Acupuncture Practitioners Research Articles

Acupuncture therapy related cardiac injury

Cardiac injury is the most serious adverse event in acupuncture therapy. The causes include needling chest points near the heart, the cardiac enlargement and pericardial effusion that will enlarge the projected area on the body surface and make the proper depth of needling shorter, and the incorrect needling method of the points. Therefore, acupuncture practitioners must be familiar with the points of the heart projected area on the chest and the correct needling methods in order to reduce the risk of acupuncture therapy related cardiac injury.

Characteristics of Female and Male Visitors to Practitioners of Acupuncture in the HUNT3 Study

Characteristics of female and male visitors to practitioners of acupuncture were investigated in a large cross-sectional adult population in Central Norway. A total population health survey, HUNT3, conducted in 2008 with 50,827 respondents provided the data. Demographic variables, lifestyle, health, and use of conventional medicine were analyzed using multivariable logistic regression models. The one year prevalence of visiting a practitioner of acupuncture was 5.7% for females and 2.2% for males. Visitors of both genders were five times more likely to have had somatic complaints in the preceding year and were 2-3 times more likely to report poor global health than female or male non-visitors. Also, visitors of both genders were more likely to do hard physical activities every week, and they were less likely to live alone or be daily smokers. Further, female visitors were characterized by having higher education and were more likely to have a paid job than other females. Corresponding differences were not seen among males. Age showed limited associations with being a visitor, and for females only. Valid for both genders, our findings draw a picture of visitors to acupuncture treatment as persons who actively contribute to promoting their health through lifestyle choices of physical activity and non-smoking while simultaneously having worse global health and higher burdens of somatic complaints than other adults. In contrast to males, it is suggested that females may be more dependent on personal income, as indicated by higher education and being in a paid job, in choosing acupuncture treatment in addition to conventional medicine.

P03.17. A fellowship program for CAM providers in evidence informed geriatrics

Purpose Elderly residents in long term care (LTC) settings experience a myriad of health complaints that may be amenable to complementary and alternative medicine (CAM) therapies. However, specialized training addressing the unique features of geriatric health care, particularly in LTC settings, will be required if CAM professionals are to play a meaningful role. The purpose of this presentation is to describe an evidence informed geriatric fellowship program at a CAM institution which educates acupuncture, chiropractic and massage therapy practitioners.

P05.12. The formation of scholars: doctoral education in the field of acupuncture and Asian medicine

Purpose Practitioners of acupuncture and Asian medicine have begun to engage in doctoral education, however the impact of doctoral level education on this medicinal discipline is yet to be fully evaluated. This research examines three graduated cohorts and assesses the impact of doctoral education on clinical practice, employment, integrated health care settings and professionalism. This research surveys and interviews Asian Medicine practitioners that completed the doctoral program at the American College of Traditional Chinese Medicine (ACTCM) in San Franciso, CA. ACTCM began its first doctoral cohort in fall 2006. The 2.5 year Doctor of Acupuncture and Oriental Medicine (DAOM) program is offered 4 days a month (Friday through Monday), in an intensive format basis. It is a case-based program, focusing on practical and advanced knowledge and skills, collaboration with other health care practitioners, and scholarly activities. So far ACTCM has graduated three cohorts: 2009, 2010 and 2011 with a total of 36 alumni.

P04.04. Identifying the evidence gaps in acupuncture, experiences of an international project: good practice in traditional Chinese medicine (GP-TCM)

Methods An online survey to a purposive sample of acupuncture practitioners in the EU and China in 2010/2011 requested information on demographic characteristics, training and education, acupuncture practice, conditions commonly treated, perceived gaps in the evidence and where research should next focus. Data were analysed using bivariate statistics in SPSS, with content analysis of qualitative data.

Acupuncture points are large fields: The fuzziness of acupuncture point localization by doctors in practice

