پاورپوینت کامل What acupuncture can and cannot do for arthritis 49 اسلاید در PowerPoint

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پاورپوینت کامل What acupuncture can and cannot do for arthritis 49 اسلاید در PowerPoint

اسلاید ۴: Review the effects of acupuncture in treating osteoarthritis (degenerative), rheumatoid arthritis (inflammatory), and gout (metabolic);Determine when and how to refer a patient with arthritis for acupuncture.

اسلاید ۵: Osteoarthritis

اسلاید ۶: OsteoarthritisOver 20 million people in the United States live with osteoarthritisRadiographically, 30% individuals of age 45-65, and more than 80% over age 70 are affectedSecond most common cause of permanent incapacity among people over age 50Most common: knees, followed by hips, spine, feet, handsKnee OA is one of the five leading causes of physical disability in the non-institutionalized elderlyPain usually is the initial and principal source of morbidity

اسلاید ۷: Current TreatmentsWeight loss, activity modification, topical heat/cold, topical analgesic cream, shoe modification/insert, copingPhysical therapy, proper brace use, TENSOver the counter medications, dietary suppCSI, hyagan,Prescription pain medsSurgery

اسلاید ۸: Why consider acupunctureMedication side effectsPolypharmacy in the elderlyInconclusive effects of a lot of modalitiesPatients not accepting invasive proceduresPotential benefits of acupuncture over other modalitiesMinimal and no long term adverse reactionsNot invasive procedure to perform in the officeLess costly than surgery

اسلاید ۹: Any research evidence for the effects of acupuncture in osteoarthritis

اسلاید ۱۰: Acupuncture for knee and hip OAWitt et al. (2006-2008)Recruitment from July 2001 to July 2004Age > 40yo (average [SD] 61.8 [10.0]); radiographic evidence of osteophyte; disease duration > 6m; at least 15 days with pain in the past 30 days3 groups: non-randomized (n=2726); randomized to immediate acupuncture (n=322); randomized to delayed acupuncture (n=310)Knee OA 57.1%; hip OA 14.5%; both 28.4%

اسلاید ۱۱: Witt et al. (cont.)Intervention:Individualized acupuncture up to 15 sessions in 3 months (average 10.7+3.9x, 76.6% 5-10 sessions) Needle acupuncture onlyManual manipulation onlyAll three groups continue to receive any additional conventional treatments1417 study physicians in GermanyOutcome measures: WOMAC indexes of pain, stiffness and functionSF-36 total score and physical/mental subscales Baseline, after 3 months, after 6 months

اسلاید ۱۲: Witt et al. (cont.) – ResultsAt 3 month, there were significant improvements in WOMAC pain, stiffness, function, and SF-36 physical component scores in patients with knee and/or hip OA who were randomized to receive immediate acupuncture, as compared to controls who were randomized to have delayed treatments. Only SF-36 mental component score did not differ significantly b/w groups. There were no significant differences in all scores between patients who received acupuncture treatments, randomized or non-randomized

اسلاید ۱۳: Witt et al. (cont.) – ResultsAt 6 month, there were no significant differences b/w all groupsNo difference in delayed treatmentsTreatment effects lasted for at least 3 months post-intervention

اسلاید ۱۴: Witt et al. (cont.) – ResultsOther interesting findings:Subgroup analysis showed significantly more pronounced improvements in patients of:younger age,higher baseline physical or mental quality of life, andhigher baseline WOMAC indexesPhysician participants: 1% of primary care physicians in Germany, at least 140 hours of certified acupuncture education; years of clinical experience varied; treatment regimen varied – reflected well of real world general practice — no significant influence on the outcome measured in this study

اسلاید ۱۵: Witt et al. (cont.) – Cost analyses489 subjects completed cost-effectiveness analysis (acupuncture n=246; control n=243)Mean overall costs incurred by acupuncture patients during the treatment period were €۱,۲۰۴.۱۵ with additional costs of acupuncture (€۳۵/session), as compared to €۷۳۴.۶۶ in control patientsHowever, QALYs (quality adjusted life year) was gained in acupuncture groupAcupuncture for knee osteoarthritis in fema