Quality Assessment Of Acupuncture Treating Low Back Pain Based On Clinical Journals In Chinese

ObjectiveThe purpose of this research is to summarize the current situation and problems on the application of diagnostic and treatment standards and the Chinese medicine principals, to discuss the necessity and related solution of the integration of both the diagnostic and treatment standardization and the Chinese medicine principals, to provide certain guidelines for the design and writing of the acupuncture clinical articles.Materials and methodsThis study includes three major steps which are the journal collection, database formation and data analysis. By analyzing the clinical articles of acupuncture in treating the low back pain, we selected 258 clinical related articles as the objects which rank from 2000 to 2009, according to the characteristics of the low back pain and that of acupuncture in treating this disease. After the extraction of data, we analyze statistically the general condition, the western and Chinese diagnosis, treatments, evaluation of efficacy, annual trend, the standardization and Chinese medicine principals, in order to summarize the current condition on acupuncture in treating the lumbar intervertebral disc protrusion.Results1. General information of all the journals:most of the articles are written by single author, making up to 45.74%; the main authors are mostly from hospitals and clinics, making up to 87.98%; only 3.49% of the total articles are from certain project programs; specific acupuncture journals presses are the main media for disseminating acupuncture considering such 3 kinds take up 27.13% of all the 97 kinds of journals.2. Literature types:the proportion of case analysis is 61.51% which is the main type, followed by the randomized controlled type which takes up 28.68%; a few single cases are reported, only9.81%. 3. Diagnostic process:diagnostic standardization of low back pain is not that good considering 16.98% of all articles do not mention the western diagnoses; the diagnosis bases are complicated, including such circumstances as quoted diagnostic standers(25.66%), self made standards(23.4%), simple descriptions(23.77%) and none diagnostic bases(27.17%); in all the referred diagnostic criteria, that of "TCM Disease and Syndrome Diagnostic and Effective Standards", formulated by the State Administration of Traditional Chinese Medicine is most frequently used 58.82% of all the quoted standards, while all the standards are quite different from each other; there is not enough attention on the classification of the TCM syndromes, considering only 14.72% articles mention descriptions of low back pain syndromes in which only 4 cases (1.51%) refer to consult to certain TCM syndromes standards.4. Treatment:all the literatures have descriptions on the treatment areas (points),and there are 92.08% of the total accounts for the related description of operation; 32.08% of articles do not mention any descriptions on the format of the instruments while 64.15% articles make to report on the whole 3 aspects as duration, frequency and treatment course; there are only 30.57% record advantages of TCM, such as typical TCM selection of both points and methods, indicating syndrome differentiation and other Chinese medicine principals are insufficient in diagnosis and treatment.5. Effect evaluation:descriptions of the efficacy evaluation standard also have such mess standard situation referring to certain standards(35.47%), self-made standards(47.92%), simple description(6.42%) and none diagnostic bases(10.19%); there exists some quite vague and simple descriptions including "the pain semi disappears," "pain greatly reduced," "cure," "effective" etc., and even for the reference standards there exists a great difference in between them, which is quite difficult to quantify and summarize the treatment efficacy; the index which can reflect the advantage of acupuncture in evaluating the outcomes is still quite insufficient., for instance, the indicators of systemic symptoms(20.75%), patient self-efficacy evaluation(10.94%), long-term efficacy(26.04%), etc..6. Trend analysis:In recent years, the number and percentage of articles are both rising, which refers to standards of diagnosis and treatment evaluation; the overall number and percentage of both "randomized control trial" and of which mention standards of diagnosis and treatment evaluation are also rising; however, the percentage of the articles, referring to the TCM syndrome category is going downward, which indicates the characteristics of Chinese medicine has not been fully embodied.7. Comparison on all kinds of literatures:the portion of mentioning the syndrome differentiation is13.16% of controlled trials,10.43% of case analysis,46.15% of case reports; the most often reported stands are the quoted diagnostic (50%) and evaluation standards (65.79%) of controlled trials, the none diagnostic (34.97%) and self made evaluation standards (61.96%) of case analysis, the simple diagnostic (84.61%) and self made evaluation standards (53.85%) of case reports. By analysis, case reports play well on the syndrome differentiation while controlled trials are better in diagnostic and effect evaluation standards.8. Systemic analysis on standardization and TCM principle application of acupuncture treating lumbar intervertebral disc protrusion:taking acupuncture treating lumbar intervertebral disc protrusion for example, we find there are only 38.98% of articles which describe all the three aspects in diagnostic bases, treatment and effect evaluation while only 2 out of 61 articles (3.27%) describe all the three aspects in syndrome classification, treatment based on syndrome differentiation and index could show the advantage of Chinese medicine in effect evaluation.ConclusionThe standardization of diagnostic and therapeutic evaluation criteria is still quite insufficient, quite a few literatures do not mention the diagnostic bases and for those referred standards there are problems and difficulties in mutual evaluation and comparison. The application of TCM theory are far from enough, including the idea of treatment based on syndrome differentiation and treating the human body as a whole. Therefore, we have to take more efforts in the standardization of both the western and Chinese medicine diagnoses, try to describe clearly all the procedures in diagnoses, treatment and effect evaluation in writing clinical acupuncture literatures. Meanwhile, we should promote the standardization of TCM clinical literatures in diagnoses and effect evaluations and make the index more measurable. We also have to take the advantages of Chinese medicine principles like the idea of treatment based on syndrome differentiation and holism, on the bases of a better diagnosis and effect evaluation standardization.