Acupuncture textbooks, schools, practitioners and clinical researchers designing randomized controlled trials on acupuncture all assume that acupuncture points are small and must be located precisely. Seventy-one medical doctors with ≥200 h acupuncture training and ≥2 years of clinical experience independently identified 23 commonly used acupuncture points on a male volunteer, using sticky transparent films with an X/Y grid placed asymmetrically around acupuncture points. For each acupuncture point, the field covering 95% (68%) of all point locations varied from 2.7 (0.7) cm(2) for PC-6 up to 41.4 (10.2) cm(2) for ST-38. Commonly-used acupuncture points showed unexpectedly large variance in location: 95% (or 68%) areas were SP-6: 12.2 cm(2) (3.0 cm(2) ), ST-36: 20.7 cm(2) (5.1 cm(2) ), LI-15: 18.7 cm(2) (4.6 cm(2) ), BL-23: 22.4 cm(2) (5.6 cm(2) ) and BL-54: 22.5 cm(2) (5.6 cm(2) ). Points close to anatomical landmarks (forearm, ankle, poplitea; BL-60, BL-40, TW-5, PC-6) were located with less variance. Precision of point location was independent of length of acupuncture experience, kind of training or medical specialty. In respect to the high degree of variation in the localization of acupuncture points, we suggest that the term 'acupuncture field' is more appropriate than 'acupuncture points' to describe the clinical reality; for the design of sham-controlled acupuncture trials, we recommend a minimum distance of 6 cm between verum and sham points on face, hands and feet, and up to 12 cm for all other parts of the body.

Cómo se trata globalmente la patología reumática con acupuntura según los criterios diagnósticos avanzados

Treatment of rheumatic disease based on advanced diagnostic criteria (ADC) allows acupuncture to be optimized as a medical procedure. The essential and eminently practical physiological foundations of ADC are based on the interpretation and updating of the therapeutic principles of Traditional Chinese Medicine. The focus of rheumatic diseases through global ADC stresses the pathogenesis of the underlying internal disorders. These systemic alterations favor the development of rheumatic disorders and, in particular, their chronification over time, a characteristic of these diseases. For all these reasons, effective acupuncture practitioners cannot overlook a global therapeutic vision of rheumatic patients.

Communication about self-care in traditional acupuncture consultations: The co-construction of individualised support and advice

ObjectiveTo analyse the co-construction of self-care advice in traditional acupuncture consultations. MethodAnalysis of 27 audio-recorded and transcribed consultations, involving 7 practitioners, augmented by integrating the data from 15 patient interviews and regular practitioner discussions. ResultsSelf-care talk was initiated equally by practitioner and patient, and was threaded through and between acupuncture consultations. It involved interactive discussions that were interwoven with other types of talk, especially life-world and acupuncture talk. Practitioner engagement in self-care talk appeared to increase with experience. The self-care talk was co-constructed within the context of a relationship that was characterised by continuity, mutuality and trust. ConclusionSelf-care support and advice was integral to the practice of traditional acupuncture and individualised in terms of the patient's life-world and/or the Chinese medicine diagnosis. The co-construction of self-care talk did not replicate the asymmetry of conventional medical consultations. Practice implicationsThe active participation of both patients and acupuncture practitioners in self-care talk may be related to professional practice that is underpinned by a holistic theory base such as Chinese medicine and is delivered in the context of therapeutic relationships based on continuity, mutuality and trust. These findings may inform professional education and the design of multi-disciplinary care pathways.

Book Review: Chinese Scalp Acupuncture

Chinese Scalp Acupuncture, though written primarily as a clinic manual for practitioners of acupuncture, would be very interesting reading for neurologists, physical therapists, occupational therapists, veterans hospital administrators, and any other specialists who work in any capacity with patients suffering from brain injuries, neurological diseases, chronic debilitating pain, or neuro-psychological disorders such as post-traumatic stress disorder (PTSD).The authors are passionate about acupuncture and wish not only to train as many practitioners as possible in its uses and techniques but also to increase both public and professional awareness of the power of scalp acupuncture in treating conditions that many medical practitioners consider to have few if any treatment options. Their enthusiasm for their work and caring for their patients is palpable throughout the book.

Exploring practice characteristics and research priorities of practitioners of traditional acupuncture in China and the EU—A survey

Ethnopharmacological relevanceAcupuncture practice is based on the theoretical, historical and philosophical principles, which are part of Chinese medicine. Traditional acupuncture practitioners assess their patients’ conditions using Chinese medicine diagnostic techniques, which determine clinical care and treatment. Little is known about differences in the perceptions of research evidence among practitioners in the European Union (EU) and China, given the diversity of acupuncture practice. Material and methodsThis study explored differences between practitioners of traditional acupuncture regarding perceived need for research evidence and prioritisation for future clinical trials, based on their practice within the EU and China.A convenience sample of acupuncturists in the EU (contacted by their professional organisation) and China (from geographically dispersed hospitals) were invited to participate in a survey, which was conducted during 2010/2011. Data collected included: practitioners’ demographic details, country of training, practice setting, acupuncture techniques, perceived adverse event reporting, diagnostic methods, conditions commonly treated, conditions perceived as needing more evidence and practitioner perceptions of conditions which could demonstrate benefit if investigated in clinical trials. ResultsFrom 1126 survey responses, 1020 (559 EU, 461 China) could be included in the analysis for direct comparison. A response rate for the EU could not be calculated but for China was 98%. Pain was the most frequently reported commonly treated condition by EU acupuncturists and neurological conditions (mainly stroke) for Chinese practitioners. The top reported priorities for research were obstetrics/gynaecological conditions in the EU and neurological problems in China. ConclusionThe survey identified differences in practice and training between acupuncturists in China and the EU and between EU member states. These differences may inform prioritisation of health conditions for future trials. Innovative research methods are recommended to incorporate the complexity and plurality of acupuncture practice and theory. Creation of collaborative networks is crucial in overcoming these differences to facilitate international, multi-centre clinical trials.

