were included in the final review. The barriers and facilitators affecting the integration of acupuncture were mapped into four levels (individual, interpersonal, organizational, and policy). The most frequently reported barriers and facilitators were mapped into the Social Ecological Model constructs within the "Individual" level (i.e., beliefs and attitudes of acupuncture, and practical issues) and the "Organizational" level (i.e., credentialing, space and facility, referral system). Conclusion: This review has identified and synthesized the breadth of evidence on the barriers and facilitators to the integration of acupuncture into the U.S. health care system. Results of this review will guide future implementation studies to develop and test implementation strategies to integrate acupuncture into the U.S. health care system.

Placebo by proxy expectations toward acupuncture change over time: a survey comparing parental expectations to acupuncture pre- and postoperatively

Background

Patients entering a treatment have expectancy to outcome based on their previous experience, the information received, and the credibility of the treatment. Once the treatment has started, patients may detect and interpret contextual cues and somatic state. Influenced and conditioned by positive or negative interpretations, their reappraisal may improve or worsen the treatment outcome. The aims were to investigate whether parental pre-treatment expectancies towards acupuncture differ compared to post-treatment expectancies, and assess predictors for possible change of parental expectancy. Further, we wanted to explore whether the change correlates with the treatment outcome, i.e. postoperative vomiting in children.

Methods

Two hundred and eighty-two parents completed per- and 24 h postoperatively a survey on their expectancy to acupuncture treatment for alleviation of postoperative vomiting in children. The survey was embedded in a randomised controlled trial.

Results

Parental expectancy to acupuncture treatment changed over time. The changes were predicted by several variables such as children’s gender, parents’ age and education, previous experiences, and assignment to treatment group. The strongest predictor was parental anxiety to their child undergoing surgery. Further, the change of parental expectancy was correlated with postoperative vomiting.

Conclusions

Anxious parents are prone to change their expectancy in a positive direction during the treatment period, which in turn may improve treatment outcome. Acupuncture therapists in clinical practice should pay a special attention to the potential that lies here, and acknowledge parental anxiety as a possible facilitator, and not a barrier, to elicit placebo by proxy effects. Further research to expand the findings of the present study into other treatments is in order. Future research should also provide more knowledge about how parental expectancy changes over time, and how different factors predict and produce change of parental expectancy.

Trial registration

ClinicalTrials.gov NCT01729052. Registered November 20, 2012.

Electronic supplementary material

The online version of this article (10.1186/s12906-018-2248-z) contains supplementary material, which is available to authorized users.

Perception of acupuncture among users and nonusers: A qualitative study

This study uses a qualitative methodology to examine the perception of acupuncture among users and nonusers. Altogether 37 participants, age 35 or older, were interviewed. Participants' perception of advantages and disadvantages of adopting acupuncture, and their criteria in selecting acupuncturists, were collected. Results found that among the user group, acupuncture was perceived as being effective, having little side effects, and generating lasting impact. Among nonusers, acupuncture was perceived as lacking a clinical base, high risk, and nonstandardized. Nonusers had less confidence in acupuncture than biomedicine. Participants relied on social communication and the practitioner's professional qualifications in choosing acupuncturists. Marketing implications are discussed.

Placebo by Proxy--the Influence of Parental Anxiety and Expectancy on Postoperative Morbidities in Children

BACKGROUND

Placebo effects emerging from expectancies of relatives, also known as placebo by proxy, is a rather unexplored field. In this study, we assume a correlation between parental anxiety/expectancy and postoperative morbidities in children. Accordingly, a reduction of parental anxiety is expected to enhance the effect of treatment.

METHODS

From October 2012 to June 2013, parents of 282 children completed a self-report closed-ended questionnaire embedded in a main RCT at three ambulatory care centers.

RESULTS

There were no significant associations between parental expectancy or anxiety and children experiencing vomiting and pain.

CONCLUSION

The present study is the first to investigate placebo by proxy in acupuncture treatment for children. The findings were not able to demonstrate any placebo effect by proxy. Unknown confounders and limitations of methods may have contributed to the negative findings. Thus, the findings must be read with precaution, as the possibility of a type II error cannot be excluded.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01729052.

Attitudes toward acupuncture in Hong Kong

Purpose

– This paper aims at describing and exploring how consumers perceive acupuncture as a medical treatment in relation to biomedicine.

Design/methodology/approach

– Data were collected through an online survey using quota sampling. The attitudes of 879 Hong Kong residents aged 20 or above were surveyed. Questions were generated from a previous focus group study.

Findings

– Factor analysis found that attitude toward acupuncture consisted of five underlying dimensions, including trust in biomedicine, risks versus benefits, cure and effectiveness, qualification and skills of acupuncturists, side effects and costs and severe aftereffects. Lack of trust in acupuncturists and perceived inferiority of acupuncture to biomedicine were the major barriers of public acceptance of acupuncture. Perceived strengths of acupuncture identified were not involving taking medicine, fewer side effects and being good for preventive care.

Research limitations/implications

– This study used a convenience sample recruited through personal networks, so the findings cannot automatically be generalized to the rest of the population.

Practical implications

– There is a need to build trust in the therapy and the reputation of acupuncturists through better communication of the profession’s qualification and accreditation system, as well as dissemination of clinical evidence on a long-term basis. Consumers need to be better educated about the sensations to be expected during acupuncture and the criteria for selecting an acupuncturist.

Originality/value

– This has been the first quantitative study focusing on Hong Kong consumers’ perceptions of acupuncture.

Acupuncture for Pediatric Pain

Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed.

The current acceptance, accessibility and recognition of Chinese and Ayurvedic medicine in the United States in the public, governmental, and industrial sectors

To assess the current level of acceptance in the United States of complementary and alternative medicine, recent research into the prevalence, acceptance, accessibility, and recognition of complementary and alternative therapies were reviewed. Several signs point to an increasing acceptance of complementary and alternative medicine in the United States; the use of complementary and alternative medicine is significantly increasing, many aspects of Chinese medicine and Ayurveda are becoming mainstream, practitioners in the United States are beginning to be licensed, and insurance companies are beginning to cover some complementary and alternative therapies. Remaining challenges to true acceptance include the restrictive Western mindset, the absence of published studies, a lack of consistent manufacturing processes and quality standards, and a fear of adulteration. Although the field still faces many challenges, alternative and complementary medicine, including Chinese medicine and Ayurvedic medicine, is becoming more accepted and accessible in the United States.