BACKGROUND: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. METHODS: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. RESULTS: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. CONCLUSIONS: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.

BACKGROUND: Tobacco use remains the leading cause of morbidity and mortality in the US. Effective tobacco cessation aids are widely available, yet underutilized. Tobacco cessation brief interventions (BIs) increase quit rates. However, BI training has focused on conventional medical providers, overlooking other health practitioners with regular contact with tobacco users. The 2007 National Health Interview Survey found that approximately 20% of those who use provider-based complementary and alternative medicine (CAM) are tobacco users. Thus, CAM practitioners potentially represent a large, untapped community resource for promoting tobacco cessation and use of effective cessation aids. Existing BI training is not well suited for CAM practitioners' background and practice patterns, because it assumes a conventional biomedical foundation of knowledge and philosophical approaches to health, healing and the patient-practitioner relationship. There is a pressing need to develop and test the effectiveness of BI training that is both grounded in Public Health Service (PHS) Guidelines for tobacco dependence treatment and that is relevant and appropriate for CAM practitioners. METHODS/DESIGN: The CAM Reach (CAMR) intervention is a tobacco cessation BI training and office system intervention tailored specifically for chiropractors, acupuncturists and massage therapists. The CAMR study utilizes a single group one-way crossover design to examine the CAMR intervention's impact on CAM practitioners' tobacco-related practice behaviors. Primary outcomes included CAM practitioners' self-reported conduct of tobacco use screening and BIs. Secondary outcomes include tobacco using patients' readiness to quit, quit attempts, use of guideline-based treatments, and quit rates and also non-tobacco-using patients' actions to help someone else quit. DISCUSSION: CAM practitioners provide care to significant numbers of tobacco users. Their practice patterns and philosophical approaches to health and healing are well suited for providing BIs. The CAMR study is examining the impact of the CAMR intervention on practitioners' tobacco-related practice behaviors, CAM patient behaviors, and documenting factors important to the conduct of practice-based research in real-world CAM practices.

BACKGROUND:Some researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers' views of their patients' expectations regarding CAM therapy and the role of these expectations in patient outcomes.METHODS:To better understand how CAM providers view and respond to their patients' expectations of a particular therapy, we conducted 32 semi-structured, qualitative interviews with acupuncturists, chiropractors, massage therapists and yoga instructors identified through convenience sampling. Interviews were recorded, transcribed and analyzed thematically using Atlas ti version 6.1.RESULTS:CAM providers reported that they attempt to ensure that their patients' expectations are realistic. Providers indicated they manage their patients' expectations in a number of domains-- roles and responsibilities of providers and patients, treatment outcomes, timeframe for improvement, and treatment experience. Providers reported that patients' expectations change over time and that they need to continually manage these expectations to enhance patient engagement and satisfaction with treatment.CONCLUSIONS:Providers of four types of CAM therapies viewed patients' expectations as an important component of their experiences with CAM therapy and indicated that they try to align patient expectations with reality. These findings suggest that CAM providers are similar in this respect to conventional medical providers.

BACKGROUND:No consistent relationship exists between pre-treatment expectations and therapeutic benefit from various complementary and alternative medicine (CAM) therapies in clinical trials. However, many different expectancy measures have been used in those studies, with no validated questionnaires clearly focused on CAM and pain. We undertook cognitive interviews as part of a process to develop and validate such a questionnaire.METHODS:We reviewed questions about expectations of benefits of acupuncture, chiropractic, massage, or yoga for pain. Components of the questions - verbs, nouns, response options, terms and phrases describing back pain - were identified. Using seven different cognitive interview scripts, we conducted 39 interviews to evaluate how individuals with chronic low back pain understood these individual components in the context of expectancy questions for a therapy they had not yet received. Chosen items were those with the greatest agreement and least confusion among participants, and were closest to the meanings intended by the investigators.RESULTS:The questionnaire drafted for psychometric evaluation had 18 items covering various domains of expectancy. "Back pain" was the most consistently interpreted descriptor for this condition. The most understandable response options were 0-10 scales, a structure used throughout the questionnaire, with 0 always indicating no change, and 10 anchored with an absolute descriptor such as "complete relief". The use of words to describe midpoints was found to be confusing. The word "expect" held different and shifting meanings for participants. Thus paired items comparing "hope" and "realistically expect" were chosen to evaluate 5 different aspects of treatment expectations (back pain / back dysfunction and global effects / impact of back pain on specific areas of life / sleep, mood, and energy / coping). "Impact of back pain" on various areas of life was found to be a consistently meaningful concept, and more global than "interference".CONCLUSIONS:Cognitive interviews identified wordings with considerable agreement among both participants and investigators. Some items widely used in clinical studies had different meanings to participants than investigators, or were confusing to participants. The final 18-item questionnaire is undergoing psychometric evaluation with goals of streamlining as well as identifying best items for use when questionnaire length is constrained.

