Heat and Acupuncture to Manage Osteoarthritis of the Knee (HARMOKnee): Protocol for an Effectiveness-Implementation Hybrid Randomized Controlled Trial.

BACKGROUND: Knee osteoarthritis (KOA) is one of most prevalent and fastest-growing causes of pain, impaired mobility, and poor quality of life in the rapidly aging population worldwide. There is a lack of high-quality evidence on the efficacy of traditional Chinese medicine (TCM), particularly acupuncture, and a lack of KOA practice guidelines that are tailored to unique population demographics and tropical climates. OBJECTIVE: Our HARMOKnee (Heat and Acupuncture to Manage Osteoarthritis of the Knee) trial aims to address these gaps by evaluating the short- and medium-term clinical and cost-effectiveness of acupuncture with heat therapy in addition to standard care, compared to standard care alone. Through a robust process and economic evaluation, we aim to inform evidence-based practice for patients with KOA to facilitate the large-scale implementation of a comprehensive and holistic model of care that harmonizes elements of Western medicine and TCM. We hypothesize that acupuncture with heat therapy as an adjunct to standard care is clinically more effective than standard care alone. METHODS: A multicenter, pragmatic, parallel-arm, single-blinded, effectiveness-implementation hybrid randomized controlled trial will be conducted. We intend to recruit 100 patients with KOA randomized to either the control arm (standard care only) or intervention arm (acupuncture with heat therapy, in addition to standard care). The inclusion criteria are being a community ambulator and having primary KOA, excluding patients with secondary arthritis or previous knee replacements. The primary outcome measure is the Knee Osteoarthritis Outcome Score at 6 weeks. Secondary outcome measures include psychological, physical, quality of life, satisfaction, and global outcome measures at 6, 12, and 26 weeks. A mixed method approach through an embedded process evaluation will facilitate large-scale implementation. An economic evaluation will be performed to assess financial sustainability. RESULTS: Patient enrollment has been ongoing since August 2022. The recruitment process is anticipated to conclude by July 2024, and the findings will be analyzed and publicized as they are obtained. As of November 6, 2023, our patient enrollment stands at 65 individuals. CONCLUSIONS: The findings of our HARMOKnee study will contribute substantial evidence to the current body of literature regarding the effectiveness of acupuncture treatment for KOA. Additionally, we aim to facilitate the creation of standardized national guidelines for evidence-based practice that are specifically tailored to our unique population demographics. Furthermore, we seek to promote the adoption and integration of acupuncture and heat therapy into existing treatment models. TRIAL REGISTRATION: ClinicalTrials.gov NCT05507619; https://clinicaltrials.gov/study/NCT05507619. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54352.

A Review of the Traditional Chinese Medicine Glossary of Meridian Pathways and Its English Translations.

The meridian and collateral theory in traditional Chinese medicine (TCM) provides practitioners with essential guidance about the complex network of meridians and collateral systems, as well as informing discussions on physiopathology, diagnoses, and treatments. Various translations have enabled nonnative Chinese to understand the intricacy of the meridian pathways. However, original meanings are easily lost in the text transcription and translation, leading to misinterpretation and confusion in the learning process. We set out to (a) review the standard glossary that describes the meridian pathways; (b) review English translations of the bladder meridian pathway in selected sources; and (c) propose more accurate English translations of both. Our proposed texts offer preliminary guidance on the standardization of the terminology describing the meridian pathways and remind us of the importance of being as precise as possible when translating TCM literature, so that the work retains its original meaning.

Distal Acupoints Outperform Proximal Acupoints in Treating Knee Osteoarthritis: A Randomized Controlled Trial.

OBJECTIVES: To determine the difference in efficacy between distal and proximal acupoints in treating knee osteoarthritis. DESIGN: Ninety-two eligible participants were randomly assigned into three groups: distal acupoint treatment group (DG), proximal acupoint treatment group (PG), and sham acupuncture control group (SG). Primary and secondary outcomes were compared before and after the intervention. Interventions. A single acupuncture treatment was applied at Quchi (LI11), Shaohai (HT3), and Tianjing (TE10) in DG participants; Yanglingquan (GB34), Yinlingquan (SP9), and Heding (EX-LE2) in PG participants; and Zhongwan (CV12) and Liangmen (ST21) in SG participants. Main outcome measures. The visual analog scale (VAS) and active and passive knee range of motion (ROM) were used primarily to evaluate the treatment efficacy. The radial pulse diagnosis was used as a secondary outcome measure to determine the changes in the spectral energy of the radial pulses. RESULTS: The three groups had significant pain reduction after acupuncture (p < 0.05). DG had the greatest difference in pre- and post-VAS scores. Compared with the control group, significant improvement was observed in DG active and passive ROM and in PG passive ROM (p < 0.05). The high-frequency spectral energy of the left chi pulse in PG was significantly decreased, while the low-frequency spectral energy of the left cun pulse in PG and the left guan pulse in DG were significantly increased after acupuncture. CONCLUSIONS: Distal acupoints provide better pain relief and improve ROM than proximal acupoints in treating knee osteoarthritis. Significant changes in spectral energy were observed in the left cun, guan, and chi pulses, indicating pain relief and blood flow improvement after acupuncture.