Patient safety incidents from acupuncture treatments: A review of reports to the National Patient Safety Agency

Acupuncture is frequently employed to treat chronic pain syndromes or other chronic conditions. Nevertheless, there is a growing literature on adverse events (AEs) from treatments including pneumothorax, cardiac tamponade and spinal cord injury. Acupuncture is provided in almost all NHS pain clinics and by an increasing number of GP's and physiotherapists. Considering acupuncture's popularity, its safety has become an important public health issue. To evaluate the harm caused to patients through acupuncture treatments within NHS organisations. The National Reporting and Learning System (NRLS) database was searched for incidents reported from 1st January 2009 to 31st December 2011. The free text fields of all reports received from all healthcare settings and specialties were searched for the keyword 'acupuncture'. All relevant incidents were reviewed to provide a qualitative theme of the harm to patients. 468 patient safety incidents were identified; 325 met our inclusion criteria for analysis. Adverse events reported include retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), Bruising or soreness at needle site (2%), Pneumothorax (1%) and other adverse reactions (12%). The majority (95%) of the incidents were categorised as low or no harm. A number of AEs are recorded after acupuncture treatments in the NHS but the majority is not severe. However, miscategorisation and under-reporting may distort the overall picture. Acupuncture practitioners should be aware of, and be prepared to manage, any significant harm from treatments.

Acupuncture Use among American Adults: What Acupuncture Practitioners Can Learn from National Health Interview Survey 2007?

This paper examined the National Health Interview Survey (NHIS) 2007 and explored acupuncture users sociodemographics characteristics, reasons and the nature of acupuncture use, and the relationship of such use with conventional medical care. All individuals who completed adults core interviews (N = 23,393) were included. Three subsets of samples (nonuser, former user, and recent user) were used in the analysis performed in Stata. Our findings revealed that ever acupuncture user (including former and recent user) increased from 4.2% to 6.3% of the population, representing 8.19 million and 14.01 million users in 2002 and 2007, respectively. We expected this trend to continue. People not only used acupuncture as a complementary and alternative approach to conventional treatment for a specific health condition, but also used it as a preventive means to promote general health. Effectiveness and safety appeared not to be the main predictors of acupuncture use; rather, awareness, cost, and insurance coverage played a bigger role in decision making.

鍼灸マッサージ師の雇用希望のある診療所の状況と業務実態に関する調査

【目的】鍼灸マッサージ師の雇用希望のある診療所の状況や鍼灸マッサージ師の業務実態について分析し、 今後の診療所における鍼灸師およびマッサージ師の就業開拓の基礎資料とすることを目的とした。 【方法】診療所に従事する鍼灸マッサージ師の業務実態と今後の雇用ニーズ等に関する調査において鍼灸師またはマッサージ師の雇用希望があると回答した52施設を対象とした。 免許別に鍼灸師雇用希望施設 (n=5)、 鍼灸師およびあん摩マッサージ指圧師雇用希望施設 (n=25)、 あん摩マッサージ指圧師雇用希望施設 (n=22) の3群に分けて診療所の状況や業務実態について分析を行った。 【結果】産婦人科や婦人科のある診療所で雇用希望のあるのは鍼灸師のみであった。 整形外科やリハビリテーション科のある診療所では、 鍼灸師およびあん摩マッサージ指圧師のいずれも雇用希望が多い。 鍼灸師およびあん摩マッサージ指圧師の雇用満足度は、 費用対効果より患者ニーズからみた満足度の方が高い。 【結論】鍼灸師およびあん摩マッサージ指圧師の雇用ニーズのある診療所の特徴を分析することができ、 医療機関への就業の促進の一助となるものと考える。

Acupuncture in practice: mapping the providers, the patients and the settings in a national cross-sectional survey

BackgroundThere is relatively limited knowledge about the practitioners who provide acupuncture treatment within the UK, what conditions patients consult for and the treatment provided.ObjectivesTo characterise the conditions treated and by...

