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JKM > Volume 40(2); 2019 > Article
Lee, Choi, Kim, Jeong, and Kim: A Web-based Survey Research on Improving and Utilizing Korean Medicine Clinical Practice Guideline for Ankle Sprain

Abstract

Objectives

The purpose of this study was to increase the utilization of Korean Medicine Clinical Practice Guidelines(KMCGP) for ankle sprain by investigating the recognition of guideline developed in 2015 and evaluating the current status of treatment.

Methods

An e - mail questionnaire survey was conducted for Korean medicine doctor(K.M.D) registered in Korean Medicine Association. Survey data were analyzed through Excel.

Results

The most common Korean medicine treatments used in clinic were acupuncture(adjacent points)(28.5%), cupping therapy(19.7%) and pharmacopuncture(9.8%). The treatments with high patient satisfaction were acupuncture (adjacent points)(27.9%), moxibustion(22.4%) and herbal medicine(10.4%). Herbal medicine(17.9%), tuina(10.7%) and embedding therapy(9.2%) were difficult to perform during treatment because of cost. In the case of a later revision, respondents most thought it is necessary to update evidence and adjust recommendation ratings. A majority of all respondents said they would like to know about the revised guideline through the Internet. In the expected revision effect, the first order was ‘presentation of standardized treatment method’, the second was ‘establishing the basis of Korean medicine treatment’, and the third was ‘strengthening the status of Korean medicine as therapeutic medicine’. Many respondents wished to add exercise therapy. In order to increase the utilization rate of the guideline, many respondents thought it should be included in textbooks and 90.6% of respondents answered that they would use more than 50% of the revised guideline.

Conclusion

It is necessary to update evidence and adjust recommendation ratings and to promote KMCGP. At the same time treatment methods should be taught to K.M.D

Acknowledgments

Acknowlegements
This study was supported by the Traditional Korean Medicine R&D program funded by the Ministry of Health and Welfare through the Korea Health Industry Development Institute (KHIDI) (https://www.khidi.or.kr/kps) (HB16C0026).

Table 1
Characteristic of Responders (Person, Percentage(%))
Sex Male Female Total
653(76.7) 200(23.4)
Age group 20s
122(14.3)
30s
355(41.6)
40s
276(32.0)
50s
84(9.9)
60s & more
16(1.9)
853(100)
Yrs of CC Yrs<10
422(49.5)
10<Yrs≤20
312(36.6)
20<Yrs≤30
94(11)
30<Yrs≤40
20(2.3)
40<Yrs
4(0.5)
Emp KMC
588(68.9)
KMH
72(8.4)
KMUH
63(7.4)
NH
48(5.6)
WH
7(0.8)
PH
55(6.4)
RI
7(0.8)
Etc.
13(1.5)
Num of Tx num<10
445(52.2)
10<num≤20
229(26.8)
20<num≤30
103(12.1)
30<num≤40
38(4.5)
40 40<num≤50
10(1.2)
50<num≤100
23(2.7)
100<num
5(0.6)

Yrs: years, CC: clinical career, Emp: employment, KMH: Korean medicine clinic, KMH: Korean medicine hospital, KMUH: Korean medicine university hospital, NH: nursing hospital, WH: western hospital, PH: public health, RI: research institute, Num: number, Tx: treatment

Table 2
Recognition Status of Guideline (Person, Percentage(%))
Knew the contents Heard of contents Didn’t know Total
Overall response 86(10.1) 300(35.2) 467(54.7) 853
2–30s 54(11.3) 185(38.8) 238(49.9) 477
40s 32(8.5) 115(30.6) 229(60.9) 376
Num of Tx less than 10 47(10.6) 148(33.3) 250(56.2) 445
Num of Tx over 10 39(9.6) 152(37.3) 217(53.2) 408
Korean medicine clinic 48(8.2) 191(32.5) 349(59.4) 588
Hospital 31(16.3) 78(41.1) 81(42.6) 190

