Original Article

I. Qualitative Research

Qualitative Research on Treatment of Acupressure and Cupping Evaluated by the Consolidated Criteria for Reporting Qualitative Research (COREQ) Guideline (Supplementary material 4.)

Mindy Szu-Min Peng¹, Wenly Chiu-Wen Su¹, May Mei-Sheng Ku², Wilson Wei-Chun Wang¹, Erin Shu-Lin Chuang¹, Lisa Li-Chen Hsieh³, Hsiu-Hsi Chen¹ and Chen-Yang Hsu¹

¹ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University

² Institute of Environmental Health, College of Public Health, National Taiwan University

³ Ji-Din Clinic, Kaohsiung, Taiwan

Abstract

Background

The utilization of the methods and theories of quantitative study have demonstrated its benefit in discovering the subject- or patient- oriented experiences which can further be based and be summarized into constructs supporting propositions without being dominated by the viewpoint of study investigator. However, the case reports on the use of acupressure and cupping have not been addressed by qualitative study. We thus based on the COREQ guideline to examine the qualitative study for five cases receiving the treatment of acupressure and cupping.

Material and Methods

We first developed a scoring system based on the COREQ with three domains and 32 items to assess the quality of the qualitative research in the field of acupressure and cupping. The interview candidate for this study were first selected by the investigator, LLCH, and the five cases were determined by the discussion between the authors to ensure the feasibility and representativeness. The quality of the five selected case report was evaluated by the authors using the developed scoring chart with standard calibrated between authors. The total score and that for each domain was used to summarize the quality of the case reports.

Results

A scoring system for the 32 items and three domains was developed. The score for each item range from 0, 1, and 2, representing the quality of poor, modest, and good. For items not feasible for the scenario, a NA (not applicable) mark was applied and the item was not counted. The standard of each item for all authors were calibrated through discussion. The mean of total score was 29.8 (range: 25.0-33.0, full score: 64) with the item-adjusted rank of 47%. The mean of score was 13.2 (range: 10-14, rank: 83%), 7.4 (range: 7-9, rank: 25%), and 9.2 (range: 8-10, rank: 51%) in the “Domain 1: Research team and reflexivity”, “Domain 2: Study design”, and “Domain 3: Analysis and findings”, respectively.

Conclusion

We demonstrate how to use COREQ guideline to score case reports of acupressure and cupping. Based on the COREQ standard, the quality of case report research is modest, especially for the Domain of study design.

Introduction

The utilization of the methods and theories of quantitative study have demonstrated its benefit in discovering the subject- or patient- oriented experiences (Atchan et al. 2016, Anthony et al. 2009, Hyett et al. 2014, Schoultz et al. 2016, Tong et al. 2007, Nissen et al. 2014). Two therapies of TCM, acupressure and cupping play important roles on treating diseases. There are numerous case reports addressing the efficacy of two therapies. However, whether these case report can be translated into qualitative studies to fit in with the quality of COREQ-based evaluation has been barely addressed.

Methods

All patients were treated with acupressure and cupping by Dr. Lisa Li-Chen Hsieh at Ji Din Clinic, Kaohsiung, Taiwan. All were seen and evaluated by at least one of the research fellows. The main symptoms in all patients included nose allergy, sports injuries, height, fail to sit for a long time, scoliosis, and myopia and so on. The experiences during treatment including interaction with physicians and treatment efficacy were shown at self-report. Total of 11 potential relevant reports with “Acupressure and Cupping” come from Ji Din Clinic. 6 reports be withdraw by professional researcher due to less quality of report. Finally, there are five self-reports included in the analysis (see Figure 1). We further quantify and assess the context of self-report to scientific principle for current evidences using a COREQ-based scoring system.

Results

Quality of self-report

After scoring each reports to evaluate the quality of evidence with COREQ guideline, the mean of total score is 29.8 (range: 25-33) and the mean of score are 13.2 (range: 10-14), 7.4 (range: 7-9), and 9.2 (range: 8-10) in the “Domain 1: Research team and reflexivity” (including personal characteristics and relationship with participants), “Domain 2: Study design” (including theory framework, participant selection, setting, and data collection), and “Domain 3. Analysis and findings” (including data analysis and reporting), separately (see Table 1). The worst performance was in the “Domain 2: Study design” with lack of description including participant selection and data collection.

In Figure 2, the means score in each section at five case-report is 83% (13/16) in the “Domain 1: Research team and reflexivity”, 25% (7/30) in the “Domain 2: Study design”, and 51% (9/18) in the “Domain 3. Analysis and findings”.

Case-reports

Case 1

“I remember that at the beginning, Dr. Hsieh was treating my nose. However, in the past few years, most of the illnesses be treated by Dr. Hsieh were sports injuries, such as arms, legs, feet and even the spine.” “The first thing to overcome during the treatment is the pain when the injured part is pressed.” “When you are receiving the treatment, you can feel the strength of Dr. Hsieh's pressure. Regardless of how much Dr. Hsieh presses, there is only a feeling of oppression in the place where it is not a wound or a symptom. However, as long as it is pressed to some places, Dr. Hsieh will start to ask: "Is it painful?..."

