Menorrhagia affects approximately 30% of women and is a common reason for hysterectomy. Research from China suggests that acupuncture has the potential to provide women with an effective, minimally invasive and acceptable treatment option for Menorrhagia.
The Foundation and the Department of Health Sciences and Clinical Evaluation, University of York, are currently collaborating on a programme of research designed to develop the evidence base as to whether or not women with Menorrhagia should be offered acupuncture on the NHS.
Alison Gamon, and NCA graduate and DPhil scholarship student at York University, is the researcher. The programme of research will employ both qualitative and quantitative research methodologies. The first stage of the research is now underway and aims to assess the acceptability of acupuncture as a treatment option for women with Menorrhagia.
The second phase will be a pilot for the final phase of the research programme; a full-scale pragmatic randomised controlled trial to evaluate the clinical and cost effectiveness of acupuncture as a treatment option for women with Menorrhagia assessed as suitable for treatment within primary care.
Low Back Pain Project: evaluating the effectiveness of acupuncture in the treatment of low back pain.
Back pain is a major cause of ill health and time lost from work. The ‘orthodox’ treatments often have limited success and the NHS has identified back pain as a priority condition for research. A literature review revealed that acupuncture can be an effective treatment though there is a lack of high quality research trials. The Foundation therefore identified low back pain as a priority research area.
In preparation for a randomised controlled trial, a feasibility study was carried out in which GPs referred four patients with chronic low back pain to an acupuncture clinic in York for a course of ten treatments (Fitter & MacPherson, 1995). The purpose was to test out our methods of assessing the outcomes of treatment. These results were encouraging in terms of procedures, end-point measures and outcomes. A full pilot study was undertaken with twenty patients being referred to two acupuncture clinics in York by local GPs and also by consultants in the Pain Clinic at the NHS hospital in York (MacPherson et al 1999).
In collaboration with Kate Thomas of the Medical Care Research Unit at Sheffield University, this project was developed into a successful application for funding from the Department of Health R & D Health Technology Assessment Programme. The research design is that of a pragmatic randomised controlled trial to evaluate the evidence for the clinical benefits, the cost effectiveness and the safety of acupuncture for chronic low back pain (Thomas et al 1999).
The trial involves 240 patients referred by 35 GPs from the York Primary Care Group and then randomised to the offer of acupuncture or to normal GP management. The acupuncture group will receive up to 10 treatments from 6 acupuncturists based at two centres in York. In-depth interviews with selected patients are helping us capture the patients’ strategies for coping with low back pain and their experience of acupuncture.
The trial started in the summer of 1999 and there will be two years of data collecting before the results of this study can be analysed and published.
Acupuncture in General Practice: a case study of an acupuncturist working in general medical practice.
Much of the research programme is in pursuit of our goal of exploring what role acupuncture could play in the NHS. We are therefore interested in the experience of acupuncturists working within the NHS and in ways of making the collaboration as effective as possible. To this end, we have undertaken a small action research case study to explore the process of establishing and providing an acupuncture service within general medical practice. A practice in Sheffield employed an acupuncturist on a sessional basis to provide treatments for their patients. Mike Fitter contributed research expertise to help set up the clinical audit and monitoring systems. Our aims were to identify:
- the benefits to patients and GPs of offering acupuncture with general practice
- the most effective ways of developing collaborative working and an integrated service.
Data on the clinical outcomes of the acupuncture treatments has been analysed, a symposium report has been presented by acupuncturist Pam Machin and we expect to publish the results as a case study on the delivery of acupuncture within a GP practice.
Concordance studies in Traditional Chinese medicine
Within the Low Back Pain Trial there has been the opportunity to investigate as a sub-study the diagnostic categories of traditional Chinese medicine for low back pain. Given that these back pain categories inform treatment, and because we will be obtaining robust data on outcomes for each category, we will be able to develop some useful data on the value of these traditional Chinese medical categories. To support this investigation, we will evaluate the concordance between acupuncture practitioners in their diagnoses. To establish inter-rater reliability we will use Cohen’s Kappa as a statistical measure agreement over and above chance. This work is being extended to exploring tongue diagnosis in traditional Chinese medicine, establishing the how widely this diagnostic tool is used by acupuncturists as well as assessing levels of practitioner concordance.
The Foundation is a small yet dynamic organisation committed to promoting high quality research into our understanding of acupuncture as well as evaluating the benefits, the cost effectiveness and the safety. Our primary goal is to develop and improve the practice of Chinese medicine and to work towards a more central role for acupuncture within the UK’s national health care system.
The Foundation is involved in a number of research projects, the largest of which is a pragmatic randomised controlled trial evaluating the cost effectiveness of acupuncture in the treatment of low back pain. Adverse events following acupuncture are being evaluated in two studies, one a prospective survey of acupuncturist, the other a survey of patients’ experience of adverse events.
The Foundation has also had an interest in women’s health which has developed to the point where a preliminary study has been launched exploring the role of acupuncture for women with menorrhagia. The Foundation is also exploring the diagnostic categories of traditional Chinese medicine with the aim of establishing levels of concordance between practitioners.
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