Background
Methods
Questionnaire development
Questionnaire distribution
Data entry
Data analysis
Results
Demographic characteristics of participant KMDs
Factors | mean ± SD/n (%) |
---|---|
Age (years) | 38.6 ± 6.2 |
30–39 | 85 (69.7) |
40–49 | 27 (22.1) |
≥ 50 | 10 (8.2) |
Gender | |
Male | 123 (100) |
Female | 0 (0) |
Clinical experience (years) | 12.1 ± 5.5 |
5 ≤ <10 | 44 |
10 ≤ <15 | 48 |
15 ≤ <20 | 19 |
≥ 20 | 12 |
Level of healthcare facility of currently employed institutiona
| |
Primary | 39 (32) |
Secondary | 83 (68) |
Highest academic degree | |
Bachelor’s | 30 (24.4) |
Master’s | 44 (35.8) |
Ph. D. | 49 (39.8) |
Specialist training | |
Yes (specialist) | 94 (76.4) |
No | 29 (23.6) |
Name of academic society in specialty for specialist training (if applicable) | |
The Society of Korean Medicine Rehabilitation | 30 (31.9) |
Korean Acupuncture and Moxibustion Medicine Society | 27 (28.7) |
The Society of Internal Korean Medicine | 24 (25.5) |
Other | 13 (13.8) |
Clinical practice patterns of LSS
Usage rate of treatment (multiple responses allowed) ( n (%)) | |
Acupuncture | 119 (96.7) |
Pharmacopuncture | 116 (94.3) |
Herbal medicine | 115 (93.5) |
Chuna manipulation | 112 (91.1) |
Cupping | 104 (84.6) |
Bee venom pharmacopuncture | 96 (78.0) |
Moxibustion | 3 (2.4) |
Clinical practice and time-to-effect (mean ± SD) | |
Number of LSS outpatients consultations/day | 7.3 ± 6.8 |
Number of treatment visits/week | 1.9 ± 0.3 |
Average length of treatment required for 50% pain decrease (weeks) | 7.8 ± 3.3 |
Average length of treatment required for 80% pain decrease (weeks) | 16.1 ± 7.7 |
Treatment methods | Short term (8 weeks) importance | Long term (1 year) importance |
---|---|---|
mean ± SD | mean ± SD | |
Herbal medicine | 6.0 ± 1.1 | 6.6 ± 0.7 |
Bee venom pharmacopuncture | 6.1 ± 1.0 | 5.7 ± 1.2 |
Pharmacopuncture | 6.0 ± 0.9 | 5.7 ± 1.1 |
Acupuncture | 5.8 ± 1.0 | 5.6 ± 1.2 |
Chuna manipulation | 5.4 ± 1.2 | 5.4 ± 1.3 |
Cupping | 4.5 ± 1.5 | 4.1 ± 1.5 |
Moxibustion | 4.0 ± 1.6 | 4.3 ± 1.7 |
Diagnosis and prognosis determination of LSS
Factors | n (%) | |
---|---|---|
Tests | Magnetic resonance imaging (MRI)a
| 121 (98.4) |
X-ray | 116 (94.3) | |
Computed tomography (CT) | 82 (66.7) | |
C-reactive protein (CRP) | 12 (9.8) | |
Digital infrared thermal imaging (DITI) | 8 (6.5) | |
Electromyogram | 7 (5.7) | |
Erythrocyte sedimentation rate (ESR) | 7 (5.7) | |
Main points of consideration in MRI reading | Degree of nerve compressiona
| 91 (74) |
Diameter/area of spinal canal | 79 (64.2) | |
Correlations between level of dysfunctional disc on MRI and clinical symptoms | 66 (53.7) | |
Degree of degeneration of vertebral body and/or joints (spondylosis) | 46 (37.4) | |
Number and level of dysfunctional discs (e.g. L1/2 vs. L5/S1) | 30 (24.4) | |
Degree of intervertebral disc displacement | 28 (22.8) | |
Degree of intervertebral disc degeneration | 16 (13) | |
Vertebral alignment | 13 (10.6) | |
Physical examination | Straight leg raise test (SLR)a
| 94 (76.4) |
Manual muscle testing (MMT) | 79 (64.2) | |
Sensory testing | 53 (43.1) | |
Heel walk/toe walk | 48 (39) | |
Valsalva test | 14 (11.4) | |
Well leg raise test | 14 (11.4) | |
Milgram’s test | 11 (8.9) | |
Laseque sign | 9 (7.3) | |
Deep tendon reflex | 9 (7.3) | |
Bragard test | 8 (6.5) | |
