Influence of the patient-practitioner interaction context on acupuncture outcomes in functional dyspepsia: study protocol for a multicenter randomized controlled trial

Influence of patient-clinician relationship style on acupuncture outcomes in functional dyspepsia: A multi-site randomized controlled trial in Korea

INTRODUCTION

Research suggests that a warm and empathic "patient-centered" patient-clinician relationship produces better clinical outcomes when compared with a more neutral "disease-centered" relationship. Acupuncturists performed both styles of therapy for patients with functional dyspepsia in Korea.

METHODS

The present randomized controlled trial assigned patients (n = 73) to identical acupuncture treatment with either patient-centered augmented care or disease-centered limited care. The Korean version of the Nepean Dyspepsia Index (NDI-K) was the primary outcome measure. Secondary outcome measures included Consultation And Relational Empathy (CARE) scale.

RESULTS

Both groups showed improvement in NDI-K. Patient-centered augmented acupuncture produced less effective symptom improvement compared to disease-centered limited acupuncture (NDI-K sum score and frequency; P = 0.008 and P = 0.037 respectively). CARE scores were higher for the augmented versus limited group (P = 0.001), supporting the fidelity of the experimentally controlled patient/clinician relationship. There were no significant differences between the groups in any of other secondary outcomes.

CONCLUSION

Patients demonstrated greater improvement following acupuncture conducted with a more neutral, "disease-centered" style of relationship. This result is counter to similar research conducted in Western countries and suggests that cultural factors can significantly shape optimum styles of acupuncture therapy.

PRACTICE IMPLICATIONS

Clinicians should consider cultural differences when applying acupuncture therapy.

The role of psychological factors in functional gastrointestinal disorders: a systematic review and meta-analysis

PURPOSE

To systematically reevaluate the role of psychological factors in functional gastrointestinal disorders (FGIDs) and thus provide a scientific basis for the psychological treatment of FGIDs.

METHODS

A literature search was conducted using the PubMed, Embase, Web of Science, and Cochrane Library databases from January 2018 to August 2022 for researches on psychological factors affecting patients with functional gastrointestinal disorders. Meta-analysis was carried out with Stata17.0 after the screening, extraction, and evaluation of article quality.

RESULTS

The search included 22 articles with 2430 patients in the FGIDs group and 12,397 patients in the healthy controls. Meta-analysis showed anxiety [(pooled SMD = 0.74, 95%CI: 0.62 ~ 0.86, p < 0.000) (pooled OR = 3.14, 95%CI: 2.47 ~ 4.00, p < 0.000)], depression [(pooled SMD = 0.79, 95%CI: 0.63 ~ 0.95, p < 0.000) (pooled OR = 3.09, 95%CI: 2.12 ~ 4.52, p < 0.000)], mental disorders (pooled MD =  -5.53, 95%CI: -7.12 ~  -3.95, p < 0.05), somatization (pooled SMD = 0.92, 95%CI: 0.61 ~ 1.23, p < 0.000), and sleep disorders (pooled SMD = 0.69, 95%CI: 0.04 ~ 1.34, p < 0.05) are risk factors for functional gastrointestinal disorders.

CONCLUSION

There is a significant association between psychological factors and FGIDs. Interventions such as anti-anxiety drugs, antidepressants, and behavioral therapy are of great clinical significance in reducing FGIDs risk and improving prognosis.

Patients' Expectancies to Acupuncture: A Systematic Review

Objective: This systematic review aimed to document and describe how and when to assess patients' expectancies to acupuncture and the relationship between patients' expectancies and clinical effects. Materials and Methods: Three English databases, including PubMed, Cochrane Central Register of Controlled Trials, and EMBASE, and four Chinese databases, including the Chinese Biomedicine Literature Database, Chinese Journal Full-text Database, Chinese Scientific Journal Full-text Database, and Wanfang Database, were searched up to February 2020. Studies involving patients' expectancies to acupuncture were included. Based on the detailed situations of patients' expectancies, we made a standardized data extraction table that included the basic information of articles, study design details, and measurement of expectations. Based on the data, a descriptive analysis was performed, covering the characteristics of studies, measuring methods of expectations and the relationship between patients' expectancies and clinical effects. Methodology quality assessment was also performed by the risk of bias and the standards for reporting interventions in controlled trials of acupuncture. Results: There were 61 randomized controlled trials included in our analysis. The number of articles increased gradually over time and grew significantly after 2008. About half of trials focused on pain alleviation. Expectancies were measured before the treatment (N = 43), after the treatment (N = 3), and both before and after the treatment (N = 10), and five studies did not mention it. The measurement of expectancies used self-made questionnaires or scales (N = 27), the Acupuncture Expectations Scale (N = 6), and other scales (N = 11), while 17 studies did not describe what scale they used. The used questionnaires or scales mostly tried to ascertain the strength of confidence that acupuncture would help. Patients' expectancies and clinical effects were relevant in 19 studies, irrelevant in 21 studies, and were not mentioned in 21 studies. Conclusions: Patients' expectations to acupuncture have received increasing attention in recent years, but there is still no recognized measurement time and methods. It is critical to develop questions and answers regarding patients' expectations with better discrimination and reliability to accurately assess expectations and to explore the relationship between patients' expectations and acupuncture outcomes in future trials.

