Growing the acupuncture research skills base

Karen Charlesworth writes about the aim of the Northern College of Acupuncture, where she is research director, to help acupuncturists to upskill in research

Karen Charlesworth

Member: North Yorkshire

The late, great Professor Hugh MacPherson – globally renowned for his work in acupuncture research – believed that high-quality evidence was one of the most important ways that traditional acupuncture could claim acceptance in mainstream healthcare. ‘Whatever the sceptics say, it’s widely accepted that traditional acupuncture is a very effective form of medicine for a lot of different conditions,’ he said in an interview in 2016. ‘And it's research that’s done that. It’s shaken up a lot of assumptions and prejudices, created a lot of opportunities, and it’s given us a credibility that we didn’t previously have.’

But Hugh was also the first to point out that it’s not easy for acupuncturists to do research: ‘In general, people come into acupuncture to do acupuncture, not necessarily to ask questions about how it works and what it’s good at treating,’ he said. ‘And if they do want to ask those questions, it’s a difficult journey. It’s hard for them to gain the research skills they need, and compared with conventional medicine it’s also hard to come by funding for research into acupuncture, certainly in the UK.’ If acupuncture was taught more in universities, he believed, there would be more accessible pathways to skills and funding, ‘and that would give us a good research skills base in the profession, which would in turn contribute to a strong evidence base and increase acupuncture’s credibility.’

In 1988, Hugh co-founded the Northern College of Acupuncture (NCA) in his adopted home city of York – to train acupuncture practitioners, of course, but also to provide more of those accessible pathways to research skills, and so to build the evidence base. Fast-forward 30-odd years and I’ve become the college’s current research director. I’m proud to say that we’re still turning out cohorts of students who are true to Hugh’s original vision of ‘the research-literate practitioner’. That means a practitioner who’s not only equipped to understand and critique the evidence base, but also has the skills to actually carry out their own research.

My job is basically to get as many people as possible excited about acupuncture research, and to contribute to a vibrant, diverse and reflexively critical research culture at the College and in our professions. It can be a challenge because research scares some people, while others don’t see it as relevant – and lots of our students start out convinced that they’ll never understand the maths! But it’s a point of honour for us that almost everyone who graduates from NCA carries away not only a sound understanding of p-values and confidence intervals – but also, much more importantly, an enthusiasm about what research can achieve for the profession, plus the skills to contribute to the evidence base if they choose.

In 2022, NCA will mark its 34th year as an acupuncture educator – and our research programme has never been stronger. We invite all acupuncturists and Chinese herbal medicine practitioners to engage with those parts of our research programme that inspire them. Summaries of our student/staff research and our annual Hugh MacPherson Memorial Lecture are freely available to all, while our annual research conference is now online so we can make it available to a wider audience. Our college principal, Richard Blackwell, comments: ‘By making a broad programme of events and engagement widely available to practitioners, we hope to contribute to the richness of research activity within our professions, and to grow the evidence base.’

If you’ve got a good idea…

Getting people excited about acupuncture research doesn’t just mean the NCA’s own students and alumni. As an educational charity, one of the college’s objectives is ‘to provide for, promote and engage in research into the science and art of traditional Chinese medicine’. The College has just launched its Research Support scheme, which we ultimately hope to make available to non-NCA researchers as well as our own graduates. The aim is to provide support for would-be researchers to design and carry out a high-quality project that reaches scientifically robust conclusions, and then to support its publication.

The scheme covers supervision, mentoring, use of software and secure data storage, ethics review and the opportunity to apply for the college’s separate Support for Publication scheme. Candidates discuss their idea with a panel of NCA research staff, and submit a proposal setting out the key parameters of their project. For practitioners who want to engage in research but don’t know where or how to go about it, it’s a great starting point.

It’s also very much in the spirit of Hugh MacPherson. It probably won’t surprise anyone to know that Hugh counted himself a bit of a Marxist, and when it came to the subject of intellectual capital he would paraphrase Das Kapital: ‘Who owns the means of production of knowledge?’. He used to answer that by saying everyone should co-own the means of production of knowledge, of course. With this scheme, the College is aiming to give everyone who wants it a share in the means of production of knowledge, by giving them the support, expertise, ethics support and supervision to create new knowledge in the field of acupuncture research.

