Patients With Prostate-Related Illness - Perceived Quality of Life Before and After Acupuncture Treatment: A Pilot Study
By Aaron Katz, MD and Cesar E. Armoza, PhD, LAc
Purpose of the Study
The purpose of this study was to investigate changes in health-related conditions among patients who received acupuncture treatment.
Specifically, this study sought to examine whether perceived quality of life among patients with a prostate-related illness improved after receiving acupuncture treatment. Method
Participants were eight male patients, ages 55 to 64. Patients have a prostate-related illness. Participants were patients of the College of Physicians and Surgeons at Columbia University.
Before and after receiving acupuncture treatment, patients answered the SF-36V2 Health Survey. The survey is a standardized test, which assesses general health-related conditions, such as physical functioning, bodily pain, general health, vitality, social functioning, and mental health. The survey was also used to estimate the overall physical functioning and mental health of the patients. The survey has norms for U.S. populations of different ages and gender.
Paired-samples T-test analyses were conducted a) to examine individual differences in each of the subscales of the survey; b) to examine group mean differences for each of the scales; and c) to compare the participants with the norms of U.S. populations with similar demographic characteristics. Tables and figures were constructed to graphically display the results.
Question 1: Are changes on patients" perceived quality of life a function of the acupuncture treatment?
As Table 1 shows, patient 2 and patient 3 increased their overall physical functioning, while patient 5 and patient 6 increased their overall mental health. However, there were patients who did not show differences after treatment. For example, patient 1, patient 7, and patient 8 did not show changes after treatment.
An examination of the scores among the subscales indicates that physical functioning, general health, vitality, and role emotional are the scales in which the patients showed greater improvement. To illustrate, Figure 1 displays changes in physical functioning among the eight patients. The red line represents the pre-test scores on physical functioning; the green line represents the post-test scores on physical functioning. As Figure 1 shows, the lines are not parallels and the green line (post-test scores) is often above the red line (pre-test). These findings indicate positive changes on the patients" physical functioning after treatment. The same information is presented in Figure 2.
Question 2: Are there changes in patients" health condition based on the SF-36 subscales after acupuncture treatment?
By examining the results of the T-test analyses (see Table 2), it could be concluded that the patients increased their general health and their social functioning. These findings are demonstrated on the size of the negative mean differences; greater negative numbers indicate that the patients reported engaging in more activities in those areas after the treatment. It is important to observe that the mean differences are all negative, which indicates that the means increased after treatment. T-test analyses show no mean differences due to small sample size (N = 8).
Question 3: Are there changes in patients" overall physical functioning and mental health after acupuncture treatment?
As Table 3 displays, most of the patients increased their overall physical functioning and mental health after the treatment. Figure 3 and Figure 4 display the same results in bar charts. We also examined the patients" scores on overall physical functioning and mental health. We found that some of the patients increased their physical functioning, while others increased their mental health. Figure 5 and Figure 6 display each of the patient"s scores. However, it is important to acknowledge that there were patients who did not show differences after treatment.
Table 3: Mean Differences on Overal Physical Functioning and Mental Health: Pre- and Post-Acupuncture Treatment
Physical Summary - 1 Physical Summary - 2
Mental Summary - 1 Mental Summary - 2
Note: T-test analyses show no mean differences due to small sample size (N=8).
Question 4: How are the patients" scores on the SF-36 in comparison to the U.S. norm sample?
The pre- and post-test scores of the eight patients were compared to the U.S. norm male population, age 55-64. First, we compared the mean for physical functioning of the eight patients with the U. S. normal population. We found that for our sample, the pre-test mean for physical functioning was 49.10 ( SD = 10.58) while the mean for the U.S. norm population was 48.16 (SD = 10.23). These results suggest that initially, our sample was very similar to the norm population. We also compared our sample"s post-test mean on physical functioning with the U.S. norm population. We found that for our sample, the post-test mean for physical functioning was 52.02 (SD = 8.16), which was higher than the U.S. norm population.
Second, we compared the mental health pre-test mean of the eight patients with the U. S. norm population. In our sample, the pre-test mean for the mental health scale was 52.91 ( SD = 6.47) and for the U.S. norm population, 52.53 ( SD = 9.67). Once again, our sample"s pre-test mean is similar to the norm population. However, we found that for our sample, the post-test mean for mental health was 55.32 ( SD = 3.69), which was higher than the norm population.
According to traditional Chinese medicine, prostate cancer, or any abnormal enlargement of the prostate, is mostly due to kidney qi. Qi is defined as the vital energy of every living organism and the source of all movement and change in the universe. When the kidney blood and qi become static or blocked due to toxic accumulation on the lower jiao (lower abdomen), it could result in an enlargement of the prostate. The treatment then should revitalize or increase qi circulation in the kidneys and blood. Once the qi circulation is restored, patients begin to feel an improvement in symptoms.
The acupuncture protocol designed to increase qi circulation and minimize the symptoms listed above is as follows:
Ear Points: (both ears, must insert points first): Shen Men, Sympathetic Point, Kidneys, Liver, and Upper Lung
Body Points: Liver 2 (xianjian), Spleen 6 (sanyinjiao), Stomach 36 (zusanli), Stomach 25 (tianshu), Ren 17 (tanzhong), LI (Large Intestine) 20 (yingxiang), special point yintang
Master Tong Body Special Points
Special Point 1 is applied with the patient in the supine position. Measure 3 cun above on the medial posterior border of the tibia. Needle 1-1.5 cun in depth, keeping needle at a 45 degree angle.
