Facilitators of and barriers to implementing a traditional Chinese medicine collaborative model of care for axial spondyloarthritis: a qualitative study

Abstract

Background: Conventional therapy may be inadequate for many patients with axial spondyloarthritis (axSpA). Traditional Chinese medicine (TCM) may be a viable alternative, but its effectiveness for axSpA is unknown. We are currently conducting a pragmatic randomised controlled trial (RCT) to investigate the effectiveness of a TCM collaborative model of care (TCMCMC), which combines usual rheumatologic care with acupuncture for patients with axSpA. This nested qualitative sub-study aims to identify facilitators of and barriers to the implementation of the TCMCMC. Methods: We conducted individual in-depth interviews with participants who had completed the acupuncture regimen to elicit opinions on the facilitators of and barriers to the implementation of the TCMCMC. The interviews were transcribed and analysed using thematic analysis. Results: Twelve participants were included, with data saturation occurring after 10 interviews. The analysis revealed both a number of important ‘facilitators’ and ‘barriers’. Facilitators to the implementation of the TCMCMC included effectiveness of TCM to relieve symptoms, inadequacy of conventional treatment and positive social perceptions of TCM. Barriers included scepticism towards TCM, inability of TCM to provide instant relief, needle-related discomfort, variable effectiveness of TCM influenced by physicians’ skills and experience and the high cost of TCM. Recommendations to overcome barriers included further patient education about TCM. Conclusion: Policymakers should take into account the various feasibility factors identified in this study when developing and implementing a TCMCMC. Trial registration number: NCT03420404 (ClinicalTrials.gov)

Efficacy and safety of non-pharmacological and non-biological interventions: a systematic literature review informing the 2022 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis

“…These studies confirmed perceived efficacy and highlighted the value of education, exercise and nonpharmacological therapy in general, when used alongside pharmacological interventions. [71][72][73][74][75][76][77][78] It is already well-established that csDMARDs are ineffective in treating axial symptoms in patients with in axSpA, 106,107 a finding once again observed in this SLR. It is also already known that comedication with csDMARDs can reduce immunogenicity against bDMARDs.…”

“…cognitive–behavioural therapy). These studies confirmed perceived efficacy and highlighted the value of education, exercise and non-pharmacological therapy in general, when used alongside pharmacological interventions 71–78…”

“…Eight qualitative studies, three of which in r-axSpA,71–73 and five in axSpA,74–78 were also included (online supplemental tables S18–S20). These studies found that a combination of face-to-face contact and self-education is preferred by the patients, and that E-tools (eg, a web interface to monitor patients’ symptoms, quality of life and physical activity) can be useful for disease monitoring 73 76.…”

“…60,61,[64][65][66][67][68][69][70] Furthermore, two studies on hip arthroplasty for advanced hip involvement in r-axSpA showed satisfactory clinical and radiological outcomes. 62,63 Eight qualitative studies, three of which in r-axSpA, [71][72][73] and five in axSpA, [74][75][76][77][78] were also included (Supplementary Tables S18-20). These studies found that a combination of face-to-face contact and self-education is preferred by the patients, and that E-tools (e.g.…”