Lifestyle and Self-Care Advice Within Traditional Acupuncture Consultations: A Qualitative Observational Study Nested in a Co-Operative Inquiry

The study objective was to develop methodology for observational research within traditional acupuncture consultations in community-based practice, and to explore how traditional acupuncturists communicate with patients about lifestyle and self-care. This was a mixed-method qualitative study, using audio-recording of consultations followed by telephone interviews of patients. The study was nested within a cooperative inquiry. As co-researchers, group members participated in framing the research questions, deciding methods to be used, and discussing the emergent findings. Four (4) experienced traditional acupuncture practitioners, registered with the British Acupuncture Council, contributed to the co-operative enquiry and recorded consultations in three clinics in Somerset. Subjects comprised a convenience sample of patients attending 21 consultations. A purposive subsample of patients was selected for interview. Audio-recording was challenging to some practitioners who felt that it might result in infrequent, but nevertheless worrying, withholding of personal information by patients. Patients, however, reported that they were generally positive about the audio-recording. Each consultation was analyzed as a trajectory in which eight categories of talk interwove with each other and with periods of physical examination, needling, and silence. Trajectories showed where talk about self-care ("self-care talk") appeared in the consultations, the content of such talk, and who initiated it. The data confirmed that self-care advice arises from, and is explained in terms of, each person's individual Chinese Medicine diagnosis. The identification of different types of talk and the way that "self-care talk" is interwoven throughout the consultation emphasized the integral nature of self-care support and advice in the practice of traditional acupuncture. Some patients had difficulty putting self-care advice into practice, even when they were intellectually committed to it, suggesting that practitioners may need to follow up more carefully on the advice they have given. Self-care in traditional acupuncture consultations is integral, interactive, and individualized. This study has mapped out a potential agenda for research into self-care in traditional acupuncture consultations and illustrates the exciting opportunities that open up when observational and interview data are combined.

Adverse events associated with acupuncture: three multicentre randomized controlled trials of 1968 cases in China

BackgroundIn order to evaluate the safety of acupuncture in China objectively, we investigated the adverse events associated with acupuncture based on three multicentre randomized controlled trials (RCTs) to assess the safety of acupuncture, identifying the common types of acupuncture adverse events, and analysing the related risk factors for their occurrence.MethodsThis observational study included patients who received acupuncture from three multicentre RCTs respectively for migraine, functional dyspepsia and Bell's palsy. The 1968 patients and their acupuncturists documented adverse events associated with acupuncture after treatment. We collected data about adverse events due to acupuncture treatment from their case report forms. We analysed the incidence and details of the adverse effects, and studied the risk factors for acupuncture adverse events with non-conditional logistic regression analysis.ResultsAmong the 1968 patients, 74 patients (3.76%) suffered at least one adverse event throughout the treatment period. We did not observe the occurrence of serious adverse events. 73 patients with adverse events recovered within 2 weeks through effective treatment such as physiotherapy or self-treatment. A total of 3 patients withdrew because of adverse events. There were 9 types of adverse events related to acupuncture, including subcutaneous haematoma, bleeding, skin bruising and needle site pain. Subcutaneous haematoma and haemorrhage in the needling points were the most common adverse events. Age and gender were related to the occurrence of acupuncture adverse events. The older the patients were, the higher the risk of adverse events was. In addition, male patients had slightly higher risk of an adverse event than female patients.ConclusionsAcupuncture is a safe therapy with low risk of adverse events in clinical practice. The risk factors for adverse events (AEs) were related to the patients' gender and age and the local anatomical structure of the acupoints. AEs could be reduced and mitigated by improving the medical environment, ensuring a high technical level of the acupuncture practitioners and establishing a good relationship of mutual trust between doctor and patient.Trial RegistrationClinicalTrials.gov: NCT00599586, NCT00599677, NCT00608660

Acupuncture for Depression: Exploring Model Validity and the Related Issue of Credibility in the Context of Designing a Pragmatic Trial

