The study involved a prospective postal audit of treatments undertaken during a four week period in 2000. All 1848 professional acupuncturists who were members of the British Acupuncture Council and were practising in the United Kingdom were invited to record details of adverse events and mild transient reactions after treatment. Standardised self report forms were used. Participating practitioners also provided information on themselves, including age, sex, length of training, and years of practice. To have a 95% probability that no serious event occurs in n
treatments, a survey sample size needs to be three times n
On this basis, a sample of 30
000 treatments was sought. Piloting indicated that a four week period was needed.
A total of 574 practitioners participated, 31% of the total population. The mean age of participants was 44.8 years (range 23-79 years), 65% were female, and 62% had been practising acupuncture for more than five years. Information on sex, training college, and length of practice was available from the British Acupuncture Council's database. Participants were sufficiently representative of the population of practitioners for a re-weighting of the primary data to be unnecessary. Participating practitioners reported on 34
Practitioners were asked to give details of any adverse events they considered to be “significant,” including any event that was “unusual, novel, dangerous, significantly inconvenient, or requiring further information.” There were no reports of serious adverse events, defined as events requiring hospital admission, leading to permanent disability, or resulting in death (95% confidence interval 0 to 1.1 per 10
000 treatments). Practitioners did, however, report 43 minor adverse events, a rate of 1.3 (0.9 to 1.7) per 1000 treatments. The most common events were severe nausea and fainting (table). Three avoidable events—two patients had needles left in, and one patient had moxibustion burns to the skin—were caused by practitioners' errors.
Participating practitioners recorded 10
920 mild transient reactions occurring in 5136 treatments, 15% (14.6% to 15.3%) of the 34
407 total. Some local reactions at the site of needling were reported—mild bruising in 587 (1.7%) cases, pain in 422 (1.2%) cases, and bleeding in 126 (0.4%) cases. Patients experienced an aggravation of existing symptoms after 966 (2.8%) treatments, 830 (86%) of which were followed by an improvement, possibly indicating a positive “healing crisis.” The most commonly reported mild transient reactions were “feeling relaxed” in 4098 (11.9%) cases and “feeling energised” in 2267 (6.6%) cases, symptoms that often indicate an encouraging response to treatment.3