Using Evidence Assignment for Chronic Low Back Pain Management

This assignment discusses the effectiveness of acupuncture in managing chronic low back pain. The PICO framework was used to formulate the research question and three randomized controlled trials were selected as the best evidence. The article provides a summary of the findings from each study and concludes that acupuncture therapy conducted at least twice or thrice per week is an effective strategy for managing chronic low back pain.

Running head: 400863 Spring 2018, Assessment 3 Part B
Using Evidence Assignment
Name of the Student
Name of the University
Author Note

400863 Spring 2018, Assessment 3 Part B
Assignment — Using Evidence
Student name: Student ID:
Part A
The PICO framework was selected for formulating the research question, in relation
to the phenomenon being investigated. The research terms that corresponded to each element
of the PICO framework are given below:
P (Population) Aged patients with chronic low back pain
I (Intervention) Acupuncture
C (Comparison) Standard care
O (Outcome) Better health outcomes and reduced pain
Table 1- PICO framework
This was followed by input of key phrases and search terms in the electronic database
of CINAHL that were combined with the boolean operator ‘AND’. The articles were limited
to those that were peer reviewed and published in English language, on or after 2013, and
containing information on elderly people (+65 years as the target population). This helped in
final retrieval of three articles that are supported by the search history images provided
below:
Student name Student Number Page 1

400863 Spring 2018, Assessment 3 Part B
Figure 1- Search history
Figure 2- Search history
Student name Student Number Page 2

400863 Spring 2018, Assessment 3 Part B
The three sources of evidence that were extracted at the end of the results are given
below:
Weiß, J., Quante, S., Xue, F., Muche, R., & Reuss-Borst, M. (2013). Effectiveness and
acceptance of acupuncture in patients with chronic low back pain: results of a prospective,
randomized, controlled trial. The Journal of Alternative and Complementary
Medicine, 19(12), 935-941.
Shin, J. Y., Ku, B., Kim, J. U., Lee, Y. J., Kang, J. H., Heo, H., ... & Lee, J. H. (2015). Short-
Term effect of laser acupuncture on lower back pain: A Randomized, Placebo-Controlled,
Double-Blind Trial. Evidence-Based Complementary and Alternative Medicine, 2015.
Bahrami-Taghanaki, H., Liu, Y., Azizi, H., Khoursand-Vakilzadeh, A., Esmaily, H.,
Bahrami, A., & Zhao, B. X. (2014). A randomized controlled trial of acupuncture for chronic
low back pain. The Journal of Alternative and Complementary Medicine, 20(5), A40-A40.
PART B
Section 1
The three articles were finally extracted after the application of filters and limiters and
selected best evidence for the scenario 3 owing to the fact that all three were randomised
controlled trials that refers to a scientific experiment that is usually conducted with the aim of
lowering risks of bias, while testing the efficacy of a new intervention. Moreover, RCTs have
been considered best scientific evidence and are arranged in the highest rank (level I) (Barton
et al., 2015). Thus, using results obtained from the RCTs will facilitate determination of the
strength of the results that are presented by the authors. All three are also valid and reliable
since little time has passed since they were generated. Owing to the fact that all three articles
investigated the impacts of different types of acupuncture for the management of chronic low
Student name Student Number Page 3

