期刊
JOURNAL OF PAIN
卷 11, 期 5, 页码 431-435出版社
CHURCHILL LIVINGSTONE
DOI: 10.1016/j.jpain.2009.08.010
关键词
Randomized controlled trial; effect modification; quality assurance; acupuncture
资金
- Techniker Krankenkasse (TK)
- BKK Aktiv
- Betriebskrankenkasse der Allianz Gesellschaften
- Bertelsmann BKK
- Bosch BKK
- BKK BMW
- Daimler-Chrysler BKK
- BKK Deutsche Bank
- Ford Betriebskrankenkasse
- BKK Hoechst
- HypoVereinsbank Betriebskrankenkasse
- Siemens-Betriebskrankenkasse
- Handelskrankenkasse
- Innungskrankenkasse Hamburg
The aim of this paper was to quantify the influence of the physician's training and experience in the field of acupuncture on the outcome in patients with chronic pain. Patients visiting their physician because of chronic low back pain, headache, pain due to osteoarthritis of the knee or hip, or neck pain, were included in 4 multicenter, randomized, controlled studies. All patients received routine care; patients in the acupuncture groups received additional acupuncture treatment (on average 10 sessions). The data was pooled, and the 3-month change from baseline of the SF-36 bodily pain subscale as the main outcome defined. A total of 9,990 patients (mean age 49.6 +/- 13.6 years, 68% female) treated by 2,781 physicians (mean age 46.3 +/- 7 years, 37% female) were analyzed. The physicians had 7.3 +/- 5.2 (mean +/- sd) years of experience in acupuncture and their mean duration of formal acupuncture training had been 287 321 hours. The outcome was markedly improved in the acupuncture group. We identified only 1 physician characteristic with a significant influence on the outcome: Internists performed better (odds ratio OR = 1.49, confidence interval CI: 1.01;2.18; P = .043); orthopedists worse (OR = .79, CI: .62;1; P = .043) than the average physician. Neither the duration of training nor the duration of experience had any impact on the extent of the acupuncture effect. Perspective: In this analysis, physician characteristics such as training did not influence patients' outcome after acupuncture, suggesting that formal training parameters have only a limited influence on treatment effect. Other skills such as the therapeutic relationship, which are difficult to measure, may probably play a more important role and should be taken into consideration. (C) 2010 by the American Pain Society
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