The Acceptability of Acupuncture for Low Back Pain: A Qualitative Study of Patient's Experiences Nested within a Randomised Controlled Trial
The Acceptability of Acupuncture for Low Back Pain: A Qualitative Study of Patient's Experiences Nested within a Randomised Controlled Trial
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DOI：
10.1371/journal.pone.0056806
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发表时间：
2013-02-21
期刊：
影响因子：
3.7
通讯作者：
MacPherson, Hugh
中科院分区：
文献类型：
--
作者：
Hopton, Ann;Thomas, Kate;MacPherson, Hugh
简介：国家健康和临床卓越研究所的指南建议针灸作为慢性背痛的临床有效治疗。然而，有什么因素有助于患者的积极和消极的经验，以及这些因素如何相互作用的治疗的可接受性方面的知识不足。本研究采用患者访谈针灸治疗背痛，以确定，理解和描述的元素，有助于或减损接受treatment.Methods：本研究采用半结构化访谈。12名患者接受了采访，使用采访时间表作为子研究嵌套在一个随机对照试验的针灸治疗慢性背痛。访谈进行了分析，使用主题analysis.Results和讨论：三个过度的主题从分析中出现。第一个标题的可接受性促进者包含五个子主题：疼痛缓解的经验，改善体力活动，放松，心理上的好处，减少对药物的依赖。第二个主题确定了可接受性的障碍，包括针头相关的不适和症状暂时恶化，继续治疗的压力和经济成本。第三个主题包括可接受性的介质，其中包括治疗前的介质，如期望和以前的经验，和治疗相关的介质的时间，治疗联盟，生活方式的建议和病人的积极参与恢复。这些主题告知我们的理解，针灸治疗腰痛患者的可接受性。结论：针灸治疗腰痛的可接受性是复杂的和多方面的。医生和患者之间的治疗关系成为可接受性的强大驱动力，并作为一个有用的工具，以发展患者的自我效能在疼痛管理的长期。不愉快的治疗相关影响不一定会降低患者对可接受性的总体感知。
Introduction: The National Institute for Health and Clinical Excellence guidelines recommend acupuncture as a clinically effective treatment for chronic back pain. However, there is insufficient knowledge of what factors contribute to patients' positive and negative experiences of acupuncture, and how those factors interact in terms of the acceptability of treatment. This study used patient interviews following acupuncture treatment for back pain to identify, understand and describe the elements that contribute or detract from acceptability of treatment.Methods: The study used semi-structured interviews. Twelve patients were interviewed using an interview schedule as a sub-study nested within a randomised controlled trial of acupuncture for chronic back pain. The interviews were analysed using thematic analysis.Results and Discussion: Three over-arching themes emerged from the analysis. The first entitled facilitators of acceptability contained five subthemes; experience of pain relief, improvements in physical activity, relaxation, psychological benefit, reduced reliance on medication. The second over-arching theme identified barriers to acceptability, which included needle-related discomfort and temporary worsening of symptoms, pressure to continue treatment and financial cost. The third over-arching theme comprised mediators of acceptability, which included pre-treatment mediators such as expectation and previous experience, and treatment-related mediators of time, therapeutic alliance, lifestyle advice and the patient's active involvement in recovery. These themes inform our understanding of the acceptability of acupuncture to patients with low back pain.Conclusion: The acceptability of acupuncture treatment for low back pain is complex and multifaceted. The therapeutic relationship between the practitioner and patient emerged as a strong driver for acceptability, and as a useful vehicle to develop the patients' self-efficacy in pain management in the longer term. Unpleasant treatment related effects do not necessarily detract from patients' overall perception of acceptability.