Korean medicine syndrome differentiation theory | Qi and Blood diagnosis (氣血辨證)a
| 83 (67.5) |
Eight principle pattern identification (八綱辨證) | 82 (66.7) | |
Meridian system diagnosis (經絡辨證) | 82 (66.7) | |
Organ system diagnosis (臟腑辨證) | 62 (50.4) | |
Six meridian diagnosis (六經辯證) | 24 (19.5) | |
Sasang constitutional medicine diagnosis (四象體質辨證) | 21 (17.1) | |
Defensive Qi and nutrient Blood diagnosis (衛氣營血辨證) | 7 (5.7) | |
10 Types of LBP from ‘Dongeuibogam (東醫寶鑑)’ | LBP from Kidney deficiency (腎虛腰痛) | 108 (87.8) |
LBP from Cold pathogen (寒腰痛) | 29 (23.6) | |
LBP from Dampness pathogen (濕腰痛) | 24 (19.5) | |
LBP from Phlegm (痰飮腰痛) | 20 (16.3) | |
LBP from Blood stagnation (瘀血腰痛) | 18 (14.6) | |
LBP from Wind pathogen (風腰痛) | 11 (8.9) | |
LBP from Qi (氣腰痛) | 5 (4.1) | |
LBP from Dampness-Heat pathogen (濕熱腰通) | 4 (3.3) | |
LBP from contusion (挫閃腰痛) | 2 (1.6) | |
LBP from retention of food (食積腰痛) | 2 (1.6) |
Prognostic factors | Importance |
---|---|
mean ± SD | |
Clinical symptomsa
| 6.2 ± 1.0 |
Age | 6.1 ± 1.1 |
Radiological findings | 5.9 ± 1.1 |
Past history (e.g. surgery, trauma) | 5.8 ± 1.2 |
Patient attitude toward disorder | 5.6 ± 1.2 |
Time elapsed since onset and cause of onset | 5.5 ± 1.3 |
Personality and other psychological factors (e.g. depression, anxiety) | 5.3 ± 1.1 |
Physical examination | 4.8 ± 1.4 |
Comorbidities | 4.8 ± 1.3 |
Korean Medicine syndrome differentiation | 4.3 ± 1.5 |
Intervention usage for LSS
Factors | n (%) | |
---|---|---|
Herbal medicine | Chungpa-juna
| 122 (99.2) |
Yookmijihwang-tang (六味地黃湯) | 57 (46.3) | |
Dokhwalgisaeng-tang (獨活寄生湯) | 43 (35) | |
Hwalhyeoljitong-tang (活血止痛湯) | 30 (24.4) | |
Ojeok-san (五積散) | 30 (24.4) | |
Shingi-hwan (腎氣丸) | 19 (15.4) | |
Danggwisoo-san (當歸鬚散) | 13 (10.6) | |
Jakyagkamcho-tang (芍藥甘草湯) | 13 (10.6) | |
Bojoongikgi-tang (補中益氣湯) | 11 (8.9) | |
Chuna manipulation | Sidelying lumbar extension dysfunction correction technique | 45 (36.6) |
Prone lumbosacral joint distraction method | 41 (33.3) | |
Spine flexion distraction method: Flexion shift technique | 41 (33.3) | |
Prone posteriorly rotated ilium/sidebent sacrum correction technique | 36 (29.3) | |
Sidelying lumbar ‘pitch and roll’ distraction method | 35 (28.5) | |
Prone leg raise ilium correction technique | 32 (26) | |
Prone anteriorly rotated ilium correction technique | 31 (25.2) | |
Prone sacrum sidebent rotation dysfunction correction technique | 23 (18.7) | |
Spine flexion distraction method: Extension technique | 18 (14.6) | |
Sidelying lumbar flexion dysfunction correction technique | 13 (10.6) | |
Style of acupuncture | Ashi points | 113 (91.9) |
Motion Style Acupuncture Treatment (MSAT)a
| 102 (82.9) | |
Acupoints associated with symptoms (acupoints relating to specific disorder/syndromes) | 91 (74) | |
Dong-Si Acupuncture | 14 (11.4) | |
Pharmacopuncture | Shinbaro 2a
| 86 (69.9) |
Shinbaro 1 | 85 (69.1) | |
Shinbaro 3 | 60 (48.8) | |
Joongseongouhyul (中性瘀血) | 32 (26) | |
Hwangryunhaedok (黃蓮解毒) | 28 (22.8) | |
Muscle relaxation | 12 (9.8) | |
Anti-inflammation | 11 (8.9) | |
Scolopendra | 10 (8.1) | |
Acupoints used for acupuncture | Hyeopcheok (Huatuo Jiaji, EXB2) points | 86 (69.9) |
GB30 (環跳) | 60 (48.8) | |
Ashi points | 49 (39.8) | |
BL23 (腎兪) | 42 (34.1) | |
BL40 (委中) | 30 (24.4) | |
BL25 (大腸兪) | 23 (18.7) | |
