Beyond Needling—Therapeutic Processes in Acupuncture Care: A Qualitative Study Nested Within a Low-Back Pain Trial

Foundation for Traditional Chinese Medicine, York, UK.
The Journal of Alternative and Complementary Medicine (Impact Factor: 1.59). 12/2006; 12(9):873-80. DOI: 10.1089/acm.2006.12.873
Source: PubMed


In the medical and scientific literature, there is a dearth of reports about how acupuncturists work and deliver care in practice. An informed characterization of the treatment process is needed to support the appropriate design of evaluative studies in acupuncture.
The design was that of a nested qualitative study within a pragmatic clinical trial. Six acupuncturists who treated up to 25 patients each were interviewed after the treatment phase of the trial to obtain an account of their experiences of providing acupuncture care to patients with low back pain referred by their GP. Using semistructured interviews and a topic guide, data were collected and analyzed for both a priori and emergent themes. This paper focuses on practitioners' accounts of the goals and processes of care, and describes the strategies employed in addition to needling and other hands-on treatments.
From the interview data, it is clear that a coherent body of theoretical knowledge informed clinical decisions and practice, and that the goals of treatment went beyond the alleviation of immediate pain-related symptoms. Acupuncturists in this study all described a pattern of patient-centered care based on a therapeutic partnership. Study participants confirmed the importance of three processes that characterized acupuncture care in this trial, each contributing to the goal of a positive long-term outcome; building a therapeutic relationship; individualizing care; and facilitating the active engagement of patients in their own recovery. Acupuncturists described elements of care that characterized these processes including establishing rapport, facilitating communication throughout the period of care, using an interactive diagnostic process, matching treatment to the individual patient, and the use of explanatory models from Chinese medicine to aid the development of a shared understanding of the patient's condition and to motivate lifestyle changes that reinforce the potential for a recovery of health. Acupuncturists did not view these therapeutic goals, processes, and strategies as a departure from their usual practice.
This study suggests that acupuncture care for patients with chronic conditions such as low back pain is likely to be a complex intervention that utilizes a number of patient-centered strategies to elicit longterm therapeutic benefits. Research designed to evaluate the effectiveness of acupuncture as it is practiced in the UK needs to accommodate the full range of therapeutic goals and related treatment processes.

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    • "needling sensation) and the therapeutic model of patient care. A number of studies have reported acupuncturists' views about research participation [10] [11] [12] [13] [14] [15]. Common themes in these studies expressed by practitioners included: the importance of individualised treatment; valued features of the therapeutic relationship as the basis for establishing trust and rapport; empowering and educating patients and reflections on conflicts and benefits of research participation including constraints imposed by treatment protocols. "
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    • "The findings from a small study involving interviews with six practitioners in a trial of acupuncture for back pain found that these acupuncturists had a goal of a positive long-term outcome, and developed a therapeutic partnership to support the active engagement of patients in their own recovery. [16] Consistent with many of the findings we report here, the authors reported that the key elements were: establishing rapport, using an interactive diagnostic process, matching treatment to the patient, and using explanatory models from Chinese medicine to aid a shared understanding and motivate lifestyle changes to reinforce the potential recovery. "
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