Physician and treatment characteristics in a randomised multicentre trial of acupuncture in patients with osteoarthritis of the knee.
ABSTRACT The aim of this paper is to describe the treatment and physician characteristics in a randomised trial of acupuncture for osteoarthritis of the knee.
Three-armed, randomised, controlled multicentre trial with 1-year follow-up.
Twenty-eight outpatient centres in Germany.
A total of 294 patients with osteoarthritis of the knee were randomised to 12 sessions of semi-standardised acupuncture (at least 6 local and 2 distant points needled per affected knee from a selection of predefined points, but individual choice of additional body or ear acupuncture points possible), 12 sessions of minimal acupuncture (superficial needling of at least 8 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list control (2 months no acupuncture).
Participating trial physicians and interventions.
Forty-seven physicians specialised in acupuncture (mean age 43+/-8 years, 26 females) provided study interventions in 28 outpatient centres in Germany. The median duration of acupuncture training completed by participating physicians was 350 h (range 140-2508). The total number of needles used was 17.4+/-4.8 in the acupuncture group compared to 12.9+/-3.3 in the minimal acupuncture group. In total, 39 physicians (83%) stated that they would have treated patients in either a similar or in exactly the same way outside of the trial, whereas 7 (15%) stated that they would have treated patients differently (1 missing).
Our documentation of the trial interventions shows that semi-standardised acupuncture strategy represents an acceptable compromise for efficacy studies. However, a substantial minority of participating trial physicians stated that they would have treated patients differently outside of the trial.
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ABSTRACT: Chinese herbal medicine (CHM) has been commonly used for treating osteoarthritis in Asia for centuries. This study aimed to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM used in treating osteoarthritis in Taiwan. A complete database (total 22,520,776 beneficiaries) of traditional Chinese medicine (TCM) outpatient claims offered by the National Health Insurance program in Taiwan for the year 2002 was employed for this research. Patients with osteoarthritis were identified according to the diagnostic code of the International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM for treating osteoarthritis. There were 20,059 subjects who visited TCM clinics for osteoarthritis and received a total of 32,050 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (19.2%), followed by 50-59 years (18.8%) and 60-69 years group (18.2%). In addition, female subjects used CHMs for osteoarthritis more frequently than male subjects (female: male = 1.89: l). There was an average of 5.2 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for osteoarthritis. Du-zhong (Eucommia bark) was the most commonly prescribed Chinese single herb, while Du-huo-ji-sheng-tang was the most commonly prescribed Chinese herbal formula for osteoarthritis. According to the association rule, the most commonly prescribed formula was Du-huo-ji-sheng-tang plus Shen-tong-zhu-yu-tang, and the most commonly prescribed triple-drug combination was Du-huo-ji-sheng-tang, Gu-sui-pu (Drynaria fortune (Kunze) J. Sm.), and Xu-Duan (Himalaya teasel). Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating osteoarthritis. This study conducted a large scale pharmaco-epidemiology survey of Chinese herbal medicine use in OA patients by analyzing the NHIRD in Taiwan in year 2002.BMC Complementary and Alternative Medicine 03/2014; 14(1):91. DOI:10.1186/1472-6882-14-91 · 1.88 Impact Factor
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ABSTRACT: Medical acupuncture is a term given to a pragmatic treatment approach used within the public health services in North Western Europe and other Western countries. Its rationale and methods are derived from, but distinct from, classical traditional Chinese medicine as it is practiced in China and in Europe. The article summarizes 9 principles of the medical acupuncture modality, offers an explanatory model, and reviews international research during 2005 to 2012.Journal of Acupuncture and Tuina Science 08/2013; 11(4). DOI:10.1007/s11726-013-0691-4
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ABSTRACT: The glassy translucent material found at the ends of bones, within synovial joints, is termed articular cartilage. While healthy, it provides a low-friction bearing surface, preventing bone-to-bone contact, and to an extent, absorb shock during vigorous activities. However, when damaged could lead to pain, deformity and reduced mobility; the social impact of which, entails high costs in terms of therapeutic treatments and loss of income. The present chapter reviews the common knowledge of the constraints to articular cartilage regeneration; namely cartilage structure, composition and major diseases. The first of the three sections detail the major constituents of the tissue and their structural organisation; the tissues mechanical properties, and ends with a brief description of how these features change in an unhealthy cartilage; be it mechanical or disease. In the second section, both clinical and academic approaches are pooled together, to review the current strategies in restoring health to joints with diseased or damaged cartilage. The final section highlights the fact that progression of cartilage disease affects not only the cartilage, but its underlying bone. The implications of the subchondral bone in the propagation of cartilage degeneration are discussed, and finally, their considerations in cartilage defect healing.