Building a diagnostic evaluation model of knee osteoarthritis with Chinese medicine syndrome differentiation : a questionnaire tool developed via a Delphi process

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Introduction: Knee Osteoarthritis (KOA) is a chronic disorder characterised by substantial pain, stiffness, and functional loss affecting daily activities and life quality. Current treatments are symptomatic, addressing signs and symptoms but not the underlying disease process. Acupuncture is a popular alternative and/or intergrative treatment. Unfortunately, research reports only short term efficacy, contrary to clinical practice observations. Research protocols excluding bian zheng is one proposed reason for this difference; an important differentiation framework underpinning acupuncture point selection with a patient’s KOA type. This thesis therefore proposes pattern differentiation key to effective acupuncture KOA treatment. Aim: The project aims to develop a clinical questionnaire tool using pattern differentiation, to guide appropriate acupuncture point selection for treatment of KOA patients Specifically, this thesis investigates how patterns might be integrated into such a tool and investigates an initial draft design. Methods: Two research database reviews and a Delphi study comprise the thesis. The first literature review investigates Chinese Medicine (CM) pattern differentiation in the English research literature (Chapter II); the second compares the epidemiological KOA pattern profiling reported in the Chinese literature (Chapter III). The literature review results inform the development of a draft questionnaire tool to assist diagnostic differentiation using 𝘣π˜ͺ𝘒𝘯 𝘻𝘩𝘦𝘯𝘨. An anonymous, two round Delphi of the proposed questionnaire was subsequently undertaken (n=18), with consensus level set at 60% (Chapter IV). Results: The English literature review results (n=9) identified little CM pattern differentiation in reported KOA studies, despite some of the studies identifying the need for such. For the second literature review, the pattern profiles of KOA patients varied considerably, likely due to differences in geographical locations of the study populations. However, there were common 𝘣π˜ͺ𝘒𝘯 𝘻𝘩𝘦𝘯𝘨 diagnostic factors present once the more complex patterns were deconstructed. The Delphi results noted high levels of consensus with several single diagnostic factors (Kidney deficiency (85.7%), Spleen deficiency (71.4%), 𝘺𝘒𝘯𝘨 deficiency (64.3%), 𝘘π˜ͺ deficiency (64.3%), 𝘘π˜ͺ stagnation (64.3%), Blood stasis (85.7%), coldness (78.6%), dampness (85.7%) and heat (71.4%)). Consensus also occurred on seven other factors (64.3% to 100%), consistent with the CNKI studies. Conclusion: The questionnaire built using expert consensus may help practitioners or researchers incorporate 𝘣π˜ͺ𝘒𝘯 𝘻𝘩𝘦𝘯𝘨 into research design, assisting with inter-rater diagnostic agreement levels and reducing variability. This would be also supporting the construct validity and acupuncture point selection for KOA type. The methodology outlined can be replicated for other diseases.
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