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Interest In And Perceptions Of Acupuncture
Among Physical Medicine And Rehabilitation Residents
Adrian Cristian, MD
Simon Chunhan Lin, MD
ABSTRACT
Background Acupuncture is an accepted form of alternative medicine for many patients and physiatrists but is not typically offered during residency training.
Objectives To determine the interest level of physical medicine and rehabilitation (PM&R) residents in acupuncture, and to assess their perceptions of the role of acupuncture in the rehabilitation of patients with musculoskeletal problems.
Design, Setting, and Subjects Cross-sectional survey of 20 PM&R residents in various stages of their training (postgraduate years 2-4), rotating through a PM&R department that offers an acupuncture clinic in an inner-city veterans hospital in Bronx, NY.
Main Outcome Measure Survey results indicating residents' level of interest in acupuncture prior to and after the rotation, favorite aspect of the rotation, interest in other applications of acupuncture, perceived benefits of acupuncture in the treatment of their patients, and interest in pursuing certification in acupuncture.
Results Nine of 20 residents (45%) had no prior exposure to acupuncture; 6 (30%) had reading knowledge of acupuncture but had no hands-on experience; 3 (15%) had limited hands-on experience and reading knowledge; and 2 (10%) had extensive experience prior to the rotation. Mean level of interest in acupuncture prior to the rotation was 7 on a scale of 0-10. After the rotation, it was 9.1 (P<.001). After the rotation, 18 residents (90%) indicated that they were interested in pursuing certification in acupuncture. Preferred aspects of the residents' rotation were the hands-on training and the bedside teaching. Twelve residents (60%) believed that acupuncture had a significant benefit for patients with musculoskeletal problems; 8 residents (40%) believed acupuncture was of some benefit.
Conclusions Following exposure to the use of acupuncture for musculoskeletal problems in a rehabilitation clinic setting, PM&R residents were interested in further acupuncture training, believed that patients benefited after receiving acupuncture treatments, and reported their favorite aspect of the rotation was their acupuncture hands-on practical training and patient management. We recommend that PM&R training programs consider offering acupuncture training to residents.
KEY WORDS
Acupuncture, Physician, Rehabilitation Medicine, Residency Training
INTRODUCTION
Both health care professionals and the public have expressed growing interest in acupuncture and there are numerous reports of its widespread use.1,2 Physician attitudes 3-5 include interest in acquiring knowledge about this modality, and offering acupuncture to their patients.
Our study evaluated the impact of a 2-month rotation through an acupuncture clinic on physical medicine and rehabilitation (PM&R) residents. Our primary interests were their level of interest in acupuncture before and after the rotation, favorite aspects of the rotation, and perceptions of the benefits of acupuncture for the treatment of patients with musculoskeletal problems.
METHODS
Twenty PM&R residents rotated for 2-month periods through an acupuncture clinic at an inner-city veterans hospital in Bronx, NY (staffed by certified acupuncturist physiatrists). In this clinic, residents received hands-on instruction in acupuncture for the treatment of patients with musculoskeletal problems. In addition, they received some didactic training in the theories of acupuncture. Reading material was provided as part of their rotation syllabus.
The majority of patients treated had chronic degenerative conditions of the musculoskeletal system (primarily neck, back, shoulder, and knee). Residents assisted the physiatrists with the acupuncture treatments which consisted of a combination of techniques including plum blossom, cupping, and gua sha, as well as traditional meridian acupuncture.
Residents were also exposed to the integration of both Eastern and Western medicine principles (e.g., the use of nonsteroidal anti-inflammatory drugs and physical therapy with acupuncture). The residents followed their patients during the rotation and monitored their progress using selected parts of the McGill Pain Questionnaire and a visual analog scale (VAS).
The residents were given a 6-question survey to complete at the end of their rotation. This survey questioned residents' exposure to acupuncture prior to the rotation, their level of interest in acupuncture prior to and after the rotation, their favorite aspect of the rotation, interest in other applications of acupuncture, the perceived benefits of acupuncture in the treatment of their patients, and their interest in pursuing certification in acupuncture. The Wilcoxon signed-rank test was used to assess changes in the residents' level of interest before and after the acupuncture experience.
RESULTS
The majority of the 20 residents did not have any hands-on, practical experience or training in acupuncture prior to the rotation, although most had information about acupuncture. Nine residents (45%) had no prior exposure to rehabilitation acupuncture; 6 residents (30%) reported reading about acupuncture, but had no practical experience; 3 residents (15%) had limited practical experience and reported reading on the subject; and 2 residents (10%) had extensive experience prior to the rotation.
The residents' interest level was high even prior to the rotation (mean score of 7 on a scale of 0-10). After completion of the rotation, their interest level increased to a mean of 9.1 (P<.001). Eighteen residents reported that their favorite part of the rotation was the hands-on training and wished for more. Twelve (60%) expressed interest in exposure to the uses of acupuncture in other types of pain management that does not involve the musculoskeletal system. Fourteen (70%) also desired more discussion on the role of acupuncture in patient management.
