Linde Klaus, Streng Andrea, Hoppe Andrea, Weidenhammer Wolfgang, Wagenpfeil Stefan, Melchart Dieter
Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität München, Munich, Germany.
J Clin Epidemiol. 2007 Mar;60(3):280-7. doi: 10.1016/j.jclinepi.2006.06.014. Epub 2006 Oct 2.
To compare patient characteristics and outcomes between a randomized controlled trial (RCT) and an observational study (OS) of acupuncture treatment in patients with migraine.
Within the framework of a research program for acupuncture for chronic pain, both an RCT and an OS of routine care were performed in patients with migraine. One hundred forty-five patients received acupuncture in the RCT and 732 in the OS. All patients completed a pain questionnaire, including instruments evaluating disability, quality of life, and depression, at baseline and at 6-month follow-up.
At baseline, patients participating in the RCT had a significantly longer history of complaints and more headache days but better quality of life and fewer depressive symptoms than patients participating in the OS. In unadjusted analyses, improvements after 6 months were more pronounced in the OS than in the RCT. After adjustment for potential confounders, the differences decreased but were still significant for several outcomes.
Participants of the RCT were probably not representative of migraine patients undergoing acupuncture treatment in routine care under current regulations in Germany. However, changes after treatment were similar in the RCT and the OS of routine care.
比较偏头痛患者针刺治疗的随机对照试验(RCT)与观察性研究(OS)之间的患者特征及治疗结果。
在一项慢性疼痛针刺治疗研究项目的框架内,对偏头痛患者进行了RCT和常规护理的OS。145例患者在RCT中接受针刺治疗,732例患者在OS中接受针刺治疗。所有患者在基线期和6个月随访时均完成了疼痛问卷调查,包括评估残疾、生活质量和抑郁的量表。
在基线期,参与RCT的患者比参与OS的患者有更长的主诉病史和更多的头痛天数,但生活质量更好,抑郁症状更少。在未调整分析中,6个月后的改善在OS中比在RCT中更明显。在对潜在混杂因素进行调整后,差异有所减小,但仍有几个结果具有显著性。
根据德国现行法规,RCT的参与者可能不代表在常规护理中接受针刺治疗的偏头痛患者。然而,RCT和常规护理的OS中治疗后的变化相似。