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Benson J, Fry L, Rychel J. Use of Rehabilitation Therapy in Palliative Care Patients. Vet Clin North Am Small Anim Pract 2023; 53:897-919. [PMID: 37019719 DOI: 10.1016/j.cvsm.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Palliative care is a unique area of veterinary medicine, where primary goals include maintaining quality of life, as opposed to treating with a curative intent. Using the disablement model and client partnership allows for the development of a function-targeted treatment plan individualized to patient and family needs. Rehabilitation modalities, especially when combined with adaptive pain management, are well-suited to palliative care because they can greatly enhance a patient's ability to achieve improved function and quality of life. These areas join in a concept called palliative rehabilitation which combines the unique needs of these patients and the tools accessible to the rehabilitation practitioner.
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Affiliation(s)
- Jeret Benson
- Doctor of Veterinary Medicine, Red Sage Integrative Veterinary Partners, 1006 Luke Street, Fort Collins, CO 80524, USA
| | - Lindsey Fry
- Doctor of Veterinary Medicine and Diplomate of the American College of Veterinary, Sports Medicine and Rehabilitation, 1006 Luke Street, Fort Collins, CO 80524, USA
| | - Jessica Rychel
- Doctor of Veterinary Medicine and Diplomate of the American College of Veterinary, Sports Medicine and Rehabilitation, 1006 Luke Street, Fort Collins, CO 80524, USA.
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Oberoi D, Reed EN, Piedalue KA, Landmann J, Carlson LE. Exploring patient experiences and acceptability of group vs. individual acupuncture for Cancer-related pain: a qualitative study. BMC Complement Med Ther 2022; 22:155. [PMID: 35698124 PMCID: PMC9190111 DOI: 10.1186/s12906-022-03600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
Background Individual acupuncture (AP) is a safe and effective treatment for cancer-related pain and other symptoms in cancer survivors. However, access to individual AP is limited, and costs can be prohibitive. Group AP could be a more cost-effective alternative as it is less expensive and non-inferior to individual AP for pain relief. Despite growing evidence in favour of group AP, patient acceptability and experience of group AP in cancer patients is relatively unknown. This exploratory study sought to compare patient experiences and acceptability of group versus individual AP in cancer patients. Methods Semi-structured, open-ended, in-depth interviews were conducted in a subset of 11 cancer patients enrolled in a randomized non-inferiority trial of group vs. individual AP for cancer pain. Participants for this study were recruited via purposive sampling, aiming for diversity in age, sex, education, employment, cancer types, and treatment arms. Data was analyzed using inductive thematic analysis. Results Two major themes were identified: a) overall experience of AP treatment b) value of AP. Participants across both treatment arms acknowledged improvement in pain, quality of sleep, mood and fatigue. Participants in the group AP arm reported a significant increase in perceived social support, while participants in the individual arm valued privacy and one-on-one interaction with the acupuncturist. Although some participants in the group arm had privacy-related concerns before the commencement of the program, these concerns waned after a few AP sessions. Participants across both the treatment arms reported cordial clinician-patient relationship with the acupuncturist. Willingness to pursue AP treatment in the future was comparable across both the treatment arms and was limited by out-of-pocket costs. Conclusion Patient acceptability and experience of treatment in group AP was on par with individual AP. Group AP may further augment perceived social support among patients and privacy concerns, if any, subside after a few sessions. Trial registration ClinicalTrials.gov (NCT03641222). Registered 10 July 2018 - Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03600-6.
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Vázquez-Justes D, Yarzábal-Rodríguez R, Doménech-García V, Herrero P, Bellosta-López P. Effectiveness of dry needling for headache: A systematic review. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:806-815. [PMID: 35659858 DOI: 10.1016/j.nrleng.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache. METHODS We performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers. RESULTS Of a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes. CONCLUSIONS Dry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.
