Associate Professor Director MSc Health Psychology University of Southampton
Exploring non-specific effects in acupuncture for low back pain
Felicity Bishop is a health psychologist whose research focuses on two themes: the psychology of complementary and alternative medicines, and the application of placebo effects in clinical practice and research. After studying experimental psychology at Oxford University she completed a Master's and PhD in health psychology at Southampton University where she is now an Associate Professor. Felicity has previously worked as a visiting researcher at Harvard and is currently a visiting fellow at the Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney.
Acupuncture, like any other treatment, generates effects via specific and non-specific, or contextual, mechanisms. In this lecture, Felicity will discuss this controversial distinction and present an argument for the value of research on contextual mechanisms. She will then describe recent research carried out in Southampton University on the psychosocial context of acupuncture, including the latest findings from the nationwide mixed methods MOCAM study.
Ooi Thye Chong
Lecturer in Integrative Medicine, University of Edinburgh
The meridian balance method electro-acupuncture treatment and chronic pelvic pain in women: a mixed methods research pilot study
Ooi Thye Chong recently left the New York Cancer Institute, New York City for the University of Edinburgh as a lecturer in integrative medicine. She is passionate about enhancing the patients' sense of wellbeing and in making a significant difference in their experience of their illness, through a mix of acupuncture, Chinese herbal medicine and teaching patients self-care skills. She has made several trips to China to deepen and broaden her knowledge of classical Chinese medicine.
While in New York she created, managed and directed several successful integrative medicine programs. Ooi Thye is a Registered Nurse and holds National Board Certification as a Licensed Acupuncturist and a Chinese Medicine Herbalist. She earned a Bachelor's degree in Social Psychology from Sussex University, a Master's degree in Public Health from Columbia University, New York, and a Master’s degree in Chinese Medicine.
Ooi Thye is in the final year of her PhD. Her thesis examines the impact of the meridian balanced method acupuncture style on chronic pelvic pain in women
Large-scale studies that employed traditional acupuncture (TA) to study chronic pain conditions such as back pain, osteoarthritis of the knee and migraine headache have demonstrated some efficacy. However, there is little evidence to show whether TA is of benefit in the management of chronic pelvic pain (CPP) in women. Furthermore, as far as we are aware there are no studies on chronic pain conditions that utilized the meridian balance method (BM) electro-acupuncture (EA) treatment. Thus, we have completed a three-armed randomized controlled pilot study (RCT) using a mixed methods research (MMR) approach to assess the feasibility of a future large-scale trial to determine the effectiveness of the meridian BMEA treatment on CPP in women. The primary objectives were to determine recruitment and retention rates. The secondary objectives were to evaluate the effectiveness of interventions, acceptability of methodology to participants enrolled in the trial. Women with pelvic pain were randomized to the meridian BMEA treatment (acupuncture needling + Chinese medicine consultation) or standard care for 4 weeks. The effects of the interventions were evaluated by validated pain/physical/emotional functioning questionnaires at 0, 4, 8, 12 weeks. This presentation will focus on the meridian BM acupuncture treatment and some of the preliminary results of the study.
Member (and ex-chair) of Acupuncture Association of Chartered Physiotherapists
Acupuncture or Manual therapy for Low Back Pain? – with consideration to the design of RCTs for studies of acupuncture
Vivienne Dascanio is currently engaged in doctoral studies at the University of York, investigating a novel trial design for the study of acupuncture and manual therapy for low back pain. She hopes to submit her thesis this year.
Vivienne qualified as a physiotherapist from Coventry University, UK in 1998. As a chartered physiotherapist she has over 18 years of clinical experience in both the NHS and private practice. In 2002 she specialised in musculoskeletal and sports injury conditions and founded her private practice in Peterborough. She has employed and mentored many physiotherapy and other practitioners.
Vivienne held the position of Chair at the Acupuncture Association of Chartered Physiotherapists (AACP) with over 6400 members from 2011 to 2015. She has also been a company director and a committee member on their Education, Training and Research Committee. She was one of the lead authors of the AACP’s ‘Research and Commissioning Resource’ recently republished in 2015 and is committed to supporting practitioners in the provision of evidence-based acupuncture as part of their practice.