Evaluation of effects of sleep disorders on anxiety, depression, and lower gastrointestinal symptoms in elderly patients with functional dyspepsia based on brain-intestinal axis theory

BACKGROUND

Functional dyspepsia (FD) is a common disease in elderly patients, which is prone to relapse and seriously affects the physical and mental health of patients. Brain-intestinal interaction disorder is the main cause of FD, and most of FD patients are accompanied by different degrees of sleep disorders, anxiety, depression, and other negative psychology. At present, there are few studies on sleep disorders, anxiety, depression, and lower gastrointestinal symptoms in elderly FD patients.

AIM

To investigate the effects of sleep disorders on anxiety, depression, and lower gastrointestinal symptoms in elderly patients with FD based on the brain-intestinal axis theory.

METHODS

A total of 236 elderly patients with FD diagnosed based on the Roman Ⅳ criteria at our hospital from February 2017 to September 2019 were included in this study. Different scales were used to evaluate digestive tract symptom severity, sleep quality, and anxiety and depression.

RESULTS

Among 214 elderly FD patients, 103 (48.13%) had sleep disorders and 182 (85.05%) had anxiety and depression. In elderly FD patients with sleep disorders, the incidences of lower abdominal pain, abdominal discomfort, sheep dung-like or hard feces, difficulty in defecation, feeling of incomplete defecation, and urgent need for defecation were 35.92%, 33.98%, 21.36%, 32.04%, 43.69%, and 27.18%, respectively, all of which were significantly higher those of elderly FD patients with no sleep disorder (P < 0.05). The self-rating anxiety scale score of elderly FD patients with sleep disorders was 65.34 ± 7.29 and the self-rating depression scale score was 66.17 ± 8.26, both of which were significantly higher than those of elderly FD patients without sleep disorders (P < 0.05).

CONCLUSION

Sleep disorders, anxiety, and depression are often present in elderly FD patients, and sleep disorders are closely related to lower gastrointestinal symptoms in elderly FD patients.

Quality of life and its influencing factors in elderly patients with functional dyspepsia in a tertiary hospital in Jinhua

BACKGROUND

Functional dyspepsia (FD) is a clinically common disease that mainly occurs in middle-aged and elderly patients. It is now believed that mental factors and somatization are risk factors affecting the quality of life of elderly FD patients. Because of the uneven distribution of medical resources in China, the quality of life in elderly Chinese patients with FD is insufficiently understood. Therefore, analyzing the factors influencing their quality of life is particularly necessary.

AIM

To explore the quality of life and its influencing factors in elderly patients with FD in a tertiary hospital in Jinhua.

METHODS

A total of 134 elderly patients with FD admitted to our hospital from June 2017 to August 2019 were selected as study subjects. Quality of life scale, mental and psychological status scale, and health behavior self-efficacy scale were used for evaluations, and the factors influencing the quality of life of elderly FD patients were analyzed.

RESULTS

The total score of the Functional Digestive Disorders Quality of Life (FDDQL) questionnaire in the elderly patients with FD was 57.62 ± 8.16; the score of daily activities was least influenced (75.48 ± 7.23), while the score of healthy feeling was most seriously influenced (45.61 ± 9.57), followed by the score of disease control (47.38 ± 10.36). FDDQL scores differed significantly between patients with different genders, Self-rating Anxiety Scale (SAS) scores, Self-rating Depression Scale (SDS) scores, self-efficacy, drinking history, disease course, residence, symptom severity, mood self-regulation, and regular exercise (P < 0.05 or P < 0.01), but did not between patients with different body mass indexes (BMI). FDDQL scores were positively correlated with gender, self-efficacy, BMI, drinking history, disease course, residence, and regular exercise (r = 0.147-0.215, P < 0.05), but negatively correlated with SAS and SDS scores, symptom severity, and mood self-regulation [r = -0.765-(-0.284), P < 0.05]. Multiple regression analysis showed that anxiety, symptom severity, disease course, self-efficacy, and depression were the factors influencing the quality of life of elderly FD patients.

CONCLUSION

There are many factors affecting the quality of life of elderly FD patients, with anxiety, severity of symptoms, course of disease, self-efficacy, and depression being important risk factors. Reasonable intervention targeting the above risk factors should be taken to improve the quality of life of these patients in clinical work.

Individual Differences in Responsiveness to Acupuncture: An Exploratory Survey of Practitioner Opinion

Background: Previous research has considered the impact of personal and situational factors on treatment responses. This article documents the first phase of a four-stage project on patient characteristics that may influence responsiveness to acupuncture treatment, reporting results from an exploratory practitioner survey. Methods: Acupuncture practitioners from various medical professions were recruited through professional organisations to complete an online survey about their demographics and attitudes as well as 60 questions on specific factors that might influence treatment. They gave categorical (“Yes”, “No”, and “Don’t know”) and free-text responses. Quantitative and qualitative (thematic) analyses were then conducted. Results: There were more affirmative than negative or uncertain responses overall. Certain characteristics, including ability to relax, exercise and diet, were most often considered relevant. Younger and male practitioners were more likely to respond negatively. Limited support was found for groupings between characteristics. Qualitative data provide explanatory depth. Response fatigue was evident over the course of the survey. Conclusions: Targeting and reminders may benefit uptake when conducting survey research. Practitioner characteristics influence their appreciation of patient characteristics. Factors consistently viewed as important included ability to relax, exercise and diet. Acupuncture practitioners may benefit from additional training in certain areas. Surveys may produce more informative results if reduced in length and complexity.