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Many traditional and complementary and alternative healthcare systems or practices, such as Traditional Chinese Medicine, taijiquan, or acupuncture, are easily found in many North American and European cities. For the most part these practices are not accredited, and their validation remains limited. This is primarily the result of the lack of modern scientific research. Additionally, the studies that are performed rely on evidence and research designs that often negate the true features of these practices with a loss of authenticity. Is it possible or even desirable for these systems to acquire accreditation and inclusion? If so, given the apparent, subjective nature of these practices, can a pluralistic approach to healthcare that retains the Western values of science and medicine be developed that yet respects the diversity of different concepts about life, health and services while permitting these practices to maintain their authenticity? And is it possible to develop a regulatory framework that practitioners can use? The current paper examines questions concerning the uses of non-Western healthcare practices without the loss of their authentic nature. The process of integration is here examined using the inclusion of taijiquan as a health-promoting martial art as the model.

BackgroundThe management of chronic health conditions increasingly requires an organized, coordinated, and patient-centered approach to care. The Chronic Care Model (CCM) has been adopted in primary care to improve care delivery for those with chronic health conditions. Chiropractors manage chronic health conditions; however, little is known if such care is patient-centered. The primary aim of this study is to determine to what extent chiropractic patients with chronic health conditions perceive their care is patient-centred. We will assess concordance with the CCM using the Patient Assessment of Chronic Illness Care (PACIC) survey in study patients. We will also explore perception of how patient-centered the care provided by chiropractors is for those with chronic health conditions according to patients and chiropractors.Methods/designWe will use a sequential mixed methods design with quantitative priority. In the quantitative component patients will complete a written questionnaire providing sociodemographic, health status, and health care interaction information, all of which will serve as the independent variables. Patients will also complete a modified version of the PACIC; the average overall score will be the dependent variable. In the qualitative component semi-structured interviews and focus groups with patients and chiropractors will be conducted. A pilot study will be conducted to determine if the modified PACIC will perform adequately in measuring concordance with the CCM for chiropractic care. Pilot testing will also allow for assessment of the interview and focus groups guides. Variables found to be significantly associated will be included in a multivariate linear regression analysis to identify significant predictors of the dependent variable. Qualitative data will be analyzed using an inductive thematic analysis to provide meaning to the quantitative results.DiscussionThere is a paucity of research describing the extent to which chiropractic care for patients with chronic health conditions is concordant with the CCM. This study will examine this relationship and the perceptions and experiences of patients and chiropractors regarding how patient-centered chiropractic care is for these patients.

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Pain and depression ▸ Hopton A, MacPherson H, Keding A, et al. Acupuncture, counselling or usual care for depression and comorbid pain: secondary analysis of a randomised controlled trial. BMJ Open 2014;4:e004964. Secondary analysis of patients (n=384) with pain and depression MethodsA pragmatic RCT compared acupuncture or counselling with usual care alone. Patients were recruited from GP databases. Acupuncture was customised according to a TCM framework. Depression was scored with Patient Health Questionnaire (PHQ)-9; pain was scored with SF36 bodily pain, at baseline, and 3-monthly for 1 year. ResultsOf the 755 patients enrolled, 384 (51%) reported moderate-to-extreme pain. They tended to be older than those without pain, and to have more severe depression scores both at baseline and at the end of 3 months in the study. Depression improved more in participants with moderate-to-extreme pain at baseline if they received acupuncture than in those who received counselling or usual care (see figure 1). The difference was significant between acupuncture and usual care, but not between acupuncture and counselling. Within the no-pain group, no notable differences were seen between treatment arms. In addition, the pain scores reduced significantly more in the acupuncture group than in either of the other groups. CommentAcupuncture was shown to be effective on depression only in the group that had pain at baseline.