Acupuncture Differentially Affects the High-Frequency Spectral Energy in Radial Pulse Positions Depending on Type of Lower Back Pain.

Acupuncture is a core discipline in traditional Chinese medicine (TCM) and has been practised in China for centuries. In traditional acupuncture, pulse palpation is an important clinical diagnostic technique that guides practitioners in their treatment strategies as they evaluate the effectiveness of the treatment. This paper provides the findings of our investigation of acupuncture's effect on specific radial pulse spectral energies in 41 individuals with lower back pain (LBP), in response to a single acupuncture treatment delivered bilaterally at acupoints BL23, BL25, and BL40. Baseline assessments (vital signs and radial pulse diagnoses), primary outcome measures (radial pulse diagnoses), and secondary outcome measures (the Faces Pain Scale-Revised (FPS-R) and fingertip-to-floor (FTF) tests) were performed at specified intervals before and after the intervention. Our study provides novel information about the effects of acupuncture on the radial pulse spectral energy in individuals with different types of LBP. Our findings suggest that the right Chi pulse is an effective indicator to assess the effects of acupuncture in individuals with fixed, distended, or sharp pain, whereas the left Guan pulse is a potentially useful diagnostic technique to determine acupuncture's effects in individuals with dull, aching pain. The acupoints BL23, BL25, and BL40 provide effective treatment for LBP. Study participants with dull, aching pain had a significant improvement in their lumbar ranges of motion, and their pain rating scores were markedly decreased after acupuncture treatment.

An investigation into the effects of acupuncture on radial pressure pulse waves in patients with low back pain: A protocol for a quasi-experimental study.

INTRODUCTION: The characteristics of radial pressure pulse waves (RPPW) provide an essential diagnostic technique in Traditional Chinese Medicine (TCM). The purpose of this research is to develop a study protocol that integrates the concept of TCM and traditional acupuncture treatment with modern scientific tools utilizing a quasi-experimental design. We will investigate the effects of acupuncture on the RPPW in study participants with low back pain (LBP) using modern tools, including the pulse sphygmograph, the fingertip-to-floor test, the Faces Pain Scale-Revised, the Oswestry Disability Index, the Health Status Questionnaire, and the Constitution in Chinese Medicine Questionnaire. METHODS: We will attempt to recruit 80 eligible subjects with LBP based on our predefined inclusion and exclusion criteria. Acupuncture intervention will be performed bilaterally on Shenshu (BL23), Dachangshu (BL25) and Weizhong (BL40) for 20 min. Objective and subjective baseline assessments and outcome evaluations will be performed at a specific time before and after the intervention. This paper describes the methods of our original research approved by the China Medical University Hospital's Research Ethics Committee. Recruitment is in progress and data collection will continue until March 2019. CONCLUSIONS: To our knowledge, this preliminary study is the first attempt to investigate the effects of acupuncture on the RPPW in LBP subjects using a pulse sphygmograph and other modern tools. The findings will also investigate the effectiveness of the selected acupuncture point combinations for LBP. We hope this preliminary study will provide a basic foundation for a large-scale research study that involves randomisation in the future.

Efficacy of laser acupuncture for patients with chronic Bell's palsy: A study protocol for a randomized, double-blind, sham-controlled pilot trial.