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Affiliation(s)
- D Vázquez-Justes
- Departamento de Neurología, Hospital Universitari Arnau Vilanova, Lleida, Spain
| | | | - V Doménech-García
- Universidad San Jorge, Grupo de investigación iPhysio, Villanueva de Gállego, Zaragoza, Spain
| | - P Herrero
- Universidad San Jorge, Grupo de investigación iPhysio, Villanueva de Gállego, Zaragoza, Spain.
| | - P Bellosta-López
- Universidad San Jorge, Grupo de investigación iPhysio, Villanueva de Gállego, Zaragoza, Spain
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4
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Weagle K, Henneberry RJ, Atkinson P. Pneumothorax Following Acupuncture. Cureus 2021; 13:e14207. [PMID: 33948398 PMCID: PMC8086747 DOI: 10.7759/cureus.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Pneumothorax, the accumulation of air between the visceral and parietal pleurae, represents a potentially serious cause of chest pain in patients presenting to the emergency department. While there are known risk factors for spontaneous pneumothorax, in rare cases dry needling and acupuncture, forms of complementary and alternative medicine, have been known to result in pneumothorax. We present a case of a 38-year-old healthy female who presented with acute onset of pleuritic chest pain to the Emergency Department. On further history, it was discovered that she had received dry needling acupuncture for unrelated back pain the day prior to presentation. She was initially investigated with an electrocardiogram (ECG), which was unremarkable, and point of care ultrasound (POCUS), which showed absent lung sliding and the presence of a lung point on the right side, indicative of pneumothorax. This case describes the key features of pneumothorax on POCUS and how POCUS can be a valuable tool in the diagnosis of lung pathologies and highlights the importance of considering the rare but potentially serious complications of complementary and alternative medicine practices which are typically regarded as safe.
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Affiliation(s)
| | | | - Paul Atkinson
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN.,Emergency Medicine, Dalhousie University, Halifax, CAN
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5
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Primeau CA, Zomar BO, Somerville LE, Joshi I, Giffin JR, Marsh JD. Health Economic Evaluations of Hip and Knee Interventions in Orthopaedic Sports Medicine: A Systematic Review and Quality Assessment. Orthop J Sports Med 2021; 9:2325967120987241. [PMID: 34262974 PMCID: PMC8243245 DOI: 10.1177/2325967120987241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The economic burden of musculoskeletal diseases is substantial and growing. Economic evaluations compare costs and health benefits of interventions simultaneously to help inform value-based care; thus, it is crucial to ensure that studies are using appropriate methodology to provide valid evidence on the cost-effectiveness of interventions. This is particularly the case in orthopaedic sports medicine, where several interventions of varying costs are available to treat common hip and knee conditions. PURPOSE To summarize and evaluate the quality of economic evaluations in orthopaedic sports medicine for knee and hip interventions and identify areas for quality improvement. STUDY DESIGN Systematic review; Level of evidence, 3. METHODS The Medline, AMED, OVID Health Star, and EMBASE databases were searched from inception to March 1, 2020, to identify economic evaluations that compared ≥2 interventions for hip and/or knee conditions in orthopaedic sports medicine. We assessed the quality of full economic evaluations using the Quality of Health Economic Studies (QHES) tool, which consists of 16 questions for a total score of 100. We classified studies into quartiles based on QHES score (extremely poor quality to high quality) and we evaluated the frequency of studies that addressed each of the 16 QHES questions. RESULTS A total of 93 studies were included in the systematic review. There were 41 (44%) cost analyses, of which 21 (51%) inappropriately concluded interventions were cost-effective. Only 52 (56%) of the included studies were full economic evaluations, although 40 of these (77%) fell in the high-quality quartile. The mean QHES score was 83.2 ± 19. Authors consistently addressed 12 of the QHES questions; questions that were missed or unclear were related to statistical uncertainty, appropriateness of costing methodology, and discussion of potential biases. The most frequently missed question was whether the cost perspective of the analysis was stated and justified. CONCLUSION The number of studies in orthopaedic sports medicine is small, despite their overall good quality. Yet, there are still many highly cited studies based on low-quality or partial economic evaluations that are being used to influence clinical decision-making. Investigators should follow international health economic guidelines for study design and critical appraisal of studies to further improve quality.
