ACC & Acupuncture

 

Acupuncture and ACC
Accident compensation has a long history in New Zealand. The Accident Compensation Corporation (ACC) began in 1974 and has continued to evolve ever since. ACC helps prevent injuries and get New Zealanders and visitors back to everyday life if they’ve had an accident. ACC help pays for a range of medical, health and treatment costs if we cover your injury. You may have to pay for part of your treatment costs. Includes serious injury and disability.
You can register with us if you’re a treatment provider or registered health professional under the Accident Compensation Act 2001. This includes: acupuncturist
To register as a health provider you need to:
Be registered with the appropriate authority, eg your professional body
Hold a current annual practising certificate from the same authority

 

How does ACC work?

Acupuncture modalities currently funded by ACC The Accident Compensation Corporation (ACC) includes acupuncture within the suite of allied health treatment modalities. Allied Health is the third major group in the New Zealand health and disability workforce (alongside medical and nursing professionals) and includes physiotherapists, chiropractors, osteopaths, occupational therapists, speech therapists and acupuncturists (www.ahanz.org.nz). ACC currently funds two sets of treatment modalities within acupuncture services, conventional therapies and adjunct therapies. The conventional therapies are comprised of traditional acupuncture, Western acupuncture, laser acupuncture, electroacupuncture, and auricular acupuncture; the adjunct therapies include cupping, Gua Sha scraping, tuina massage, and moxibustion. ACC does not fund herbal plasters, liniments, herbalism, nutritional supplements, and ion-pumping cords. Acupuncturists have been recognised under ACC cost of treatment regulations since 1990. The Accident Compensation Act (AC Act) defines an acupuncturist as a person who is a) a full member of the New Zealand Register of Acupuncturists Incorporated (NZRA), now known as Acupuncture NZ (AcNZ), or the New Zealand Acupuncture Standards Authority Inc (NZASA) and b) who holds a current practising certificate. Other Health Practitioners (as defined under the Health Practitioners Competence Assurance Act 2003) may utilise acupuncture interventions as determined under the scopes of practice within which they work.

Musculoskeletal conditions may be eligible for cover if it can be established that the condition is a personal injury caused by an accident (PICBA) or a work-related gradual onset condition (e.g. carpal tunnel syndrome) (WRGPDI). The criteria for each are described in the Accident Compensation Act 2001. ACC does not cover musculoskeletal injuries which are considered to be wholly or substantially due to noninjury factors, such as disease or aging.

muscularskeletal and ACC coverage

Neck Pain

Mechanical Neck Pain Included evidence: seven systematic reviews, which included eight individual RCTs, and one additional RCT were identified. Study quality varied, however, most were of moderate to high quality. Included studies investigated treatments using either a TCM or western medical framework and delivered traditional acupuncture, electroacupuncture, dry needling and cupping. Acupuncture interventions were mainly compared with sham acupuncture, wait-list or inactive treatment (e.g. sham laser or TENs). Participants within the included studies varied significantly regarding the duration and severity of neck pain, with conditions ranging from acute to chronic durations. The reported number, duration and frequency of treatment sessions was often 15 – 30 minutes long, with 5 – 15 sessions delivered over 3 – 5 weeks of treatment. Length of follow-up was mostly short to medium term with a small number of studies reporting long-term functional or pain outcomes. There is conflicting evidence suggesting that traditional acupuncture may be more effective at reducing pain and improving disability in the short-term for patients with mechanical neck pain when compared to sham acupuncture, however, the evidence does not provide support for a long-term effect. Based on two HQ++ SRs of level 1+ evidence and one LQ- SR of level 1- evidence. The SRs included 4 relevant RCTs. There is conflicting evidence regarding the benefits of dry needling and electroacupuncture on the outcome of pain over the short-term in patients with mechanical neck pain when compared to control interventions. Based on one HQ++ SR of level 1+ evidence, three AQ+ SRs of level 1 evidence and one HQ++ RCT. The SRs included three relevant RCTs, two on dry needling and one on electroacupuncture. Insufficient evidence is available on other acupuncture therapies including auricular acupuncture, laser acupuncture, moxibustion, cupping and Gua Sha scraping for patients with mechanical neck pain.


