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Short Communication
Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions
Ye-Seul Lee, Myeong Soo Lee, David Moher, In-Hyuk Ha, Jian-Ping Liu, Terje Alræk, Stephen Birch, Tae-Hun Kim, Yoon Jae Lee, Juan V.A. Franco, Jeremy Y. Ng, Holger Cramer
Perspect Integr Med. 2024;3(3):162-167.   Published online October 23, 2024
DOI: https://doi.org/10.56986/pim.2024.10.005
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  • 22 Download
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Integrative Medicine (IM), which includes therapies such as acupuncture, herbal medicine, yoga, and meditation, is gaining attention for managing chronic pain conditions. However, concerns about the quality of evidence supporting the use of these interventions persist. The 5th Annual Jaseng Academic conference 2024, in Seoul, South Korea, themed "Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions," addressed these concerns by focusing on advancements in study design, evidence synthesis, and open science practices. This conference proceeding summarizes key insights from the conference, emphasizing the role of pragmatic randomized controlled trials (pRCTs) in evaluating real-world effectiveness, and addressing the complexities involved in IM research such as sham controls. The integration of IM therapies into comprehensive pain management strategies (particularly in Korea), supported by government-backed research and policy initiatives was also discussed. Advancements in methodologies were addressed, such as bibliometric analysis, evidence mapping, and the development of clinical practice guidelines (CPGs) for integrative therapies. These methodologies offer valuable insights but face challenges due to the heterogeneity of IM interventions, and potential synergistic or antagonistic effects when combined with conventional medicine. Finally, the potential of open science to enhance transparency, reporting, and reproducibility in IM was explored, emphasizing the increased role of adherence to reporting guidelines (CONSORT and PRISMA). The future of IM research is built upon the continued efforts of refined study designs, rigorous evidence synthesis, and the integration of open science principles, for a robust and more credible evidence base.
Review Articles
Trends in Clinical Research on Ultrasound-Guided Acupuncture: A Scoping Review
Sook-Hyun Lee, Yoon Jae Lee, Ju Yeon Kim, In Heo, Jae-Heung Cho, Byung-Kwan Seo, Yeoncheol Park, Jung-Hyun Kim, In-Hyuk Ha
Perspect Integr Med. 2024;3(3):152-161.   Published online October 23, 2024
DOI: https://doi.org/10.56986/pim.2024.10.004
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  • 20 Download
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary Material
Acupuncture is widely used to reduce pain and improve function in various conditions. Despite ongoing research in ultrasound-guided acupuncture, evidence supporting efficacy remains inconclusive. This study aimed to examine Korean and international research trends, clinical efficacy, and safety of ultrasound-guided acupuncture by performing a scoping review of clinical research on ultrasound-guided acupuncture. Literature searches were conducted across 11 databases, including all clinical studies published before April 2024, without restrictions on condition/disease or type of study. Of the 2,644 identified articles, 25 studies were selected for review, mostly involving patients with musculoskeletal pain, and post-stroke sequelae. Interventions included ultrasound-guided acupuncture, warming acupuncture, dry needling, and electroacupuncture. The effectiveness of ultrasound-guided acupuncture was evaluated using pain, functional disability, and effective rate as outcome measures, and most studies reported significant improvements. This study is the first scoping review to report on trends, clinical efficacy, and safety of ultrasound-guided acupuncture. While it demonstrates potential for treating musculoskeletal disorders, post-stroke sequelae, spinal injuries, and other conditions/diseases, research on its application remains limited to specific conditions/diseases. Furthermore, substantial variations were observed in types of acupuncture, application areas, and treatment frequencies. Future research should focus on high-quality randomized controlled trials with standardized ultrasound frequencies for specific conditions/diseases.