400863 Spring 2018, Assessment 3 Part B
back pain, which was the phenomenon of investigation of scenario 3, they were considered
best for this research question.
Section 2
Introduction- Low back pain (LBP) refers to a common disease that involves the
nerves, bones, and muscles present in the back and vary from sudden sharp ache to dull
feelings. LBP is usually classified as acute or chronic depending on the time they last in a
person. While those lasting for less than 6 weeks are acute, chronic LBP usually last for more
than 12 weeks among the affected people (Goodman, Burke & Livingston, 2013). Recent
researchers have placed due attention on acupuncture as an alternative therapy for the
treatment of chronic LBP, even citing it more effective than medications (Lam, Galvin &
Curry, 2013). Hence, this essay will discuss findings from three scholarly articles that explore
the effects of acupuncture on LBP treatment.
Discussion- Weiß et al. (2013) stated that upon randomly assigning LBP patients to
two groups, those who were subjected to acupuncture sessions twice weekly demonstrated
meaningfully healthier physical functioning, vitality, general health, and expressive role, in
comparison to patients in group B (control). Pain outcomes were also superior in group A,
compared to patients in group B, thus establishing the acceptability and effectiveness of
acupuncture in management of chronic LBP. According to Shin et al. (2015) when patients in
case group were subjected to laser acupuncture, in comparison to the controls subjected to
sham laser acupuncture, no significant differences were observed between them. However,
members in both groups showed a noteworthy enhancement in each measured parameter,
relative to the starting point values. Hence, the authors were not able to establish laser
acupuncture as an effective treatment for LBP. In the RCT conducted by Bahrami-Taghanaki
et al. (2014) Chinese men and women suffering from chronic LBP were subjected to
Student name Student Number Page 4

400863 Spring 2018, Assessment 3 Part B
treatment that trailed RA protocol, besides acupuncture related to time (TA) in the case
group. They stated that there was a decrease in visual analogue scale (VAS) scores from 69.6
± 7.9 to 11.8 ± 4.9 in the case group, when compared to the controls. In other words, the first
and the third articles are superior in their evidences that can be applied in real time settings,
since the second article failed to explore and confirm the efficacy of the intervention
(acupuncture) on health of LBP patients.
Hence, it can be stated that subjecting patients who are diagnosed with chronic LBP
to acupuncture therapies that are conducted at least twice or thrice, per week will prove as an
effective strategy in management of the chronic condition, thus providing pain relief.
Conclusion- Thus, it can be concluded that the strength of the first and third evidences
are maximum, in comparison to the second scholarly article discussed in the previous section.
Hence, normal acupuncture or laser acupuncture therapy can be implemented while treating
LBP patients. However, further research needs to be conducted on bee venom acupuncture,
before it is used as an intervention in such cases.
Student name Student Number Page 5

400863 Spring 2018, Assessment 3 Part B
References
Bahrami-Taghanaki, H., Liu, Y., Azizi, H., Khoursand-Vakilzadeh, A., Esmaily, H.,
Bahrami, A., & Zhao, B. X. (2014). A randomized controlled trial of acupuncture for
chronic low back pain. The Journal of Alternative and Complementary
Medicine, 20(5), A40-A40.
Barton, C. J., Lack, S., Hemmings, S., Tufail, S., & Morrissey, D. (2015). The ‘Best Practice
Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1
evidence with expert clinical reasoning. Br J Sports Med, 49(14), 923-934.
Goodman, D. M., Burke, A. E., & Livingston, E. H. (2013). Low back pain. Jama, 309(16),
1738-1738.
Lam, M., Galvin, R., & Curry, P. (2013). Effectiveness of acupuncture for nonspecific
chronic low back pain: a systematic review and meta-analysis. Spine, 38(24), 2124-
2138.
Shin, J. Y., Ku, B., Kim, J. U., Lee, Y. J., Kang, J. H., Heo, H., ... & Lee, J. H. (2015). Short-
Term effect of laser acupuncture on lower back pain: A Randomized, Placebo-
Controlled, Double-Blind Trial. Evidence-Based Complementary and Alternative
Medicine, 2015.
Weiß, J., Quante, S., Xue, F., Muche, R., & Reuss-Borst, M. (2013). Effectiveness and
acceptance of acupuncture in patients with chronic low back pain: results of a
prospective, randomized, controlled trial. The Journal of Alternative and
Complementary Medicine, 19(12), 935-941.
Student name Student Number Page 6

400863 Spring 2018, Assessment 3 Part B
Appendix
Article by Weiß et al. (2013)
Student name Student Number Page 7

400863 Spring 2018, Assessment 3 Part B
Article by Shin et al. (2015)
Student name Student Number Page 8

400863 Spring 2018, Assessment 3 Part B
Article by Bahrami-Taghanaki et al. (2014)
Student name Student Number Page 9