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Affiliation(s)
- Codie A. Primeau
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Bryn O. Zomar
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | | | - Ishita Joshi
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - J. Robert Giffin
- Bone and Joint Institute, Western University, London, Ontario, Canada
- London Health Sciences
Centre, University Hospital, London, Ontario, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacquelyn D. Marsh
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
- London Health Sciences
Centre, University Hospital, London, Ontario, Canada
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6
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Vázquez-Justes D, Yarzábal-Rodríguez R, Doménech-García V, Herrero P, Bellosta-López P. Effectiveness of dry needling for headache: A systematic review. Neurologia 2020; 37:S0213-4853(19)30144-6. [PMID: 31948718 DOI: 10.1016/j.nrl.2019.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/15/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache. METHODS We performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers. RESULTS Of a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes. CONCLUSIONS Dry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.
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Affiliation(s)
- D Vázquez-Justes
- Departamento de Neurología, Hospital Universitari Arnau Vilanova, Lleida, España
| | | | - V Doménech-García
- Universidad San Jorge, Grupo de investigación iPhysio, Villanueva de Gállego, Zaragoza, España
| | - P Herrero
- Universidad San Jorge, Grupo de investigación iPhysio, Villanueva de Gállego, Zaragoza, España.
| | - P Bellosta-López
- Universidad San Jorge, Grupo de investigación iPhysio, Villanueva de Gállego, Zaragoza, España
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Fenocchi L, Riskowski JL, Mason H, Hendry GJ. A systematic review of economic evaluations of conservative treatments for chronic lower extremity musculoskeletal complaints. Rheumatol Adv Pract 2019; 2:rky030. [PMID: 31431975 PMCID: PMC6649923 DOI: 10.1093/rap/rky030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/19/2018] [Indexed: 11/12/2022] Open
Abstract
Objective The aim was to appraise and synthesize studies evaluating the clinical and cost effectiveness of conservative interventions for chronic lower extremity musculoskeletal (MSK) conditions and describe their characteristics, including the type of economic evaluation, primary outcomes and which conditions. Methods The search strategy related to economic evaluations of lower limb MSK conditions that used conservative therapies. Eight electronic databases were searched (CENTRAL, MEDLINE, PubMed, EMBASE, CINAHL, PEDro, NHSEED and Proquest), as were the reference lists from included articles. The quality of articles was appraised using a modified version of the economic evaluations’ reporting checklist (economic) and The Cochrane Collaboration’s tool for assessing risk of bias (clinical). Results Twenty-six studies were eligible and included in the review. Economic evaluations of conservative interventions for OA or pain affecting the knee/hip (n = 25; 93%) were most common. The main approaches adopted were cost–utility analysis (n = 17; 68%) or cost–effectiveness analysis (n = 5; 19%). Two studies involved interventions including footwear/foot orthoses; for heel pain (n = 1; 4%) and overuse injuries (n = 1; 4%). Fifty per cent of economic evaluations adopted the EQ-5D-3L as the primary outcome measure for quality of life and quality-adjusted life year calculations. Conclusion Economic evaluations have been conducted largely for exercise-based interventions for MSK conditions of the hip and knee. Few economic evaluations have been conducted for other clinically important lower limb MSK conditions. A matrix presentation of costs mapped with outcomes indicated increasing costs with either no difference or improvements in clinical effectiveness. The majority of economic evaluations were of good reporting quality, as were the accompanying clinical studies.
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Affiliation(s)
- Linda Fenocchi
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University.,Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK
| | - Jody L Riskowski
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University
| | - Helen Mason
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK
| | - Gordon J Hendry
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University
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8
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White A, Kawakita K. The Evidence on Acupuncture for Knee Osteoarthritis – Editorial Summary on the Implications for Health Policy. Acupunct Med 2018. [DOI: 10.1136/aim.24.suppl.71] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Decisions on whether a health service should provide a particular treatment are based on the evidence on three questions: 1) whether the treatment can work, ie it is biologically active; 2) whether the treatment is safe and effective in daily practice; and 3) whether it is economically worthwhile. Evidence presented at the Kyoto conference shows that acupuncture for osteoarthritis of the knee has a biological effect, has a large clinical effect in practice, has negligible risk, and has a cost effectiveness which is well within the usual acceptable limit. On the present evidence, acupuncture is likely to offer an alternative to treatment with non-steroidal anti-inflammatory drugs (NSAIDs).
