P1.37: Efficacy of acupuncture in patients with chronic low back pain ‐ the Acupuncture Randomised Trials (ART)

Abstract

In a randomised controlled trial we investigated whether acupuncture is more effective compared to no acupuncture or minimal acupuncture in patients with chronic low back pain. This study is part of a large acupuncture research initiative of German health insurance companies (Modellvorhaben der Techniker Krankenkasse). Patients (age >40 years) with chronic low back pain (symptom duration >6 month) were randomised to treatment with semistandardised acupuncture (AC), minimal acupuncture (MA, superficial needling at non-acupuncture points) or to waiting list control (WL). AC and MA were administered by specialised acupuncture physicians in 31 outpatient centers and consisted each of 12 sessions per patient over 8 weeks. Patients completed standardised questionnaires at baseline and end of week 8 including assessment of the main outcome parameter pain intensity (VAS 0-100 mm) and back function (FFbH-R). A total of 298 patients (68% female, 32% male, 59±9.1 years) were included from March to October 2002. Change in pain intensity (VAS) from baseline to 8 weeks was significantly different between AC and WL (-28.7±30.3 mm (mean ± sd) vs. -6.9±22.0 mm, p< 0.001) and not significantly different between AC and MA (-28.7 ±30.3 mm vs. -23.6±31.0 mm, p=0.256). Similarly, back function at week 8 demonstrated a significant difference between AC and WL (66.8±18.3 vs 57.7±19.9, p=0.001), and no difference between AC and MA (66.8±18.3 vs 62.9±20.3, p=0.165). Acupuncture in patients with chronic low back pain was associated with marked improvement of pain intensity and back function compared to no acupuncture treatment. However, no significant differences were found between acupuncture and minimal acupuncture.P1.39: How to quantify putative quality determinants in indoor and outdoor care of elderly patients in Germany?Yvonne Georgi*, Ursula Weibler, Frank Krummenauer * Corresponding Author: Medizinischer Dienst der Krankenversicherung Rheinland-Pfalz, Alzey email: yvonne.georgi@mdk-rlp.de Quality management in indoor and outdoor care of the elderly (Harrington, 2003) is ensured by periodical quality assessments. However, as long as these are reported in a rather qualitative manner, (interventional) process control remains difficult. Therefore, putative determinants of care outcome quality and their possible change after qualitiy assessment and consulting should be quantified. A total of 67 items and 52 items were identified for outdoor and indoor care quality assessment, respectively, corresponding to 12 and 9 putative overall quality determinants. The latter were estimated based on care quality assessments performed by the Medizinische Dienst der Krankenversicherung Rheinland-Pfalz in 2002. The items were averaged to derive overall scores for these putative care quality determinants, ranging from 1.0 (optimum rating) to 0.0 (worst rating). A total of 91 outdoor and 127 indoor quality assessments were reviewed. Both for the indoor and the outdoor care units rather pessimistic outcome was observed for "care documentation" and "inter...