AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2642-973X/008
*Corresponding Author: Osamu Yamamura, Department of Neurological Sciences .China
Citation: Pu Liu, Qu Jian. (2019). Parkinson's disease: Role of Acupuncture Study a Randomized Study of Fatigue Behavior. Brain and Neurological Disorders. 2(1); DOI: 10.31579/2642-973X/008
Copyright: © 2019 Pu Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 31 December 2018 | Accepted: 17 January 2019 | Published: 23 January 2019
Keywords: acupuncture, fatigue, Parkinson's disease, randomized controlled trial
Fatigue is a common and disabling problem in patients with Parkinson's disease (PD), and there is currently no satisfactory treatment. As acupuncture has been reported to be effective in fatigue related to other conditions, we sought to evaluate its efficacy in PD.
Fatigue is one of the commonest nonmotor symptoms in Parkinson's disease (PD) and has negative impact on quality of life (Barone et al., 2009; Friedman, Abrantes, & Sweet, 2011; Skorvanek et al., 2013). In one of the first studies on fatigue in PD, 15–33% of patients rated it as their most disabling symptom, and more than half rated fatigue among their three worst symptoms (Havlikova et al., 2008). There is currently no satisfactory treatment of PD‐related fatigue (Franssen, Winward, Collett, Wade, & Dawes, 2014).
Acupuncture has been shown to be effective in the treatment of fatigue related to other conditions, in particular, cancer‐related fatigue (Molassiotis et al., 2012; Sood, Barton, Bauer, & Loprinzi, 2007). Apart from a recent study (Kluger et al., 2016) its role in PD‐related fatigue has not been explored. The aim of this randomized, controlled pilot study was to evaluate the efficacy of a 5‐week course of acupuncture in the treatment of fatigue in PD.
This was a randomized, patient and assessor‐blinded, controlled pilot study assessing the efficacy of acupuncture in patients with PD‐related fatigue.
Subjects and setting
Participants attending the Parkinson's disease Clinic of National Neuroscience Institute‐Tan Tock Seng Hospital, Singapore who met the following inclusion and exclusion criteria were recruited. The inclusion criteria were (1) diagnosis of PD based on criteria developed by Gelb, Oliver, & Gilman (1999) which is adopted by the National Institute of Neurological Disorders and Stroke, US National Institute of Health, (2) age 21–85 years old, (3) presence of moderately severe fatigue as defined by a score of ≥10 on the General Fatigue domain of the Multidimensional Fatigue Inventory (Smets, Grasen, Bonke, & De Haes, 1995), and (4) no acupuncture treatment in the past 6 months.
The exclusion criteria were (1) significant cognitive, language or psychiatric illnesses which prevents the subject from understanding instructions and participating in the study, (2) needle phobia, (3) comorbidity with a bleeding disorder, (4) known anemia with hemoglobin level <10 g/dl, (5) known congestive cardiac failure and/or end‐stage renal disease, (6) female subjects of childbearing age, and (7) presence of symptomatic postural hypotension.
Screening and Randomization
Opportunistic screening of patients attending the Parkinson's Disease Clinic of National Neuroscience Institute‐Tan Tock Seng Hospital, Singapore was conducted. After informed consent, eligible patients were randomized in a 1:1 fashion without stratification to real or sham acupuncture using permuted blocks. Allocation to treatment group was managed by an interactive web response system using computer‐generated lists organized by a statistician who is independent of the study. Only the two treating acupuncturists had access to the interactive web response system. All other study team members were blind to group assignment.
Treatment consisted of twice‐weekly sessions at least 3 days apart for 5 weeks, giving a total of 10 sessions of acupuncture. Acupuncture was performed with the patient supine on a acupuncture table. The retractable noninvasive sham and invasive acupuncture needles developed by Jongbae Park (Park Sham Device, PSD) were used in this study (Park, White, Stevinson, Ernest, & James, 2002). Both real and sham needles have a fine needle body and copy handle and look exactly the same. However, the retractable needle has a retractable shaft and blunt tip. When pressed onto the skin, it telescopes into the handle and the blunt tip stays on the skin instead of penetrating it. The plastic tube with adhesive foot‐plate is placed on the skin to hold it in place. The real needle, on the other hand, has a normal sharp tip which allows it to pierce the skin. Both needles are 70 mm long. The Park Sham needle has been well validated as an inactive and credible placebo control in clinical acupuncture trials.
Primary outcome measure
The primary outcome measure was the change in General Fatigue domain score of the Multidimensional Fatigue Inventory (MFI) from baseline at 5 weeks. The MFI is a 20‐item self‐reporting tool that measures five dimensions of fatigue: General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation, and Mental Fatigue. Each subscale contains four items, which are scored on a five‐point Likert scale.
In a previous study of prevalence of fatigue in PD using the MFI, the mean General Fatigue score was 15.2 with a standard deviation of 3.0 (Skorvanek et al., 2013). Assuming a 20% reduction in MFI score in the acupuncture group compared to control, a two‐sided sample comparison of means requires 16 participants per group with significance level at 0.05 and power of 0.8. Hence, a total of 32 participants need to be recruited. Assuming a drop‐out rate of 20%, the number of participants needed will be 40. The effect size of 20% was chosen on the premise that anything less than this is not likely to be clinically significant.
Group demographics and characteristics
p‐ values that are in bold shows statistical significance.
Assessment of blinding
Patients were queried at Week 5 point regarding what group they thought they were in, and there were no between‐group differences in patients’ perceptions of group assignment consistent with effective blinding (chi‐square, p = .32).
The results of this pilot study show that a 5‐week course of acupuncture treatment, real or sham, was effective in improving fatigue in a cohort of patients with PD. Furthermore, this improvement was maintained up to 4 weeks after completion of treatment. Apart from improved UPDRS Motor scores, real acupuncture group had no significant impact on scores of quality of life, mood, and excessive daytime sleepiness compared with sham acupuncture. In fact, there was a trend toward greater reduction in fatigue scores in the sham group (p = .09). To evaluate whether the improvement in fatigue is clinically meaningful, we looked at the minimal important difference of the MFI. The minimal important difference is defined as “the smallest difference in score in the domain of interest which patients perceive as beneficial and which would mandate, in the absence of troublesome side effects and excessive cost, a change in the patient's management” and is particularly useful in patient‐reported outcome measures (Jaeschke, Singer, & Guyatt, 1989). Unfortunately, no data exist on the minimal important difference of the MFI in PD. Hence, we can only extrapolate from data involving patients with rheumatological conditions, and in this group of patients, the minimal important difference for the MFI‐Total is 11.5 (Nordin, Taft, Lundgren‐Nilsson, & Dencker, 2016). Using this result, 40% of real acupuncture and 60% of sham acupuncture patients in our study had clinically meaningful improvements in fatigue.
Acupuncture (real and sham) is safe and effective in reducing fatigue in a cohort of patients with PD. Given the current absence of satisfactory treatment of fatigue, there is a potential role for the use of acupuncture in the treatment of PD‐related fatigue, even if its mechanism of action is largely placebo.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
