Methods

For hands-on instruction consider a university research methods module. There are now acupuncture focused and CAM focused research Masters degrees [LINK to section 10] and also short training courses co-organised by the International Society for Complementary Medicine Research: www.iscmr.org/about/rtm.
For detailed and comprehensive accounts of different methodologies used in healthcare research refer to the many text books on this subject.
For social science research methods: http://www.socialresearchmethods.net/kb/.
For an acupuncture/CAM slant see the reference list in the Introduction above.
The Research Council for Complementary Medicine document ‘Introduction to Research’ provides a simple account of the main methods: www.rccm.org.uk/node/15

Case Study

Have you ever treated a patient with an interesting or uncommon condition? Have you ever had exceptional results when treating a patient? Have you ever tried a new approach that had a particularly good or interesting outcome? Have you ever treated a condition where the results defied all the received wisdom of Chinese (or Western) medicine? If so, have you ever wanted to share this information with colleagues - perhaps on a wide scale? If your answer to any of these questions is "yes" then why not consider writing up a case study?

Case studies have been integral to Chinese medicine and the way knowledge about it has been transmitted for centuries. A case study usually documents in detail the process of treatment and the response of an individual patient (Lao et al 2002). It is a format that is particularly suited to the individual practitioner. Based on normal clinical practice, the only investment that you require is time for reflection and writing. It also provides you with a convenient and relatively simple starting point for conducting research.

For you as an individual practitioner writing a case study, there is the opportunity to examine and reflect on a course of treatment you have given to an individual patient. In addition, your systematic analysis of the case can result in better treatment of other patients. And, by sharing your experience with others, you may develop contacts with other practitioners treating similar conditions.

Writing a case study can also benefit the profession as a whole. Often, case studies can be the basis for the introduction of new therapeutic methods, thereby contributing to the evolution and development of the profession. They can also be the catalysts for further research, as innovative treatment modalities raise new, interesting questions that demand further exploration. And, they can even lead to getting funding for a larger project!

The British Acupuncture Council has, for several years, promoted the writing of case studies by offering a small prize to those accepted for publication in the European Journal of Oriental Medicine (www.ejom.co.uk).
Suggested Guidelines for Case Study Presentations
You may wish to use this as a guide to areas it may be appropriate to cover in a case study.

Briefly state what it is about the case that prompted you to record and submit it.

Information about the patient

  • Confidentiality - make sure to change the patient name and any easily identifiable details
  • Age of patient
  • Relevant background and health history
  • Medication history together with dosages
  • Previous experiences with orthodox and complementary and alternative medicine
  • Signs and symptoms
  • Diagnosis (and how arrived at)
  • Purpose of treatment

Treatment Plan and General Principles

  • Detail the treatment plan - principles, priorities and points
  • State the treatment style utilised (5 Element, 8 principles, integrated, etc.)
  • Detail the needling approach - depth, action, whether deqi is obtained, etc.
  • Detail any additional aspects of treatment, such as moxa, lifestyle advice, dietetics, etc.
  • Planned frequency and duration of subsequent treatment sessions

Treatment Details in Practice

  • Give a concise description of what you actually did in treatments, highlighting any changes of direction or particularly interesting details
  • Note your observations during treatment
  • Note the patient's responses

Evaluation

  • Assess the treatment program from the patient's and acupuncturist's perspectives
  • Discuss and comment

References

  • Where appropriate, state the source that influenced any of your treatment decisions (e.g. for point selection, method, style). If these are sources that can be referenced, place them in an alphabetical list at the end.

Following these guidelines will produce a very thorough case study. However, case studies can also be powerful and effective when less detailed. Be guided by what you would need to know as a practitioner reading the study, and write accordingly.

References

P Ferrigno, JD Ryan and JC Deare. Writing Chinese Medicine Case Reports: Guidelines for the Australian Journal of Acupuncture and Chinese Medicine. AJACM 2006;1(1):25-30
http://ajacm.com.au/Journal_AJACM/Articles_and_Abstracts/AJACM_2006_Volume_1_Issue_1.aspx

Lao L, Sherman K, Bovey M, "The role of acupuncture schools and individual practitioners in acupuncture research", Clinical Acupuncture and Oriental Medicine, 3[1] 2002, pp 32-38.