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Affiliation(s)
| | - Kenji Kawakita
- Department of Physiology Meiji University of Oriental Medicine Japan
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9
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Abstract
The NICE Osteoarthritis Guideline Development Group (GDG) has been challenged for not using the available acupuncture evidence in the most appropriate manner in three crucial areas. This response explains the methods used by the GDG with particular reference to the economic analysis, and illustrates that the methods used were those most appropriate for developing a NICE clinical guideline. The cost-effectiveness conclusions made by the GDG are supported by the currently available evidence.
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10
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Kjaer P, Kongsted A, Hartvigsen J, Isenberg-Jørgensen A, Schiøttz-Christensen B, Søborg B, Krog C, Møller CM, Halling CMB, Lauridsen HH, Hansen IR, Nørregaard J, Jørgensen KJ, Hansen LV, Jakobsen M, Jensen MB, Melbye M, Duel P, Christensen SW, Povlsen TM. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2242-2257. [PMID: 28523381 DOI: 10.1007/s00586-017-5121-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE To summarise recommendations about 21 selected non-surgical interventions for recent onset (<12 weeks) non-specific neck pain (NP) and cervical radiculopathy (CR) based on two guidelines from the Danish Health Authority. METHODS Two multidisciplinary working groups formulated recommendations based on the GRADE approach. RESULTS Twelve recommendations were based on evidence and nine on consensus. Management should include information about prognosis, warning signs, and advise to remain active. For treatment, guidelines suggest different types of supervised exercise and manual therapy; combinations of exercise and manual therapy before medicine for NP; acupuncture for NP but not CR; traction for CR; and oral NSAID (oral or topical) and Tramadol after careful consideration for NP and CR. CONCLUSION Recommendations are based on low-quality evidence or on consensus, but are well aligned with recommendations from guidelines from North America. The working groups recommend intensifying research relating to all aspects of management of NP and CR.
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Affiliation(s)
- Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. .,Evidence, Education and Emergency Services, The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark.
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Evidence, Education and Emergency Services, The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Alexander Isenberg-Jørgensen
- Centre for Spine Surgery and Research, Spine Centre of Southern Denmark, Hospital Lillebaelt, Østre Houghvej 55, 5500, Middelfart, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Hospital Lillebaelt, Østre Houghvej 55, 5500, Middelfart, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense M, Denmark
| | - Bolette Søborg
- Evidence, Education and Emergency Services, The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark
| | - Charlotte Krog
- Københavns Fysioterapi I/S, J. E. Ohlsens Gade 2, 1, th, 2100, København Ø, Denmark
| | | | - Christine Marie Bækø Halling
- Evidence, Education and Emergency Services, The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark.,KORA, the Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150, Copenhagen K, Denmark
| | - Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Inge Ris Hansen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jesper Nørregaard
- Centre for Rheumatology and Spine Diseases, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Karsten Juhl Jørgensen
- Evidence, Education and Emergency Services, The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark.,The Nordic Cochrane Centre, Rigshospitalet, 7811, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Lars Valentin Hansen
- Spine Unit, Department of Ortopaedic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Marie Jakobsen
- Evidence, Education and Emergency Services, The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark.,KORA, the Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150, Copenhagen K, Denmark
| | - Martin Bach Jensen
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7,1, 9220, Aalborg Ø, Denmark
| | - Martin Melbye
- Aalborg Spine Clinic, Aalborg Rygklinik, Vingaardsgade 9, 9000, Aalborg, Denmark
| | - Peter Duel
- Neurosurgical Department, Aarhus University Hospital, Nørrebrogade, 8000, Aarhus C, Denmark
| | - Steffan W Christensen
- Department of Health Science and Technology, SMI®, Aalborg University, Aalborg, Denmark.,Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Tina Myung Povlsen
- Evidence, Education and Emergency Services, The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark.,Research and Test Center for Health Technologies. Rigshospitalet, Nordre Ringvej 57. Opgang 8, 5.sal., 2600, Glostrup, Denmark
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Abstract
BACKGROUND Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic. OBJECTIVES To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005. SELECTION CRITERIA We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models. MAIN RESULTS Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I2 = 20%). Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence. AUTHORS' CONCLUSIONS Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.
