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.
- SourceAvailable from: Steven H Stumpf[Show abstract] [Hide abstract]
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.
- [Show abstract] [Hide abstract]
ABSTRACT: There is a place for the acupuncture profession within primary care. Nationwide, community clinics that serve the population of under- and uninsured persons are facing a tremendous shortage of primary care practitioners. Marginalized health care professions, that is, acupuncture, chiropractic, and naturopathy, are being drawn into a primary care role. An unanticipated workforce opportunity exists to fill the caregiver gap in community clinics. This transition can be quickly realized in states such as California where statutory code states that acupuncture is to be regulated and controlled as a primary care profession, but the requisite training has yet to be provided. Specific clinical experience in primary care settings would help overcome long-standing barriers that have resulted in the marginalization of the profession, high under- and unemployment among acupuncturists, and result in greater access to acupuncture treatment. A 1-year primary care training program for licensed acupuncturists (LAcs), which features clinical and didactic training, akin to what a physician assistant receives, would prepare acupuncturists to work in mainstream medicine. With appropriate training and biomedical collaboration skills, the participation of acupuncturists in mainstream medical settings can be accomplished with support from the acupuncture profession and mainstream medicine.08/2010; 15(1):3-13. DOI:10.1177/1533210110374640
- [Show abstract] [Hide abstract]
ABSTRACT: Acupuncture was first legalized in Maryland in 1973. By the end of 2009, regulatory legislation had passed in all but six states. The growth of acupuncture is most commonly measured by its well-documented demand as a treatment modality and the rapid increase in the number of licensees. Much less documented is a puzzling stagnation in work opportunities and income. As many as half of all licensees, on graduation and licensure, may be unable to support themselves by working in their chosen profession. However, unlike other well-established complementary and alternative health professions, such as chiropractic and massage, acupuncture is conspicuously absent from the Bureau of Labor and Statistics occupations manual, with only a handful of secondary and incomplete studies available, which together provide an inexact picture of the workforce. In this article, the authors review seven reports that provide limited information including hours worked, income, and practice type. Although data from these published articles are not standard, it can be reasonably concluded from the available information that, over the past decade, 50% of the licensed acupuncture (LAc) workforce is working less than 30 hr weekly; 50% are earning less than $50,000 on average; and the number of LAcs working independently in practice, either in their own office or sharing one, has increased from approximately 75% to 90%. Suggestions are presented for conducting a much needed comprehensive analysis of the acupuncture workforce.08/2010; 15(1):31-39. DOI:10.1177/1533210110377884