Minimum Clinically Important Difference for Nonsurgical Interventions for Spinal Diseases: Choosing the Appropriate Values for an Integrative Medical Approach
Ye-Seul Lee, Sungmin Lee, Yoon Jae Lee, In-Hyuk Ha
Perspect Integr Med. 2023;2(2):86-99.   Published online June 23, 2023
DOI: https://doi.org/10.56986/pim.2023.06.003
  • 1,399 View
  • 32 Download
  • 2 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary Material
The minimal clinically important difference (MCID) plays a crucial role in the design and interpretation of clinical trials, as it helps in distinguishing between statistically significant and clinically meaningful outcomes. This scoping review aims to collate and appraise the current research concerning the validation of MCIDs for surgical and nonsurgical measures for spine disorders. Two databases of MEDLINE (PubMed and EMBASE) were searched. There were 1,590 studies retrieved and 79 were selected as eligible for review. Measurement tools such as the Oswestry Disability Index, Neck Disability Index, Numeric Rating Scale, and Visual Analogue Scale were assessed by regions and interventions. A total of 24 studies identified MCIDs on nonsurgical interventions, and 55 studies identified MCIDs on surgical interventions. The range of MCIDs varied greatly depending on study population, specific interventions, calculation methods, and outcomes. This scoping review emphasizes the complexity and variability in determining MCIDs for musculoskeletal or neurodegenerative spinal diseases, influenced by several factors including the intervention type, measurement tool, patient characteristics, and disease severity. Given the wide range of reported MCIDs, it is crucial to consider the specific context when interpreting these values in clinical and research settings. To select an appropriate MCID value for comparison in a clinical trial, careful consideration of the patient group, intervention, assessment tools, and primary outcomes is necessary to ensure that the chosen MCID aligns with the research question at hand.

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  • Minimum clinically important difference and substantial clinical benefit in patients with chronic temporomandibular disorders
    Jaemin Son, Eun‐San Kim, Yoon Jae Lee, Nam‐Woo Lee, In‐Hyuk Ha
    Journal of Oral Rehabilitation.2024; 51(8): 1468.     CrossRef
  • Safety and effectiveness of integrative Korean medicine for the management of patients sustaining injuries in traffic accidents during pregnancy: A retrospective chart review and questionnaire survey
    Dahyun Kyung, Kyoung Sun Park, Ji-Eun Koo, Sujin Kim, Jiwon Park, Jun-Hyo Bae, Jieun Bae, Suna Kim, Yoon Jae Lee, In-Hyuk Ha
    Medicine.2024; 103(21): e38250.     CrossRef
A Scoping Review of Clinical Research on Motion Style Acupuncture Treatment
Doori Kim, Yoon Jae Lee, In-Hyuk Ha
Perspect Integr Med. 2023;2(2):65-76.   Published online June 23, 2023
DOI: https://doi.org/10.56986/pim.2023.06.001
  • 3,376 View
  • 56 Download
  • 3 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDF
This scoping review was conducted to examine the concept of Motion style acupuncture treatment (MSAT), use in clinical practice, its effectiveness, and safety. A literature review of clinical study treatment methods combining acupuncture and movement therapy was performed using PubMed. Of 2,096 studies retrieved, 22 were included in this review. There were 12 randomized controlled trials, and all 22 studies were published in China and Korea, mostly, within the last 3 years. There were five studies concerning local acupoints and 17 studies regarding needling at distal acupoints, and the level of risk of the procedure was “high” in eight studies and “moderate” in 14 studies. The study participants were patients with musculoskeletal pain, and many studies reported significant improvements in pain and functional disability outcomes following treatment using MSAT. For conclusion, MSAT refers to a treatment method in which a patient performs active/passive movements under the supervision of a physician with the acupuncture needle retained at the insertion site. However, there are a limited number of MSAT studies, and various treatment types and related terms are mixed. Further studies, classification of the types of MSAT using a well-established classification system, and a clearer definition of the MSAT concept are needed.

