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A prospective observational study investigating the effectiveness and safety of integrative Korean medicine treatment in lumbar stenosis or spondylolisthesis patients with low back pain or sciatica at 3 locations of Jaseng Hospital of Korean Medicine as assessed through of pain, functional disability, walking ability, and quality of life patient-reported outcomes
This is a prospective observational study to the aim of investigating the effectiveness and safety of integrative Korean medicine treatment (generally consisting of herbal medicine, Chuna manual medicine, bee venom pharmacopuncture and pharmacopuncture, acupuncture, electroacupuncture, and cupping) in lumbar stenosis or spondylolisthesis patients with low back pain or sciatica diagnosed by lumbar X-ray and/or MRI and clinical symptoms including neurogenic claudication at 3 locations of Jaseng Hospital of Korean Medicine (Bucheon, Daejeon, Busan (Haeundae)) as assessed through of pain, functional disability, walking ability, and quality of life patient-reported outcomes with a 5-year follow-up period
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lumbar stenosis group | Lumbar stenosis patients will be administered integrative Korean medicine treatment consisting of herbal medicine, Chuna manual medicine, bee venom pharmacopuncture and pharmacopuncture, acupuncture, electroacupuncture, cupping, and other interventions, as needed. |
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| Lumbar spondylolisthesis group | Lumbar spondylolisthesis patients will be administered integrative Korean medicine treatment consisting of herbal medicine, Chuna manual medicine, bee venom pharmacopuncture and pharmacopuncture, acupuncture, electroacupuncture, cupping, and other interventions, as needed. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Herbal medicine | Drug | Herbal medicine will be administered in water-based decoction (120ml) and dried powder (2g) form (Ostericum koreanum, Eucommia ulmoides, Acanthopanax sessiliflorus, Achyranthes japonica, Psoralea corylifolia, Saposhnikovia divaricata, Cibotium barometz, Lycium chinense, Boschniakia rossica, Cuscuta chinensis, Glycine max, Atractylodes japonica) at the physician's discretion. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Numeric rating scale (NRS) of higher score at baseline out of low back pain or radiating leg pain | Change from higher score at baseline out of low back pain or radiating leg pain intensity to same score at 4 months. Total score range: -10 (worse outcome) to 10 (better outcome) | Change from baseline to 4 months |
| Measure | Description | Time Frame |
|---|---|---|
| Numeric rating scale (NRS) of low back pain | Low back pain intensity for the past 3 days. Total score range: 0 (better outcome) to 10 (worse outcome) | Baseline, observation at least once a week for the duration of active treatment up to a maximum of 24 weeks (2, 4, 6, 8, 12, 16, 20, 24 weeks), 1, 3, 5 years |
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Inclusion Criteria:
Exclusion Criteria:
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Lumbar stenosis or lumbar spondylolisthesis
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| Name | Affiliation | Role |
|---|---|---|
| Sun-A Kim, KMD | Daejeon Jaseng Hospital of Korean Medicine | Principal Investigator |
| Hyun-Woo Cho, KMD | Haeundae Jaseng Hospital of Korean Medicine | Principal Investigator |
| Ji-Yun Seo, KMD | Bucheon Jaseng Hospital of Korean Medicine | Principal Investigator |
| Kyoung-Sun Park, KMD | Jaseng Hospital of Korean Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jaseng Medical Foundation | Seoul | South Korea |
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| Chuna manual medicine | Procedure | Chuna is a Korean manual therapy directed at the spine and joints that incorporates various spinal manual medicine techniques for joint mobilization involving high-velocity, low amplitude thrusts to joints slightly beyond the passive range of motion and gentle force to joints within the passive range of movement. Chuna manual medicine will be administered to the pelvic, lumbar, thoracic, and cervical vertebrae at the physician's discretion. |
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| Bee venom pharmacopuncture | Procedure | Bee venom pharmacopuncture will be administered only after confirming a negative response to hypersensitivity skin test. Diluted bee venom (saline:bee venom ratio, 10,000:1) filtered for allergens will usually be injected at 4-5 acupoints proximal to the dysfunctional site at the physician's discretion. Each acupuncture point will be injected to a total of 0.5-1 cc using disposable injection needles (CPL, 1 cc, 26G x 1.5 syringe, Shinchang medical co., Korea). |
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| Pharmacopuncture | Procedure | Pharmacopuncture consisting of select herbal ingredients will be administered at Hyeopcheok (Huatuo Jiaji, EX B2), Ah-shi points and local acupuncture points using disposable injection needles (CPL, 1 cc, 26G x 1.5 syringe, Shinchang medical co., Korea) at the physician's discretion. |
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| Acupuncture | Procedure | Acupuncture treatment will be administered using mainly proximal acupuncture points and Ah-shi points. |
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| Electroacupuncture | Procedure | Electroacupuncture treatment will be administered using mainly proximal acupuncture points and Ah-shi points. |
