Treatment Recommendations Should Take Account of Individual Patient Variation Not Just Group Responses

@article{Lundeberg2009TreatmentRS,
  title={Treatment Recommendations Should Take Account of Individual Patient Variation Not Just Group Responses},
  author={Thomas Lundeberg and Ir{\'e}ne Lund},
  journal={Acupuncture in Medicine},
  year={2009},
  volume={27},
  pages={31 - 32}
}
Recommendations for treatment are commonly based on results evaluating variation in systematic effects (group responses) from randomised controlled trials without taking the individual patient's variation into account. In the evaluation of acupuncture-related treatment effects, the trial design and statistical analysis used are a challenge since the assessed variables commonly have subjective properties and are based on the person's own self-report. Thus, the results that are seen are often… 
View on SAGE
aim.bmj.com
9 Citations
Background Citations
3

9 Citations

Citation Type

Citation Type

How Can the Efficacy of Acupuncture be Assessed in Improving Chronic Pain?
  • Medicine
  • 2014
TLDR
The goal of current research is to provide scientific evidence for the effectiveness of acupuncture so that it can be formally integrated into the policy of any National Health Service provider.
What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews
TLDR
An iterative approach using adequate interventions, appropriate outcome measures and adherence to reporting standards is required to evaluate the efficacy of acupuncture in cancer supportive and palliative care.
Single or Multiple Electroacupuncture Sessions in Nonspecific Low Back Pain: Are We Low-Responders to Electroacupuncture?
The effect of laserpuncture at the LI4 Hegu point on the plasma levels of β-endorphin in healthy subjects
TLDR
The conclusion of this study is that laserpuncture can affect the plasma levels of β-endorphin in healthy subjects when there is no statistically significant difference in the mean plasma levels between groups.
The Brain Effects of Laser Acupuncture in Depressed Individuals: An fMRI Investigation
TLDR
The biological plausibility of low-intensity laser acupuncture as an antidepressant treatment was investigated, with significant brain patterns for each ac upoint greater than the other acupoints and placebo.
Effect of catechol-O-methyltransferase Val158Met polymorphism on resting-state brain default mode network after acupuncture stimulation
TLDR
Results demonstrated that during sustained periods after acupuncture stimulation, the brain network is likely under genetic control, and COMT might be a candidate gene that regulates the resting DMN response to acupuncture stimulation.
The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation
TLDR
It is found that laser stimulation of acupoints lead to activation of frontal-limbic-striatal brain regions, with the pattern of neural activity somewhat different for each acupuncture point, in the first study to investigate laser acupuncture on a group of ac upoints useful in the management of depression.
Neural mechanisms of reflex inhibition of heart rate elicited by acupuncture-like stimulation in anesthetized rats
Investigation of the safety and efficacy of nacre for use in skin and wound repair
TLDR
It is suggested that within the context of a youth-services agency such as this, where children are involved in any kind of abuse, the use of these methods is a good idea.

References

SHOWING 1-10 OF 48 REFERENCES
Pain, its assessment and treatment using sensory stimulation techniques. Methodological considerations
TLDR
Analysis of pain assessment should consider the non-metric properties and take the systematical as well as the individual responses into account, andThreshold assessment may be an additional valuable tool for clinical evaluation given analyses separated for gender.
Enriched enrolment with randomised withdrawal (EERW): Time for a new look at clinical trial design in chronic pain
Aspects of Pain, Its Assessment and Evaluation from An Acupuncture Perspective
  • I. Lund, T. Lundeberg
  • Medicine, Psychology
    Acupuncture in medicine : journal of the British Medical Acupuncture Society
  • 2006
TLDR
A gold standard for pain assessment is still lacking, but rating scales, questionnaires, and methods derived from psychophysical concepts, such as threshold assessments and perceptual matching, are used.
Evaluation of randomized discontinuation design.
  • B. Freidlin, R. Simon
  • Medicine
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2005
TLDR
With careful planning, the randomized discontinuation designs can be useful in some settings in the early development of targeted agents where a reliable assay to select patients expressing the target is not available.
Algorithm for neuropathic pain treatment : An evidence based proposal
TLDR
NNT and NNH are currently the best way to assess relative efficacy and safety, but the need for dichotomous data, which may have to be estimated retrospectively for old trials, and the methodological complexity of pooling data from small cross-over and large parallel group trials, remain as limitations.
Efficacy, Speed of Action and Tolerability of Almotriptan in the Acute Treatment of Migraine
TLDR
A meta- analysis of pooled individual patient data from four randomized, placebo-controlled, double-blind trials comparing several doses of almotriptan with placebo confirmed the findings of individual clinical trials, while demonstrating for the first time, significant pain-free efficacy at 30 min compared with placebo.
Construction of a single global scale for multi-item assessments of the same variable.
TLDR
Different approaches that take into account the non-metric properties of ordered categorical data when aggregating multi-item scales into global scaling were suggested.
Evidence based medicine: what it is and what it isn't
TLDR
As evidence based medicine continues to evolve and adapt, now is a useful time to refine the discussion of what it is andWhat it is not.
Marked interindividual variability in the response to selective inhibitors of cyclooxygenase-2.
TLDR
There was considerable variability at an individual level in the degree of COX-2 inhibition and selectivity attained by both drugs, suggesting sources of variability might be exploited to identify patients uniquely susceptible to benefit or at developing risk of cardiovascular complications.
Almotriptan and zolmitriptan in the acute treatment of migraine.
...
1
2
3
4
5
...