Vivienne has published in several research journals and has presented her PhD work both nationally and internationally. She has also been an advocate of acupuncture, presenting at the Houses of Parliament, at national conferences and internationally to support the use of acupuncture within mainstream healthcare practice
Acupuncture and manual therapy were both recommended in the NICE guidelines for low back pain (LBP) in 2009 but the latest review has reversed this decision for acupuncture. The nature of the clinical trials that feed evidence into these reviews is a critical factor. This pilot study attempted to avoid many of the errors and bias seen in previous acupuncture trials by choosing a novel cohort design study with a nested factorial RCT. The objective was to examine the feasibility of undertaking the study design, while investigating acupuncture alone versus manual therapy alone versus a combination of acupuncture and manual therapy versus usual care, for LBP. Chartered physiotherapists delivered all of the interventions. The study design has been suggested as an effective method for use with chronic conditions and for minimizing attrition. It provides a ‘run-in period’ of three months, from collecting baseline data to the first set of outcome data and randomisation. Only participants who return their three monthly questionnaires will be eligible for randomisation to the pilot trial. As the majority of attrition has been shown to occur within the first period of follow-up in an RCT, it is expected subsequent attrition, after randomisation, to be minimal. The results of the pilot trial will be presented at conference. Design considerations, recruitment and retention rates, and attrition will be discussed. The acceptability and feasibility of this design for use with complex interventions such as acupuncture with common musculoskeletal conditions will be considered.
British Acupuncture Council member
The effect of acupuncture on IVF successes rates and live birth rates
Karin Gillerman completed a 4-year TCM degree in 1998, followed by internships in Israel and the US, specialising particularly in acupuncture for women’s reproductive health at the Pacific College of Oriental Medicine. In Israel she was a regular contributor on complementary medicine topics in the media. She has practised acupuncture in London since 2000, in NHS and private integrated practices. Over the past two years she has led a randomised controlled trial of acupuncture at the Homerton University Hospital: "The impact of acupuncture on the success rates of IVF and live birth rates"
Over the last 20 years, many clinical trials have attempted to assess the benefits of acupuncture on IVF treatment but they have all differed in study design, protocol, outcome measures and commercial bias. This heterogeneity has precluded any firm conclusion regarding the efficacy or otherwise of acupuncture in this field. To address this heterogeneity, and to try and provide an evidence based conclusion , it was decided to adopt the Delphi consensus protocol which was reached in 2012 via 15 international acupuncturists with extended experience in treating women with acupuncture during IVF. This protocol was recommended for future research (Smith et al 2012) but so far has not been implemented: this is the first study to use it. The study was a randomised controlled trial which was conducted over 2 years at the fertility department of the Homerton hospital in London. The primary end point was live birth rate. The final results show a large difference between the acupuncture group and the control group in favour of acupuncture. The acupuncture group was found to be superior for both positive pregnancy tests and live birth rates. The results of this study suggest that acupuncture should be offered as a possible method of improving IVF outcome. This study is the first to follow a widely approved consensus protocol hoping to settle disagreement in the literature and resolve previous disparity.
Myeong Soo Lee
Professor of Traditional Chinese Medicine (TCM) and Integrated Health, School of Health and Social Care, London South Bank University
Myeong Soo Lee is a principal researcher of the Korea Institute of Oriental Medicine (KIOM), Daejeon, South Korea. Dr. Lee received his BSc and MSc in Physics from Pusan National University, Korea in 1992. He worked as a researcher at the Department of Microbiology and Immunology, in Wonkwang University, Korea for 10 years and gained his PhD in 2004 from their Professional Graduate School of Oriental Medicine,. He studied evidence based complementary medicine at the Peninsula Medical School, Exeter, for 3 years as visiting researcher. He is adjunct professor of London South Bank University, UK and Tianjin University of Traditional Chinese Medicine.
He is a board member of the International Society of Complementary Medicine Research and the Cochrane Collaboration Complementary and Alternative Medicine Field, and has a leading role in international groups studying pattern identification and developing clinical practice guidelines for traditional medicine. He is an editorial board member for traditional medicine and other professional journals and Associate Editor of the European Journal of Integrative Medicine. He has published over 400 articles in journals and books.
He is currently working on systematic reviews and designing clinical trials assessing the efficacy of several types of complementary therapies for various health conditions. His team in KIOM has focused on three research projects including developing diagnostic methods for blood stasis in Korean Medicine, clinical practice guidelines in Korean Medicine, and clinical efficacy of Korean Medicine for IVF.
1) Standardisation of Korean medicine diagnostic methods in pattern identification and blood stasis syndrome. This presentation covers two major projects on pattern identification, for stroke and for blood stasis. The 9-year stroke project ran from 2005 to 2013 and was divided into three 3-year stages. The objective of the ﬁrst phase was to standardize stroke diagnosis using pattern identiﬁcation, to create a standard clinical chart with a combination of TKM and Western medicine, and to construct a biobank and ﬁnd biomarkers associated with patterns of stroke. The objective of the second and third stages was validation and confirmation of the standardised patterns developed in the first phase, using clinical data and candidate biomarkers. Data from 4,921 stroke patients were collected and this presentation will show the process of developing standardized traditional diagnostic methods for pattern identification and their clinical application. The second part of the talk focuses on the diagnosis of the blood stasis pattern in Chinese Medicine. This is characterised by stagnation, including extravasated blood and sluggish blood circulation or viscous or congested blood, all of which may become pathogenic factors. Blood stasis is associated with chronic and incurable disease, such as pain, infertility, cancer and health conditions caused by stress, which are not curable with modern medicine. A community-based, multi-centre trial was designed as an observational study, with data collected in order to standardise blood stasis diagnosis in Korea. This presentation will show the modern concept of blood stasis by developing a diagnostic tool and diagnostic indices for blood stasis, identify the biological indices and pathological mechanisms related to blood stasis, construct a clinical study base and database for diagnosing and treating blood stasis, and establish traditional Korean medicine diagnoses and treatments for blood stasis disease.