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Affiliation(s)
- Kien Trinh
- McMaster UniversityDeGroote School of Medicine, Office of MD Admissions1200 Main Street WestMDCL‐3112HamiltonCanadaL8N 3Z5
| | - Nadine Graham
- McMaster UniversitySchool of Rehabilitation Science1200 Main Street WestHamiltonCanada
| | - Dominik Irnich
- University of MunichDepartment of AnesthesiologyPettenkofertsrasse 8 AMunichGermanyD‐80336
| | - Ian D Cameron
- Kolling Institute, Northern Sydney Local Health DistrictJohn Walsh Centre for Rehabilitation ResearchSt LeonardsAustralia2065
| | - Mario Forget
- National Defence/Défense Nationale, Government of Canada/Gouvernement du CanadaCanadian Forces Health Services Group/Groupe de Services de Santé des Forces Canadiennes33 Canadian Forces Health Services Centre/33ième Centre de Services de Santé des Forces CanadiennesKingstonCanadaK7K 7B4
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12
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Abstract
BACKGROUND Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic. OBJECTIVES To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005. SELECTION CRITERIA We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models. MAIN RESULTS Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I(2) = 20%). Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence. AUTHORS' CONCLUSIONS Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.
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Affiliation(s)
- Kien Trinh
- DeGroote School of Medicine, Office of MD Admissions, McMaster University, 1200 Main Street West, MDCL-3112, Hamilton, ON, Canada, L8N 3Z5
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Godwin J. Rising to the Challenges of Evidence-Based Medicine: A Way Forward for Acupuncture. J Altern Complement Med 2014; 20:805-9. [DOI: 10.1089/acm.2014.0213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kielczynska BB, Kligler B, Specchio E. Integrating acupuncture in an inpatient setting. QUALITATIVE HEALTH RESEARCH 2014; 24:1242-52. [PMID: 25079502 DOI: 10.1177/1049732314544969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Acupuncture, a licensed health care profession in the United States, is poorly integrated into the American health care system, despite the evidence of its effectiveness. The purpose of this study was to offer a phenomenological description of the experience of acupuncturists who delivered acupuncture care in a tertiary teaching hospital in New York City. We analyzed data using methodology proposed by Colaizzi and identified four major clusters of themes: (a) acupuncturists' excitement about practicing in a hospital setting and frustration about organizational obstacles to effective acupuncture integration; (b) pride in being holistic practitioners; (c) attempts to preserve the holism and effectiveness of acupuncture while adjusting to the limitations of an inpatient setting, and (d) acupuncturists' realization that the medical staff knew very little about acupuncture and "it's all about trust." Practitioners of other healing traditions and therapies might find our study helpful in their own efforts toward similar integration.
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Kim SY, Lee H, Chae Y, Park HJ, Lee H. A Systematic Review of Cost-Effectiveness Analyses Alongside Randomised Controlled Trials of Acupuncture. Acupunct Med 2012; 30:273-85. [DOI: 10.1136/acupmed-2012-010178] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarise the evidence on the cost-effectiveness of acupuncture. Methods We identified full economic evaluations such as cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) alongside randomised controlled trials (RCTs) that assessed the consequences and costs of acupuncture for any medical condition. Eleven electronic databases were searched up to March 2011 without language restrictions. Eligible RCTs were assessed using the Cochrane criteria for risk of bias and a modified version of the checklist for economic evaluation. The general characteristics and the results of each economic analysis such as incremental cost-effectiveness ratios (ICERs) were extracted. Results Of 17 included studies, nine were CUAs that measured quality-adjusted life years (QALYs) and eight were CEAs that assessed effectiveness of acupuncture based on improvements in clinical symptoms. All CUAs showed that acupuncture with or without usual care was cost-effective compared with waiting list control or usual care alone, with ICERs ranging from ¢3011/QALY (dysmenorrhoea) to ¢22 298/QALY (allergic rhinitis) in German studies, and from £3855/QALY (osteoarthritis) to £9951/QALY (headache) in UK studies. In the CEAs, acupuncture was beneficial at a relatively low cost in six European and Asian studies. All CUAs were well-designed with a low risk of bias, but this was not the case for CEAs. Conclusions Overall, this review demonstrates the cost-effectiveness of acupuncture. Despite such promising results, any generalisation of these results needs to be made with caution given the diversity of diseases and the different status of acupuncture in the various countries.
