Observations placeholder

Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study)

    Charlotte Paterson, PhD,MRCGP, senior research fellow and
    Rod S Taylor, MSc, PhD, professor in health services research

    Peter Griffiths, PhD, RN, professor of health services research

    Nicky Britten, PhD, FRCGP (Hon), professor of applied health care

    Sue Rugg, PhD,MSc, DipCOT, research fellow and
    Jackie Bridges, PhD, MSN BNurs(Hons), RN, senior research fellow

    Bruce McCallum, BA(Hons), LicAc, head of academic studies and research and
    Gerad Kite, MAc, principal
    on behalf of the CACTUS study team

+ Author Affiliations

    Institute of Health Services Research, Peninsula Medical School, University of Exeter, Exeter
    School of Health Science, University of Southampton, Southampton
    School of Community and Health Sciences, City University London
    London Institute of Five-Element Acupuncture London

    Address for correspondence
    Dr Charlotte Paterson, Institute of Health Service Research, Peninsula Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG. E-mail: charlotte.paterson@pms.ac.uk

Abstract

Background  -   Medically unexplained physical symptoms (MUPS) are common and difficult to treat.

Aim   -  To investigate the effectiveness of adding five-element acupuncture to usual care in ‘frequent attenders’ with MUPS.

Design and setting  -   Randomised controlled trial in four London general practices.

Method  -   Participants were 80 adults with MUPS, consulting GPs =8 times/year. The intervention was individualised five-element acupuncture, =12 sessions, immediately (acupuncture group) and after 26 weeks (control group). The primary outcome was 26-week Measure Yourself Medical Outcome Profile (MYMOP); secondary outcomes were wellbeing (W-BQ12), EQ-5D, and GP consultation rate. Intention-to-treat analysis was used, adjusting for baseline outcomes.

Results  -   Participants (80% female, mean age 50 years, mixed ethnicity) had high health-resource use. Problems were 59% musculoskeletal; 65% >1 year duration. The 26-week questionnaire response rate was 89%. Compared to baseline, the mean 26-week MYMOP improved by 1.0 (95% confidence interval [CI] = 0.4 to 1.5) in the acupuncture group and 0.6 (95% CI = 0.3 to 0.9) in the control group (adjusted mean difference: acupuncture versus control –0.6 [95% CI = –1.1 to 0] P = 0.05). Other between-group adjusted mean differences were: W-BQ12 4.4 (95% CI = 1.6 to 7.2) P = 0.002; EQ-5D index 0.03 (95% CI = –0.11 to 0.16) P = 0.70; consultation rate ratio 0.90 (95% CI = 0.70 to 1.15) P = 0.4; and number of medications 0.56 (95% CI = 0.47 to 1.6) P = 0.28.

All differences favoured the acupuncture group.

Imputation for missing values reduced the MYMOP adjusted mean difference to –0.4 (95% CI = –0.9 to 0.1) P = 0.12. Improvements in MYMOP and W-BQ12 were maintained at 52 weeks.

Conclusion   -  The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.