BACKGROUND: Bell's palsy is the most frequent cause of unilateral peripheral facial palsy, a common condition that third of patients can have inadequate recovery and subsequent physical and social impairments. The largely ineffective and even controversial nature of the various medical and surgical treatment options means that novel, alternative approaches are needed. In preclinical and clinical evidence, low-level laser therapy (LLLT) has demonstrated the ability to regenerate peripheral nerves. Laser acupuncture treatment (LAT), the stimulation of traditional acupoints with low-intensity, non-thermal laser irradiation, is a common treatment modality, but its efficacy in chronic Bell's palsy is undetermined. This study aims to evaluate the efficacy of LAT in patients experiencing inadequate recovery from Bell's palsy. METHODS: This 2-armed, parallel, randomized, subject-assessor-blinded, single-center, sham-controlled pilot trial will randomly assign 32 eligible patients into either a real LAT group (n = 16) or a sham LAT group (n = 16). The real LAT group will receive 3 LAT sessions each week for 6 weeks (a total of 18 sessions), delivered to acupoints corresponding with the affected side of the face. The sham LAT group will receive the same treatment as the real LAT group, but with a sham laser device. The primary outcome measure will be the change from baseline at week 6 in the Facial Disability Index score. Secondary outcomes will monitor changes during treatment in the House-Brackmann and Sunnybrook facial nerve grading systems and stiffness scale, at weeks 1, 3, and 6. DISCUSSION: To the best of our knowledge, this double-blind, randomized, sham-controlled trial is the first such investigation into the efficacy of LAT in chronic Bell's palsy. Clinical trials using LLLT have shown positive therapeutic effects in acute Bell's palsy, although as yet, the feasibility and efficacy of LAT remain unclear in patients experiencing inadequate recovery from Bell's palsy. TRIAL REGISTRATION: This trial protocol has been approved by the Research Ethics Committee of the China Medical University Hospital, Taichung, Taiwan (Protocol ID: CMUH107-REC1-030) also registered at ClinicalTrials.gov (identifier no. NCT03592797).

The Development and Application Evaluation of Meridian Energy Detection System in Traditional Oriental Medicine: A Preliminary Study.

As technology advances, more modern medical devices are developed to help the physicians in performing objective assessment and diagnosis. In this study, our main objective was to evaluate the clinical application of the low voltage Meridian Energy Detection System in assessing the electrodermal activity (EDA) of the specific acupoints in a specific age group of healthy individuals and to assess the difference in the energy overview between the genders and specific time of assessment. 43 young healthy adults were recruited in a single group, nonrandomized, evaluation study. Written informed consent of each participant was obtained prior to the assessments. Results on energy overview between genders and specific time of assessment as well as factors influencing EDA were discussed. It was concluded that the study using Meridian Energy Detection System in healthy individuals provided an understanding of the difference in energy level of the meridians between the genders. Male healthy individuals had significantly higher values for Physical Status as well as Yin and Yang energy while female healthy individuals had significantly higher values for Mental Health and Autonomic Nervous System. There was no significant difference when comparing the assessments at the specific time of assessment. Hence there was no specific time in using the device. However, due to the limitation of the sample size and the healthy subjects, future research can be designed to investigate whether the time of assessment can affect the results in individuals with specific disease conditions in larger scale. It may merit further studies on the application of such device as preliminary diagnosis of the overall conditions and investigate the treatment efficacy by observing the change in the meridian energy level.

Fall prevention among children in the presence of caregivers in a paediatric ward: a best practice implementation.

AIM: This study aims to reduce the incidence of falls in paediatric inpatients aged 3 and below by implementing fall prevention strategies. METHODS: The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programmes were used for this project. The project was carried out in three phases over a 4-month period from March to June 2011. A fall prevention poster was introduced during the implementation phase, and pre- and post-implementation audits were carried out in a 43-bed acute care paediatric ward in Singapore, with a sample size of 30. RESULTS: The audit result of Criterion 1, evaluating the effectiveness of the fall prevention measures, improved by 13%, to 93%. Criterion 2, measuring nurses' compliance in the regular reinforcement of safety, improved significantly by 27%, to 40%. However, Criterion 3, which measured nurses' compliance in identifying patients at high risk of falls by placing a green identification wrist tag on such patients, decreased by 23%, to 50%. DISCUSSION: A multi-language poster on fall prevention was strategically positioned at the foot of all the cots. The poster served as an effective reminder and communication method between nurses and caregivers and also among caregivers of the child. Caregivers' increased awareness and knowledge of fall prevention contributed to a 50% decrease in fall incidence of patients aged 3 and below in the presence of a caregiver from January to June 2011, as compared with the incidence rate in 2010. CONCLUSION: This project has shown that fall incidents can be reduced when caregivers' awareness of fall prevention measures in the hospital setting were to be improved. The poster on fall prevention has increased caregivers' awareness and reduced inpatient falls in the acute care setting. The pre- and post-implementation audits showed that the presence of a poster on fall prevention to remind parents/caregivers to raise and securely lock the cot rails at all times was effective in reducing the number of falls for children aged 3 years and below. The experience gained from this project was that communication to every staff member and caregivers is essential in implementing practice change. As a result of the study, the hospital plans to implement constant monitoring and reminders to nurses and caregivers to improve compliance to the recommended measures on fall prevention in the near future.