Num: number, Tx: treatment

Table 3
Learning Path of Guideline (Person, Percentage(%))
Korean medicine Association conservative education Internet Introduction of colleagues Korean medicine newspaper Korean Medicine Research Institute promotion Etc. Total
Overall response 28(7.2) 199(51.0) 54(13.8) 35(9.0) 62(15.9) 12(3.1) 390
2–30s 14(5.8) 124(51.5) 37(15.4) 19(7.9) 37(15.4) 10(4.1) 241
40s 14(9.4) 75(50.3) 17(11.4) 16(10.7) 25(16.8) 2(1.3) 149
Num of Tx less than 10 13(6.6) 95(48.5) 30(15.3) 16(8.2) 36(18.4) 5(2.6) 195
Num of Tx over 10 15(7.7) 104(53.3) 24(12.3) 19(9.7) 26(13.3) 7(3.6) 195
Korean medicine clinic 22(9.1) 137(56.6) 24(9.9) 21(8.7) 30(12.4) 8(3.3) 242
Hospital 5(4.5) 45(40.9) 24(21.8) 12(10.9) 22(20.0) 2(1.8) 110

Num: number, Tx: treatment

Table 4
Degree of Utilization of Guideline (Person, Percentage(%))
less than 20% 20%≤Degree<50% 50%≤Degree<70% 70%≤Degree≤100% Total
Overall response 20(23.3) 22(25.6) 25(29.1) 19(22.1) 86
2–30s 10(18.5) 15(27.8) 17(31.5) 12(22.2) 54
40s 10(31.3) 7(21.9) 8(25.0) 7(21.9) 32
Num of Tx less than 10 15(31.9) 13(27.7) 10(21.3) 9(19.1) 47
Num of Tx over 10 5(12.8) 9(23.1) 15(38.5) 10(25.6) 39
Korean medicine clinic 10(20.8) 13(27.1) 16(33.3) 9(18.8) 48
Hospital 8(25.8) 9(29.0) 7(22.6) 7(22.6) 31

Num: number, Tx: treatment

Table 5
Revision Direction of Guideline (Person, Percentage(%))
Supplementary diagnosis Supplementation by adding or removing treatment methods Update evidence or adjust recommendation rating Simplify guideline No revision required Etc. Total
Overall response 16(18.6) 23(26.7) 25(29.1) 19(22.1) 1(1.2) 2(2.3) 86
2–30s 10(18.5) 13(24.1) 15(27.8) 13(24.1) 1(1.9) 2(3.7) 54
40s 6(18.8) 10(31.3) 10(31.3) 6(18.8) 0(0.0) 0(0.0) 32
Num of Tx less than 10 11(23.4) 11(23.4) 129(25.5) 11(23.4) 0(0.0) 2(4.3) 47
Num of Tx over 10 5(12.8) 12(30.8) 13(33.3) 8(20.5) 1(2.6) 0(0.0) 39
Korean medicine clinic 13(27.1) 13(27.1) 9(18.8) 12(25.0) 1(2.1) 0(0.0) 48
Hospital 3(9.7) 9(29.0) 12(38.7) 6(19.4) 0(0.0) 1(3.2) 31

Num: number, Tx: treatment

Table 6
Desired Path to Learn Revised Guideline (Person, Percentage(%))
Korean medicine Association conservative education Internet Introduction of colleagues Korean medicine newspaper Korean Medicine Research Institute promotion Total
Overall response 253(29.7) 438(51.3) 11(1.3) 46(5.4) 105(12.3) 853
2–30s 135(28.3) 250(52.4) 7(1.5) 16(3.4) 69(14.5) 477
40s 118(31.4) 188(50.0) 4(1.1) 30(8.0) 36(9.6) 376
Num of Tx less than 10 131(29.4) 236(53.0) 6(1.3) 18(4.0) 54(12.1) 445
Num of Tx over 10 122(29.9) 202(49.5) 5(1.2) 28(6.9) 51(12.5) 408
Korean medicine clinic 179(30.4) 298(50.7) 10(1.7) 39(6.6) 62(10.5) 588
Hospital 62(32.6) 88(46.3) 1(0.5) 6(3.2) 33(17.4) 190