Special Point 2 is applied with the patient in the supine position. Measure 1.5 cun below Spleen 9 (yolingquan). Needle 5 fen to 1 cun in depth.
Electrical Stimulation: Use in leg points and Stomach 25
Lamp: Applied only in the middle jiao (above the umbilicus for twenty minutes, never lower abdomen)
The points above are grouped in the following combinations, facilitating the following results:
Ear points Kidney and body points Kidney 3, Spleen 6 and Stomach 36 are used for strengthening the kidney qi and vital energy.
Body points Liver 2, Stomach 25, special points 1, 2 and 3, and Ear point Liver are used together for promoting blood circulation and removing blood stasis.
Ear points Shen Men and Sympathetic are used for relaxing the body.
Ear point Lung and body points Ren 17, yintang and LI 20 work together in strengthening the lung qi, aid in respiration, stimulate the qi of the entire body, and maintain normal water metabolism to keep urination smooth.
In summary, we found that although our sample was initially similar to the U.S. norm population on their reported physical functioning and mental health, after the acupuncture treatment, they reported improvement in the way they perceived the quality of their lives. Further, that perception of improvement exceeded the U.S. norm population.
Astin JA, PhD. Journal of the American Medical Association, May 20, 1998, v. 279, n. 19. p. 1548(6). Why patients use alternative medicine: results of a national study.
Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine at U.S. medical schools. Journal of the American Medical Association, September 2, 1998;280(9):784-7.
If you search the Medline database using the keywords "quality of life" in the field MeSH terms for the years 1978, 1988, 1998 and 2001, you will obtain, respectively, 273, 715, 3,135 and 26,640 published articles.
Nussbaum MC. Sen Amartya: The Quality of Life. Oxford: Clarendon Press, 1995.
Salek S. Compendium of Quality of Life Instruments. Wiley, February 1999.
Bulletin, Medical Outcomes Trust, Scientific Advisory Committee, September 1995;3(4). Instrument review criteria.
O"Connor R, et al. Issues in the measurement of health-related quality of life. Working paper. Melbourne, Australia: NHMRC National Centre for Health Program Evaluation, July 30, 1993.
Leplege A, Hunt S. The problem of quality of life in medicine. JAMA, July 2, 1997; v. 278, n. 1, p. 47(4).
Ventegodt S, Hilden J, Zachau-Christiansen B. Measuring the Quality of Life: A Methodological Framework. The Quality-of-Life Research Project, Department of Pediatrics, University Hospital (Ruigshopitalet), Tagensvej 18B, DK-2200 Copenhagen N, Denmark, 1991.
Fayers P, Machin D. Quality of Life. Wiley, 2000.
Berger M, Bobbit RA, Carter WB, Gilson BS (1991). The sickness impact Profile: development and final revision of a health status measure. Medical Care 1991;19:787-805.
Hunt SM, McKenna SP, McEwen J, et al. The Nottingham Health Profile: subjective health status and medical consultations. Social Science and Medicine 1981;15A:221-229.
Ware JE Jr., Snow K, Kosinski M, Gandek. SF-36 Health Survey: Manual and Interpretation Guide. 2000.
Ware JE Jr., Kosinski M, Keller SD (1994). SF-36 Physical and Mental Health Summary Scales. 1994.
Ware JE Jr. (1997). Understanding health outcomes: the SF-36 and SF-12 health surveys: how to use them. Health status, concepts, measures, and applications. Tufts University School of Medicine. Health Stat, 1997.
Brooks R, with the EuroH-RQoL group. EuroH-RQoL: the current state of play. Health Policy 1996; 37, 53-57.
Hickey AM, Bury G, O"Boyle CA, et al. A new short-form individual quality of life measure (SEIH-RQoL-DW): application in cohort of individuals with HIV/AIDS. British Medical Journal 1996;313:29-33.
Ruta DA, Garrrat AM, Leng M, et al. A new approach to the measurement of quality-of-life: the Patient Generated Index. Medical Care 1994;32:1109-1126.
Ware JE Jr. SF-36 Health Survey update. Spine 2000;25(24):3130-3139.
Posted in the The SF Community Web site ( www.SF-36.com). News section.
Consent form format (instructions). Columbia Presbyterian Medical Center. Consent to Participate in a Research Study.
Ellinson J. Toward sociomedical health indicators. Social Indicators Research 1974;1(1):59-71.
Ellinson J. Methods of measuring quality of life. In: Berfenstow R, Johnson E (eds.). Measurement of Quality of Life Proceedings from the International Workshop on Quality of Life Measures-Methodology and Application in Health Policy. Uppsala, Sweden: 1981, pp. 68-77.
Wenger NK, Mattson ME, Furberg CD, Ellinson J (eds.). Assessment of quality of life in clinical trials of cardiovascular therapies. The American Journal of Cardiology Oct. 1, 1984;84:908-931.
Wenger NK, Mattson ME, Furberg, CD, Elinson J (eds.). Proceedings of the Workshops on Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies. Le Vacq, 1984.
Patrick D, Ellinson J. Sociomedical approaches to disease and treatment outcomes in cardiovascular care. Quality of Life and Cardiovascular Care 1985;1(2):53-62.