Evidence from RCTs on optimal acupuncture treatment for knee osteoarthritis--an exploratory review.
ABSTRACT There are many differing opinions on what constitutes an optimal acupuncture dose for treating any particular patient with any particular condition, and only direct comparisons of different methods in a clinical trial will provide information on which reliable decisions can be made. This article reviews the recent research into acupuncture treatment for osteoarthritis of the knee, to explore whether any aspects of treatment seem more likely to be associated with good outcome of treatment. Among four recent, high quality RCTs, one showed a much greater treatment response than the other three, and the possible factors are discussed. A recent systematic review included 13 RCTs, and this article discusses the possible explanations for differences in their outcomes. It is speculated that optimal results from acupuncture treatment for osteoarthritis of the knee may involve: climatic factors, particularly high temperature; high expectations of patients; minimum of four needles; electroacupuncture rather than manual acupuncture, and particularly, strong electrical stimulation to needles placed in muscle; and a course of at least 10 treatments. These factors offer some support to criteria for adequate acupuncture used in the recent review. In addition, ethnic and cultural factors may influence patients' reporting of their symptoms, and different versions of an outcome measure are likely to differ in their sensitivity - both factors which may lead to apparent rather than real differences between studies. The many variables in a study are likely to be more tightly controlled in a single centre study than in multicentre studies.
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ABSTRACT: Factors that determine practice success have not been thoroughly examined in the acupuncture profession. Five surveys representing three important communities within acupuncture provide a window into some of the factors that these groups believe influence economic success. Acupuncture communities have historically aligned on preferences for theoretical foundations, spiritual beliefs, and needling techniques. Recently, communities within the profession have conducted surveys to learn how other acupuncturists are doing in terms of income, number of work hours, typical fees, how much student loan debt acupuncturists retain post graduation, and how this student loan debt may be paid by these LAc loanholders. Knowledge about the relationships of income levels, years in practice, and hours worked can empower current and emerging practitioners to gauge the likelihood of their ability to practice successfully and pay off their student loan debt. Generally speaking, the respondents to these independent surveys charge fees between $20 and $65 per patient visit; work approximately 30 or fewer hours per week; and generate median gross incomes between $20,000 and $50,000. Mean figures are generally higher. These surveys are not representative of the profession as a whole because the groups that completed them are a few among the myriad groups found within the profession. The surveys were constructed in such a way that data required transformations for the sake of making comparisons. Despite data limitations in a profession where workforce survey data are rare, it is important to examine any findings that shed light on the acupuncture workforce.
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ABSTRACT: Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an 'intramuscular' procedure involving the isolated treatment of 'myofascial trigger points' (MTrPs).Physical Therapy Reviews 08/2014; 19(4):252-265. DOI:10.1179/108331913X13844245102034
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ABSTRACT: Patients with knee osteoarthritis who do not improve with pharmacological treatment seek for options in acupuncture. This treatment, even when it has sufficient evidence, remains left out of most clinical practice guidelines. We have analyzed in depth the originals referring to knee osteoarthritis and acupuncture that appear on our last published meta-analysis, compiling the relevant information in order to try to explain its heterogeneous results. Out of the 7 analyzed trials, the variety of the environment where they have been carried out, the skills and number of therapists that performed the technique, the different techniques applied, styles and doses, and the different control groups are emphasized. Relative improvement in acupuncture cases ranged from 86.5% and 7.1%; the improvement in groups of patients treated with fake acupuncture (on its various branches) was more uniform, around 30%. To sum up, if we pursue an optimal treatment, we must observe the diagnosis of the condition according to traditional Chinese medicine, design a personalized treatment, behold the environment, combine both local (based on canal diagnosis) and distal (in order to work directly on the substrate) points, add low frequency electroacupuncture in local points and, should it be deemed necessary (due to meteorological or etiopathogenic reasons) add moxibustion to the treatment. Patients will receive an average of 8 to 12 sessions, at a pace of one session per week, although the first sessions could be performed twice per week.Revista Internacional de Acupuntura 09/2013; 7(4):131–143. DOI:10.1016/S1887-8369(13)70103-0