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Acupuncture and the Pulse
In 1991, I attended a martial arts workshop hosted coincidentally by Sung Baek, a martial artist and the head of his lineage as a Korean trained acupuncturist. I was enamored by the details Sung could attain from the pulse, as told to me by some of his apprentices.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
Marijuana, Apathy and Chinese Medicine, Part 2
A talented young woman presented herself with emotional mood swings, which included being nervous, anxious and jittery.
The Nectar of Plants: Essential Oils and Chinese Medicine
Essential oils are a very hot topic these days, especially with the likes of the Ebola virus and the resurgence of measles lurking in our awareness, but when I first became interested in Chinese medicine, essential oils weren't on the radar screen for acupuncturists.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
The Modern Acupuncturist
You studied ancient Chinese medicine, but I'll bet you don't practice it! Contrary to popular belief, our medicine has evolved A LOT over the years. Let's take a brief walk through history and discover the differences between ancient and modern acupuncturists.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
The Year to Make Things Happen
It is hard to believe that the Year of the Ram – 2015 is half over. Time seems to be moving especially fast. This is the year for things to happen for the acupuncture profession.
Use Technology to Gain New Patients and Improve Efficiency
From the smartphone in your pocket to your microwave oven, advancements in technology have made almost every aspect of our lives easier.
What Does Success Mean to You?
Recently, I was asked to speak to young, budding businesswomen about running a successful business — and at first I thought, "Me? You want me to speak to others about success?!"
Acupuncture in the U.K. Today: A Personal View
When asked to write a short piece on the current state of the U.K. acupuncture profession, my first response was to say it has all been relatively quiet.
TMF 2015 Scholarships
The Trudy McAlister Foundation (TMF), a nonprofit organization established to support students who are on track to make contributions either to clinical practice and/or to the understanding of the role of Traditional Oriental Medicine, has announced the 2015 scholarship recipients.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
The Source-Luo Point Combination
The luo collaterals are part of the acupuncture channel system presented in the Su Wen and the Ling Shu (The Nei Jing). The function and clinical application of the luo mai are primarily presented in chapter 10 of the Ling Shu, however, they are also found in others chapters in the Su Wen and the Ling Shu.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
Calculating Billable Units
I recently learned of an office that was audited based on the number of acupuncture sessions performed in one day. Is there a maximum number of sessions that can be performed in one day?
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
How One Little Symbol (#) Gets You More Patients
Are you struggling to get more fans or followers for your acupuncture practice? Or are looking for ways to simply connect with your patients? Or do you just want to know how to keep them engaged (comments, retweeting, liking and sharing)?
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients, in May 2014, researchers showed that drinking the equivalent of 2 to 4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Breath: The Movement of Oxygen and Energy
I remember with surprising clarity the first time a patient started crying during an acupuncture treatment I was giving. This is now quite a long time ago, back in 1999, when I was a student.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
March, 2012, Vol. 12, Issue 03
Trying to Get Something From Nothing
By Keith Eric Grant, PhD, NCTMB
"Sometimes nothing can be a real cool hand" – Paul Newman in the movie, "Cool Hand Luke."
You are going to be hearing more and more about evidence-based massage therapy (EBMT). Partly, this reflects a current trend in health care to re-evaluate treatment and to determine what has a sound basis for use and what doesn't. One example of this is the Institute of Medicine report, "Evidence-Based Medicine and the Changing Nature of Healthcare."
A second factor is the existence of the Massage Therapy Foundation (MTF), which has goals of making those in the profession aware of research, promoting research literacy and integrating research with practice. I would count the forthcoming book on such integration by Dryden and Moyer as among the efforts facilitated by the MTF.
A third factor is massage therapy now being regulated by the majority of states, combined with the legal presumption that such regulation is done for the protection of the public. If we consider that training is necessary for safe practice, the presumption of public protection can only be fulfilled when state-mandated training is based upon a solid foundation of objectively validated knowledge.