Citations

Citations to this article as recorded by  
  • Effectiveness of lumbar motion style acupuncture treatment on inpatients with acute low back pain: A pragmatic, randomized controlled trial
    Oh-Bin Kwon, Dong Wook Hwang, Dong-Hyeob Kang, Sang-Joon Yoo, Do-Hoon Lee, Minjin Kwon, Seon-Woo Jang, Hyun-Woo Cho, Sang Don Kim, Kyong Sun Park, Eun-San Kim, Yoon Jae Lee, Doori Kim, In-Hyuk Ha
    Complementary Therapies in Medicine.2024; 82: 103035.     CrossRef
  • Graded exercise with motion style acupuncture therapy for a patient with failed back surgery syndrome and major depressive disorder: a case report and literature review
    Do-Young Kim, In-Hyuk Ha, Ju-Yeon Kim
    Frontiers in Medicine.2024;[Epub]     CrossRef
  • Effectiveness and Safety of Progressive Loading–Motion Style Acupuncture Treatment for Acute Low Back Pain after Traffic Accidents: A Randomized Controlled Trial
    Seung-Yoon Hwangbo, Young-Jun Kim, Dong Guk Shin, Sang-Joon An, Hyunjin Choi, Yeonsun Lee, Yoon Jae Lee, Ju Yeon Kim, In-Hyuk Ha
    Healthcare.2023; 11(22): 2939.     CrossRef
Protocol
A Study Protocol for a Multicenter, Pragmatic, Randomized Controlled, Parallel-Grouped Pilot Clinical Trial: Effectiveness of Non-Pharmacological Versus Pharmacological Treatments for Non-Acute Lumbar Disc Herniation
Hui Yan Zhao, Purumea Jun, Chaewon Lee, In-Hyuk Ha, Chang-Hyun Han
Perspect Integr Med. 2023;2(1):59-64.   Published online February 21, 2023
DOI: https://doi.org/10.56986/pim.2023.02.009
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  • 30 Download
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary Material
Background
This study was the development of a protocol for the comparison between the efficacy of non-pharmacological and pharmacological treatment approaches for lumbar disc herniation in a pragmatic environment to obtain real-world based study data.
Methods
The protocol sets out a two-armed, parallel, multicenter pragmatic, randomized-controlled trial (RCT) which will be conducted in four spine specialist hospitals in Korea to determine cost-efficiency.
Results
The study will enroll 36 participants and allocate patients into either the non-pharmacological treatment group or the pharmacological treatment group in a 1:2 ratio. Patients must have evidence of disc-related disease diagnosed using MRI, as well as having lower back pain or radiating leg pain (numeric rating scale score ≥ 5). The treatment will last for 8 weeks with a 26-week follow-up. The primary outcome will be measured using the Oswestry Disability Index score from Week 9. Secondary outcomes related to lower back pain and radiating leg pain will be measured using the scores from the numeric rating scale, the visual analogue scale, the European Quality of Life 5 Dimensions 5 Level Version), the 12-item Short Form Survey, and the patient global impression of change.
Conclusion
This is the first protocol for a pragmatic RCT evaluating the efficacy, safety, and cost-efficiency of non-pharmacological and pharmacological treatment strategies in a clinical setting. Following the basis of this protocol, RCTs may play an important role in establishing guidelines for treating radiating leg pain and lower back pain and provide effective information to clinicians in practical settings.
Review Articles
Clinical Research on Pharmacopuncture in Korea: A Scoping Review
Me-riong Kim, Seong Min Lee, Yoon Jae Lee, In-Hyuk Ha
Perspect Integr Med. 2023;2(1):8-23.   Published online February 21, 2023
DOI: https://doi.org/10.56986/pim.2023.02.003
  • 3,660 View
  • 94 Download
  • 14 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary Material
This scoping review was performed as an update on the effects and safety of pharmacopuncture clinical research for the treatment of multiple indications in Korea. Nine electronic databases were searched to identify comparative clinical studies and clinical practice guidelines on Korean pharmacopuncture from inception to December 31, 2022. In vivo and in vitro studies, and case reports were excluded. There were 226 studies identified, including randomized controlled trials, retrospective comparison observational studies, and single-subject crossover designs, of which 17 focused on clinical safety profiles. Most studies pertained to rehabilitation medicine, especially for musculoskeletal (n = 129) and nervous system disorders (n = 35). The evidence supported treatment of neoplasms, obesity, and stroke sequelae. Adverse events of pharmacopuncture were mostly mild and temporary, and occurred more frequently with bee venom compared with herb-derived solutions. Thirty-five clinical practice guidelines including recommendations on pharmacopuncture were included. To the best of our knowledge, this is the first scoping review of clinical pharmacopuncture use in Korea, and our findings support its use in clinical practice and research. Considering the diverse clinical applications of pharmacopuncture, additional pragmatic trials are required to further strengthen the evidence base and develop standard research methodology in Korean medicine.

