“It's Better in a Group Anyway”: Patient Experiences of Group and Individual Acupuncture

Chuang, Elizabeth; Hashai, Noa; Buonora, Michele; Gabison, Jonathan; Kligler, Benjamin; McKee, M. Diane

doi:10.1089/acm.2017.0262

Cited by 17 publications

(17 citation statements)

References 27 publications

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“…Participants who might have had an initial preference for individual treatment reliably initiated and continued treatment in the group setting. In qualitative interviews with participants in both study arms, 77 we identified both positive (social interaction) and negative (privacy concerns, mixed-gender groups) elements, but none of these ultimately affected initiation and continuation of treatment.…”

Section: Discussionmentioning

confidence: 92%

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

et al. 2020

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Background Acupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. However, access to acupuncture treatment has been limited in medically underserved and low-income populations. Objective Acupuncture therapy delivered in groups could reduce cost and expand access. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain. Design This was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic (> 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks. Participants Seven hundred seventy-nine participants were randomized. Mean age was 54.8 years. 35.3% of participants identified as black and 56.9% identified as Latino. Seventy-six percent were Medicaid insured, 60% reported poor/fair health, and 37% were unable to work due to disability. Interventions Participants received weekly acupuncture treatment in either group or individual setting for 12 weeks. Main Measures Primary outcome was pain interference on the Brief Pain Inventory at 12 weeks; secondary outcomes were pain severity (BPI), physical and mental well-being (PROMIS-10), and opiate use. Outcome measures were collected at baseline, 12 and 24 weeks. Key Results 37.5% of individual arm and 30.3% in group had > 30% improvement in pain interference (d = 7.2%, 95% CI − 0.6%, 15.1%). Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%. In the responder analysis of physical well-being, 63.1% of individual participants and 59.5% of group had clinically important improvement at 12 weeks (d = 3.6%, 95% CI − 4.2%, 11.4%). Conclusions Both individual and group acupuncture therapy delivered in primary care settings reduced chronic pain and improved physical function at 12 weeks; non-inferiority of group was not shown. Trial Registration Clinicaltrials.gov # NCT02456727

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Section: Discussionmentioning

confidence: 92%

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

et al. 2020

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“…For example, Tofthagen et al [13] reported significant improvement in cancer-related pain and numbness for patients undergoing group AP; however, they used a retrospective study design and had no comparison group. Similarly, in a qualitative study, Chuang et al [12] reported that patient experiences in group AP were on par with individual AP for pain relief and improvement in QoL; however, their findings were limited 6…”

Section: Discussionmentioning

confidence: 99%

“…Group (or community) AP is an emerging cost-effective method of treating patients. Although the practice can vary, group AP is performed in a group setting, typically with reclining chairs dispersed around a large room, and one practitioner treating up to six people per session [11,12]. Despite its growing popularity, there is relatively little evidence to demonstrate the effectiveness of AP performed in a group setting.…”

Section: Introductionmentioning

confidence: 99%

Group versus Individual Acupuncture (AP) for Cancer Pain: A Randomized Noninferiority Trial

