Summaries and commentaries by editor Adrian White on a selection of recent acupuncture research stud by ProQuest


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                                                                                                           Acupunct Med 2009;27:191–194. doi:10.1136/aim.2009.001859

Summaries and commentaries by editor Adrian White on a selection of
recent acupuncture research studies
Psychological effects of acupuncture                                                                  study showed no difference between individualised, standardised or
Some recent studies have given new insights into the ‘placebo’ affects                                simulated acupuncture treatments, all of which were superior to
associated with acupuncture. These are reviewed as a group.                                           usual care for function at 8 weeks and 52 weeks, and for pain at
                                                                                                      8 weeks.2
Expectation did not influence the outcome (1)                                                         Methods
c    Foster NE, Thomas E, Hill JC, et al. The relationship between patient and practitioner           The authors first identified which factors predicted improvements in
expectations and preferences, and clinical outcomes in a trial of exercise and acupuncture for knee   patients’ back pain and function. Then we tested for an interaction
osteoarthritis. Eur J Pain 2009 Epub Aug 6.
                                                                                                      between the prognostic factors and acupuncture treatment in four
This paper is an analysis of further data from an earlier RCT
                                                                                                      models: functional outcomes (measured by the Roland-Morris
(n = 352). The study itself found that the effect of advice and exercise
                                                                                                      Disability Scale) at 8 and 52 weeks post-randomisation, and
on knee pain and function in osteoarthritis was not further increased
                                                                                                      symptom outcomes (measured with a numerical rating scale) at 8
by the addition of either acupuncture or sham acupuncture.1 This
                                                                                                      and 52 weeks.
analysis investigated the relationship between the clinical outcomes
for patients and their preferences and expectations, as well as those of                              Results
the therapist.                                                                                        Overall, the strongest predictors of improvement in back function
                                                                                                      and symptoms were higher baseline levels of these measures, receipt
                                                                                                      of an acupuncture treatment, and non-use of narcotic analgesics.
Patients (n = 352) in 37 centres were randomised to advice and
                                                                                                      Benefit from acupuncture compared to usual care was greater with
exercise, or advice and exercise plus true or non-penetrating
                                                                                                      worse pre-treatment levels of back dysfunction (interaction p,0.004
acupuncture. Before randomisation, patients recorded their general
                                                                                                      for the functional outcome, Roland Morris Disability Scale at
expectations of the outcome and any preferences they had for a
                                                                                                      8 weeks). No other consistent interactions were observed.
specific treatment, and scored, on an 11 point scale, the strength of
their expectations that their knee problem would be improved by
either advice and exercise or acupuncture. In addition, the 67
                                                                                                      Expectation of benefit from acupuncture was one of the factors
physiotherapists, after assessing each patient, recorded their own
                                                                                                      included in this analysis: expectation made no difference to the
preferences for them and their treatment expectations.
                                                                                                      outcome of treatment.
   The clinical outcome was (a) change scores on the Western Ontario
and McMaster Osteoarthritis Index (WOMAC) and (b) treatment
response according to the OMERACT-OARSI criteria.                                                     Outcome influenced by patient and practitioner characteristics
                                                                                                      c      Kelley JM, Lembo AJ, Ablon JS, et al. Patient and practitioner influences on the placebo effect
Results                                                                                               in irritable bowel syndrome. Psychosom Med 2009;71:789–97.
Ten per cent of patients had a preference for advice and exercise, 13%                                This is another output from the recent study (n = 289) of placebo
for acupuncture and 44% would choose either. Mean scores for the                                      acupuncture for irritable bowel syndrome. The first results published
expectation of benefit was 5.9 (SD 2.3) for advice and exercise and 6.3                               in BMJ showed that an ‘augmented’ or empathic consultation had
(SD 2.2) for acupuncture. At 6 and 12 months, there was no                                            significantly larger effect than a ‘limited’ consultation, which in turn
significant relationship between patients’ clinical outcomes and their                                showed a greater effect than a waiting list (time, regression to the
treatment preferences; nor between patients’ expectations and pain                                    mean and Hawthorne effect).3
(WOMAC) at 6 or 12 months. Overall, 202 patients happened to                                             This analysis examined whether the characteristics of the patient,
receive the treatment for which they had a preference—but they did                                    the practitioner, or their interpersonal interaction had any effect on
not show any greater improvement than the remainder. However, in                                      the outcome. Patients were assessed for five personality character-
the analysis with a secondary outcome (OMERACT-OARSI), those                                          istics: extraversion, neuroticism, agreeableness, conscientiousness and
who received the treatment for which they had high expectations of                                    openness to experience. The patient-practitioner interaction was
benefit were almost twice as likely to be classified as a treatment                                   assessed by blinded scoring of videos of their consultations for items
responder at 6 months (OR 1.7, 95% CI 1.06, 2.79) and 12 months                                       such as aloofness, tact and empathy.
(OR 1.9, 95% CI 1.13, 3.13).
   The physiotherapists expressed a preference for treatment for 43%                                  Methods
of their patients, their expectations of benefit were the same for                             
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