title: Acupuncture-Related Quality of Life Changes Using PROMIS Computer Adaptive Tests in a Pragmatic Trial with Oncology and General Integrative Medicine Patients: The Role of Baseline Acupuncture Expectations.
abstract: BACKGROUND
  Acupuncture has been shown to alleviate symptoms and increase general well-being in different medical patient samples. A major challenge in acupuncture clinical research is the availability of comparable and standardized patient-reported outcome measurement (PRO) tools.
  
  
  OBJECTIVE
  This study used a pragmatic design to examine longitudinal changes in quality of life (QOL) in a medical patient sample following acupuncture using PROs from the National Institutes of Health's Patient Reported Outcomes Measurement Information System (PROMIS) initiative. It also examined the role of acupuncture expectancies, as well as patient and provider perceptions of acupuncture benefit.
  
  
  METHODS
  Following informed consent, patients completed baseline QOL measures (T1) prior to their first acupuncture session. Subsequent assessments (up to 20) were completed immediately following ensuing acupuncture sessions. Patients completed assessments either on a touch-screen computer at the clinic or from their home computer.
  
  
  RESULTS
  Compared with acupuncture-naïve participants, those who received prior acupuncture treatment reported significantly higher anxiety, fatigue, sleep disturbance, and lower positive affect at baseline. By the second assessment, however, these differences became nonexistent. Participants who held greater baseline acupuncture expectations (e.g., their situation would improve a lot, they would have improved coping skills, their symptoms would disappear, their energy would increase) reported significantly higher fatigue, pain interference, and problems with physical functioning. Between T1 and T2, all participants reported significant improvements in anxiety, depression, and fatigue. Exploratory longitudinal models demonstrated significant linear improvements over time in anxiety (p = 0.006), depression (p = 0.007), pain interference (p < 0.001), and sleep disturbance (p = 0.004). No linear reduction over time was found with fatigue (p = 0.587), physical function (p = 0.654), or positive affect (p = 0.247).
  
  
  CONCLUSIONS
  Overall, PROMIS computer adaptive tests were able to assess domains of QOL briefly. Although pretreatment acupuncture expectations highlighted subgroup differences in outcomes at baseline, linear-growth models demonstrated the positive effects of acupuncture over time on anxiety, depression, pain interference, and sleep disturbance.
authors.affiliation: 1 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL.|2 Osher Center for Integrative Medicine at Northwestern Medicine , Northwestern Medical Group, Chicago, IL.
authors.forename: David
authors.initials: D
authors.lastname: Victorson
authors.affiliation: 1 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Beaumont
authors.affiliation: 3 Pediatric Residency Program, Advocate Children's Hospital , Park Ridge, IL.
authors.forename: Rupa
authors.initials: R
authors.lastname: Mahadevan
authors.affiliation: 2 Osher Center for Integrative Medicine at Northwestern Medicine , Northwestern Medical Group, Chicago, IL.
authors.forename: Ania
authors.initials: A
authors.lastname: Grimone
authors.affiliation: 2 Osher Center for Integrative Medicine at Northwestern Medicine , Northwestern Medical Group, Chicago, IL.
authors.forename: Virginia
authors.initials: V
authors.lastname: Burns
authors.affiliation: 2 Osher Center for Integrative Medicine at Northwestern Medicine , Northwestern Medical Group, Chicago, IL.
authors.forename: Wendy
authors.initials: W
authors.lastname: Murry
authors.affiliation: 1 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gutierrez
authors.affiliation: 2 Osher Center for Integrative Medicine at Northwestern Medicine , Northwestern Medical Group, Chicago, IL.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schuette
authors.affiliation: 2 Osher Center for Integrative Medicine at Northwestern Medicine , Northwestern Medical Group, Chicago, IL.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Brady
authors.affiliation: 2 Osher Center for Integrative Medicine at Northwestern Medicine , Northwestern Medical Group, Chicago, IL.
authors.forename: Melinda
authors.initials: M
authors.lastname: Ring
mesh_terms: D015670:Acupuncture Therapy / Q000523:psychology* / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D055048:Integrative Medicine / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life; D055815:Young Adult
keywords: acupuncture; outcomes; pragmatic trial; quality of life