Citations

Citations to this article as recorded by  
  • The effect of integrative Korean medicine treatment on symptomatic lumbar facet joint cysts: A case series
    Hee-seung Choi, Yoon Jae Lee, Dae-Hyun Hahm, Hyangsook Lee, In-Hyuk Ha
    EXPLORE.2024; 20(1): 130.     CrossRef
  • Long-Term Follow-Up of Inpatients with Rotator Cuff Tear Who Received Integrative Korean Medicine Treatment: A Retrospective Analysis and Questionnaire Survey
    Dong-Hwi Yoo, Jae-Yong Choi, Sang-Gun Lee, Ki-Won Choi, Han-Bin Park, Ho Kim, Hyunwoo Cho, Sang Don Kim, Doori Kim, Yoon Jae Lee, Kyoung Sun Park, In-Hyuk Ha
    EXPLORE.2024; 20(2): 212.     CrossRef
  • Long-term follow-up of inpatients with meniscus tears who received integrative Korean medicine treatment: A retrospective analysis and follow-up survey
    June Haeng Lee, Jin Young Song, Kyoung Sun Park, Jinho Lee, In-Hyuk Ha, Yoon Jae Lee
    Medicine.2024; 103(6): e36917.     CrossRef
  • Pharmacopuncture therapy for adhesive capsulitis: A pragmatic randomized controlled pilot study
    Doori Kim, Kyoung Sun Park, Sun-A Kim, Ji Yeon Seo, Hyun-Woo Cho, Yoon Jae Lee, Changsop Yang, In-Hyuk Ha, Chang-Hyun Han
    Integrative Medicine Research.2024; 13(3): 101065.     CrossRef
  • Effectiveness of lumbar motion style acupuncture treatment on inpatients with acute low back pain: A pragmatic, randomized controlled trial
    Oh-Bin Kwon, Dong Wook Hwang, Dong-Hyeob Kang, Sang-Joon Yoo, Do-Hoon Lee, Minjin Kwon, Seon-Woo Jang, Hyun-Woo Cho, Sang Don Kim, Kyong Sun Park, Eun-San Kim, Yoon Jae Lee, Doori Kim, In-Hyuk Ha
    Complementary Therapies in Medicine.2024; 82: 103035.     CrossRef
  • Survey on the current usage of ultrasound-guided procedures in Korean Medicine Clinics and Hospitals
    Ju Yeon Kim, Jung Min Yun, Sook-Hyun Lee, Yoon Jae Lee, Dong Kun Ko, In Heo, Woo-Chul Shin, Jae-Heung Cho, Byung-Kwan Seo, In-Hyuk Ha
    Medicine.2024; 103(14): e37659.     CrossRef
  • Effectiveness and safety of hominis placental pharmacopuncture for chronic temporomandibular disorder: A multi-center randomized controlled trial
    Kyoung Sun Park, Eun-San Kim, Koh-Woon Kim, Jae-Heung Cho, Yoon Jae Lee, Jinho Lee, In-Hyuk Ha
    Integrative Medicine Research.2024; 13(2): 101044.     CrossRef
  • Analysis of Research Trends on the Korean Medicine Treatments of Subacromial-Subdeltoid Bursitis
    Hyunsuk Park, Dong-Jin Jang, Jonghyun Lee, Sungjae Yoo, Minji Sun, Junsoo Kim, Yongjun Kim, Jeong-Hee Noh, Si-Hyoung Kim, Jung-Min Yun
    Journal of Korean Medicine Rehabilitation.2024; 34(2): 85.     CrossRef
  • Effectiveness and Safety of Pharmacopuncture on Inpatients with Tension Headache Caused by Traffic Accidents: A Pragmatic Randomized Controlled Trial
    Ja-Yean Son, Kangmoo Goo, Na-young Kim, Seok-Gyu Yang, Dong Hwan Lee, Yu-Ra Im, Oh Bin Kwon, Hyun-Woo Cho, Sang Don Kim, Doori Kim, In-Hyuk Ha
    Journal of Clinical Medicine.2024; 13(15): 4457.     CrossRef
  • Integrative Korean medicine treatment for inpatients with osteoarthritis of the knee: An observational study
    Soo Kyeong Lee, Eun Je Oh, Gun Hee Bae, Jae Hyuk Woo, Yoon Jae Lee, In-Hyuk Ha, Ju Yeon Kim, Doori Kim