MacPherson H, Kaptchuk T (eds) "Acupuncture in practice: case history insights from the West". New York: Churchill Livingstone, 1997.

Chen J, Wang N (eds) "Acupuncture Case Histories from China.

Case Series

This is a group of cases on a linked theme, most commonly patients with the same medical condition. Summarising and presenting a number of cases, especially where you have used similar outcomes tools to measure progress, can make a strong case for the effectiveness of your treatment (though it doesn’t prove that the patients would not have got better in time without the treatment). It is certainly a useful preliminary before considering controlled clinical trials; it also provides information for practitioners about what might work well or not in particular situations. For most individual practitioners it is difficult to accumulate large numbers of such cases in a short time-frame, except for very common conditions: group projects would help to overcome this.

For further information:

N=1 studies [LINK to article in the Acupuncturist]

Qualitative research

Qualitative research answers ‘how’ and ‘why’ questions. It is used for delving into the experiences and perceptions of patients and practitioners in particular, usually through interviews. There is an increasing trend for clinical trials to include qualitative research alongside the quantitative, to provide more insight into the meaning of the results. Refer to books on qualitative research. For acupuncture applications look at papers by Charlotte Paterson, Claire Cassidy, John Hughes and Felicity Bishop, amongst others.

Surveys

Surveys are ubiquitous throughout all areas of research and are covered extensively by general research methods texts. Questionnaires are the commonest data collection method for surveys and their design is the subject of various books. Searching a database such as Pubmed for ‘acupuncture and survey’ will produce hundreds of examples.

Action Research

Action Research arose in the social sciences as a means not just of investigating issues but also effecting social change. It involves cycles of reflection/research/analysis together with problem-solving actions, usually in a collaborative way between researchers and participants. Details can be found in the social sciences literature more than in healthcare, though both audit and reflective practice (which is widely used in acupuncture education and practitioner CPD guidelines, but not research) would fall into the action research framework. Here are two recent examples of acupuncture action research projects:
The Westminster Menopause Study: http://www.westminster.ac.uk/eastmedicine/projects/menopause-research
See also this presentation of interim results: [LINK to presentation at ARRC 2013 by Trina Ward and Katy Scanlon]
 MoxAfrica : an action research project on many levels, with the fundamental aim of setting up moxibustion services in Africa for TB sufferers: http://www.moxafrica.org/

Controlled trials

These are more the domain of the professional researcher though it is possible to run a small trial yourself in practice.
Guidelines for writing a protocol for a clinical trial:
White A, Park J. Protocols for clinical trials of acupuncture Acupunct Med 1999;17:1 54-58
[Free access at  http://www.acupunctureinmedicine.org.uk/]

Guidelines for acupuncture trials carried out under a Comparative Effectiveness Research banner: http://www.biomedcentral.com/1472-6882/12/148

The NIHR Clinical Trials Toolkit (www.ct-toolkit.ac.uk/home): practical advice for researchers in designing and conducting publicly funded clinical trials in the UK

Systematic reviews

These are reviews of the literature on a particular subject, usually a single condition treated with one, or a related group of, interventions. They should follow rigorous, defined procedures so as to be transparent and objective. The most esteemed medical reviews are those of the Cochrane Collaboration and their library includes more than 50 acupuncture reviews. These are freely available (http://www.thecochranelibrary.com/view/0/index.html), as are the guidelines on how to carry out the reviews: http://handbook.cochrane.org/.It is not a soft option for getting into research: it is time-consuming and requires meticulous attention to detail. You can find out more from the links below and by reading examples of acupuncture systematic reviews in the literature. Quite often there are systematic review workshops put on in the standalone training organised by the International Society for Complementary Medicine Research (www.iscmr.org/about/rtm) and at CAM research conferences. Although systematic reviews are seen as high level evidence they are limited by the quantity and quality of research available. Also, differences in inclusion/exclusion criteria and in how the data are analysed and interpreted can substantially change the conclusions and recommendations.

Other references/links

Nursing Times: A practical guide to conducting a systematic review http://www.nursingtimes.net/a-practical-guide-to-conducting-a-systematic-review/200450.article
Institute of Medicine: Standards for systematic reviews http://www.iom.edu/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews/Standards.aspx
Scottish Intercollegiate Guideline Network (SIGN): guidelines for systematic literature review http://www.sign.ac.uk/guidelines/fulltext/50/section6.html