An observational study on the costs and consequences of acupuncture for the management of chronic low back pain in Korean patients

Kim, Song-Yi,Lee, Hyejung,Lee, Hyangsook,Park, Ji-Yeun,Park, Sang Kyun,Park, Hi-Joon THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2015 ACUPUNCTURE IN MEDICINE Vol.33 No.2

<P><B>Objectives</B></P><P>To investigate the consequences and costs of acupuncture in general medical practice for patients with chronic low back pain (CLBP) in Korea.</P><P><B>Methods</B></P><P>A multicentre observational study was performed. Outpatients with CLBP who received at least one acupuncture session in a Korean Medicine clinic during the study period were included and followed up for 3 months. All patients received regular acupuncture treatments in accordance with the doctors’ discretion. The consequences in terms of effects included condition-specific outcomes and preference-based outcome. For cost analysis, the cumulative resource use for direct medical costs at each research clinic during the study period and direct patient data using the self-reported healthcare utilisation questionnaires were used.</P><P><B>Results</B></P><P>A total of 157 patients were eligible to participate and 105 were finally included. Significant improvements in condition-specific and preference-based measures were observed after acupuncture treatment. An average of approximately $146 (£93) per patient was reported for direct medical costs in each clinic for 1 month and $231 (£148) for 3 months. Other medical expenses related to CLBP were reduced during this period.</P><P><B>Conclusions</B></P><P>The use of acupuncture to manage CLBP in general clinical practice in Korea inexpensively improved pain, functional disability and quality of life. The study results are meaningful and consistent with the results of previous trials performed in other European countries but the power of the study is not strong, having major design weaknesses. A large-scale cohort or registry based on practice may be helpful to strengthen the evidence of the cost-effectiveness of acupuncture.</P>

Disappearance of an adnexal mass with Saam acupuncture: a case report

Seo, Jung Chul,Kwon, Oh-Chang,Kwon, Hyo-Jung,Chung, Dae-Kyoo,Cho, Yoon-Jeong,Lee, Geon Ho THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2014 ACUPUNCTURE IN MEDICINE Vol.32 No.1

<P>We report the case of a 30-year-old woman with a right adnexal mass resembling an ovarian cyst who declined diagnostic laparoscopy and requested treatment with acupuncture. The patient was treated with Saam acupuncture for 14 weeks. After treatment, transvaginal sonography revealed disappearance of the right adnexal mass. No adverse effects of the Saam acupuncture treatment were reported.</P>

Acupuncture for recovery after surgery in patients undergoing colorectal cancer resection: a systematic review and meta-analysis

Kim, Kun Hyung,Kim, Dae Hun,Kim, Hee Young,Son, Gyung Mo THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2016 ACUPUNCTURE IN MEDICINE Vol.34 No.4

<P>Objective To assess the efficacy/effectiveness and safety of acupuncture in patients recovering from colorectal cancer resection. Methods We systematically searched four English language databases (Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and AMED (Allied and Complementary Medicine Database)) and one Chinese database (CAJ, China Academic Journals). Randomised trials of acupuncture compared with usual/routine care, sham interventions or active comparators in patients undergoing colorectal cancer resection were eligible for inclusion. Postoperative symptoms and quality of life (QoL) were the primary outcomes for the review. Results Of 1225 screened hits, seven randomised trials with 540 participants were included. High or uncertain risk of bias and significant heterogeneity were observed. All outcomes were measured before discharge, and no trial explicitly reported post-discharge outcomes. The response to acupuncture in terms of postoperative symptoms was inconsistent across trials. QoL was not measured in the included studies. For certain outcomes reflecting physiological recovery, favourable effects of acupuncture were observed compared with sham acupuncture, namely time to first flatus (n=207, three studies; mean difference (MD) -7.48 h, 95% CI -14.58 to -0.39 h, I-2=0%) and time to first defaecation (n=149, two studies; MD -18.04 h, 95% CI -31.90 to -4.19 h, I-2=0%). Two studies reported there were no acupuncture-related adverse events, whereas the remaining studies did not consider adverse events. Conclusions We found low-to moderate-quality evidence for the efficacy and safety of acupuncture for recovery after surgery in colorectal cancer patients. Future trials with adequate allocation concealment, blinding of outcome assessors, and measurement of post-discharge outcomes including QoL or functional recovery are warranted.</P>

Acupuncture for patients with lumbar spinal stenosis: a randomised pilot trial

Kim, Kun Hyung,Kim, Yu Ri,Baik, Seung Kug,Noh, Seung Hee,Kim, Dae Hun,Lee, Sang Weon,Yang, Gi Young THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2016 ACUPUNCTURE IN MEDICINE Vol.34 No.4