Reed

Landmann²,

Oberoi

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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Background. A service delivery model using group acupuncture (AP) may be more cost-effective than individual AP in general, but there is little evidence to assess whether group AP is a comparable treatment in terms of efficacy to standard individual AP. The study aimed to compare the group to individual delivery of 6-week AP among cancer patients with pain. Methods. The study design was a randomized noninferiority trial of the individual (gold standard treatment) vs. group AP for cancer pain. The primary outcome was pain interference and severity, measured through the Brief Pain Inventory (BPI). Secondary outcomes included measures of mood, sleep, fatigue, and social support. Changes in outcomes from pre- to postintervention were examined using linear mixed effects modeling and noninferiority was inferred using a noninferiority margin, a difference of change between the two arms and 95% CIs. Pain interference was tested with a noninferiority margin of 1 on the BPI, while pain severity and secondary outcomes were compared using conventional statistical methods. Results. The trial included 74 participants randomly allocated to group (35) or individual (39) AP. The noninferiority hypothesis was supported for pain interference [Ө − 1, Δ 1.03, 95% CI: 0.15–2.20] and severity [Ө − 0.81, Δ 0.52, 95% CI:.33–1.38] as well as for mood [Ө − 7.52, Δ 9.86, 95% CI: 0.85–18.86], sleep [Ө − 1.65, Δ 2.60, 95% CI: 0.33–4.88], fatigue [Ө 8.54, Δ − 15.57, 95% CI: 25.60–5.54], and social support [Ө.26, Δ − 0.15, 95% CI: − 0.42–0.13], meaning that group AP was not inferior to individual AP treatment. Both arms evidenced statistically significant improvements across all symptoms before and after the intervention. Effect sizes for the group vs. individual AP on outcomes of pain, sleep, mood, and social support ranged from small to very large and were consistently larger in the group condition. The total average cost-per-person for group AP ($221.25) was almost half that of individual AP ($420). Conclusions. This is the first study to examine the noninferiority of group AP with the gold standard individual AP. Group AP was noninferior to individual AP for treating cancer pain and was superior in many health outcomes. Group AP is more cost-effective for alleviating cancer pain and should be considered for implementation trials.

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“…Preliminary data have helped to clarify acceptability of community/group acupuncture; potential barriers such as language, working status, child care duties, functional disability and opioid analgesic use were not found to be deterrents to treatment. 32,33 Randomization to group acupuncture did not affect treatment initiation or retention. 34…”

Section: Introductionmentioning

confidence: 96%

“…Qualitative evaluation of participants receiving acupuncture in both individual and group settings is described in a separate paper. 33…”

Section: Introductionmentioning

confidence: 99%

Developing and employing a ‘responsive manualization’ in the ‘Acupuncture Approaches to Decrease Disparities in Outcomes of Pain Treatment’ comparative effectiveness study

et al. 2019

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Objective: The aim of this article is to describe the process used to develop an acupuncture therapy manual for a large effectiveness trial comparing individual care against group care for chronic pain in an underserved population. The design needed to not only ensure research consistency and replicability but also be ‘responsive’ to real world heterogeneous and evolving presentations in challenging physical settings. Background: Chronic pain is prevalent in the United States. While acupuncture is effective for chronic pain, minority, ethnically diverse and lower socioeconomic populations have limited access. Group acupuncture is proposed as a lower cost option to facilitate access in safety net settings, but research on the effectiveness of group versus individual acupuncture is lacking. Methods: We engaged a modified Delphi process with expert practitioners from diverse backgrounds who were experienced in individual and group practice. All contributions were recorded and collated for second- and third-round consensus discussions that included contributions by the trial’s research acupuncturists. Results: A ‘responsive manual’ flow chart was created with suggested sequencing that included interviews concurrent with palpation, Tui na, Gua sha, acupuncture needling, ear treatment, basic recommendations and options for departure with rationale. The manual was implemented by six research acupuncturists in five primary care settings in the Bronx, New York, with weekly team meetings to discuss manual use. There were no serious adverse events (AE) and few minor AE reported in this trial. Conclusion: A ‘responsive manual’ can be structured and implemented that is not only consistent and replicable but also flexible to accommodate the real-world clinical needs of practitioners and patients in challenging physical settings.

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“It's Better in a Group Anyway”: Patient Experiences of Group and Individual Acupuncture

Abstract: Patients in both arms valued their acupuncture experience. Participants described both positive and negative aspects of the group setting.

Cited by 17 publications

References 27 publications

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

Group versus Individual Acupuncture (AP) for Cancer Pain: A Randomized Noninferiority Trial

Developing and employing a ‘responsive manualization’ in the ‘Acupuncture Approaches to Decrease Disparities in Outcomes of Pain Treatment’ comparative effectiveness study

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