title: Acupuncture for 'frequent attenders' with medically unexplained symptoms: a randomised controlled trial (CACTUS study).
abstract: BACKGROUND
  Medically unexplained physical symptoms (MUPS) are common and difficult to treat.
  
  
  OBJECTIVE
  To investigate the effectiveness of adding five-element acupuncture to usual care in 'frequent attenders' with MUPS.
  
  
  METHODS
  Randomised controlled trial in four London general practices.
  
  
  METHODS
  Participants were 80 adults with MUPS, consulting GPs ≥8 times/year. The intervention was individualised five-element acupuncture, ≥12 sessions, immediately (acupuncture group) and after 26 weeks (control group). The primary outcome was 26-week Measure Yourself Medical Outcome Profile (MYMOP); secondary outcomes were wellbeing (W-BQ12), EQ-5D, and GP consultation rate. Intention-to-treat analysis was used, adjusting for baseline outcomes.
  
  
  RESULTS
  Participants (80% female, mean age 50 years, mixed ethnicity) had high health-resource use. Problems were 59% musculoskeletal; 65% >1 year duration. The 26-week questionnaire response rate was 89%. Compared to baseline, the mean 26-week MYMOP improved by 1.0 (95% confidence interval [CI] = 0.4 to 1.5) in the acupuncture group and 0.6 (95% CI = 0.3 to 0.9) in the control group (adjusted mean difference: acupuncture versus control -0.6 [95% CI = -1.1 to 0] P = 0.05). Other between-group adjusted mean differences were: W-BQ12 4.4 (95% CI = 1.6 to 7.2) P = 0.002; EQ-5D index 0.03 (95% CI = -0.11 to 0.16) P = 0.70; consultation rate ratio 0.90 (95% CI = 0.70 to 1.15) P = 0.4; and number of medications 0.56 (95% CI = 0.47 to 1.6) P = 0.28. All differences favoured the acupuncture group. Imputation for missing values reduced the MYMOP adjusted mean difference to -0.4 (95% CI = -0.9 to 0.1) P = 0.12. Improvements in MYMOP and W-BQ12 were maintained at 52 weeks.
  
  
  CONCLUSIONS
  The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.
authors.affiliation: Institute of Health Services Research, Peninsula Medical School, University of Exeter, UK. charlotte.paterson@pms.ac.uk
authors.forename: Charlotte
authors.initials: C
authors.lastname: Paterson
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
authors.forename: Nicky
authors.initials: N
authors.lastname: Britten
authors.forename: Sue
authors.initials: S
authors.lastname: Rugg
authors.forename: Jackie
authors.initials: J
authors.lastname: Bridges
authors.forename: Bruce
authors.initials: B
authors.lastname: McCallum
authors.forename: Gerad
authors.initials: G
authors.lastname: Kite
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005194:Family Practice / Q000706:statistics & numerical data*; D005221:Fatigue / Q000628:therapy; D005260:Female; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000628:therapy; D009140:Musculoskeletal Diseases / Q000628:therapy; D059408:Pain Management; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012923:Social Class; D013001:Somatoform Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome