An Exploration of the Components and Outcomes of a Chinese Medicine Acupuncture Intervention for the Treatment of Rheumatoid Arthritis; A Case Series.
By Barbara Cushnie
Rationale: Evidence suggests (Lai-Shan Tam 2007) point protocol acupuncture could alleviate number of tender joints in Rheumatoid Arthritis (RA) but high quality research has not been carried out into the effectiveness of Traditional Chinese Medicine (TCM) acupuncture for RA; TCM acupuncture defined by the author as using traditional TCM diagnosis and point prescriptions individualised for each patient, subject to adaptations as treatments progress.
Objectives: ‘Chinese Medicine Acupuncture can best be investigated as a complex intervention’ (Paterson and Britten 2004). This study aimed to identify and explore some of the components of TCM acupuncture which may relate to and interact with each other and/or may contribute to positive outcomes for RA patients.
Design and Outcome Measures: A case series with 5 patients. Quantitative data was collected using the following outcome measures: American College of Rheumatology Patient/Practitioner Assessment, Patient Self Report Tender and Swollen Joint Count Mannequin and Measure Your Own Medical Profile. Qualitative data from: Practitioner Notes, Practitioner Field Diary and Patient Questionnaire.
Results: Quantitative: Marked improvement for 3 patients (who were on analgesics and Non Steroidal Anti-Inflammatory Drugs only) for whom, collectively, 9 ACR measures exceeded 20% improvement and 3 ACR measures exceeded 60% improvement. For those improved, the most improved measure was Number of Painful Joints, followed by Level of Pain.
Qualitative: Components of the intervention perceived by patient and/or practitioner to have made a difference to outcomes were needling intervention, uptake of practitioner recommended lifestyle advice, patient/practitioner relationship, patient’s new TCM/holistic understanding and patient’s expectations of the treatment. Factors outside the intervention perceived to have made a difference to outcomes were non RA health issues, family stresses and patient’s own initiated lifestyle changes.
Conclusion: Larger, more detailed research is needed to further investigate the relationship between components identified and potential positive outcomes suggested.