Shoulder Pain
Frozen Shoulder Included evidence: four systematic reviews, which included six RCTs, and one additional RCT. Studies were of low to moderate quality. Included studies investigated treatments which mainly used a TCM framework and delivered a combined or individual treatment of acupuncture (traditional acupuncture, cupping, electroacupuncture, tuina therapy and laser acupuncture) and rehabilitation, physiotherapy or electrotherapy. These interventions were mainly compared with physiotherapy, electrotherapy and injections alone. Patients were commonly aged in their 50’s and varying and poorly reported stages of the condition. The number, duration and frequency of treatment sessions were around 30 – 40 minutes long, with 8 – 10 sessions delivered over 4 – 6 weeks of treatment. The evidence suggests that acupuncture or electroacupuncture, alone or in combination with physiotherapy or electrotherapy may be effective for reducing pain, improving range of motion and function in patients with the frozen shoulder when compared to physiotherapy or electrotherapy alone. Based on one LQ- SR of level 1- evidence containing three RCTs and one LQ- RCT. Insufficient evidence is available on other acupuncture therapies including auricular acupuncture, laser acupuncture, dry needling, moxibustion, cupping, tuina massage and Gua Sha scraping for patients with frozen shoulder.

Sciatica
Sciatica Included evidence: three systematic reviews, which included 13 individual RCTs, were identified that reviewed the effectiveness of acupuncture interventions for sciatica. Studies were of low to moderate quality. Included studies mainly investigated treatments which used a TCM framework and delivered traditional acupuncture and electro-acupuncture. Acupuncture interventions were mainly compared with conventional medication (Ibuprofen, Prednisone, Meloxicam and Diclofenac). Patient age and duration of condition significantly varied between the included studies ranging from 18 – 79 years of age and reported durations of 4 days to 18 years. The number, duration and frequency of treatment sessions was well-reported, with sessions often of 20 – 45 minutes long, with 5 – 20 sessions delivered over a short period of 1 – 3 weeks. Length of follow-up was mostly short-term with few studies reporting long-term functional or pain outcomes. The evidence indicates that traditional acupuncture and electroacupuncture are probably effective in reducing pain in the short-term when compared with conventional medication. However, there is little evidence on its sustained effect over the medium and long-term and its effect on function and quality of life. Based on two SRs of HQ++ and one SR of AQ+, all of level 1 evidence. The SRs included thirteen relevant RCTs. Insufficient evidence is available on other acupuncture therapies including dry needling, auricular acupuncture, laser acupuncture, moxibustion, cupping, Gua Sha scraping and traditional Chinese tuina massage for patients with sciatic

Back Pain
Lumbar Disc Herniation Included evidence: two systematic reviews which included 14 individual RCTs. Studies were reported to be of low quality. One looked at the effectiveness of tuina manual therapy while the other looked at the interventions of acupuncture and electroacupuncture. Tuina manual therapy was also used in conjunction with other interventions, mostly oral Meds, traction and intravenous injections. The control groups were mainly oral Meds and traction using varied duration periods which were different from the intervention in most cases. The included studies that reported treatment schedules averaged 11.3 ± 8.1 sessions (range 1–36) and the length of each session was 25.3 ± 5.7 minutes (range 15–30). Follow up length was only reported within two of the included RCTs and ranged between 1 day to 60 weeks. There was low-quality evidence that tuina, alone or used alongside traction, may be effective for the relief of pain due to lumbar disc herniation, but the clinical impact of the treatment is uncertain. The evidence indicates that traditional acupuncture plus traction may be effective in reducing pain post-treatment for patients with lumbar disc herniation when compared to traction alone. Based on one LQ- SR of level 1- evidence. The SR included five relevant RCTs. The evidence suggests that tuina massage may be effective in improving pain and function for patients with lumbar disc herniation when compared to conventional medication and traction, however, the evidence for functional improvement was not as strong as pain relief. Based on one AQ+ SR of level 1+ evidence. The SR included eight relevant RCTs. Insufficient evidence is available on other acupuncture therapies including electroacupuncture, auricular acupuncture, laser acupuncture, dry needling, moxibustion, cupping and Gua Sha scraping for patients with lumbar disc herniation

