Acupuncture point combinations for treating traditional Chinese patterns and lateral epicondylalgia prescribed in the literature and by physiotherapist acupuncturists

Abstract

Introduction: Acupuncture is widely accepted as a treatment of diseases both in the East and in the West, but studies still show some methodological difficulties. Reviews of lateral epicondylalgia have shown positive clinical results recommending treatment by acupuncture. Computational simulations are a method of experimenting with diagnostic models when the spectrum of signs and symptoms found in patients can lead to high costs and time to complete the study. Objective: To analyze the acupuncture points combinations for traditional Chinese and lateral epicondylalgia patterns prescribed in the literature and by acupuncturist physiotherapists. Methods: Two studies were conducted based on three acupuncture databases including traditional patterns and their clinical manifestations, acupuncture points with their respective traditional information and traditional patterns related to lateral epicondylalgia. A textbook was used to generate a questionnaire based on traditional databases and 8 acupuncture specialists reported their agreement with the prescriptions and modified them pragmatically. In addition, a questionnaire developed, in which 14 physical therapists specializing in acupuncture prescribed combinations of acupuncture points for 30
patients simulated with signs and symptoms of lateral epicondylalgia. Results: The study showed that only 32% of the acupoints were used in 93% of the prescriptions (7% did not use acupuncture), with an average of 6 acupoints in each prescription. It was observed that the experts agreed (45% to 58%) or strongly agreed (0% to 29%) with the prescriptions of the book, but inter-examiner concoding is no better than chance (Light κ = 0.051, CI95% = [- 0.011; 0.113]). The number of acupoints in prescriptions is correlated to the number of manifestations in traditional diagnoses (ρ = 0.260, p = 0.038). The similarity of diagnoses is consistently associated with the similarity of acupuncture prescriptions in the literature (γ = 0.720, CI95% = [0.658, 0.783]) and such association is weakly influenced by pragmatic practice (γ = 0.692 to γ = 0.740). It can be observed in the study that of the 17 acupuncture points in the scientific literature, 14 (82%) were prescribed at least once by the evaluators. The inter-examiner reliability for the prescription of the 14 acupuncture points included in this analysis ranged from κ = 0.112, 95% CI = 0.055; 0,194] (point LR-3) for κ = -0.003, 95% CI = [- 0.024; 0.024] (point LI-4). The pragmatic prescriptions of acupuncture points for lateral epicondylalgia have not proved reliable among specialists in physical therapists in acupuncture. Conclusion: This study provides supporting evidence on the effects of pragmatic practice of acupuncture, in particular on the variability of acupuncture recommendations for traditional diagnoses. The prescriptions of acupuncture varied in number and composition in the literature. The association between the similarity of traditional diagnoses and prescriptions is strongly and little influenced by the pragmatic modification of such prescriptions. This study helps to fill an existing gap for the acupuncturist physiotherapists community by providing evidence on the usual practice of
acupuncture, particularly regarding the variability of acupuncture points recommendations for lateral epicondylalgia. Variability may result from different educational backgrounds and levels of experience. The replication of this study in other musculoskeletal disorders is quite interesting for further analysis.