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Myofascial pain syndrome is the second most common reason patients seek the help of health care workers. It costs billions of dollars each year in lost revenue due to loss of productivity and other costs. The treatment of myofascial pain syndrome has been extensively researched and it appears that dry needling and medicinal injections of trigger points are some of the most effective modalities. However, an unwanted side effect common to both these therapies is post-needling soreness. Despite being mentioned in passing by many authors, very little detail is available regarding post-needling soreness. It is unclear whether post-needling soreness arises from the trigger point itself, or whether the tissue damage caused by the needle insertion is responsible. Therefore, this study was aimed at investigating whether dry needling muscle tissue in asymptomatic subjects (i.e. subjects not suffering from myofascial pain syndrome) resulted in post-needling soreness. Two different dry needling techniques were also compared with a placebo group in order to determine which technique resulted in the least post-needling soreness. This study was designed as a prospective, randomised, placebo controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups. Group one received the single needle insertion technique and the second group received the fanning dry needling technique. The last group formed the control group and the subjects were treated using the Park Sham Device (placebo needles). All the subjects were between the ages of 18 and 50 and were required to be asymptomatic in the low back region. / M

Cognitive behavioural therapy for insomnia (CBT-i) is the most effective treatment for insomnia. Studies show that auricular acupuncture (AA) may alleviate insomnia symptoms. The overall aim of the thesis was to compare treatment effects of auricular acupuncture (AA) with cognitive behavioural therapy for insomnia (CBT-i) on symptoms of insomnia, anxiety, depression, hypnotic drugs consumption and quality of life from short- and long-term perspectives. Paper I had a qualitative approach with a descriptive design. 16 participants received group-treatment with AA during their protracted withdrawal phase and were interviewed about their experiences. They participants experienced a reduction in protracted withdrawal symptoms, improved subjective sleep quality, a strong sensation of peacefulness and increased wellbeing. Paper II, III and IV present results from a randomised controlled trial in where the effects of group-treatment with AA and CBT-i were compared in short- and long-term using subjective (questionnaires and sleep diary) and objective (actigraphy) measurements. The results showed that CBT-i was superior to AA in reducing insomnia symptoms in both the short and long run. Both groups experienced significant long-term reduction of depressive symptoms. Further, both groups managed to maintain a decreased intake of hypnotic drugs at the end of the treatment when compared to baseline measurement. Short-term reduction of symptoms of anxiety and depression improved only in the AA group. The results from the objective actigraph recordings showed that the AA group slept more and the CBT-i group less after the treatment and that sleep patterns in both groups reverted to pre-treatment levels after 6 months. Conclusively: AA, as administered in this study, was not as good as CBT-i in treating insomnia symptoms, and should not be used as a stand-alone treatment for insomnia. Our results also demonstrate that prolonged sleep time does not necessarily yield better sleep, and that the perception of insomnia symptoms is not inevitably affected by sleep duration. AA was as effective as CBT-i in ending hypnotic drugs consumption. Moreover, AA was more successful than CBT-i in reducing symptoms of anxiety and depression in the short run. Further studies investigating AA for anxiety and depression are motivated.