Evaluating care that is not credible to its practitioners or patients will result in a gap between evidence and practice and the potential value, or harm, of the intervention may be underestimated. Our aim was to develop a pragmatic trial that would have better model validity and credibility than trials to date in this clinical area. In-depth interviews; a nominal consensus technique and five arm pilot trial conducted in UK primary care using counseling and usual general practitioner (GP) care as comparisons for acupuncture. Patients with long standing, severe illness that had not responded, or partially responded to conventional treatments may be interested in using acupuncture and participating in a trial. Using a database method to recruit, pilot trial patients were mostly severely depressed (87.5%); chronically ill (60% with 3+ previous episodes), with high levels of comorbidity, and medication use. Acupuncture was as credible to pilot trial participants as usual GP care and more credible than counseling: most patients (62.5%) preferred to be allocated to acupuncture, rating it more highly at baseline than counseling or usual GP care as potentially able to benefit their depression (P = 0.002). Disparities were identified in the working models of acupuncturists and counselors that suggest inherent differences between interventions in terms of the process and intended potential outcomes of therapy, as well as the interaction between patients and therapists. The Medical Research Council (MRC) framework with its phased, mixed method approach has helped to develop research that has better model validity than trials to date in this field. The next phase of research will need to involve acupuncture and counseling practitioners to help researchers to develop realistic and credible care packages for a full-scale trial, where patients are likely to be severely and chronically ill.

Assessing the quality of reports about randomized controlled trials of acupuncture treatment on mild cognitive impairment.

ObjectiveTo evaluate the reports' qualities which are about randomized controlled trials (RCTs) of acupuncture treatment on Mild Cognitive Impairment (MIC).MethodsNine databases including the Cochrane Central Register of Controlled Trials (CENTRAL,2010), PUBMED (1984-5/2010), EMbase (1984-5/2010), MEDLINE (1984-5/2010), CINAL (1984-5/2010), China National Knowledge Infrastructure (CNKI, 1980-5/2010), China Biomedicine Database disc (CBMdisc, 1980-5/2010), VIP (a full text issues database of China, 1989-5/2010) were searched systematically. Hand search for further references was conducted. Language was limited to Chinese and English. We identified 14 RCTs that used acupuncture as an intervention and assessed the quality of these reports against the Consolidated Standards for Reporting of Trials (CONSORT) statement and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA).ResultsIn regard to the items in the CONSORT statement, 13(92.86%) RCTs described baseline demographic and clinical characteristics in each group. 7 (50.0%) mentioned the method of generating the random sequence, only 2 (14.3%) RCTs had adequate allocation concealment. No RCTs used blinding. RCTs reported the sample size calculation. In regard to the items in STRICTA, 10 (71.43%) mentioned the depths of insertion, 6 (42.86%) reported acupuncture response, 11 (78.57%) mentioned the technique of acupuncture, 12 (85.71%) recorded the time, and only 3 (21.43%) RCTs reported the numbers of needles inserted. No RCTs reported the background of the acupuncture practitioners and professional title of practitioners.ConclusionThe reporting quality of RCTs of acupuncture for mild cognitive impairment was moderate to low. The CONSORT statement and STRICTA should be used to standardize the reporting of RCTs of acupuncture in future.

Survey: Use of acupuncture for the treatment of acute low back pain by physicians and physiotherapists in Ontario

Objective To determine the prevalence of the use of acupuncture treatment for acute low back pain (LBP) among acupuncture practitioners, and investigate acupuncture practitioners’ perceptions on the effectiveness of this treatment modality and the costs associated with its use in Canada.

Double blinding with a new placebo needle: a further validation study.

The masking properties of a new, non-penetrating, double-blind placebo acupuncture needle were demonstrated. Practitioners correctly identified some of the needles; if they were confident in this opinion, they would be unblinded. To investigate the clues that led to correct identification, and the confidence in this decision. Ten acupuncture practitioners, blindly and randomly, applied 10 each of three types of needle to the shoulder: blunt, non-penetrating needles that pressed the skin ('skin-touch placebo needle'); new non-penetrating needles that penetrated soft material (stuffing) but did not reach the skin ('non-touch control needle'); matching penetrating needles. Afterwards, practitioners were asked to judge the type of needle, their confidence in their decision and what clues led them to their judgements. Of the 30 judgements made by each practitioner, the mean number of correct, incorrect and unidentifiable answers were 10.4 (SD 3.7), 15.2 (SD 4.9) and 4.4 (SD 6.1), respectively. There was no significant difference in the confidence scores for 104 correct (mean, 54.0 (SD 20.2)%) and 152 incorrect (mean, 50.3 (SD 24.3)%) judgements. Twelve needles were identified with 100% confidence-three correct, and nine incorrect. For needles correctly identified, the proportions of non-touch (p = 0.14) and skin-touch (p = 0.17), needles were no greater than chance, but the proportion of penetrating needles correctly identified exceeded chance (p < 0.01). 53% of judgements were made from the "feeling of needle insertion", but 57% of these were wrong. Practitioners had a slight tendency to guess the penetrating needles correctly, but were uncertain about most of their judgments, posing only a very small risk to double blinding.