The association of positive patient expectations with placebo responses is well recognized. However, the potential role of health care providers' behavior in modeling these expectations has not been adequately established, The overall goal of this proposal is to describe and quantify placebo effects in a trial of acupuncture for osteoarthritis (OA) of the knee. No previous studies have scientifically evaluated the effects of communicative style in providers of alternative and complementary medicine, and tile placebo response that may result. This proposal will examine placebo responses in the context of practitioner-patient interactions at the time of the acupuncture treatment. The study will have three phases: Phase 1 will include a qualitative component to determine potential patient-related determinants of placebo response, such as beliefs and expectations towards treatment of knee OA with acupuncture, in phase 2 we will develop and test an instrument to measure evaluate outcome and self efficacy expectations. Phase 3 will be a nested RCT to evaluate practitioner-patient interactions and placebo responses. The experimental design will include two stages or randomization. Patients will initially be randomized to one of two different structures of practitioner-patient interaction. Acupuncture practitioners will be trained to behave following semi-structured communicative styles, including traditional approaches in Chinese Medicine, and techniques previously described in patient-doctor communication studies. Within each of these groups patients will be further randomized to receive acupuncture or sham acupuncture. In addition there will be a natural control group (waiting list group), in which patients will be offered acupuncture three months after study entry.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR049999-03
Application #
6792782
Study Section
Special Emphasis Panel (ZRG1-SSS-N (21))
Program Officer
Ader, Deborah N
Project Start
2002-09-26
Project End
2006-08-31
Budget Start
2004-09-01
Budget End
2005-08-31
Support Year
3
Fiscal Year
2004
Total Cost
$728,670
Indirect Cost
Name
Baylor College of Medicine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
051113330
City
Houston
State
TX
Country
United States
Zip Code
77030
Jain, Preetesh; Kantarjian, Hagop; Nazha, Aziz et al. (2013) Early responses predict better outcomes in patients with newly diagnosed chronic myeloid leukemia: results with four tyrosine kinase inhibitor modalities. Blood 121:4867-74
Street Jr, Richard L; Cox, Vanessa; Kallen, Michael A et al. (2012) Exploring communication pathways to better health: clinician communication of expectations for acupuncture effectiveness. Patient Educ Couns 89:245-51
Amezaga Urruela, Matxalen; Suarez-Almazor, Maria E (2012) Acupuncture in the treatment of rheumatic diseases. Curr Rheumatol Rep 14:589-97
Suarez-Almazor, Maria E; Looney, Carol; Liu, Yanfang et al. (2010) A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication. Arthritis Care Res (Hoboken) 62:1229-36
Kelly, P A; Kallen, M A; Suarez-Almazor, M E (2007) A combined-method psychometric analysis recommended modification of the multidimensional health locus of control scales. J Clin Epidemiol 60:440-7