Abstracts 2011 Volume 6 Issue 2

Acupuncture by Another Name: Dry Needling in Australia (Janz and Adams)

Metal Analysis of Si Wu Tang in Relation to its Clinical Application

Australian Acupuncture and Chinese Medicine Association (AACMA) 2008 Mentoring Survey Summary (Moore)

Measuring Practitioner Opinion on Adverse Reactions to Acupuncture (McDowell, Johnson and Hale)

Acupuncture Treatment for Frozen Shoulder from Traumatic Injury (Tapper and Stub)

Janz S and Adams J. Acupuncture by Another Name: Dry Needling in Australia. AUST J Acupunct Chin Med 2011;6(2):3-11.
Like acupuncture, dry needling involves the insertion of acupuncture needles into specific points on the body to improve health. Unlike acupuncture, the practice of dry needling is unregulated in Australia. This paper challenges the notion that dry needling is not a part of acupuncture practice and also examines the risks associated with the practice of dry needling from a public health perspective. The practice of acupuncture and dry needling are first examined and compared to identify commonalities. A review into the incidence of risks of dry needling reveals very limited literature with only one case report and no review articles identified. Based on the similarities between acupuncture and dry needling, the extensive literature on the serious risks of acupuncture is extrapolated to evaluate the risks of dry needling. Dry needling is not a new or separate practice to acupuncture; rather it is a subsystem of musculoskeletal acupuncture which has been practised continuously for at least 1 400 years. Dry needling is a pseudonym for a brief course of study in myofascial acupuncture also known as ashi acupuncture and trigger point acupuncture. Dry needling is likely to result in an increased incidence of serious risks, particularly pneumothorax, due to the short training courses and deep needling techniques which typify the practice. In the interest of public health and safety, the practice of dry needling should be restricted to suitably qualified practitioners.

Millikan M, Xu H and Trevean H. Metal Analysis of Si Wu Tang in Relation to its Clinical Application. AUST J Acupunct Chin Med 2011;6(2):12-17.
Si Wu Tang, a Chinese herbal formula composed of four Chinese herbs (Danggui, Chuanxiong, Baishao and Shudi) was analysed for its magnesium, manganese, zinc, iron and calcium concentrations when made into a decoction. The commonly prescribed amount is 42 g in a specific ratio of the four herbs, and from this it was determined that all metals analysed were within safe limits and daily tolerable limits would not be able to be reached by ingesting this formula (42 g/day) alone. The highest metal in the Si Wu Tang decoction was found to be magnesium at 25 mg/L, which is under the daily intake recommendations. Varying the brewing time during the preparation of the herbs was found to have various effects on the different micronutrients when made up into separate decoctions from 1 g of each separate herb and these observations may be beneficial to Chinese medicine practitioners who wish to vary the Si Wu Tang formula to better suit a patient’s needs. Samples were analysed at least in triplicate and error was found not to be over 15% at the 95% confidence level. Investigating the amount of metals present will increase the understanding of the levels of these beneficial metals and the potential curative effects they provide.
KEYWORDS: Si Wu Tang, magnesium, dysmenorrhoea, herbal decoction.

Moore A. Australian Acupuncture and Chinese Medicine Association (AACMA) 2008 Mentoring Survey Summary. AUST J Acupunct Chin Med 2011;6(2):19-27.
There has been long-standing discussion by Chinese medicine practitioners in Australia concerning the ways in which they could best be supported in their endeavours. Mentoring by experienced practitioners is considered a possible format for this to occur. Aims: To gain an understanding of AACMA members’ perceptions and requirements regarding mentoring. Design: A written survey composed of 15 questions with quantitative and qualitative components. Subjects & setting: The survey was distributed to all AACMA members in Australia in 2008. Interventions & outcome measures: Qualitative survey data was analysed using thematic analysis. Results: From 129 responses, a number of themes emerged regarding members’ perceptions and requirements for mentoring. Key themes include: a variety of understandings of what mentoring is; the purpose of mentoring is to develop confidence and clinical experience; the need for guidelines and support for mentors; restrictions on who can be a mentor; that anyone can be a mentee; participation can be optional; any program should be flexible and suit the individuals involved; and that a mentoring program is seen as valuable and good for the profession. Conclusions: The study provides an evidentiary basis for the establishment of a pilot mentoring program for practitioners and, auspiced by a professional association such as AACMA, may indeed be a timely and valuable endeavour on behalf of the profession.
KEYWORDS: Professional development, professional support, mentoring, education, clinical practice, qualitative research

McDowell J, Johnson G and Hale L. Measuring Practitioner Opinion on Adverse Reactions to Acupuncture. AUST J Acupunct Chin Med 2011;6(2):28-35.
The terminology associated with the categorisation and reporting of adverse reactions to acupuncture (ARA) does not necessarily fit well with other universal adverse reaction reporting systems. Evaluation of practitioners' interpretation of ARA concepts and associated terminology is needed to ensure high quality reporting. This study reports the survey of acupuncture practitioners’ opinion regarding ARA terminology, using a custom- designed Adverse Reactions to Acupuncture Questionnaire (ARAQ). The questionnaire was administered on two separate occasions to examine the consistency of question response in the context of usual clinical practice over time. Method: Twelve female acupuncturists (11 physiotherapists and one general practitioner), mean age 46.83 (±8.3) years completed the initial and follow-up ARAQ administered eight months apart. Analysis: Intra-rater agreement analysis was performed using intra-class coefficients (ICCs) for the visual analogue scales (VASs) and linear weighted Cohen’s κ coefficients for the ranked questions. A systematic decision rule process analysed the repeated responses for the word categorisation task. Results: A statistical level of intra-rater agreement (P ≤ 0.05) was achieved in 77% of the VAS questions (0.76–0.88) on repeated administration of the ARAQ. In the word categorisation task, 41% of acupuncture-related symptoms attained entry to identical adverse event domains on repeated responses. Whilst overall hierarchical weighting of preference responses were predominantly unchanged for the ranking questions the majority of κ coefficients for individual ranking tasks were low. Conclusion: The levels of practitioner intra-rater agreement in the VAS questions and word categorisation task relating to ARA performed most consistently over time. It is suggested that the styles of questions be carefully considered in future questionnaire development of this nature. The variation in agreement may be as a result of the style of question however it is acknowledged that the responses may also be confounded by changing opinions of experts as they acquire new or different knowledge.
KEYWORDS: questionnaire, question styles, opinion, acupuncture, adverse events, nomenclature

Tapper S and Stub T. Acupuncture Treatment for Frozen Shoulder from Traumatic Injury. AUST J Acupunct Chin Med 2011;6(2):36-42.
In our literature review we find the evidence in both conventional and complementary therapies does not reliably inform us of the effectiveness of treatments for frozen shoulder (FS). Physiotherapy, non-steroidal anti-inflammatory drugs, glucocorticosteroid injections, capsular stretching, exercises and surgery demonstrated limited evidence of efficacy. Similarly, studies varied greatly regarding the effectiveness of acupuncture treatment for shoulder injury. In the following case study we discuss acupuncture treatment of a frozen shoulder resulting from traumatic injury. However in this case, traditional acupuncture intervention markedly improved the patient’s symptoms. After eight treatments the pain level was significantly reduced and stabilised. Furthermore, full range of motion was regained. MRI findings two months post-injury and two months post-acupuncture treatment also provide evidence of anatomical improvement during the course of treatment. We suggest future acupuncture research trials would be more clinically relevant, and likely show more clinically significant results, if subjects were treated according to their presenting TCM diagnosis and neuro-anatomical presentations.