Prime

Type your tag names separated by a space and hit enter

Self-help advice as a process integral to traditional acupuncture care: implications for trial design.

Abstract

BACKGROUND

In the literature on acupuncture research, the active (or specific) component of acupuncture is almost always presented as acupuncture needling alone. However, specific components, by definition, should include all interventions driven by acupuncture theory that are also believed to be causally associated with outcome. In this paper, we explore the delivery of self-help advice as a component of the process of acupuncture care, and discuss the implications for future trial designs.

METHODS

In a nested qualitative study, six acupuncturists were interviewed about the treatments they provided within a pragmatic clinical trial. The acupuncturists practised individualised acupuncture according to traditional principles. Audiotapes were transcribed and coded and the contents analysed by case and by theme. The analysis focuses on a priori and emergent themes associated with the process of delivering self-help advice as described by the practitioners.

RESULTS

Individualised self-help advice is seen by practitioners as being an integral part of the acupuncture treatment that they provide for patients with low back pain. Several categories of generic advice were described; all were embedded in the acupuncture diagnosis. These included; movement, exercise and stretching to move 'qi stagnation'; rest in cases of 'qi deficiency'; diet when the digestive system was compromised; protection from the elements where indicated by the diagnosis, e.g. Bi Syndrome. According to the practitioners, longer-term benefits require the active participation of patients in their self-care. Simplified concepts derived from acupuncture theory, such as 'stagnation' and 'energy', are employed as an integral part of the process of care, in order to engage patients in lifestyle changes, help them to understand their condition, and to see ways in which they can help themselves.

CONCLUSION

Within acupuncture care, self-help advice is not seen as an 'add-on' but rather as an integral and interactive component of a theory-based complex intervention. Studies designed to evaluate the overall effectiveness of traditional acupuncture should accommodate the full range of therapeutic components, strategies and related patient-centred treatment processes. In acupuncture trials, non-needling components, such as self-help advice, when drawn directly from the diagnosis and integral to the process of care, should not be misclassified as incidental, non-specific, or placebo if we are to accurately assess the value of treatment as delivered.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Health Sciences, University of York, UK. hm18@york.ac.uk

    Source

    MeSH

    Acupuncture Therapy
    Humans
    Life Style
    Low Back Pain
    Patient Acceptance of Health Care
    Qualitative Research
    Research Design
    Self Care

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    18514912

    Citation

    TY - JOUR T1 - Self-help advice as a process integral to traditional acupuncture care: implications for trial design. AU - MacPherson,Hugh, AU - Thomas,Kate, Y1 - 2008/04/08/ PY - 2007/5/3/received PY - 2008/2/20/revised PY - 2008/2/23/accepted PY - 2008/4/8/aheadofprint PY - 2008/6/3/pubmed PY - 2008/8/23/medline PY - 2008/6/3/entrez SP - 101 EP - 6 JF - Complementary therapies in medicine JO - Complement Ther Med VL - 16 IS - 2 N2 - BACKGROUND: In the literature on acupuncture research, the active (or specific) component of acupuncture is almost always presented as acupuncture needling alone. However, specific components, by definition, should include all interventions driven by acupuncture theory that are also believed to be causally associated with outcome. In this paper, we explore the delivery of self-help advice as a component of the process of acupuncture care, and discuss the implications for future trial designs. METHODS: In a nested qualitative study, six acupuncturists were interviewed about the treatments they provided within a pragmatic clinical trial. The acupuncturists practised individualised acupuncture according to traditional principles. Audiotapes were transcribed and coded and the contents analysed by case and by theme. The analysis focuses on a priori and emergent themes associated with the process of delivering self-help advice as described by the practitioners. RESULTS: Individualised self-help advice is seen by practitioners as being an integral part of the acupuncture treatment that they provide for patients with low back pain. Several categories of generic advice were described; all were embedded in the acupuncture diagnosis. These included; movement, exercise and stretching to move 'qi stagnation'; rest in cases of 'qi deficiency'; diet when the digestive system was compromised; protection from the elements where indicated by the diagnosis, e.g. Bi Syndrome. According to the practitioners, longer-term benefits require the active participation of patients in their self-care. Simplified concepts derived from acupuncture theory, such as 'stagnation' and 'energy', are employed as an integral part of the process of care, in order to engage patients in lifestyle changes, help them to understand their condition, and to see ways in which they can help themselves. CONCLUSION: Within acupuncture care, self-help advice is not seen as an 'add-on' but rather as an integral and interactive component of a theory-based complex intervention. Studies designed to evaluate the overall effectiveness of traditional acupuncture should accommodate the full range of therapeutic components, strategies and related patient-centred treatment processes. In acupuncture trials, non-needling components, such as self-help advice, when drawn directly from the diagnosis and integral to the process of care, should not be misclassified as incidental, non-specific, or placebo if we are to accurately assess the value of treatment as delivered. SN - 0965-2299 UR - https://www.unboundmedicine.com/medline/citation/18514912/Self_help_advice_as_a_process_integral_to_traditional_acupuncture_care:_implications_for_trial_design_ L2 - http://linkinghub.elsevier.com/retrieve/pii/S0965-2299(08)00015-0 ER -