<P>Objective To assess the safety and feasibility of acupuncture for participants with symptomatic lumbar spinal stenosis (LSS) in a pilot study. Methods 50 participants with a clinical and radiological diagnosis of LSS were randomised to receive acupuncture combined with usual care (acupuncture group), or usual care alone (control group). Participants in the acupuncture group were offered 12-16 sessions of manual acupuncture +/- electroacupuncture over 6 weeks and maintained their usual self-management. The control group was provided with physical therapy as required and maintained their usual self-management. The primary outcome was the change in back-specific functional status, as measured by the Oswestry disability index (ODI) at the 3-month follow-up. Secondary outcomes included symptoms and other relevant domains. Outcome assessors were not blinded. Results 39 participants (78%) completed the trial with 524 treatment visits. There were no significant differences between the two groups in back-specific function (ODI: mean difference -2.5, 95% CI -8.9 to 3.8). Pain in the back and/or leg showed small improvements at 3 months, while there were no significant differences in other secondary outcomes. The total number of adverse events was 61 (12% of 524 treatment visits). All but one were minor and transient. The one severe adverse event was deemed to be unrelated to acupuncture. Conclusions The study was feasible. Acupuncture combined with usual care did not confer significant functional improvements over usual care alone. Further randomised trials with adequate sample sizes and outcome assessor blinding are warranted to evaluate the role of acupuncture for LSS.</P>

Identification of determinants of the utilisation of acupuncture treatment using Andersen's behavioural model

Lee, Ye-Seul,Lee, In-Seon,Kim, Song-Yi,Lee, Hyangsook,Park, Hi-Joon,Lee, Hyejung,Kim, Sung-Hoon,Chae, Younbyoung THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2015 ACUPUNCTURE IN MEDICINE Vol.33 No.2

<P><B>Objectives</B></P><P>The utilisation of healthcare services is the result of a complex decision-making process with different determinants. This study aims to identify the determinants of the utilisation of acupuncture treatment using Andersen's behavioural model and quality of life.</P><P><B>Methods</B></P><P>In this study we reviewed Korean Health Panel data, a nationally representative set of data, and analysed the utilisation of outpatient acupuncture services during 2011. A two-part model, which included predisposing, enabling and need factors of Andersen's behavioural model in model 1 and the additional factor of health-related quality of life (HRQOL, EQ-5D Korean index) in model 2, was analysed by logistic analysis to identify determinants of acupuncture service usage among subjects who visited traditional Korean medical clinics.</P><P><B>Results</B></P><P>The higher frequency of acupuncture service usage among patients who visited traditional Korean medical clinics was associated with gender, age, number of chronic diseases, physical disabilities and HRQOL of the subjects.</P><P><B>Conclusions</B></P><P>This study shows that the important determinants of the frequency of acupuncture treatment utilisation are gender, age, number of chronic diseases and the presence of physical disabilities. Our findings contribute to understanding the characteristics of patients who use acupuncture treatment and may be used as a basic resource for related policy making by government officials and medical professionals.</P>

Motion patterns in acupuncture needle manipulation

Seo, Yoonjeong,Lee, In-Seon,Jung, Won-Mo,Ryu, Ho-Sun,Lim, Jinwoong,Ryu, Yeon-Hee,Kang, Jung-Won,Chae, Younbyoung THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2014 ACUPUNCTURE IN MEDICINE Vol.32 No.5

<P><B>Background</B></P><P>In clinical practice, acupuncture manipulation is highly individualised for each practitioner. Before we establish a standard for acupuncture manipulation, it is important to understand completely the manifestations of acupuncture manipulation in the actual clinic. To examine motion patterns during acupuncture manipulation, we generated a fitted model of practitioners’ motion patterns and evaluated their consistencies in acupuncture manipulation.</P><P><B>Methods</B></P><P>Using a motion sensor, we obtained real-time motion data from eight experienced practitioners while they conducted acupuncture manipulation using their own techniques. We calculated the average amplitude and duration of a sampled motion unit for each practitioner and, after normalisation, we generated a true regression curve of motion patterns for each practitioner using a generalised additive mixed modelling (GAMM).</P><P><B>Results</B></P><P>We observed significant differences in rotation amplitude and duration in motion samples among practitioners. GAMM showed marked variations in average regression curves of motion patterns among practitioners but there was strong consistency in motion parameters for individual practitioners. The fitted regression model showed that the true regression curve accounted for an average of 50.2% of variance in the motion pattern for each practitioner.</P><P><B>Conclusions</B></P><P>Our findings suggest that there is great inter-individual variability between practitioners, but remarkable intra-individual consistency within each practitioner.</P>

The role of touch in acupuncture treatment

Chae, Younbyoung,Olausson, Hå,kan THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2017 ACUPUNCTURE IN MEDICINE Vol.35 No.2

