Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists

Abstract

Objectives: To assess interrater reliability of Traditional Chinese Medicine (TCM) diagnosis and treatment of chronic low back pain. Design: Under a Latin square design, six TCM acupuncturists evaluated the same six patients on the same day. Setting: Northwest Institute of Acupuncture and Oriental Medicine, Seattle, Washington. Interventions: Assessment only. Outcome measures: TCM diagnosis, acupoint prescriptions, auxiliary treatment recommendations. Results: Twenty diagnoses and 65 acupoints were used at least once. The diagnosis of Qi/Blood Stagnation with Kidney Deficiency and the acupoint UB23 were used for every patient by most acupuncturists. However, consistency across acupuncturists regarding diagnostic details and other acupoints was poor. No diagnoses, and only one acupoint, were used preferentially for a subgroup of patients. Some diagnoses and treatment recommendations were dependent more on the practitioner than on the patient. Fine-grained diagnoses and most acupoints were unrelated to either patient or practitioner. Conclusions: TCM diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely across practitioners. Acupuncture clinical trials using an individualized treatment arm may be difficult to replicate or evaluate because of low concordance among acupuncturists. Comparison of individualized treatment with a thoughtfully developed standardized approach is warranted to determine which, if either, is superior.