When asked how beneficial residents believed acupuncture to be in the management of musculoskeletal pain, 12 (60%) believed that it offered a significant benefit, and 8 (40%) thought that it offered some benefit. After completing the rotation, 18 residents (90%) expressed interest in pursuing certification in acupuncture.
DISCUSSION
Our findings indicate a high level of interest in acupuncture and acupuncture training by PM&R residents completing a 2-month rotation through an acupuncture clinic. Physician interest and referral of patients for alternative medicine has been studied and is high.4,5 Acupuncture reportedly has the highest rate of physician referral.3
Many medical schools and residency programs now offer varying types of courses in complementary and alternative medicine.4,6,7 Typically, this training is conducted through lectures and clinical electives. Complementary medicine is purportedly popular among physiatrists and their patients.8,9 Krauss et al8 stated that 57% of patients with physical disabilities sought care from an alternative health care provider (vs 34% of the general population). The patients chose alternative treatments for pain, depression, anxiety, insomnia, and headaches. Wainapel et al9 reported that 29% of rehabilitation outpatients used 1 or more alternative medical therapies within the preceding 12 months. The most common therapies were massage, chiropractic, vitamin and mineral supplementation, and acupuncture. The most common conditions were musculoskeletal pain syndromes; 53% of patients reported some degree of efficacy. Physiatrists are uniquely qualified to treat with acupuncture given their knowledge of musculoskeletal anatomy, their manual skills in both examining and treating patients, and their experience with injections of joints and muscles.10
At our site, residents receive 1-2 didactic lectures on the theories of acupuncture. In addition, there is a large hands-on component in which residents are taught the manual skills involved in acupuncture treatments. Reading material is assigned as part of the syllabus readings for the rotation.11 Since the program began 2 years ago, at least 1 of the residents elected to complete formal training in acupuncture. In addition, 2 of the attending physiatrists in our department and 1 at our affiliates completed a certificate-granting program.
A shortcoming of our study was that we did not offer the questionnaire before the start of the rotation. It would have been enlightening to note any impact of the rotation on the residents' interest in certification or perceived benefits of acupuncture. Perhaps future studies should address this.
CONCLUSION
A high level of interest exists in PM&R residents in learning acupuncture. A natural match exists between the physical skills and training that physiatrists currently receive and the ones required of acupuncture. Furthermore, patients treated by physiatrists are often generally responsive to receiving complementary and alternative therapies. Our recommendation is that PM&R programs consider integrating acupuncture training into their curriculum.
REFERENCES
- Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med. 1993; 328:246-252.
- Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569-1575.
- Astin JA, Marie A, Pelletier KR,Hansen E, Haskell WL. A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Intern Med. 1998;158:2303-2310.
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- Perkin MR, Pearcy RM, Fraser JS. A comparison of the attitudes shown by general practitioners, hospital doctors and medical students towardsalternative medicine. J R Soc Med. 1994;87:523-525.
- Milan FB, Landau C, Murphy DR, et al. Teaching residents about complementary and alternative medicine in the United States. J Gen Intern Med. 1998;13:562-567.
- Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine at US medical schools. JAMA. 1998;280:784-787.
- Krauss HH, Godfrey C, Kirk J, Eisenberg DM. Alternative health care: its use by individuals with physical disabilities. Arch Phys Med Rehabil. 1998;79:1440-1447.
- Wainapel SF, Thomas AD, Kahan BS. Use of alternative therapies by rehabilitation outpatients. Arch Phys Med Rehabil. 1998;79:1003-1005.
- Braverman SE. Acupuncture education and integration in the physical medicine and rehabilitation residency. Phys Med Rehabil Clin North Am. 1999;10:755-765.
- Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture Publishers; 1995.
AUTHORS' INFORMATION
Dr Adrian Cristian's specialty is Physical Medicine and Rehabilitation. Dr Cristian is Chief, Rehabilitation Medicine, Bronx VAMC in Bronx, New York, and Assistant Professor, Rehabilitation Medicine at Mount Sinai School of Medicine, New York, NY.
Adrian Cristian, MD*
Room 3d-16
Department of Rehabilitation Medicine
Bronx VAMC
130 W Kingsbridge Rd
Bronx, NY 10468
Phone: 718-584-9000, #5095 • E-mail: adrian.cristian@med.va.gov
Dr Simon Lin's specialty is Physical Medicine and Rehabilitation. Dr Lin is currently completing a Pain Medicine Fellowship at Cedars-Sinai Medical Center in Los Angeles, California.
Simon Lin, MD
E-mail: linsc@hotmail.com
*Correspondence and reprint requests
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