Knee Pain
Knee Osteoarthritis Included evidence: 15 systematic reviews, which included 78 RCTs, plus nine additional RCTs were identified, that reviewed the effectiveness of acupuncture interventions for knee OA. Studies were of low to moderate quality. Included studies mainly investigated treatments which used a TCM framework and delivered traditional acupuncture, trigger point acupuncture or moxibustion. Acupuncture interventions were mainly compared with sham acupuncture, no treatment or conservative therapies. Moxibustion was mainly compared with Meds therapies such as diclofenac, or sham moxibustion. Patients were generally recruited from hospital clinics, were aged greater than 50 years old and suffered from knee OA of chronic duration and moderate severity, however, the included studies varied significantly. A history of traumatic injury was often an exclusion criterion, so this may limit the relevance of the findings for ACC. The number, duration and frequency of treatment sessions were not well-reported, but where it was, sessions were about 20 – 30 minutes long, with 5 – 20 sessions delivered over 5 – 9 weeks of treatment or daily treatments over a short period of 7 – 10 days. Length of follow-up was mostly short-term with few studies reporting long-term functional or pain outcomes. The evidence suggests that acupuncture and electroacupuncture probably reduce pain in the short-term when compared to the controls of medication, placebo and a waiting list, however, their effects on function and quality of life remain unclear and conflicting. Based on three AQ+ SRs and three LQ- SRs, three of level 1+ evidence and three of level 1 evidence and two RCTs, one of LQ- and one of AQ+. The SRs included 43 relevant RCTs. The evidence suggests that the effectiveness of acupuncture treatments depends on the age of the patient and the severity of their osteoarthritis. Specifically, the evidence suggests that laser acupuncture, needle acupuncture and moxibustion are probably not effective in improving pain and function in older patients with moderate or severe knee pain. Based on one HQ++ RCT of level 1+ evidence quality on laser and needle acupuncture and one HQ++ RCT of 1+ evidence quality on moxibustion. There is conflicting evidence about the benefits of moxibustion on the outcomes of pain and function over the short-term in patients with knee osteoarthritis. Based on one HQ++ SR, two AQ+ SRs of level 1 evidence and four RCTs of HQ++ (1), AQ+ (1) and LQ- (2) of level 1 and 1- quality. The SRs included 21 relevant RCTs. The evidence indicates that pulsatile cupping may be effective in improving knee pain and function in patients with knee osteoarthritis in the short and medium-term when compared to no intervention. Based on one AQ+ SR and one AQ+ RCT both of level 1 evidence quality and 1 LQ- RCT of level 1- evidence. The SR included seven relevant RCTs. Insufficient evidence is available for other acupuncture therapies including Gua Sha scraping and traditional Chinese tuina massage for patients with knee osteoarthritis. Ankle Sprain Included evidence: three systematic reviews which included 18 individual RCTs. Studies were generally of low quality and lacked validated outcome measures for the primary and secondary outcomes of interest within this review including pain, function and QOL. Included studies mainly investigated treatments which used a TCM framework and delivered traditional acupuncture, auricular acupuncture, electroacupuncture and warm acupuncture. Acupuncture interventions were mainly compared with usual care/standard physiotherapy (bandage and/or ice pack), massage, topical NSAIDs and oral medication. The included studies considered three main types of comparisons: acupuncture versus no treatment or placebo, acupuncture versus another standard non-surgical intervention and acupuncture used in conjunction with other treatments to assess its effectiveness as an add-on treatment. Patients were generally between 18 and 25 years of age and had suffered an acute ankle sprain of less than a week’s duration. Most studies within the SRs included ankle sprains of mixed severity or did not detail severity. The number, duration and frequency of treatment sessions were commonly between 5 and 15 sessions over 1 to 2 weeks. Length of follow-up was mostly of short-term. Insufficient evidence is available for the outcomes of pain, function and quality of life using needle-based and other acupuncture therapies for patients with ankle sprains. The available evidence lacks validated outcome measures for the primary and secondary outcomes of interest within this review including pain, function and quality of life. Based on three SRs of HQ++ and AQ+ with level 1+ and 1 evidence. The SRs included 18 relevant RCTs.