Num: number, Tx: treatment

Table 7
Major Treatments in Clinic (Person, Percentage(%))
Atx(AP) E F or E Atx(DP) HM Ph Mx CT Tuina TT RICE or PT ET MRT ExT AT Etc Total
Overall response 730(28.5) 249(9.7) 102(4.0) 218(8.5) 78(3.0) 250(9.8) 183(7.2) 505(19.7) 18(0.7) 88(3.4) 96(3.8) 5(0.2) 13(0.5) 11(0.4) 3(0.1) 10(0.4) 2559
2–30s 407(28.4) 157(11.0) 67(4.7) 108(7.5) 54(3.8) 155(10.8) 97(6.8) 245(17.1) 9(0.6) 48(3.4) 62(4.3) 3(0.2) 9(0.6) 6(0.4) 2(0.1) 2(0.1) 1431
40s 323(28.6) 92(8.2) 35(3.1) 110(9.8) 24(2.1) 95(8.4) 86(7.6) 260(23.0) 9(0.8) 40(3.5) 34(3.0) 2(0.2) 4(0.4) 5(0.4) 1(0.1) 8(0.7) 1128
Num of Tx less than 10 381(28.5) 130(9.7) 60(4.5) 125(9.4) 50(3.7) 126(9.4) 98(7.3) 232(17.4) 10(0.7) 50(3.7) 48(3.6) 2(0.1) 8(0.6) 8(0.6) 2(0.1) 5(0.4) 1335
Num of Tx over 10 349(28.5) 119(9.7) 42(3.4) 93(7.6) 28(2.3) 124(10.1) 85(6.9) 273(22.3) 8(0.7) 38(3.1) 48(3.9) 3(0.2) 5(0.4) 3(0.2) 1(0.1) 5(0.4) 1224
Korean medicine clinic 504(28.6) 159(9.0) 65(3.7) 163(9.2) 41(2.3) 158(9.0) 135(7.7) 374(21.2) 12(0.7) 60(3.4) 6(3.5) 5(0.3) 8(0.5) 8(0.5) 2(0.1) 8(0.5) 1764
Hospital 163(28.6) 63(11.1) 23(4.0) 34(6.0) 26(4.6) 72(12.6) 34(6.0) 99(17.4) 4(0.7) 17(3.0) 26(4.6) 0(0.0) 4(0.7) 3(0.5) 0(0.0) 2(0.4) 570

Atx(AP): Acupuncture(selection of adjacent points), E: Electro-Acupuncture, F or E: Fire needling or Electrothermic needle, Atx(DP): Selection of distant points, HM: Herbal Medicine, Ph:Pharmacopuncture, Mx: Moxibustion, CT: Cupping Therapy(including pricking-cupping bloodletting), TT: Taping Therapy, PT: Physical Therapy, ET: Embedding Therapy MRT: Muscle Relaxation Therapy, ExT: Exercise Therapy, AT: Acupotomy Therapy,

Table 8
Satisfactory Treatments in Clinic (Person, Percentage(%))
Atx(AP) E F or E Atx(DP) HM Ph Mx CT Tuina TT RICE or PT ET MRT ExT AT Etc Total
Overall response 714(27.9) 195(7.6) 223(8.7) 90(3.5) 266(10.4) 197(7.7) 573(22.4) 25(1.0) 126(4.9) 98(3.8) 11(0.4) 11(0.4) 17(0.7) 4(0.2) 9(0.4) 0(0.0) 2559
2–30s 396(27.7) 122(8.5) 117(8.2) 58(4.1) 169(11.8) 103(7.2) 286(20.0) 11(0.8) 78(5.5) 63(4.4) 6(0.4) 8(0.6) 11(0.8) 2(0.1) 1(0.1) 0(0.0) 1431
40s 318(28.2) 73(6.5) 106(9.4) 32(2.8) 97(8.6) 94(8.3) 287(25.4) 14(1.2) 48(4.3) 35(3.1) 5(0.4) 3(0.3) 6(0.5) 2(0.2) 8(0.7) 0(0.0) 1128
Num of Tx less than 10 371(27.8) 104(7.8) 124(9.3) 58(4.3) 142(10.6) 106(7.9) 265(19.9) 16(1.2) 65(4.9) 56(4.2) 6(0.4) 8(0.6) 10(0.7) 2(0.1) 2(0.1) 0(0.0) 1335
Num of Tx over 10 343(28.0) 91(7.4) 99(8.1) 32(2.6) 124(10.1) 91(7.4) 308(25.2) 9(0.7) 61(5.0) 42(3.4) 5(0.4) 3(0.2) 7(0.6) 2(0.2) 7(0.6) 0(0.0) 1224
Korean medicine clinic 491(27.8) 126(7.1) 157(8.9) 50(2.8) 167(9.5) 143(8.1) 427(24.2) 19(1.1) 81(4.6) 61(3.5) 9(0.5) 8(0.5) 13(0.7) 3(0.2) 9(0.5) 0(0.0) 1764
Hospital 162(28.4) 48(8.4) 39(6.8) 26(4.6) 74(13.0) 41(7.2) 108(18.9) 4(0.7) 31(5.4) 30(5.3) 2(0.4) 1(0.2) 3(0.5) 1(0.2) 0(0.0) 0(0.0) 570