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Objective: The aim of this study was to investigate the relative effectiveness of TENS, versus, needling, versus Electro-needling in the treatment of MTSS. First objective The first objective was to evaluate the effectiveness of TENS therapy on MTSS with respect to the patients subjective and objective responses to the treatment. Second Objective The second objective was to evaluate the effectiveness of needling therapy on MTSS, with respect to the patient’s subjective and objective responses to the treatment. Third Objective The third objective was to evaluate the effects of electro-needling on MTSS, with respect to the patients’ subjective and objective responses to the treatment. Fourth Objective The fourth objective was to integrate the subjective and objective data collected in order to determine the viability of each of the therapies in comparison to one another as treatment options of MTSS. / M

BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure. METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers of which N = 292 (54% anesthesiologists, 44% CRNAs, 2% AAs) responded yielding an overall 17% response rate. RESULTS: Spearman’s correlation coefficient revealed a statistically significant correlation between acupuncture and geographic region, with the West having the highest predisposition toward acupuncture use (rs = 0.159, p = 0.007). Females are more likely to use acupuncture than men (rs = -.188, p = 0.002). Age yielded a moderate effect size with providers between the ages of 31-50 years old experiencing the best outcomes administering acupuncture (rs = 0.65, 95% CI = 2.79, 3.06). A strong effect size exists between acupuncture and country of pre-anesthesia training (rs = 1.00, 95% CI = 1.08, 1.16). Some providers have used acupuncture (27%) and acupressure (18%) with positive outcomes, however the majority of providers have not used these modalities, but would consider using them (54%, SD = 1.44 acupuncture; 60%, SD = 1.32 acupressure). Seventy-six percent of respondents would like acupuncture education and 74% would like acupressure education (SD = 0.43, SD = 0.44, respectively). Lack of scientific evidence (79%, SD = 0.73) and unavailability of credentialed providers (71%, SD = 0.92) were the primary barriers. CONCLUSIONS: While most U.S. anesthesia providers have not used these modalities, they still report a favorable perception of acupuncture/acupressure’s role as part of an anesthetic and the majority of providers express an interest in receiving education. This study adds to the body of acupuncture and acupressure research by providing insight into anesthesia providers’ perceptions of these alternative medicine modalities.

DIPLOMA THESIS: The impact of acupuncture on heart rate variability in patients with migraine SOCIAL AND CLINICAL PHARMACY DEPARTMENT, FACULTY OF PHARMACY IN HRADEC KRÁLOVÉ, CHARLES UNIVERSITY IN PRAGUE AUTHOR: Kateřina Jehličková SUPERVISOR: PharmDr. Jitka Pokladníková, Ph.D. INTRODUCTION: Migraine is one of the most common diseases that affects up to 25% of human adult worldwide. The popularity of alternative therapeutic method is increasing, in this case namely acupuncture, currently between 11-46% globally, 4-9,9% respectively. OBJECTIVE: The primary goal of this work is to evaluate if acupuncture has any effect on HRV in patients with migraine. Secondary goal is to find out which psychosocial factors may influance HRV parameter changes. METHODOLOGY: HRV measurment was performed before acupuncture and after 12 weeks of acupuncture therapy. At first, results were processed in KUBIOS software which is specially designed for the study of heart rate variability and the needed parameters. Then the statistical analysis of a paired t-test (p=0,05) and linear regression (p=0,1) were done in SPSS software. MIDAS questionnaire (quality of life in patients with migraine), life satisfaction questionnaire (Satisfaction with Life Scale, SWLS) and The Symptom Checklist (SCL-90) were used to determine factors...