Heel Pain
Plantar Heel Pain Included evidence: seven systematic reviews, which included 12 individual RCTs, plus 1 additional RCT was identified that reviewed the effectiveness of acupuncture for plantar heel pain. Studies were of low to moderate quality and mostly reported on follow up times in the short and medium-term. Included studies investigated treatments which used TCM or western framework and delivered traditional acupuncture, trigger point dry needling, electroacupuncture and warm needling acupuncture. Acupuncture interventions were mainly compared with exercise, sham acupuncture, insoles or steroid injections. Patients were generally diagnosed with plantar fasciitis however, several studies used the words plantar fasciitis and plantar heel pain interchangeably. Plantar fasciitis is a common cause of plantar heel pain, but plantar heel pain can also include wider issues which may affect results. The patients were commonly aged between 35 and 60 years old. The number, duration and frequency of treatment sessions were often of two different treatment schedules, one of the daily treatments over 1 – 2 weeks and the other of weekly sessions over 4 – 8 weeks. The evidence suggests that acupuncture and electroacupuncture may be effective in the short-term reduction of pain in patients with plantar fasciitis; however, the improvement is not sustained over the medium to long term. Based on one AQ+ SR and one LQ- SR both of level 1 evidence. The SRs included five relevant RCTs. The evidence indicates that dry needling may be more effective than control or placebo for reducing pain but not improving quality of life in the short and long term when treating patients with plantar heel pain. Based on five AQ+ SRs (four of level 1 evidence and one of 1- evidence). The SRs included eight relevant RCTs. The evidence indicates that acupuncture interventions may be effective in reducing pain in the short-term (up to 6 weeks), however, there is little evidence supporting its sustained effect over the medium and long term and its effect on improving quality of life in the short and long term. The evidence suggests that as the duration of plantar fasciitis increases, the improvement from treatment including electroacupuncture decreases. Based on one LQ- SR of level 1 evidence, containing only one relevant RCT. Insufficient evidence is available on other acupuncture therapies including auricular acupuncture, laser acupuncture, moxibustion, cupping, Gua Sha scraping and traditional Chinese tuina massage for patients with plantar heel pain.

General comments on the evidence base of acupuncture for musculoskeletal conditions There is some evidence that acupuncture modalities are effective for the short-term (up to 6 weeks) relief of pain associated with some musculoskeletal conditions but there is little evidence of medium or long-term pain relief. While it is less consistent, there is evidence that for some conditions acupuncture modalities also improve functional outcomes in the short-term. There is overall a lack of available evidence regarding the effectiveness for other modalities, such as moxibustion, Gua Sha, tuina and cupping. Treatments were often reported as being 15 – 30 minutes long, although it was not always clear if this represented total treatment or needle retention time. These findings are consistent with other recent systematic reviews and clinical guidelines for the management of low back pain and knee osteoarthritis. The findings of the evidence-based review were limited by a lack of high-quality studies for many acupuncture modalities, particularly adjunct modalities, such as cupping, tuina massage, Gua Sha scraping and moxibustion. There was also a focus on outcome measures for pain, with a lack of functional, disability, quality of life, or patient-centred outcomes. This means that for many conditions the reviewers were unable to comment on the functional impact of treatment with acupuncture.

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Posted in Pain Relief.