2) Development and implementation of Korean Medicine Clinical Practice Guidelines for Frequent Diseases This presentation reports on a study to develop and implement evidence-based clinical practice guidelines for the treatment of frequently diagnosed diseases in the field of traditional Korean medicine. Standard reporting guidance was developed in the form of a checklist and description of items and examples. This included 5 items and 40 sub-items and was designed to improve the reporting of CPGs in traditional medicine, thereby facilitating their interpretation and replication. Clinical practice guidelines for traditional Korean medicine have been developed for seven disease entities: facial palsy, herniation of the lumbar vertebra, atopic dermatitis, ankle sprain, shoulder-arm pain, obesity and depression. Randomized clinical studies were then conducted to evaluate the applicability of these guidelines, by comparing treatment outcomes from practitioner groups who were given the CPG information in a leaflet against those who were not given this information.
Professor, Department of Health Sciences, University of York
Update on acupuncture for chronic pain: a new analysis of clinical effects and long-term outcome trajectories.
Hugh MacPherson trained as a practitioner of acupuncture and Chinese herbal medicine in the early 1980’s and continues to practice acupuncture in York. He subsequently founded the Northern College of Acupuncture, and steered the College towards achieving university validation for the first acupuncture degree course in the UK. As a result of his interest in research, he set up the Foundation for Research into Traditional Chinese Medicine and subsequently joined the Department of Health Sciences, University of York, as a Senior Research Fellow. Now he is Professor of Acupuncture there. His research includes conducting clinical trials and systematic reviews to evaluate the effectiveness and cost-effectiveness of acupuncture for a variety of conditions, as well as neuroimaging studies to explore potential mechanisms of acupuncture. Hugh is currently working on a project with the World Health Organisation, which involves writing their strategy for research into traditional medicines. He is the lead editor of the book, “Acupuncture research: strategies for building an evidence base” and, with Volker Scheid, a co-editor of, “The integration of East Asian medicine into contemporary healthcare”, both published by Elsevier.
The Acupuncture Trialists Collaboration published a seminal paper on acupuncture for chronic pain in 2012, which already has been cited over 500 times. The chronic pain conditions included back and neck pain, shoulder pain, osteoarthritis and headache and migraine. In this presentation Hugh will provide an update of the results, with the addition of data from 10 more trials published between 2008 and 2015, totalling of 39 trials and over 20,000 patients. The findings reinforce the message of the original meta-analysis, namely that acupuncture has a moderate effect when compared to non-acupuncture controls (such as usual care or wait-list) and a small effect when compared to sham acupuncture. The main criticism of the study, that the difference between acupuncture and sham is too small to be meaningful, will be addressed by comparing effect sizes across a range of interventions vs. sham or placebo. Also new data will be presented on the trajectory of reported outcomes, estimating that only 15% of the benefit is lost at 12 months after treatment.
Professor of East Asian Medicine, University of Westminster
Styles of practice in East Asian Medicine: importance for practice and research
Volker Scheid is Professor of East Asian Medicines and Director of EASTmedicine, an interdisciplinary research centre for the study of East Asian medicines, at the University of Westminster. Volker's research focuses on how we can better understand and deploy the resources available to us in the various East Asian medical traditions. He has published two important monographs - Chinese Medicine in Contemporary China: Plurality and Synthesis and Currents of Tradition in Chinese Medicine 1626-2006 - as well as numerous articles in academic journals. He is a lead author of Chinese Medicine: Formulas and Strategies, and has recently edited a volume with Hugh MacPherson entitled Integrating Chinese Medicine into Contemporary Health Care. Volker has practised Chinese medicine since 1984 and maintains a busy practice in London.
Over the last 20 years Volker has spent much time trying to find frameworks for understanding East Asian medicines in a manner that does not impose on them our modern needs and our ways of imagining the world, yet allowing for comparison and critique. He believes that such frameworks are essential not merely for historians but also for practitioners seeking to develop their tradition unfettered from the dominance of modern Western concepts. These concepts are not restricted to biomedical science but also include apparent alternatives, such as holism, systems thinking, and the dream of a pure tradition located in the ‘classics' to which we can return. In his presentation, Volker will argue that in order to accomplish these goals, we might think of medical practice as primarily a problem solving activity. Developing different styles is one way in which East Asian medicines have tried to resolve the problems of medical practice that have confronted them at different historical moments. Understanding these interconnections can help us to develop the potential of East Asian medicines in relation to our own practices and also has important implications for clinical research.