Exploring acupuncturists’ perceptions of treating patients with rheumatoid arthritis

https://doi.org/10.1016/j.ctim.2006.09.008Get rights and content

Summary

Aims

To outline acupuncturists’ perceptions of treating patients with rheumatoid arthritis (RA), exploring the impact of practitioner affiliation to a traditional or western theoretical base.

Methods

Qualitative study utilising Grounded Theory Method. Nineteen acupuncturists were chosen via theoretical sampling. In-depth semi-structured interviews were tape-recorded and transcribed. Field notes were also taken. Emerging categories and themes were identified.

Results

Inter-affiliatory differences were identified in the treatments administered and the scope and emphasis of intended therapeutic effects. Limited divergence was found between acupuncturists’ perceptions of treatment outcomes. Factors perceived as impacting on treatment outcomes were identified.

Conclusions

Clinical trials of acupuncture in RA may have failed to administer a treatment which reflects that administered in clinical practice. Outcome measures employed in clinical trials of acupuncture in RA, as well as established outcome indices for RA, may lack the necessary breadth to accurately assess acupuncture's efficacy. Acupuncturist affiliation has demonstrable implications for the practice and research of acupuncture.

Introduction

There has been increasing recognition of the impact of choice of outcome criteria on conclusions of efficacy in complementary and alternative medicine (CAM).1, 2, 3 However, little research has been conducted to evaluate the perceived effects or intended therapeutic effect of CAM treatments. Despite ever increasing numbers of clinical trials attempting to evaluate the efficacy of CAM, this dearth of research to inform choice of outcome criteria poses a serious threat to the validity of findings and conclusions of efficacy.

A high prevalence of CAM use has been identified among patients with RA, with acupuncture being one of the most popular treatment modalities.4 Previous studies have suggested that most patients with RA who use acupuncture are satisfied with the treatment and believe they have gained benefit.4, 5, 6, 7 However, systematic reviews have concluded that acupuncture cannot be recommended for patients with RA.8, 9 Thus, discrepancies may exist between outcome criteria measured in clinical trials and effects perceived and valued by patients.

Acupuncture is neither a coherent nor historically stable discipline and this is exemplified in the broad spectrum of opinions and practice within the UK.10, 11, 12 It is however, commonly accepted that acupuncturists in the UK generally affiliate to one of two broad theoretical bases: traditional acupuncture, based on traditional oriental medical principles, and western acupuncture, a modern interpretation of acupuncture based on anatomical, physiological and pathological principles. 13, 14 Although these theoretical bases are not mutually exclusive, with acupuncturists known to amalgamate facets from both perspectives,11, 12 research has shown that differences typically exist in the training and practice of acupuncture by traditional and western acupuncturists.10, 11, 12, 13, 14, 15, 16 Specifically, traditional acupuncturists generally complete longer periods of training, and administer a more protracted treatment incorporating a greater range and number of needle insertion points than western acupuncturists.10, 11, 12, 13, 14, 15, 16 Despite these disparities no study has evaluated the impact of affiliation on either the intended therapeutic effect or patient outcomes.

The present study is the first of a two-stage research project. Phase 1 aims to outline acupuncturists’ perceptions of treating patients with RA using acupuncture, exploring the impact of practitioner affiliation to a traditional or western theoretical base. Phase 2 will outline the experiences of patients with RA who have received treatment with acupuncture, again exploring the impact of practitioner affiliation.

Section snippets

Sample

The sample consisted of 19 acupuncturists currently practising within the north-west of England. Nine acupuncturists described themselves as practising traditional acupuncture, all of whom were non-statutory health professionals and members of the British Acupuncture Council. Of these two practised according to traditional Chinese medicine (TCM) theory, one according to five element theory, with six amalgamating these two traditional approaches. One practised solely within the National Health

Results

Major categories and sub-categories describing acupuncturists’ perceptions of treating patients with RA have emerged from the data. Major categories included: intended therapeutic effect, acupuncture treatment, perceived treatment outcomes and factors affecting treatment outcome. These categories were linked around the central category of theoretical perspective.

