AJACM

Abstracts 2010 Volume 5 Issue 1

Investigating the Reliability of Contemporary Chinese Pulse Diagnosis (Bilton, Smith, Walsh and Hammer)

The Use of Acupuncture by Chinese Medicine Practitioners in the Australian Workers Compensation System: Results of a National Survey (Choy, Walsh and Smith)

Integrative Medicine: Combining the Practice of Orthodox and Alternative Medicine - Inclusive of 'Other' or Just Another Path to Exclusivity? (K Edin)

Acupuncture Point Injection in the Treatment of Midportion Achilles Tendinopathy: A Case Report (Murray and Hall)

 

Bilton K, Smith N, Walsh S, Hammer L. Investigating the Reliability of Contemporary Chinese Pulse Diagnosis. Aust J Acupunct Chin Med 2010;5(1):3-13.
There have been few studies that evaluate the reliability of the clinical use of pulse diagnosis despite it being a fundamental part of Oriental medicine diagnostics. The objective of this study was to determine the levels of intra-rater and inter-rater reliability of practitioners using an operationally defined method, Contemporary Chinese Pulse Diagnosis (CCPD), to evaluate the radial pulse of volunteer subjects. The study utilised a real-life design to investigate CCPD in a clinical setting. Fifteen volunteer subjects and six testers skilled in the CCPD method were recruited. Two episodes of data collection were conducted 28 days apart as a practical test and retest. For each subject, 30 pulse categories defined by the CCPD system were assessed and reassessed by the same four testers during both phases of testing. All assessments were conducted according to the CCPD method. Intra-rater reliability was measured by comparing individual tester results on day one with day two, while inter-rater agreement and reliability were determined by comparing all testers across both days. The data were analysed using Cohen's kappa coefficient. Kappa values were interpreted according to recommendations from previous clinical studies and parameters considered acceptable when using a tool such as CCPD to assist in clinical diagnosis. Results for intra-rater reliability showed excellent agreement in 43.2%, moderate to good agreement in 42.5% and poor agreement in 14.3% of the raw kappa calculations. Inter-rater agreement demonstrated excellent agreement in 23.5%, moderate to good agreement in 46% and poor agreement in 30.5% of the raw kappa calculations. In conclusion, when the system of pulse diagnosis is operationally defined, acceptable levels of reliability can be achieved. Disagreement was either intrinsic to the subject or indicative of ambiguity within the CCPD system. Accordingly, review of the terminology of the appropriate pulse categories and their clinical reliability is recommended.
KEYWORDS: pulse diagnosis, intra-rater reliability, inter-rater reliability, Chinese medicine, acupuncture, Cohen's kappa coefficient, Contemporary Chinese Pulse Diagnosis. 

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Choy B, Walsh S, Smith N. The Use of Acupuncture by Chinese Medicine Practitioners in the Australian Workers Compensation System: Results of a National Survey. Aust J Acupunct Chin Med 2010;5(1):14-25.
Statutory recognition of Chinese medicine (CM) practitioners and their use of acupuncture in the treatment of injured workers does not exist in most workers compensation (WC) systems throughout Australia, even though they are an accepted part of that system. Consequently, there is little data available on the use of acupuncture and the engagement of the CM profession in this system. This paper reports on the first survey study designed to provide information on the CM profession's engagement with the WC systems and their perceptions of these systems. Results: Five hundred completed surveys were returned, which represented a response rate of 25%. Results indicate that over 50% of the CM practitioners across Australia were engaging with the various WC systems and despite this engagement were also reporting varying levels of confusion and difficulties with the WC system frameworks. There was a noted relationship between the demographic information collected (as part of the survey) and a practitioner's perception of the WC systems. Overall, practitioners' experiences of the WC system were overwhelmingly negative, irrespective of their state or territory of residence; yet, 67% of respondents reported they would like to increase their WC patient load in the future. Conclusions: Despite the CM workforce engagement with the various state and territory based WC systems, there remains a lack of statutory gazetting of CM practitioners as treatment providers and this may account for some of the noted confusion and negativity reported in the survey results. While there was some variance in individual practitioner's perceptions of the system, a common finding was an overall lack of knowledge about this system. This raises several issues that range from the timely provision of treatment services by CM practitioners, reporting processes to insurance companies, the subsequent assessment structures of those insurers and the assessment of the appropriateness of the acupuncture treatment provided. These issues need to be addressed in practical terms with the development of policy and protocols to assist CM practitioners and also made a priority given the consistent growth in treatment frequency reported in the decade from 1994 to 2004, and which is only projected to increase given the surveys participants' wishes to engage further with the WC systems.
KEYWORDS: Acupuncture, Chinese medicine, Workers Compensation, demographic survey, Australia, work-related injuries. 

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Edin K. Integrative Medicine: Combining the Practice of Orthodox and Alternative Medicine - Inclusive of 'Other' or Just Another Path to Exclusivity? Aust J Acupunct Chin Med 2010;5(1):26-30.
The importance of creating static definitions of what constitutes western allopathic medicine (WAM) and complementary and alternative medicine (CAM) depends to a significant degree on the competing interests that appropriate these definitions. Terminology is and is not a semantic argument. Terminology is a sociological argument too. Words and the way we categorise hold enormous power over the human mind. Through usage and time, words are the matrix of any worldview and as such they are representative of thought, belief, action and collective consequence. What, then, is the definition and rationale behind integrative medicine (IM), is it a new paradigm as it appears to be, and how does it influence the broader healthcare landscape for practitioners of CAM and WAM alike? This article discusses the philosophical consequences of the definition and rationales of IM and suggests that 'integrative medicine' as a term and practice (hence, an entity) represents a worldview and agenda that is ultimately and ironically at odds with 'alternative' and 'complementary' forms of medicine, those very forms that it seeks to absorb. As practitioners of CAM modalities, we have a stake in ensuring that integrative medicine is understood as being a politico-economic entity and not the medical paradigm it suggests itself to be.
KEYWORDS: Medicine, integrative, co-option, western allopathic, orthodoxy, CAM, traditional east Asian, narrative. 

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Murray I, Hall D. Acupuncture Point Injection in the Treatment of Midportion Achilles Tendinopathy: A Case Report. Aust J Acupunct Chin Med 2010;5(1):31-35.
Midportion Achilles tendinopathy is a chronic, painful condition sometimes referred to as Achilles tendinosis or more controversially Achilles tendinitis. Considered to be one of the most common overuse injuries in participants of recreational and competitive sport, it is by no means restricted to athletes. This case presentation features the treatment of midportion Achilles tendinopathy and underlying lower-back pathology in a 46-year-old recreational runner with acupuncture and acupuncture point saline injection, following unsuccessful conventional biomedical treatment. Acupuncture was used during treatment; however, the primary intervention was the injection of saline solution BP into acupuncture points. Injection of acupuncture points is a common therapeutic technique in China. In Australia, acupuncture point injection is more commonly performed by naturopaths or homoeopaths injecting saline. The case described offers practitioners another approach using a technique which has a long history of use in Chinese medicine. The discussion also identifies that the use of saline injection is not well documented in biomedical literature and should be further investigated in prospective randomised controlled trials.
KEYWORDS: Tendinopathy, tendinitis, Achilles, midportion, acupuncture, injection, Saline, Alfredson's, Gillet, VISA-A.

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