Complementary and alternative medicine for lumbar

herniated intervertebral disc

: An evidence-based clinical practice guideline
Bonhyuk Goo1, Eun-Jung Kim2, Dongwoo Nam3, Tae-Hun Kim4, Hyun-Jong Lee5, Jae-Soo Kim5, Yong-Hyeon Baek1, Yeon-Cheol Park1, Byung-Kwan Seo1*
1Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
2Department of Acupuncture & Moxibustion Medicine, College of Oriental Medicine, Dongguk University, 123, Dongdae-ro, Gyeongju-si, Gyeongsangbuk-do 38066, Republic of Korea
3Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
4Korean Medicine Clinical Trial Center, Kyung Hee University Korean Medicine Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
5Department of Acupuncture & Moxibustion medicine, College of Korean medicine, Daegu Haany University, 136, Sincheondong-ro, Suseong-gu, Daegu 42158, Republic of Korea

This study was supported by the Traditional Korean Medicine R&D program, which is funded by the Ministry of Health & Welfare through the Korea Health Industry Development Institute (KHIDI) (HB16C0061).

Objective Results
 The aim was to develop a clinical practice guideline (CPG) for  PRISMA flow chart
Lumbar herniated intervertebral disc (LHIVD) in order to help

Identification
clinicians translate best evidence to best practice on Records identified through
complementary and integrative medicine (CAM). database searching
(n = 7156)
Duplicates removed
(n = 3137)
Methods Records screened Records excluded
(n = 4019) (n = 3530)

Screening
 Development procedure of CPG
Organizing an multidisciplinary expert committee Full-text articles assessed Full-text articles
for eligibility excluded
(n = 489) (n = 324)
Multidisciplinary expert committee
Eligibility

Clinical practice Systematic review CPG development

experts methodology expert methodology expert Studies included in qualitative
synthesis
(n = 165)
Establishing a development plan based on appraisal of previous CPG
Included

Setting up clinical questions and search strategies Studies included in quantitative

synthesis (meta-analysis)
(n = 165)
International core database
MEDLINE Embase Cochrane library
 Summary of CPG
Local database Recommendation
Clinical Question Grade / Evidence
Korea (KoreaMed, Kmbase,
China (CNKI) Japan (CiNii, J-stage) Level
KISS, NDSL, KISTI, OASIS)
 Acupuncture
Conducting literature search and selection by eligibility criteria CQ 1 Acupuncture treatment A / High
A combination of acupuncture with usual
CQ 2 A / Moderate
care
Performing quality assessment
Additional heat or electric stimulation on
CQ 3 A / High
acupuncture
Risk of Bias tool CQ 4 Deep insertion of acupuncture B / Moderate
Selection Performance Detection Reporting • Moxibustion
Attrition bias
bias bias bias bias
CQ 5 Moxibustion treatment GPP / Very low
A combination of moxibustion with usual
Synthesizing the evidence using meta-analysis CQ 6 A / High
care
CQ 7 Heat sensitive moxibustion C / Low
Deriving level of evidence and recommendation (GRADE) • Herbal Medicine
CQ 8 Herbal medicine treatment B / Moderate
Level of evidence A combination of herbal medicine with usual
CQ 9 A / High
Study design Risk of bias Inconsistency care
• Pharmacoacupuncture
Indirectness Imprecision Publication bias A combination of pharmacoacupuncture
CQ 10 B / Moderate
with usual care
Conducting consensus process by external panels (Delphi method) • Chuna
CQ 11 Chuna treatment A / High
Conducting external review and obtaining approval CQ 12 A combination of chuna with usual care A / Moderate
• Thread-embedding acupuncture
Reviewed and approved by CQ 13 Thread-embedding acupuncture treatment B / Moderate
Korean A combination of thread-embedding
Guide Center for The Society of The Society of CQ 14 B / Moderate
Acupuncture & acupuncture with usual care
Korean Korean the Spine &
Moxibustion • Cupping treatment
Medicine Medicine Joint in Korean
Medicine A combination of cupping treatment with
(GKOM) Rehabilitation medicine CQ 15 B / Moderate
Society usual care
*GPP : Good Practice Point