title: Lifestyle Advice and Self-Care Integral to Acupuncture Treatment for Patients with Chronic Neck Pain: Secondary Analysis of Outcomes Within a Randomized Controlled Trial.
abstract: BACKGROUND
  Lifestyle advice is widely considered as an integral component of acupuncture treatment. However, it is unclear whether lifestyle advice and related self-care are important for sustaining benefit over the longer term. In a novel secondary analysis of trial data, this paper explores the nature and impact of acupuncture-related diagnosis, and associated lifestyle advice and self-care, in patients with chronic neck pain.
  
  
  METHODS
  In a three-arm, randomized, controlled multicenter trial with 12 months of follow-up, a total of 517 patients with chronic neck pain were randomized in equal proportions to acupuncture, Alexander technique, or usual care alone.
  
  
  METHODS
  For each acupuncture patient, practitioners reported treatment components that included an acupuncture-related diagnosis and provision of associated lifestyle advice. Patients reported at baseline, 3, 6, and 12 months on variables related to treatment, which included aspects of self-care, self-efficacy, and lifestyle advice acted upon, as well as pain and disability scores. Congruence between practitioner advice and patient take-up was assessed using chi-squared test. Impact of lifestyle advice and self-efficacy on outcome was evaluated using regression models.
  
  
  RESULTS
  Among patients randomized to acupuncture, the most common diagnostic framework involved the Zang-Fu syndromes for 139/160 (87%) patients. Lifestyle advice was provided by practitioners to 134/160 (84%) of patients, most commonly related to exercise, relaxation, diet, rest, and work. Significant congruence with patient take-up was found for diet, rest, and work. Moreover, patients in the acupuncture group improved their ability to use what they had learnt and increased their self-efficacy. In turn, these characteristics were associated with significant reductions in pain and disability scores at 12 months.
  
  
  CONCLUSIONS
  Acupuncture-related lifestyle advice helped patients improve the way they live and care for themselves and enhanced self-efficacy and ability to use what they had learnt. These changes were associated with reductions in pain and disability at 12 months.
authors.affiliation: 1 Department of Health Sciences, University of York , York, United Kingdom .
authors.forename: Hugh
authors.initials: H
authors.lastname: MacPherson
authors.affiliation: 2 Northern College of Acupuncture , York, United Kingdom .
authors.forename: Ben
authors.initials: B
authors.lastname: Elliot
authors.affiliation: 1 Department of Health Sciences, University of York , York, United Kingdom .
authors.forename: Ann
authors.initials: A
authors.lastname: Hopton
authors.affiliation: 1 Department of Health Sciences, University of York , York, United Kingdom .
authors.forename: Harriet
authors.initials: H
authors.lastname: Lansdown
authors.affiliation: 3 Department of Health Sciences, Kristiania University College , Oslo, Norway .
authors.forename: Stephen
authors.initials: S
authors.lastname: Birch
authors.affiliation: 1 Department of Health Sciences, University of York , York, United Kingdom .
authors.forename: Catherine
authors.initials: C
authors.lastname: Hewitt
mesh_terms: D015670:Acupuncture Therapy; D059350:Chronic Pain / Q000628:therapy*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D019547:Neck Pain / Q000628:therapy*; D011369:Professional-Patient Relations; D012648:Self Care
keywords: acupuncture therapy; chronic neck pain; lifestyle advice; self-care; traditional East Asian medicine