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EBP project proposal
The EBP Proposal project proposed acupuncture as an alternative to adjunct standard medication therapy in pain management of osteoarthritis (OA) amongst women aged 55 years and above. The clinical question is, “In women above 55 year old suffering from osteoarthritis of the lower back, how does acupuncture compared to the adjunct standard medication therapy decrease pain within 6 months?” the aims of the study are; Suggestion for acupuncture therapy for Osteoarthritis patients, Symptom management of OA, Pain alleviation for the OA patients, Improving functional status especially on the joint performance as well as enabling easy and painless movement by the patient, and Controlling disease progress. The paper reviewed, synthesized and summarized different studies from various databases with a span of less than five years. The project will apply quasi-experimental study design by use of a randomized controlled trial of the acupuncture therapies on the sample population of women beyond 55 years with osteoarthritis. Some of the instruments that will be used in the study include chart audit to track changes from the onset of the study to the end, and 100mmVisual Analog Scale (VAS) for measuring pain.
|RCT||Randomized controlled trial|
|VAS||Visual Analog Scale for Pain|
|MYMOP||Measure Yourself Medical Outcome Profile|
|cLBP||Chronic Lower back pain|
|TrP||Trigger point acupuncture|
The identified practical issue the paper will address is the osteoarthritis in women above the age of 55 years. The Evidence-based practice (EBP) project will be present acupuncture as a pain management method on a patient whom has problems with osteoarthritic pain. Many people suffer from osteopathic pain which involves the joint. The cartilage or cushion between joints becomes swollen and stiff due to the break down causing pain. The major factor causing OA consist of excess weight, injury or overuse and genes, and other developmental issues. At least 80 percent of the people over 55 will show x-ray symptoms of Osteoarthritis in at least one joint (Cherniack & Cherniack, 2013). Before 55, Osteoarthritis is common in men. However, after 55 it becomes more common in women (Pelletier, 2010). Pain management is the challenge to these patients. Treatment options include medication, surgery, and therapy. The frequency of the disease calls for the adoption of alternative therapeutic approach in management. Given that it is a chronic illness, development of customized solutions for patients has enabled substantial benefits in the control of the disease. The EBP will majorly focus on acupuncture as a pain management method to osteoarthritis of the lower back for women aged 55 years and above.
People suffering from OA and seek pain relief outside the mainstream medicine have the option of acupuncture. According to Bahrami-Taghamaki et al (2014), acupuncture for thousands of years have been practiced and plays a significant role in pain relief. Using this treatment method, acupuncturists relieve pain by inserting slender metallic needles at specific points on the body. In their study, Manyanga et al (2014) elaborated that well inserted needle produce a signal that travels to the brain along the spinal cord. This triggers a release of enkephalins and endorphins which are transmitters that reduce pain sensation. Similarly, other studies suggest that inserting the acupuncture needle triggers cortisol production. Cortisol is a hormone that assists in controlling inflammation. Relief of pain is a matter of great concern to patients that suffer from OA and therefore detection of difference in results on the 100mmVisual Analog Scale (VAS) line is regarded as a change that is important clinically to patients having chronic pain.
Aim of project:
This project seeks to introduce acupuncture as the efficient, affordable and sustainable pain management solution for osteoarthritis in women over 55 years old. The paper hope to achieve the following improved outcomes:
- Suggestion for acupuncture therapy for Osteoarthritis patients.
- Symptom management of OA
- Pain alleviation for the OA patients
- Improving functional status especially on the joint performance as well as enabling easy and painless movement by the patient
- Controlling disease progress
In women above 55 year old suffering from osteoarthritis of the lower back (P), how does acupuncture (I) compared to the adjunct standard medication therapy (C) decrease pain (O) within 6 months? (T).
(P)- Population: The population will comprise of women aged 55 years and above who are ailing from OA of lower back.
(I)-intervention: Acupuncture treatment method will be given to the subjects.
(C)- Comparison: In the study, adjunct standard medication therapy will be used. The control group would be given adjunct standard medication therapy as a comparative treatment.
(O)- Outcome: Pain alleviation and increased joint functionality from the subjects under acupuncture treatment. This will be measured using 100mmVisual Analog Scale (VAS) that will be administered before treatment and after 6 month acupuncture treatment.
(T)-Time: The outcome will be measured after 6 months.
Adoption of acupuncture treatment method is of importance to manage the effects and suffering of OA patients. There have been several identified harmful effects of Non-steroidal Anti-inflammatory Drugs (NSAIDs). There are over 12,000 hospitalizations and 2,000 deaths related to NSAIDs complications in the country annually (Pelletier, 2010). Acupuncture is therefore the best alternative to adjunct standard medication therapy. In females above the age of 55 years and above, the body is on a declining scale for most of its biological functions. With respect to the toxicity and unsafe side effects of adjunct standard medication therapy, it is recommendable that this age group of women turns to proven alternative methods such as acupuncture (Cherniack & Cherniack, 2013). The cost of acupuncture is significantly lower than the standard options. Most of the procedures are simple and do not require sophisticated medical equipment for activities such as surgery (Pelletier, 2010).
Part 2- Evidence Review and Synthesis
Search of information is one of the most essential parts of carrying out an effective research on any topic. In order to get the most relevant literature for Evidence Based Practiced, it is quite paramount to have access to some of the most reputable search sites such as ProQuest (South’s Online Library), PubMed, Medline, among others. In order to have access to the most recent publications, I filtered my search to ensure that I only accessed peer-reviewed academic journal articles.
In carrying out appraisal using the Rapid Clinical Appraisal Tools, it mainly aimed at identifying some of the most evident methodological flaws found in the literature as well as providing consumers of specific research evidence with the opportunity to ensure they make highly informed decisions on the quality of the given research evidence. The Rapid Appraisal tool that was used in the appraisal included mixed research methods that were aimed at helping understand the entire article from different perspectives. The article that was used in the appraisal was White, A., Richardson, M., Richmond, P., Freedman, J., & Bevis, M. (2012). Group acupuncture for knee pain: evaluation of a cost-saving initiative in the health service, Acupuncture Medicine, 30, 170-175 from NCBI and in addition to other articles. In order to fully understand the concepts that were appraised in the article, it is quite essential to note the evaluation table and the search tracker template provided in Appendix 1 and 2
Summary of “Keeper” studies
There is a wealth of clinical literature supporting the usefulness of the acupuncture in the treatment of elderly patients suffering from osteoarthritis. Although most of the study shows that more research is needed to ascertain the efficiency of these drugs, they have also found that these traditional techniques have the same effectiveness in terms of reducing pain, but more efficient in terms of their tolerance towards adverse effect. These studies reveal the effectiveness of the acupuncture in treating chronic pain.
For example, Bahrami-Taghamaki et al (2014) argued that with the recent increased awareness of the acupuncture’s benefits for the management of chronic back pain by both the patients and professionals, the technique can be adjusted to become more beneficial than before. As a result, the authors compared the effectiveness of the regular acupuncture with a modified one which has been added confluent acupoints, which is a modification linked to the day time period in time technique acupuncture by conducting a randomized controlled trial using sixty patients from Beijing China. The authors randomly grouped the patients into two individuals to take acupuncture. The control group received the regular acupuncture (RA) while the test group (TA) received regular acupuncture together with acupuncture in confluent points related to time. To determine the changes between the two groups, the authors measured pain score using the Visual Analog Scale (VAS). The results revealed that the pain in the test group decreased .............
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