    Medicine.2024; 103(32): e39183.     CrossRef
  • Integrative Medicine Focusing on Ultrasound-Guided High-Dose Shinbaro 2 Pharmacopuncture for Acute Herniated Intervertebral Discs: A Case Report
    Nam-Woo Lee, Jinho Lee, Jung-Min Yun, Siwon Kim, Won-Seok Chung
    Healthcare.2024; 12(16): 1620.     CrossRef
  • Common Peroneal Nerve Entrapment Masked by Acute Lumbar Disc Herniation: Integrated Korean Medicine Treatment with Ultrasound-Guided Pharmacopuncture
    Hyunsuk Park, Jinhyun Kim, Sungjae Yoo, Jung-Min Yun, Kwangchan Song
    Perspectives on Integrative Medicine.2024; 3(3): 177.     CrossRef
  • A Pragmatic Randomized Controlled Trial on the Effectiveness and Safety of Pharmacopuncture for Chronic Lower Back Pain
    Kyoung Sun Park, Changnyun Kim, Joo Won Kim, Sang‐Don Kim, Jee Young Lee, Yoon Jae Lee, Jinho Lee, Min Ji Kim, Young Eun Choi, Changsop Yang, Chang-Hyun Han, In-Hyuk Ha
    Journal of Pain Research.2023; Volume 16: 2697.     CrossRef
  • Domestic Clinical Research Trends of Shinbaro Pharmacopuncture: Scoping Review
    Yeongmin Kim, Yunhee Han, Seungkwan Choi, Jungho Jo, Byeonghyeon Jeon, Hyeonjun Woo, Wonbae Ha, Junghan Lee
    Journal of Korean Medicine Rehabilitation.2023; 33(4): 125.     CrossRef
Expanding the Scope of Manual Medicine Through Research, Academic Exchange, and Healthcare Coverage: A Summary of Two International Conferences
Seung Min Kathy Lee, Su-Bin Han, Boyd Buser, Kendi Hensel, Brian Kim, William Mayo, Nicola Robinson, Byung-Cheul Shin, Daniel Williams, Joon-Shik Shin, Me-riong Kim, In-Hyuk Ha, Jinho Lee, Lawrence Prokop
Perspect Integr Med. 2022;1(1):10-16.   Published online September 22, 2022
DOI: https://doi.org/10.56986/pim.2022.09.003
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  • 56 Download
AbstractAbstract PDF
In Korea, Chuna was officially included in the Korean national health insurance (NHI) system in 2019. In the US, osteopathic manipulative treatment has been part of conventional healthcare since 1966. Since there are few countries that provide manual therapy in mainstream healthcare, academic exchange between experts in Chuna therapy on an international stage is essential; to date there has been a conference in 2018 and 2019, both of which were held in Korea. This review presents a summary of these conference proceedings. There were 13 keynote speakers including doctors of Korean medicine, osteopathic physicians, and policymakers. In the 1st conference, seven speakers shared their knowledge on the history of Chuna, policies, and the current body of evidence for using Chuna and osteopathic manipulative treatment of various conditions. In the following year, six speakers also included novel Chuna techniques, similarities and differences, and explored the possibilities for collaborations moving forward. Previous to these two international conferences, the last national conference was held in Korea in 2008. The timing of these two international conferences has proved significant due to the inclusion of Chuna in Korean national health insurance in 2019, and helped to provide guidance in expanding the scope of manual medicine.

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