Abstract
BackgroundEvidence on the impact of expectancy on acupuncture treatment response is conflicting.ObjectivesThis secondary analysis of a randomized sham-controlled trial on acupuncture for menopausal hot flashes investigated whether treatment expectancy score was associated with hot flash score at end-of-treatment. Secondary analyses investigated whether there were associations between other pre-specified factors and hot flash score.Study designWomen experiencing moderately-severe hot flashes were randomized to receive 10 sessions of real or sham acupuncture over eight weeks. Hot flash score was collected using a seven-day hot flash diary, and expectancy using the modified Credibility and Expectancy Questionnaire immediately after the first treatment. Linear mixed-effects models with random intercepts were used to identify associations between expectancy score and hot flash score at end-of-treatment. Regression was also used to identify associations between pre-specified factors of interest and hot flash score. Because there was no difference between real and sham acupuncture for the primary outcome of hot flash score, both arms were combined in the analysis.Results285 women returned the Credibility and Expectancy Questionnaire, and 283 women completed both expectancy measures. We found no evidence for an association between expectancy and hot flash score at end-of-treatment for individual cases in either acupuncture or sham group. Hot flash scores at end-of-treatment were 8.1 (95%CI, 3.0 to 13.2; P = 0.002) points lower in regular smokers compared to those who had never smoked, equivalent to four fewer moderate hot flashes a day.ConclusionIn our study of acupuncture for menopausal hot flashes, higher expectancy after the first treatment did not predict better treatment outcomes. Future research may focus on other determinants of outcomes in acupuncture such as therapist attention. The relationship between smoking and hot flashes is poorly understood and needs further exploration.
Highlights
Acupuncture is a Chinese medical intervention that involves the insertion of fine metal needles into specified areas of the body
We found no evidence for an association between expectancy and hot flash score at end-of-treatment for individual cases in either acupuncture
This is an a priori planned secondary analysis of data from a randomized controlled trial (RCT) that investigated the effects of acupuncture compared to sham on menopausal hot flashes
Summary
Acupuncture is a Chinese medical intervention that involves the insertion of fine metal needles into specified areas of the body. Several large meta-analyses of acupuncture for painful conditions have demonstrated that acupuncture produces small specific effects and considerable non-specific effects [1,2,3]. Critics of acupuncture assert that its clinical response is by and large due to high expectations of the patients[4]. The empirical evidence for or against the influence of expectancy on acupuncture treatment outcome is contradictory. Treatment expectancy can have a positive or negative impact on treatment outcome and is a major contributor to the placebo response[6]. Expectations may vary according to individual understanding about the illness, treatment, and experiences with past treatments, and may change over the course of treatment [5]. Evidence on the impact of expectancy on acupuncture treatment response is conflicting
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