A final factor is the modern technology embodied in an interactive web. Communication without regard to physical proximity is facilitating extensive discussions among those both with a stake in massage therapy and with backgrounds in research and statistics. Alice Sanvito discusses evidence-based massage on her web site and provides a number of links there to additional resources. I like the definition she gives for EBMT.
Evidenced based massage therapy is massage therapy founded on ideas and principles supported by evidence. Many of the claims made and practices used by massage therapists are founded on tradition rather than evidence. Since there is not yet a large body of knowledge documenting the physiology of and effects of massage therapy, if we were only able to make statements strictly on the basis of scientific studies, we would be severely limited indeed. Some people prefer the term "evidence informed practice" as more accurate. An evidence informed practice takes into consideration scientific evidence, clinical experience and careful observation.
The concept of being evidence-based, however, necessitates having methods to collect such evidence. In this, we also need to be careful to distinguish between whether or not an intervention can be shown to work (beyond random chance) and the model that we believe is the mechanism underlying the intervention. It is fully possible, as with massage relieving muscle soreness and the lactic acid myth, for an intervention to be effective while the supposed mechanism is incorrect. The randomized controlled trial (RCT) is taken as the "gold standard" of clinical proof, but how does that work? We need three things: a study population, a methodology for the study and the ability to analyze the results for effectiveness.
For example, our study population might be those diagnosed with high blood pressure, over the age of 40, not having other medical complications and not knowing Morse code. The goal of our study might be to determine whether or not listening to relaxing messages keyed in Morse code by a live practitioner were effective in reducing blood pressure. A complicating factor for the study is that people respond to the presence of other people. As put by Ravensara Travillian recently, "As psychosocial beings, we respond psychologically and socially in ways that can be described as healing body and mind due to presence and caring attention from others." Thus, our study will need a means of differentiating the effects of the Morse code from those effects simply from the practitioner's presence and the setup of the trial itself.
After gaining a sufficient number of suitable participants, we would fulfill the "randomized" concept of the trial by randomly dividing them into three groups: control, sham Morse-code and Morse code. The intervention might be three-times per week for 12 weeks. Controls would come in, have their blood pressure (BP) measured, wait 30 minutes, and have their BP measured again. Those in the Morse-code group would, in the 30 minutes wait, listen to Morse-code keyed by one of several live practitioners. Those in the "sham-group" would listen to 30 minutes of keying, similar to Morse-code, but keyed by "practitioners" unfamiliar with Morse-code. With this protocol, we can look for short-term effects between sessions, beginning and session end, as well as for longer term effects over the length of the study. By taking follow-up measurements after the end of the 12 weeks, we can also look for persistence of any changes.
Now we get to the point of getting something from nothing. We assume the null hypothesis, that any differences between the groups is simply from random chance, and calculate the probability (p) that this assumption is true. We conclude that there is a statistically significant difference between groups only when the probability of our observations being due entirely to chance is less than 5% (p<0.05). We have three separate probabilities to check: whether the sham group is statistically different from the control group (psychosocial effect), whether the Morse code group is different from the control group (psychosocial plus Morse code), and whether the difference between the sham and code groups is significant (Morse code effect). In a recent paper, Bakker and Wicherts underscore the importance of doing the third test explicitly, even when the differences between the sham and control groups is not significant.
If there is no difference between the three groups, the study would conclude that, in the clinical trial as designed, neither psychosocial factors nor messages in Morse-code were effective. If the sham group differed statistically from the control, we would conclude that there was a psychosocial effect. Because the psychosocial effect would also be present in the code group, only if the code group was statistically different from the sham group could we conclude that there was an effect from Morse-code itself. Note that this code effect could be of either sign, adding to a psychosocial effect or negating it.
There you have the outline of a randomized control/clinical trial. Assuming initially that we get no difference, we end up with information. Sometimes "nothing can be a real cool hand."
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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