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Open Access Study protocol

Exercise and manual auricular acupuncture: a pilot assessor-blind randomised controlled trial. (The acupuncture and personalised exercise programme (APEP) Trial)

SM McDonough1*, SD Liddle1, R Hunter1, DM Walsh1, P Glasgow2, G Gormley3, D Hurley4, A Delitto5, J Park6, I Bradbury7 and GD Baxter8

Author Affiliations

1 Health and Rehabilitation Sciences Research Institute and School of Health Sciences, University of Ulster, Jordanstown, Northern Ireland, UK

2 Sports Medicine, Sports Institute Northern Ireland, Jordanstown, Northern Ireland, UK

3 Department of General Practice, Queen's University Belfast, Belfast, Northern Ireland, UK

4 School of Physiotherapy and Performance Sciences, University College Dublin, Dublin, Ireland

5 Department of Physical Therapy, University of Pittsburgh, Pittsburgh, USA

6 Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, USA

7 Frontier Science Ltd, Inverness-shire, UK

8 Centre for Physiotherapy Research, University of Otago, Otago, New Zealand

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BMC Musculoskeletal Disorders 2008, 9:31  doi:10.1186/1471-2474-9-31

Published: 6 March 2008

Abstract

Background

Evidence supports the use of exercise for chronic low back pain (CLBP); however, adherence is often poor due to ongoing pain. Auricular acupuncture is a form of pain relief involving the stimulation of points on the outer ear corresponding with specific body parts. It may be a useful adjunct to exercise in managing CLBP; however, there is only limited evidence to support its use with this patient group.

Methods/Design

This study was designed to test the feasibility of an assessor-blind randomised controlled trial which assess the effects on clinical outcomes and exercise adherence of adding manual auricular acupuncture to a personalised and supervised exercise programme (PEP) for CLBP. No sample size calculation has been carried out as this study aims to identify CLBP referral rates within the catchment area of the study site. The researchers aim to recruit four cohorts of n = 20 participants to facilitate a power analysis for a future randomised controlled trial. A computer generated random allocation sequence will be prepared centrally and used to allocate participants by cohort to one of the following interventions: 1) six weeks of PEP plus manual auricular acupuncture; 2) six weeks of PEP alone. Both groups will also complete a further six weeks of self-paced exercise with telephone follow-up support. In addition to a baseline and exit questionnaire at the beginning and end of the study, the following outcomes will be collected at baseline, and after 7, 13 and 25 weeks: pain frequency and bothersomeness, back-specific function, objective assessment and recall of physical activity, use of analgesia, perceived self-efficacy, fear avoidance beliefs, and beliefs about the consequences of back pain. Since this is a feasibility study, significance tests will not be presented, and treatment effects will be represented by point estimates and confidence intervals. For each outcome variable, analysis of covariance will be performed on the data, conditioning on the baseline value.

Discussion

The results of this study investigating the adjuvant effects of auricular acupuncture to exercise in managing CLBP will be used to inform the design of a future multi-centre randomised controlled trial.

Trial Registration

Current Controlled Trials ISRCTN94142364.