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Acupuncture, or non-directive counselling versus usual care for the treatment of depression: a pilot study.

Schroer S, Macpherson H - Trials (2009)

Bottom Line: The primary outcome measure is the BDI II.Other secondary measures include the SF 36 bodily pain subscale, the CORE OM, the WBQ-12 and the EQ5D.Health economic data will be collected and measures of therapeutic engagement will be used to compare patient's views of therapists and GPs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Sciences, University of York, York, UK. ss51@york.ac.uk

ABSTRACT

Background: Depression is one of the most common reasons for consulting in primary care. Acupuncture is a popular complementary therapy choice for depression but its evidence base is poor with more robust high quality trials being required. More than half of depressed patients experience painful symptoms, with severe pain being associated with poor response to antidepressants. Acupuncture may have much to offer as an intervention for depression that also helps alleviate pain. Non-directive counselling is the most widely used psychological approach for depression in NHS settings, and provides a useful pragmatic comparison for acupuncture that would, according to our pre-trial qualitative research, be of high interest to doctors and patients.

Methods and design: The pilot study uses five arms and involves a pragmatic design. All patients will continue to receive usual care. Four groups of patients will be allocated to acupuncture, or non-directive counselling, in addition to usual GP care. The acupuncture and counselling arms will be further split into two groups to explore different treatment regimens. The primary outcome measure is the BDI II. Potentially eligible patients will be screened for depression using the PHQ-9, which is also a secondary outcome measure. Other secondary measures include the SF 36 bodily pain subscale, the CORE OM, the WBQ-12 and the EQ5D. Health economic data will be collected and measures of therapeutic engagement will be used to compare patient's views of therapists and GPs. The study will employ a fully randomised preference design with collection of data on patient preferences and prior expectations.

Discussion: This study has been implemented, and data are currently being analysed to inform the design of a full scale trial. Two practical operational issues that impacted on study implementation are discussed. Firstly, the challenge of recruiting depressed patients via GP consultation. Secondly, the problem of poor uptake and high attrition for counselling and acupuncture, which appeared to be associated with poor questionnaire return, and resulted in missing data. These problems may be relevant to other researchers working in the area of depression, or similar illnesses, where patients may lack motivation and energy to engage in research, or attend for treatment.

Trial registration: Current Controlled Trials (ISRCTN 59267538).

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Related in: MedlinePlus

Study flow diagram.
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Figure 1: Study flow diagram.

Mentions: Our aim was to conduct a pilot study for a full scale trial of acupuncture for depression, and to look at its potential effectiveness in terms of depression recovery and prevention of future episodes. We sought to investigate the feasibility of comparing acupuncture with non-directive counselling, a widely used primary care intervention, with both therapies being adjuncts to usual GP care. Recruitment began at the end of January 2007. Randomisation took place at the end of February 2007. Data collection was completed at the end of 2007. A CONSORT study flow diagram [27,28] shows recruitment, uptake of interventions and loss to follow up (see Figure 1). Study data are currently being analysed and will be used to inform the design of a full scale trial.


Acupuncture, or non-directive counselling versus usual care for the treatment of depression: a pilot study.

Schroer S, Macpherson H - Trials (2009)

Study flow diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2636800&req=5

Figure 1: Study flow diagram.
Mentions: Our aim was to conduct a pilot study for a full scale trial of acupuncture for depression, and to look at its potential effectiveness in terms of depression recovery and prevention of future episodes. We sought to investigate the feasibility of comparing acupuncture with non-directive counselling, a widely used primary care intervention, with both therapies being adjuncts to usual GP care. Recruitment began at the end of January 2007. Randomisation took place at the end of February 2007. Data collection was completed at the end of 2007. A CONSORT study flow diagram [27,28] shows recruitment, uptake of interventions and loss to follow up (see Figure 1). Study data are currently being analysed and will be used to inform the design of a full scale trial.

Bottom Line: The primary outcome measure is the BDI II.Other secondary measures include the SF 36 bodily pain subscale, the CORE OM, the WBQ-12 and the EQ5D.Health economic data will be collected and measures of therapeutic engagement will be used to compare patient's views of therapists and GPs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Sciences, University of York, York, UK. ss51@york.ac.uk

ABSTRACT

Background: Depression is one of the most common reasons for consulting in primary care. Acupuncture is a popular complementary therapy choice for depression but its evidence base is poor with more robust high quality trials being required. More than half of depressed patients experience painful symptoms, with severe pain being associated with poor response to antidepressants. Acupuncture may have much to offer as an intervention for depression that also helps alleviate pain. Non-directive counselling is the most widely used psychological approach for depression in NHS settings, and provides a useful pragmatic comparison for acupuncture that would, according to our pre-trial qualitative research, be of high interest to doctors and patients.

Methods and design: The pilot study uses five arms and involves a pragmatic design. All patients will continue to receive usual care. Four groups of patients will be allocated to acupuncture, or non-directive counselling, in addition to usual GP care. The acupuncture and counselling arms will be further split into two groups to explore different treatment regimens. The primary outcome measure is the BDI II. Potentially eligible patients will be screened for depression using the PHQ-9, which is also a secondary outcome measure. Other secondary measures include the SF 36 bodily pain subscale, the CORE OM, the WBQ-12 and the EQ5D. Health economic data will be collected and measures of therapeutic engagement will be used to compare patient's views of therapists and GPs. The study will employ a fully randomised preference design with collection of data on patient preferences and prior expectations.

Discussion: This study has been implemented, and data are currently being analysed to inform the design of a full scale trial. Two practical operational issues that impacted on study implementation are discussed. Firstly, the challenge of recruiting depressed patients via GP consultation. Secondly, the problem of poor uptake and high attrition for counselling and acupuncture, which appeared to be associated with poor questionnaire return, and resulted in missing data. These problems may be relevant to other researchers working in the area of depression, or similar illnesses, where patients may lack motivation and energy to engage in research, or attend for treatment.

Trial registration: Current Controlled Trials (ISRCTN 59267538).

Show MeSH
Related in: MedlinePlus