“The general doctors are only treating the symptoms, but Dr. Hsieh always find the cause of symptoms to provide the right treatment.” “After seven years of treatment, my nose allergy and sports injuries went into complete clinical remission.”

Case 2

I am a ninth grade in high school boy. I have a problem with height for a long time. “Under the recommendation of the neighbor, I went to the clinic of Dr. Hsieh”. “When I told the doctor that I wanted to treat the height problem, the doctor said that I had to cure my spine before I could grow taller.” I was a little scared at first….” “Dr. Hsieh said, “The more pain beard, the more improvement will be”. “Subsequently, I was receiving cupping treatment, and followed the instructions from Dr. Hsieh, continuing to do rehabilitation in the morning and evening every day!” “After receiving the treatment of acupressure and cupping by Dr. Hsieh, although the treatment was too painful, my height has improved.”

Case 3

“I am a 23-year-old girl. I knew Dr. Hsieh from my childhood. For me, Dr. Hsieh is like my mother taking care of my body and mind.” “Dr. Hsieh is proficient in modern medicine and traditional Chinese medicine. She integrates different perspectives from China and the West to explain the working mechanism of the human body for treatment. She is good at treating diseases through acupressure, cupping and patient cooperation.”

“When I was a little child, I would suffocate as soon as I cried, and Dr. Hsieh told my mother that I should continue and gradually treat during the growth….” “When I was in college, I suffered from scoliosis so can't sit for a long time. Dr. Hsieh cured my spine and tail vertebrae. Now I can finally avoid being uncomfortable when I am commuting.”

“Modern medicine pays attention to sub-discipline treatment. However, acupressure and cupping treatment can be integrated into one. Dr. Hsieh can take care of the body, mind and spirit through acupressure and cupping. “

“I am benefited from her treatment. I am very grateful to meet Dr. Hsieh. Without her, there would be no me who is healthy, happy, and knows how to grow up with the body.”

Case 4

“I suffered from walking pigeon-toed, myopia and height and looking for treatment for year.” “I met Dr. Hsieh through other doctor’s introduction … At first visit, I thought that the clinic was a medicine clinic in western style like I have ever experienced before, however, on subsequent visit, I gradually noted that although the clinic is not big, there are already many patients in the treatment queue.”

“Seeing the painful expressions of the first few patients made me very nervous during waiting.” “After I lay in the bed waiting for examination and treatment, Dr. Hsieh's took out a pen and pressed it down on my foot and asking whether it triggered pain.” “At that time, I felt my tears falling out, but Dr. Hsieh's said, "How sick it is, how much pain it will be.” “The more pain beard, the more improvement will be”. “…So I continued my treatment courses, with tears on ever section.”

“After receiving Dr. Hsieh’s treatment courses, the symptoms improved much.” “I thinks that Dr. Hsieh is very powerful in that she can treat all parts of the body, both from inside and also the expressed symptoms with acupressure and cupping treatment.”

“…In my feeling, Dr. Hsieh is like a mother and also a teacher…She is afraid that patients will be influenced by misconceptions, so she told patients the correct one in a straightforward way”. “I learned a lot about how to take care of the body and to stay health… I know more about how to care and protect my body now”.

Case 5

“I am a ninth grade in high school boy. I suffered from height problem. I started receiving treatment from the fifth grade, from once a week to once a month.”

“The initial treatment was cupping at the center of the back, but one of the reasons why I didn't grow taller was because my stomach was not well absorbed, so I started cupping around the abdomen at the same time.”

“At the same time as the treatment of the height, the doctor also helped me to adjust the development of other parts. For example, I had a problem with the concave chest, so the doctor helped me to pull the shoulder below the chest and the chest. There are also face adjustments, such as cupping and massage, which allow me to grow a lack of muscle and let the jaw bone grow and expand.”

“After four years of treatment, my height has been increased 30 centimeters higher.”“I no longer worry about heights leading to problems in life.” My symptoms of abdominal pain were gradually disappeared after adjusting the stomach.”

Discussion

In this study, we demonstrate how to use COREQ guideline to score case reports of acupressure and cupping. By using a scoring system with the COREQ-based underpinning, we assessed and quantified the quality of case reports of acupressure and cupping. Among the 5 enrolled self-reports, an overall rank of 47% (30/64) was observed, showing a medium quality for self-reports in this field. Considering the scores of the aspect “Domain 1: Research team and reflexivity”, “Domain 2: Study design”, and “Domain 3: Analysis and findings”, the lowest rank was the “Domain 2: Study design” (25% (7/30)), followed by the “Domain 3: Analysis and findings (51% (9/18))” and “Domain 1: Research team and reflexivity (83% (13/16))”. The low rank in the “Domain 2: Study design” shows the aspect required for improvement, especially participant selection and data collection before being translated into qualitative studies to fit in the quality of COREQ-based.