<P>Acupuncture is a therapeutic treatment that is characterised by the insertion of a needle at a particular location on the body. Acupuncture stimulation includes sensory-discriminative and affective-social touch dimensions. In this review, we discuss the role of touch during acupuncture stimulation with an emphasis on the therapeutic, sensory-discriminative and affective-social aspects. In the discriminative dimension, de qi, which is associated with needling, includes a combination of various sensations, such as heaviness, numbness, soreness and distension. Achieving the appropriate de qi sensation appears to be fundamental to the therapeutic outcome following acupuncture treatment. In the affective dimension, the acupuncture procedure typically includes gentle manual touch stimulation, which induces feelings of calm and well-being, perhaps by activating C tactile fibres. Enhanced activity of C tactile afferents may induce a 'limbic touch' response, resulting in emotional and hormonal reactions. Because acupuncture is a 'therapist intensive' and complex intervention, it is necessary to understand the role of social touch between the practitioner and patient. Both sensory-discriminative and affective-social touch aspects play an important role in the therapeutic effect of acupuncture treatment in clinical practice.</P>

Validation of the Korean version of the Acupuncture Expectancy Scale

Kim, Yun-Ji,Lee, In-Seon,Kim, Ho-Sun,Lee, Hyejung,Park, Hi-Joon,Lee, Hyangsook,Mao, Jun J,Chae, Younbyoung THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2014 ACUPUNCTURE IN MEDICINE Vol.32 No.1

<P><B>Objectives</B></P><P>Expectancy has been shown to affect patients’ responses to acupuncture therapy. However, no validated measure of expectancy for acupuncture is available in the Korean language. The Acupuncture Expectancy Scale (AES), a 4-item self-reporting questionnaire, is the validated instrument for measuring expectancies regarding acupuncture therapy. We translated the AES into Korean and examined its test–retest reliability and construct validity.</P><P><B>Methods</B></P><P>The AES was translated using a forward and backward translation procedure. Internal consistency was assessed in 275 participants with item-total correlations. Construct validity was also assessed by performing principal component analysis and correlating scores on the scale with the participants’ intention to receive acupuncture therapy. Test–retest reliability was assessed in 33 participants by calculating Cronbach's α and Spearman rank correlation coefficients.</P><P><B>Results</B></P><P>Internal consistency was high (Cronbach's α=0.910). Principal component analysis showed that expectancy of acupuncture treatment accounted for 79.2% of the variance. The AES was positively correlated with participants’ intention to receive acupuncture treatment (r=0.695, p<0.001). Test–retest reliability in 33 of the 275 participants was adequate, with the Spearman rank correlation coefficient ranging from 0.500 to 0.737 (p<0.001).</P><P><B>Conclusions</B></P><P>The Korean version of the AES is a valid and reliable instrument for measuring patients’ expectancies regarding acupuncture treatment in the Korean population.</P>

Discrimination accuracy between real and sham press needles in the hands

Kim, Sungha,Lee, Sanghun,Choi, Sunmi,Park, Jeonghwan,Kim, Sungchul THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2015 ACUPUNCTURE IN MEDICINE Vol.33 No.4

<P><B>Objectives</B></P><P>To evaluate the blinding effectiveness of a modified blunt sham press needle on the basis of the ability of subjects to discriminate between real and sham acupuncture needles compared with their discrimination ability based on pure guessing, and to define differences between senses (touch and vision) in the rates of correctly identified needles.</P><P><B>Methods</B></P><P>Sixty-three healthy students and staff members were recruited through convenience sampling. First, real or sham acupuncture was randomly administered to the left LI4 point while subjects could not observe the needle tip. A real or sham needle tip was then shown to the subjects. Finally, a random combination of real or sham acupuncture needles were randomly administered to the left and right LI4 points, this time with the subjects observing the procedure. In all conditions the subjects gave their judgement as Yes or No in response to questions asking them to identify the needle type. The proportion of correct judgements (P(C)) was computed for the last part of the trial in left and right LI4 points, and the rates of correctly identified needles for each trial were obtained.</P><P><B>Results</B></P><P>The subjects’ accuracy of discrimination between the real and sham acupuncture needles in left and right LI4 points was not significantly different from that based on pure guess (P(C)=0.50 (chance level)), which indicates complete inability to discriminate between needles. The rates of correctly identified needles using touch, vision and a combination of both senses were not significantly different (p=0.807).</P><P><B>Conclusions</B></P><P>The findings from this study show that this sham acupuncture device successfully blinded subjects to real and sham press needles, suggesting that it is effective for subject blinding in studies on acupuncture using press needles, and facilitating evaluation of the effects of acupuncture in placebo-controlled trials using a rigorous scientific research methodology.</P>

Acupuncture for erectile dysfunction in a non-diabetic haemodialysis patient: a case report

Kim, K.H.,Kim, T.-H.,Kang, J.W.,Lee, M.S.,Kim, J.-I.,Choi, J.-Y.,Sul, J.-U.,Choi, S.M. THE BRITISH MEDICAL ACUPUNCTURE SOCIETY 2011 Acupuncture in medicine Vol.29 No.1