More information about the scheme can be found on the NCA website, and we are keen to hear from BAcC members with ideas for research projects 〉 nca.ac.uk/research/support/scheme

The College also has a strong tradition of supporting more experienced researchers who are not affiliated to universities – or who would benefit from support to develop a project. One current example is the work of BAcC members Nick Lowe and Spod Dutton, developers of the Acu-Track clinical outcomes tracking app. AcuTrack collects clinical outcomes data from acupuncturists and Chinese herbal medicine practitioners to provide datasets that can be analysed to demonstrate the effectiveness of acupuncture and herbs. The NCA’s Research Ethics Committee is working with Nick and Spod to ensure the ethical basis on which the AcuTrack software operates, and giving the necessary ethical approvals for publication in peer-reviewed journals. We’ve been very pleased to support Acu-Track – not least because it provides a level of engagement with acupuncture research for busy practitioners.

Student research

Our students are at the heart of our research culture at NCA. In particular, our MSc students are encouraged to take a ‘research year' to design, carry out and write up their own research project. We had a very exciting clutch of projects submitted this year, many of which are headed for publication in peer-reviewed journals. Here are some examples:

Nicola Wardhaugh was inspired by the acupuncture clinic set up in the wake of the Grenfell Tower fire, conducting a series of qualitative interviews with patients on the effects of acupuncture. Patients reported symptomatic improvements to mental and physical health, but also wider biopsychosocial effects known as Whole Person Effects, a concept drawn and further developed from the work of researcher Charlotte Paterson.

Laurie Heaps surveyed UK acupuncturists on the subject of the dose-levels used to treat endometriosisrelated symptoms. Laurie examined data given by 49 respondents on number and frequency of treatments, acupuncture points used, timing of treatments in relation to the menstrual cycle, and co-interventions.

Nora Giese also focused on endometriosis, carrying out a literature review and a Delphi consensus study on acupuncture for pelvic pain associated with the condition. She drew together the findings of 16 relevant papers and 20 acupuncturists, finding a range of acupuncture styles, points, treatment frequencies and durations, and supplementary therapeutic modalities were used and recommended in clinical practice.

Anita Lienhard surveyed Swiss fertility physicians’ opinions regarding TCM as an adjuvant therapy, using framework analysis to analyse six in-depth interviews. She found that in general, fertility physicians were positive about TCM, appreciating the holistic approach and engaging with the emotional dimensions of fertility treatments.

Hemed Tov considered acupuncture patients’ ability to detect the effect of a specific point, and the explanations given by acupuncturists for this. Five practitioners were interviewed, and the range of explanations included physical feedback from needling, familiarity of the point and the practitioner’s attentiveness to the body.

Svetlana Wise took the subject of scalp acupuncture and conducted a scoping review to identify the range of scalp acupuncture systems, systematically summarising their anatomical and clinical characteristics. She carried out framework synthesis, bringing together 19 different scalp acupuncture systems.

We are keen to hear from BAcC members with ideas for research projects

Hugh MacPherson Memorial Lecture

The research challenges that Mike highlighted were relevant to almost all complementary medicine disciplines. Amongst other absorbing topics, he discussed issues of acupuncture’s complexity as a treatment; differences in diagnosis and the individualisation of treatments; dosage levels; and the question of why most acupuncturists find clinical trials irrelevant to their day-to-day practice.

The very first Hugh MacPherson Memorial Lecture was held online in November 2021 – and in the true spirit of Hugh it was made accessible and free of charge in order to engage as many researchers as possible. The aim of the annual lecture series is to celebrate the legacy of our dear friend and colleague by inviting a leading acupuncture researcher to speak about their current work. We were delighted to be joined by over 170 acupuncturists and researchers from all over the world to hear our inaugural lecturer – Dr Mike Armour of Western Sydney University – discuss some of the challenges and questions in his work into acupuncture for women’s health. We were honoured also to hear from Hugh’s collaborators Richard Hammerschlag and Rosa Schnyer, who gave moving tributes to Hugh as a prelude to Mike’s lecture.

The NCA’s professional development lead Hannah Swift afterwards gave her thanks ‘to all who brought their brilliant questions and reflections to the Q&A session. Hugh would have been chuffed to hear the depth of research knowledge in our audience – people deeply engaged with the legacy of his work.’

