Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists

Objectives: To assess interrater reliability of Traditional Chinese Medicin e (TCM) diagnosis and treatment of chronic low back pain. Design: Under a L atin square design, six TCM acupuncturists evaluated the same six patients on the same day. Setting: Northwest Institute of Acupuncture and Oriental M edicine, Seattle, Washington. Interventions: Assessment only. Outcome measu res: TCM diagnosis, acupoint prescriptions, auxiliary treatment recommendat ions. Results: Twenty diagnoses and 65 acupoints were used at least once. T he diagnosis of Qi/Blood Stagnation with Kidney Deficiency and the acupoint UB23 were used for every patient by most acupuncturists. However, consiste ncy across acupuncturists regarding diagnostic details and other acupoints was poor. No diagnoses, and only one acupoint, were used preferentially for a subgroup of patients. Some diagnoses and treatment recommendations were dependent more on the practitioner than on the patient. Fine-grained diagno ses and most acupoints were unrelated to either patient or practitioner. Co nclusions: TCM diagnoses and treatment recommendations for specific patient s with chronic low back pain vary widely across practitioners. Acupuncture clinical trials using an individualized treatment arm may be difficult to r eplicate or evaluate because of low concordance among acupuncturists. Compa rison of individualized treatment with a thoughtfully developed standardize d approach is warranted to determine which, if either, is superior. (C) 200 1 Harcourt Publishers Ltd.