Abstract
BackgroundAcupuncture is increasingly being used for many conditions including chronic neck pain. However the evidence remains inconclusive, indicating the need for further well-designed research. The aim of this study was to conduct a pilot randomised controlled parallel arm trial, to establish key features required for the design and implementation of a large-scale trial on acupuncture for chronic neck pain.MethodsPatients whose GPs had diagnosed neck pain were recruited from one general practice, and randomised to receive usual GP care only, or acupuncture (up to 10 treatments over 3 months) as an adjunctive treatment to usual GP care. The primary outcome measure was the Northwick Park Neck Pain Questionnaire (NPQ) at 3 months. The primary analysis was to determine the sample size for the full scale study.ResultsOf the 227 patients with neck pain identified from the GP database, 28 (12.3%) consenting patients were eligible to participate in the pilot and 24 (10.5%) were recruited to the trial. Ten patients were randomised to acupuncture, receiving an average of eight treatments from one of four acupuncturists, and 14 were randomised to usual GP care alone. The sample size for the full scale trial was calculated from a clinically meaningful difference of 5% on the NPQ and, from this pilot, an adjusted standard deviation of 15.3%. Assuming 90% power at the 5% significance level, a sample size of 229 would be required in each arm in a large-scale trial when allowing for a loss to follow-up rate of 14%. In order to achieve this sample, one would need to identify patients from databases of GP practices with a total population of 230,000 patients, or approximately 15 GP practices roughly equal in size to the one involved in this study (i.e. 15,694 patients).ConclusionThis pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial, which in turn will help to clarify the existing evidence base on acupuncture for neck pain.
Highlights
Acupuncture is increasingly being used for many conditions including chronic neck pain
White and Ernst [6] documented the poor quality of the reviewed trials, none of which scored full points on the quality assessment used in the review
These findings are reinforced by White et al [7], who discouraged further reviews on the subject, and argued instead that "the focus must be on conducting more clinical trials" of good quality, a view echoed by others in the field [6,8,9,10]
Summary
Acupuncture is increasingly being used for many conditions including chronic neck pain. The aim of this study was to conduct a pilot randomised controlled parallel arm trial, to establish key features required for the design and implementation of a large-scale trial on acupuncture for chronic neck pain. White and Ernst [6] documented the poor quality of the reviewed trials, none of which scored full points on the quality assessment used in the review These findings are reinforced by White et al [7], who discouraged further reviews on the subject, and argued instead that "the focus must be on conducting more clinical trials" of good quality, a view echoed by others in the field [6,8,9,10]
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