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Affiliation(s)
- Song-Yi Kim
- STAR (Studies of Translational Acupuncture Research), Acupuncture and Meridian Science Research Center (AMSRC), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyangsook Lee
- STAR (Studies of Translational Acupuncture Research), Acupuncture and Meridian Science Research Center (AMSRC), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Younbyoung Chae
- STAR (Studies of Translational Acupuncture Research), Acupuncture and Meridian Science Research Center (AMSRC), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Meridian and Acupoint, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hi-Joon Park
- STAR (Studies of Translational Acupuncture Research), Acupuncture and Meridian Science Research Center (AMSRC), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Meridian and Acupoint, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Carolina Asia Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hyejung Lee
- STAR (Studies of Translational Acupuncture Research), Acupuncture and Meridian Science Research Center (AMSRC), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Meridian and Acupoint, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Doran CM, Chang DHT, Kiat H, Bensoussan A. Review of economic methods used in complementary medicine. J Altern Complement Med 2011; 16:591-5. [PMID: 20804369 DOI: 10.1089/acm.2008.0404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this research is to review the economic methods used in complementary medicine (CM). METHOD A comprehensive literature review was undertaken (1995-2007) to identify peer-reviewed articles related to economic methods used in CM. RESULTS The literature found 15 full economic evaluations of CM: 3 in the manipulative and body-based practices, 5 in the whole medical systems, and 7 in the biologically based practices. No evaluations were identified for the areas of mind-body medicine, alternative medical systems, or energy medicine. The review failed to locate any articles that used alternate economic methods such as contingent valuation or discrete choice modelling. The overall consensus from the 15 economic evaluations, despite variations in project design and methodological rigor, was that CM, as evaluated in these studies, was cost-effective compared to usual care. CONCLUSIONS As health care costs continue to rise, decision makers, both consumers and policymakers, must allocate scarce resources toward those treatments that offer the best value for the money. Considerable scope exists to advance the science behind CM through a more systematic integration of economic methods into CM research.
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Affiliation(s)
- Christopher M Doran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Straiton N. The relevance of childhood developmental factors to the efficacy of acupuncture on the affective component of back pain. Acupunct Med 2009; 27:180-2. [PMID: 19942726 DOI: 10.1136/aim.2009.001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There is substantial evidence to support the use of acupuncture in the treatment of low back pain. The main predictors of chronic low back pain are non-medical and psychosocial. The understanding of how acupuncture can modulate the pain experience has recently been enhanced by the elucidation of the role of C fibre afferents on the limbic system. C fibre deactivation of the limbic system can only occur in the presence of intact corticosubcortical neuronal pathways. The normal development of these pathways is determined by social factors in the early years of life. The effect of acupuncture treatment for low back pain may be determined by successful relationships between the mother and child in the first 18 months of life.
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Abstract
BACKGROUND Acupuncture is often used for migraine prophylaxis but its effectiveness is still controversial. This review (along with a companion review on 'Acupuncture for tension-type headache') represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library. OBJECTIVES To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with migraine. SEARCH STRATEGY The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. SELECTION CRITERIA We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (no prophylactic treatment or routine care only), a sham acupuncture intervention or another intervention in patients with migraine. DATA COLLECTION AND ANALYSIS Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (outcome of primary interest), migraine attacks, migraine days, headache days and analgesic use. Pooled effect size estimates were calculated using a random-effects model. MAIN RESULTS Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a 'true' acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably. AUTHORS' CONCLUSIONS In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
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Affiliation(s)
- Klaus Linde
- Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universitaet Muenchen, Wolfgangstr. 8, Munich, Germany, 81667.
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Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial. Pain 2008; 137:405-412. [DOI: 10.1016/j.pain.2007.10.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 09/06/2007] [Accepted: 10/01/2007] [Indexed: 11/22/2022]
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