Atx(AP): Acupuncture(selection of adjacent points), E: Electro-Acupuncture, F or E: Fire needling or Electrothermic needle, Atx(DP): Selection of distant points, HM: Herbal Medicine, Ph:Pharmacopuncture, Mx: Moxibustion, CT: Cupping Therapy(including pricking-cupping bloodletting), TT: Taping Therapy, PT: Physical Therapy, ET: Embedding Therapy MRT: Muscle Relaxation Therapy, ExT: Exercise Therapy, AT: Acupotomy Therapy,

Table 9
Difficult Treatments to Perform (Person, Percentage(%))
Atx(AP) E F or E Atx(DP) HM Ph Mx CT Tuina TT RICE or PT ET MRT ExT AT Etc Total
Overall response 64(2.5) 94(3.7) 227(8.9) 116(4.5) 457(17.9) 226(8.8) 152(5.9) 149(5.8) 275(10.7) 149(5.8) 36(1.4) 235(9.2) 88(3.4) 114(4.5) 159(6.2) 18(0.7) 2559
2–30s 32(2.2) 47(3.3) 148(10.3) 76(5.3) 239(16.7) 125(8.7) 76(5.3) 90(6.3) 163(11.4) 80(5.6) 16(1.1) 122(8.5) 48(3.4) 64(4.5) 95(6.6) 10(0.7) 1431
40s 32(2.8) 47(4.2) 79(7.0) 40(3.5) 218(19.3) 101(9.0) 76(6.7) 59(5.2) 112(9.9) 69(6.1) 20(1.8) 113(10.0) 40(3.5) 50(4.4) 64(5.7) 8(0.7) 1128
Num of Tx less than 10 38(2.8) 43(3.2) 122(9.1) 63(4.7) 216(16.2) 123(9.2) 76(5.7) 92(6.9) 142(10.6) 76(5.7) 21(1.6) 130(9.7) 49(3.7) 65(4.9) 73(5.5) 6(0.4) 1335
Num of Tx over 10 26(2.1) 51(4.2) 105(8.6) 53(4.3) 241(19.7) 103(8.4) 76(6.2) 57(4.7) 133(10.9) 73(6.0) 15(1.2) 105(8.6) 39(3.2) 49(4.0) 86(7.0) 12(1.0) 1224
Korean medicine clinic 47(2.7) 67(3.8) 150(8.5) 77(4.4) 334(18.9) 148(8.4) 106(6.0) 103(5.8) 186(10.5) 110(6.2) 24(1.4) 155(8.8) 60(3.4) 80(4.5) 102(5.8) 15(0.9) 1764
Hospital 12(2.1) 23(4.0) 54(9.5) 27(4.7) 97(17.0) 55(9.6) 35(6.1) 32(5.6) 62(10.9) 30(5.3) 8(1.4) 58(10.2) 18(3.2) 20(3.5) 38(6.7) 1(0.2) 570