Discussion

Although patients were perceived as initially presenting for the alleviation of RA symptoms, the findings from the study highlight the variety of treatments and approaches which patients encounter on accessing acupuncture. There appear to be substantial inter-affiliatory differences in the treatments administered and in the scope and emphasis of intended therapeutic effects. Despite these differences only limited divergence was found between traditional and western acupuncturists’ perceptions

Conflicts of Interest

None of the researchers have received any training in acupuncture, nor affiliate to any theoretical framework of its practice. No payments were received from external organisations. No conflicts of interests were identified.

Acknowledgements

The research contributes to a doctorate at Manchester Metropolitan University, and was supported by a research studentship. The authors wish to thank participating acupuncturists for their assistance and time, and Dr. C.A. Barry, Dr. R. Shaw and Miss K. Burke for their feedback on the manuscript.

References (31)

  • Casimiro L, Brosseau L, Milne S, Robinson V, Wells G, Tugwell P. Acupuncture and electroacupuncture for the treatment...
  • J. Lautenschläger

    Akupunktur bei der behandlung entzündlich-rheumatischer erkrankungen

    Zeitschrift für Rheumatologie

    (1997)
  • S. Birch

    Diversity and acupuncture: acupuncture is not a coherent or historically stable tradition

  • Acupuncture Regulatory Working Group. The statutory regulation of the acupuncture profession. The report of the...
  • Acupuncture: efficacy, safety and practice

    (2000)
  • Cited by (29)

    • Participation in a randomised controlled trial of acupuncture as an adjunct to in vitro fertilisation: The views of study patients and acupuncturists

      2016, European Journal of Integrative Medicine
      Citation Excerpt :

      Themes shared among these studies were: reasons for seeking acupuncture treatment including dissatisfaction with conventional biomedical care; treatment experiences (e.g. needling sensation) and the therapeutic model of patient care. A number of studies have reported acupuncturists’ views about research participation [10–15]. 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.

    • Communication about self-care in traditional acupuncture consultations: The co-construction of individualised support and advice

      2012, Patient Education and Counseling
      Citation Excerpt :

      Numerous interview studies with patients and practitioners of traditional acupuncture indicate that promoting self-care and lifestyle change plays an important part in many consultations [1–10].

    • An investigation into the effectiveness of traditional Chinese acupuncture (TCA) for chronic stress in adults: A randomised controlled pilot study

      2011, Complementary Therapies in Clinical Practice
      Citation Excerpt :

      No similar specific symptom improvements were reported in the attention group. This is supported by previous studies that have found similar results where patients of traditional acupuncturists experienced benefits beyond the alleviation of their presenting condition, including improvements in physical/mental health, emotional well-being and changes in personal identity and lifestyle.16–18 The post-intervention mean PSS-14 score for the TCA group was the lowest of the three groups, but this failed to reach significance and was slightly less than that for the attention group.

    • Physician Characteristics and Variation in Treatment Outcomes: Are Better Qualified and Experienced Physicians More Successful in Treating Patients With Chronic Pain With Acupuncture?

      2010, Journal of Pain
      Citation Excerpt :

      Although we adjusted our analyses for a variety of patient characteristics, it is impossible to rule out with certainty that orthopedists saw different patients than internists and that this contributed to the statistical effects described. Although 2 qualitative studies8,19 suggested that practitioner training and skills are an important part of the acupuncture context and might have an influence on the treatment outcome, this could not be corroborated in our study. Rather formal criteria, such as years of medical experience and amount of training, are possibly not the right indicators to represent these complex issues.

    View all citing articles on Scopus

    Sources of support: The corresponding author was in receipt of a Ph.D. studentship with Manchester Metropolitan University when conducting the study.

    View full text