O presente estudo tem como objetivos: desvelar percepções de enfermeiros acerca da acupuntura como prática assistencial de enfermagem; identificar fatores dificultadores/facilitadores para a implantação da acupuntura como técnica complementar à assistência de saúde; discutir aspectos contraditórios e os dilemas ético-legais que perpassam a prática da acupuntura pelo enfermeiro em serviços de saúde pública. Pesquisa de campo exploratória foi realizada com 33 enfermeiras, de 11 Unidades de Saúde, da Região Sudeste do Município de São Paulo, que oferecem atendimento de acupuntura por profissionais médicos. Os dados coletados nas entrevistas foram examinados com base na Análise de Conteúdo de Bardin (2004) e Minayo (2007) e distribuídos em quatro categorias principais: (1) percepções de enfermeiros acerca da acupuntura na assistência à saúde; (2) fatores dificultadores e (3) facilitadores da prática da acupuntura pelo enfermeiro em serviços de saúde pública e (4) dilemas ético-legais na prática da acupuntura vivenciados pelos enfermeiros. Debates sobre percepções referentes à acupuntura revelaram credibilidade de pacientes na eficácia da técnica em uma grande variedade de enfermidades, especialmente em doenças crônicas, dor e estresse. Foi considerada como uma terapêutica holística, agindo com menos efeitos colaterais em situações em que a alopatia é ineficiente. Como fatores dificultadores foram encontrados: sobrecarga de trabalho, falta de recursos materiais e humanos e uma política de saúde que não favorece a implantação da acupuntura pelo enfermeiro. Entre os fatores facilitadores foram indicados: possibilidade de capacitação técnica do enfermeiro e de implantação do serviço de acupuntura multiprofissional pela Secretaria de Saúde, além de mais e melhor informação para a população e para profissionais, com a vantagem da proximidade já existente entre enfermeiro e usuário. Quanto aos dilemas ético-legais, questionou-se a acupuntura como prática limitada à classe médica, o preconceito quanto ao que o enfermeiro faz e pode fazer, a necessidade de regulamentação pelas autoridades competentes e, por fim, qual o perfil do profissional que poderia exercer a acupuntura, segundo as enfermeiras entrevistadas. Face ao novo paradigma emergente da saúde, na busca de um cuidado menos biologicista, mais integral e holístico, a acupuntura como prática complementar à assistência na saúde pública emerge como uma nova/velha terapêutica, trazendo muitos benefícios à saúde da população. O desafio que se coloca ao enfermeiro é a conquista da acupuntura como saber e fazer do enfermeiro, participando da implantação responsável, ética e multiprofissional da acupuntura em benefício da população / The objective of the present study were to unveil nurses´ perceptions on acupuncture as a nursing care practice; to identify difficulting or facilitating factors for implementation of acupuncture as a complementary procedure for health care; and to discuss contradictory issues, ethical and legal dilemmas which carry through the acupuncture practice by nurses in public health services. An exploratory research on field was held with 33 nurses, from 11 Health Units, located in the south-east region of São Paulo city, where acupuncture is practiced by physicians. Collected data through interviews were analyzed based on Bardin (2004) Content Analysis and Minayo (2007), distributed within four main categories: (1) nurses´ perceptions on acupuncture in health care; (2) difficulting factors and (3) facilitating factors related to acupuncture felt by nurses in public health services and (4) ethical and legal dilemmas on acupuncture practice experienced by nurses. Debates on perceptions related to acupuncture showed credibility by patients on the procedure efficacy in a large variety of illness, particularly on chronicle ones, pain and stress. It was considered as a holistic therapy, acting with less collateral effects, when allopath is inefficient. Difficulting factors found were: working overload, lack of material and human resources and the health policy which is not favorable for implementation of acupuncture done by nurses. Among facilitating factors were indicated: possibility of enabling nurses with technical qualification as well as implementation of acupuncture services by a multi-professional team through the Secretariat of Health; more and better information for people and professionals and the advantage of existing closeness between nurses and patients. Regarding the ethical and legal dilemmas, the issue of acupuncture as a practice limited to the medical group was raised, as well as the prejudice related to what nurses do or may do, the need of regulation by competent authorities and also who would be the professionals to practice acupuncture according to the interviewed nurses. Considering this emerging new health paradigm and looking for a less biologist and more integral and holistic caring, acupuncture as a complementary practice to public health care comes forth as new/old therapy, bringing many benefices to the public health. The challenge imposed to nurses is the conquest of the acupuncture as the knowing and the doing of the nurse, participating in responsive, ethical and multi-professional implementation of acupuncture practice for the people benefit