You can watch the inaugural Hugh MacPherson Memorial Lecture free via the NCA’s CPD hub 〉 thepractitionerhub.co.uk/

2022 NCA Research Conference: Building the Evidence

From 2022 onwards, the NCA’s annual research conference will be held online – not just to avoid Covid transmission risks, but also to make the conference available to a global audience. The upcoming conference on 8 April 2022 will open with a keynote by NCA’s research supervisor and co-editor of the European Journal of Integrative Medicine Ava Lorenc, looking at the issues of conducting complementary medicine research, and including a 30-minute panel discussion chaired by NCA alumnus and influencer Sandro Graca.

Presentations also include the work of Nicola Wardhaugh, Laurie Heaps and Nora Giese (above), alongside nutritionfocused research into weight loss from NCA student Kirsty Baxter and a look at the common features in patients with premenstrual syndrome from NCA nutrition student Beth Hughes. Chinese herbal medicine lecturer Phil Trubshaw will present findings from his research into the actions of herbs that calm the shen, and advanced complementary medicine student Sophia Kupse will give a presentation on her research into self-care practice in complementary medicine therapists. The keynote will be given, and the conference will close with a practically focused session on using and doing research in practice, led by research supervisor Jane Nodder and myself. There will also be a networking opportunity for attendees to chat with other researchers and talk with the presenters.

Once again, more information can be found via the NCA’s CPD hub 〉 thepractitionerhub.co.uk/

Support for Santé-AF

As part of its support for staff research, NCA is supporting my own doctoral project, Santé-AF (Sessions of Acupuncture and Nutritional Therapy Evaluation for Atrial Fibrillation) – a feasibility study to support a future large-scale pragmatic randomised controlled trial of acupuncture and nutritional therapy for the most common heart arrhythmia, atrial fibrillation. The project is supervised by the University of York’s clinical trials unit and is currently at recruitment stage, having been inevitably delayed by Covid and successive lockdowns.

Atrial fibrillation (AF) is a very common condition. It comes with some debilitating symptoms, like breathlessness, fatigue, light-headedness and of course the racing or irregular heartbeat. But arguably the biggest problem is that it causes turbulence in the circulatory system that massively increases the risk of stroke.

AF is one of those conditions for which western medicine has no reliably good answers – medications can help, but quite often have no effect or even make things worse. There are two procedures: electrical cardioversion, which involves stopping the heart and restarting it again; or there’s ablation, carried out under local anaesthetic, where the areas of heart tissue are literally scraped away. They aren’t risk-free, and many patients aren’t keen on them; also, recurrence of AF is common even after repeated procedures, and if that happens there’s nothing to do except repeat the procedures – with all the extra risk involved. Given this, and of course the personal devastation and cost to the world’s healthcare services of stroke, there’s an active programme of research right across the world to find other treatments for the condition.

And that’s where acupuncture comes in! I got interested in the first place because I’d seen the good effects of acupuncture on my own patients with AF – and then I met Dr Sanjay Gupta, a consultant cardiologist at the York Teaching Hospital, who was very interested in acupuncture as a potential treatment option for AF. There is some intriguing research already but it focuses on low numbers of patients or single case studies, so it’s not a strong evidence base – but still, it shows promise enough to build on with a trial.

I was lucky enough to be given some BAcC research grant funding, and that seed money attracted more funding and support from the National Institute for Health Research’s Clinical Research Network (CRN). So I’ve been able to work with NHS GPs to recruit patients to the study, and also to pay three acupuncturists and three nutritional therapists to provide the study treatments. The exciting thing for us as acupuncturists is that AF is a ‘lifestyle’ condition – basically, it very often results from suboptimal habits of yang sheng, or self-care – and the holistic approach of acupuncture might be very useful indeed. My plans for Santé-AF aren’t limited to the trial itself. I was very interested by Mike Armour’s assertion in our Hugh MacPherson Memorial

Lecture this year, that the majority of practitioners don’t see how clinical trials of acupuncture are relevant to them. I’ve already planned some analysis of the three Santé-AF acupuncturists’ treatment plans, to see if we can find commonalities that could be pulled together into a series of recommendations for working with AF. We also plan to hold an online ‘masterclass’ workshop in late spring next year, free of charge for BAcC members, to share our insights into treating this condition.

I’ve set up a website to document the project’s progress – sante-af.org/ – including a blog written in non-technical language for anyone who’s interested in how to run a clinical trial. I’d be delighted to hear from BAcC members with any questions or comments.