Acupoints used for pharmacopuncture | Hyeopcheok (Huatuo Jiaji, EXB2) points | 94 (76.4) |
Ashi points | 43 (35.0) | |
BL23 (腎兪) | 35 (28.5) | |
GB30 (環跳) | 24 (19.5) | |
BL25 (大腸兪) | 21 (17.1) | |
BL40 (委中) | 4 (3.3) |
Acupuncture and pharmacopuncture usage for LSS
STRICTA checklist items | Acupuncture | Pharmacopuncture | ||||
---|---|---|---|---|---|---|
Acupuncture rationale | 1a) Style of acupuncture | Refer to Table 4. | 1a) Type of pharmacopuncture | Refer to Table 4. | ||
1b) Reasoning for treatment provided | Anatomical structure that is probable cause of symptoms (e.g. shortened quadratus lumborum, shortened psoas muscles)a
| 85 (69.1) | 1b) Reasoning for treatment provided | Physical stimulation of solution (i.e. irrigation of inflammation area, desensitization effect brought on through pain on injection) | 123 (100) | |
Tender points, trigger points, or other points that evoke a painful response on palpation | 70 (56.9) | |||||
Pathological spine level as confirmed through imaging (e.g. level of disc herniation) | 63 (51.2) | Chemical efficacy of solution (i.e. pharmaceutical effect of major componants)a
| 120 (97.6) | |||
Effective acupoints as observed through clinical experience | 47 (38.2) | |||||
Ashi points (site of pain) | 44 (35.8) | Acupuncture effects of pharmacopuncture needle (i.e. effect of pharmacopuncture needle itself) | 115 (93.5) | |||
Acupoints following Korean medicine principle (e.g. GB30, BL40, BL57) | 34 (27.6) | |||||
Academic knowledge from research articles, clinical practice guidelines | 14 (11.4) | Placebo effect (i.e. effect from patient expectation) | 7 (5.7) | |||
Knowledge from formal education | 12 (9.8) | |||||
Details of needling | 2a) Number of needle insertions per patient per session | 12.5 ± 5.1 | 2a) Number of acupoint injections per patient per session (range) | 3.1 ~ 6.1 | ||
2a) Amount of pharmacopuncture solution injected per session (range, cc) | 1.3 ~ 3.5 | |||||
2b) Names of acupoints used | Refer to Table 4. | 2b) Names of acupoints used | Refer to Table 4. | |||
2c) Depth of insertion (cm) | 3.2 ± 1.4 | 2c) Depth of insertion (range, cm) | 1.7 ~ 3.7 | |||
2d) Responses sought | De qi sensation | 5.5 ± 1.4 | ||||
Muscle twitch response | 5.0 ± 1.4 | |||||
2e) Needle stimulation | Motion Style Acupuncture Treatment (MSAT) | 51 (41.5) | ||||
Lifting and thrusting (提揷) | 64 (52.0) | |||||
Holding and twisting (捻轉) | 62 (50.4) | |||||
Percentage of patients receiving electroacupuncture (%) | 91.3 ± 19.9 | |||||
2f) Needle retention time (minutes) | 14.2 ± 2.0 | |||||
2g) Needle type | Diameter of needle (mm) | 0.3 ± 0.04 | ||||
Treatment regimen | 3a) Number of sessions | Refer to Table 1. | 3a) Number of sessions | Refer to Table 1. | ||
3b) Frequency of treatment sessions (sessions/week) | 1.9 ± 0.4 | 3b) Frequency of treatment sessions (sessions/week) | 1.9 ± 0.4 | |||
3b) Duration of treatment sessions (minutes) | 18.7 ± 11.7 | 3b) Duration of treatment sessions (range, minutes) | 2.3 ~ 4.3 | |||
Other components of treatment | 4a) Other interventions administered | Refer to Table 1. | 4a) Other interventions administered | Refer to Table 1. | ||
Practitioner background | 5) Description of participating acupuncturists | Refer to Table 1. | 5) Description of participating acupuncturists | Refer to Table 1. |