Analysis and prescriptions of acupuncture points by physiotherapists for neck pain: interrater agreement

Abstract

Objective: This study investigated the agreement between prescriptions of acupuncture points in scientific literature and pragmatic prescriptions by physiotherapists for people with neck pain. Methods: Twenty-four acupuncture points was obtained from 27
randomized controlled trials investigating the effects of acupuncture on neck pain. Fourteen raters (8 men [57%], median [min, max] time since completion of graduation and specialization courses of 18 [8, 27] and 12 [2, 25] years) reported which acupuncture points they recommend via an online questionnaire. The frequency and cooccurrence of acupuncture points prescribed were assessed, as well as both absolute and interrater agreement. Results: Physiotherapists reported 22 (of 24, 94%) acupuncture points, and (medial [min, max]) 7 [1, 16] acupuncture points individually. Most commonly point was Ashi points (n=11, 79%), Houxi SI-3 (n=10, 71%), and
Kunlun BL-60 (n=9, 64%); the most common cooccurring acupuncture points were BL60 (Kunlun) and Ashi (n=9, 64%). The interrater reliability was better-than-chance for 5 points (ranging from k=0.432, 95%CI=[0.276; 0.533] Ashi point to k=0.125, 95%CI=[0.087; 0.192] point GB21). Also, interrater agreement was worse-than-chance for 16 points (ranging from k= -0.453, 95%CI=[-0.453; -0.116] TE14 to k= -0.152, 95%CI=[-0.152; 0.000] points SI12 and GV20). Conclusion: Pragmatic prescriptions of acupuncture points for neck pain by physiotherapists experts in acupuncture do not agree with prescriptions from scientific literature. There is a need for explicit, high-level evidence-based rules for prescribing and teaching combinations of acupuncture points for neck pain to be included in future clinical trials.