Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA.
Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, USA.
J Gen Intern Med. 2020 Apr;35(4):1227-1237. doi: 10.1007/s11606-019-05583-6. Epub 2020 Feb 19.
Acupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. However, access to acupuncture treatment has been limited in medically underserved and low-income populations.
Acupuncture therapy delivered in groups could reduce cost and expand access. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain.
This was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic (> 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks.
Seven hundred seventy-nine participants were randomized. Mean age was 54.8 years. 35.3% of participants identified as black and 56.9% identified as Latino. Seventy-six percent were Medicaid insured, 60% reported poor/fair health, and 37% were unable to work due to disability.
Participants received weekly acupuncture treatment in either group or individual setting for 12 weeks.
Primary outcome was pain interference on the Brief Pain Inventory at 12 weeks; secondary outcomes were pain severity (BPI), physical and mental well-being (PROMIS-10), and opiate use. Outcome measures were collected at baseline, 12 and 24 weeks.
37.5% of individual arm and 30.3% in group had > 30% improvement in pain interference (d = 7.2%, 95% CI - 0.6%, 15.1%). Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%. In the responder analysis of physical well-being, 63.1% of individual participants and 59.5% of group had clinically important improvement at 12 weeks (d = 3.6%, 95% CI - 4.2%, 11.4%).
Both individual and group acupuncture therapy delivered in primary care settings reduced chronic pain and improved physical function at 12 weeks; non-inferiority of group was not shown.
Clinicaltrials.gov # NCT02456727.
针灸已被证明对治疗慢性肌肉骨骼腰背、颈部和骨关节炎疼痛有效。然而，在医疗服务不足和低收入人群中，获得针灸治疗的机会有限。
集体针灸治疗可以降低成本并扩大服务范围。我们比较了在具有种族多样性的低收入初级保健患者中，慢性肌肉骨骼疼痛患者接受集体和个体针灸治疗的效果。
这是一项在 6 家布朗克斯初级保健社区医疗中心进行的随机比较有效性非劣效性试验。患有慢性（>3 个月）腰背、颈部或骨关节炎疼痛的参与者被随机分配到个体或集体针灸治疗组，接受为期 12 周的治疗。
779 名参与者被随机分组。平均年龄为 54.8 岁。35.3%的参与者为黑人，56.9%的参与者为拉丁裔。76%的参与者有医疗补助保险，60%的参与者报告健康状况不佳/一般，37%的参与者因残疾而无法工作。
参与者每周接受一次针灸治疗，为期 12 周，在集体或个体环境中进行。
主要结局指标为 12 周时 Brief Pain Inventory 上的疼痛干扰；次要结局指标为疼痛严重程度（BPI）、身体和精神健康状况（PROMIS-10）和阿片类药物使用情况。在基线、12 周和 24 周时收集结局指标。
个体组中有 37.5%，集体组中有 30.3%的患者疼痛干扰改善>30%（差值为 7.2%，95%置信区间为-0.6%，15.1%）。假设 10%的边缘值，集体针灸的非劣效性结果不成立。在 12 周时身体功能健康的应答分析中，个体组有 63.1%的参与者和集体组有 59.5%的参与者有临床意义的改善（差值为 3.6%，95%置信区间为-4.2%，11.4%）。
在初级保健环境中提供的个体和集体针灸治疗均能在 12 周时减轻慢性疼痛并改善身体功能；但未能证明集体针灸的非劣效性。
Clinicaltrials.gov # NCT02456727。
