Development of Clinical Practice Guidelines for the treatment of Recurrent Miscarriage with Traditional Acupuncture: A mixed-methods modified Delphi Study
By Jill Storstein - MSc in Acupuncture
Abstract
Background
Recurrent miscarriage (RM) affects 1-5% of couples. Known causes include uterine abnormalities, chromosomal anomalies, clotting disorders, endocrine imbalances, immune factors and around 75% of cases are unexplained. Recommended therapeutic options are limited, and supportive care is recommended for unexplained RM. Acupuncture is a complex intervention involving supportive care and there is preliminary evidence that it can improve blood flow and reproductive and immune function.
Aims
This study aimed to develop a guideline and a basis for research trials by gathering opinion on good clinical practice of acupuncture in the treatment and diagnosis of RM from acupuncturists with expertise in the field.
Methodology
A pragmatic mixed-methods modified-Delphi technique was used. 20 acupuncturists with significant experience treating RM were purposively sampled. Round 1 used a qualitative questionnaire with open questions to gather expert opinion. Rounds 2 and 3 were questionnaires comprised of statements generated from thematic analysis of the round 1 and 2 responses. Participants rated agreement using a 7-point Likert scale. The consensus level was set a priori at 70% of participants agreeing. Round 3 was developed from statements without consensus and round 2 comments. Agreement percentage and the median were used to apply grading criteria. The bootstrap method was used to narrow confidence intervals.
Findings
The study demonstrated a broad role for the acupuncturist involving an integrative, individualised approach. Altogether, 156 statements grouped into 8 sections were generated. The resulting guideline provides a comprehensive reference for practitioners treating RM covering: diagnostic and treatment recommendations; broader context guiding principles; detailed diet and lifestyle advice with consideration of emotional health in the RM patient. 65% of the statements had strong and 24% had moderate consensus. 4% were without consensus. Bootstrapping generated narrow confidence intervals ranging from 0.09-0.13 for 5 sample statements with wide variance in opinion.
Conclusion
The good practice guidelines developed by this Delphi study provide a reference for acupuncturists and for researchers to promote trial homogeneity and emulate clinical practice in the treatment of RM with acupuncture.