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| Cupping | Procedure | Cupping treatment will be administered at 1-2 points using mainly proximal acupuncture points and Ah-shi points. |
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| Other intervention(s) | Procedure | Patients will be allowed any other additional intervention(s) as deemed necessary regardless of type or dose, and patterns of use will be investigated and recorded as a pragmatic clinical study. |
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| Numeric rating scale (NRS) of radiating leg pain |
Radiating leg pain intensity for the past 3 days. Total score range: 0 (better outcome) to 10 (worse outcome) |
| Baseline, observation at least once a week for the duration of active treatment up to a maximum of 24 weeks (2, 4, 6, 8, 12, 16, 20, 24 weeks), 1, 3, 5 years |
| Visual analogue scale (VAS) of low back pain | Low back pain intensity for the past 3 days. Total score range: 0 (better outcome) to 100 (worse outcome) | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| Visual analogue scale (VAS) of radiating leg pain | Radiating leg pain intensity for the past 3 days. Total score range: 0 (better outcome) to 100 (worse outcome) | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| Oswestry Disability Index (ODI) | Functional disability questionnaire. The possible range of each item score is 0 to 5. Total score range: 0 (better outcome) to 100 (worse outcome) | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| Pain-free walking distance (average of the past 3 days) | Walking ability. Average pain-free walking distance during the past 3 days as recalled at each timepoint defined in Time Frame. Total score range: 0 (worse outcome) to no maximum limit (better outcome) | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| Maximum walking distance (average of the past 3 days) | Walking ability. Average maximum walking distance during the past 3 days as recalled at each timepoint defined in Time Frame. Total score range: 0 (worse outcome) to no maximum limit (better outcome) | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| Zurich Claudication Questionnaire | Claudication questionnaire. There are 12 questions for all patients, and a further 6 questions to measure treatment outcomes for those who have received treatment. The The Zurich Claudication Questionnaire consists of three subscales: (1) Symptom severity scale (items 1-7) which are subdivided into a pain domain (items 1-4) and a neuroischemic domain (items 5-7)]: The possible range of each item score is 1 to 5. (2) Physical function scale (items 8-12): The possible range of each item score is 1 to 4. (3) Patient satisfaction with treatment scale (questions 13-18): The possible range of each item score is 1 to 4. The result is expressed as a percentage of the maximum possible score. Total score range: 0% (better outcome) to 100% (worse outcome) | Baseline, 4, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| EuroQol 5-dimensions 5-levels (EQ-5D-5L) | Health-related quality of life questionnaire. Total score range: 11111 (better outcome) to 55555 (worse outcome) | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| Patient Global Impression of Change (PGIC) | Global patient-reported outcome. Total score range: 1 (better outcome) to 7 (worse outcome) | 8, 16, 20, 24 weeks, 1, 3, 5 years |
| Use of other intervention(s) | Use of any other additional intervention(s) other than the integrative Korean medicine treatment administered by the attending physician (start date of treatment, end date of treatment, name of treatment, number of treatment sessions received, and other comments) | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| Physical examination | Lumbar physical examination | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| Adverse reaction | Safety | Baseline, every visit for the duration of active treatment up to a maximum of 24 weeks (2, 4, 6, 8, 12, 16, 20, 24 weeks), 1, 3, 5 years |
| SF-36 | The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | [Time Frame: Baseline, 4, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years] |
| EQ-VAS | The EQ VAS records the respondent's self-rated health on a 20 cm vertical, visual analogue scale with endpoints labelled 'the best health you can imagine' and 'the worst health you can imagine'. | Baseline, 2, 4, 6, 8, 12, 16, 20, 24 weeks, 1, 3, 5 years |
| ID | Term |
|---|---|
| D013130 | Spinal Stenosis |
| D013168 | Spondylolisthesis |
| D017116 | Low Back Pain |
| D012585 | Sciatica |
| ID | Term |
|---|---|
| D013122 | Spinal Diseases |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
| D013169 | Spondylolysis |
| D055009 | Spondylosis |
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D020426 | Sciatic Neuropathy |
| D020422 | Mononeuropathies |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
| D009437 | Neuralgia |
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| ID | Term |
|---|---|
| D008517 | Phytotherapy |
| D001514 | Bee Venoms |
| D015670 | Acupuncture Therapy |
| D015671 | Electroacupuncture |
| D000079742 | Cupping Therapy |
| ID | Term |
|---|---|
| D000529 | Complementary Therapies |
| D013812 | Therapeutics |
| D001180 | Arthropod Venoms |
| D014688 | Venoms |
| D045424 | Complex Mixtures |
| D014118 | Toxins, Biological |
| D001685 | Biological Factors |
| D003131 | Combined Modality Therapy |
| D004599 | Electric Stimulation Therapy |
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |
| D004561 | Transcutaneous Electric Nerve Stimulation |
| D000698 | Analgesia |
| D000760 | Anesthesia and Analgesia |
| D000758 | Anesthesia |
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