Atx(AP): Acupuncture(selection of adjacent points), E: Electro-Acupuncture, F or E: Fire needling or Electrothermic needle, Atx(DP): Selection of distant points, HM: Herbal Medicine, Ph:Pharmacopuncture, Mx: Moxibustion, CT: Cupping Therapy(including pricking-cupping bloodletting), TT: Taping Therapy, PT: Physical Therapy, ET: Embedding Therapy MRT: Muscle Relaxation Therapy, ExT: Exercise Therapy, AT: Acupotomy Therapy,

Table 10
The Reason Why Fire or Electrothermic Needle Difficult to Perform (Person, Percentage(%))
Difficulty of procedure Economic burden Concerns about side effects Low effect compared to cost Low affinity Etc. Total
Overall response 104(49.1) 9(4.2) 51(24.1) 7(3.3) 28(13.2) 13(6.1) 212
2–30s 76(53.1) 5(3.5) 36(25.2) 1(0.7) 14(9.8) 11(7.7) 143
40s 28(40.6) 4(5.8) 15(21.7) 6(8.7) 14(20.3) 2(2.9) 69
Num of Tx less than 10 58(49.6) 5(4.3) 28(23.9) 2(1.7) 19(16.2) 5(4.3) 117
Num of Tx over 10 46(48.4) 4(4.2) 23(24.2) 5(5.3) 9(9.5) 8(8.4) 95
Korean medicine clinic 65(47.1) 4(2.9) 27(19.6) 6(4.3) 25(18.1) 11(8.0) 138
Hospital 30(57.7) 4(7.7) 14(26.9) 1(1.9) 2(3.8) 1(1.9) 52

Num: number, Tx: treatment

Table 11
The Reason Why these are difficult to perform (Person, Percentage(%))
Difficulty of procedure Economic burden Concerns about side effects Low effect compared to cost Low affinity Etc. Total
HM 2 (0.5) 321 (76.6) 1 (0.2) 31 (7.4) 60 (14.3) 4 (1.0) 419
Tuina 62 (24.8) 104 (41.6) 23 (9.2) 37 (14.8) 21 (8.4) 3 (1.2) 250
ET 47 (22.4) 68 (32.4) 33 (15.7) 20 (9.5) 32 (15.2) 10 (4.8) 210
F or E 104 (49.1) 9 (4.2) 51 (24.1) 7 (3.3) 28 (13.2) 13 (6.1) 212
Ph 12 (5.6) 140 (65.4) 32 (15.0) 13 (6.1) 11 (5.1) 6 (2.8) 214
AT 68 (46.9) 6 (4.1) 38 (26.2) 2 (1.4) 25 (17.2) 6 (4.1) 145
CT 58 (41.4) 6 (4.3) 39 (27.9) 5 (3.6) 11 (7.9) 21 (15) 140
TT 26 (19.3) 47 (34.8) 1 (0.7) 14 (10.4) 13 (9.6) 34 (25.2) 135
Mx 37 (26.6) 0 (0) 57 (41.0) 13 (9.4) 20 (14.4) 12 (8.6) 139

HM: Herbal Medicine, ET: Embedding Therapy F or E: Fire needling or Electrothermic needle. Ph:Pharmacopuncture, AT: Acupotomy Therapy, CT: Cupping Therapy(including pricking-cupping bloodletting), TT: Taping Therapy, Mx: Moxibustion

Table 12
Expected Effect of Revised Guideline (Person, Percentage(%))
Establishing the basis of Korean medicine treatment Suggest standardized treatment methods Ankle patient increase National insurance benefits Strengthening the status of Korean medicine as therapeutic medicine Company insurance benefits Etc. No effect Don’t know Total
Overall response 572(22.4) 712(27.8) 303(11.8) 243(9.5) 362(14.1) 309(12.1) 13(0.5) 18(0.7) 27(1.1) 2559
2–30s 323(22.6) 395(27.6) 169(11.8) 148(10.3) 194(13.6) 172(12.0) 9(0.6) 10(0.7) 11(0.8) 1431
40s 249(22.1) 317(28.1) 134(11.9) 95(8.4) 168(14.9) 13(12.1) 4(0.4) 8(0.7) 16(1.4) 1128
Num of Tx less than 10 291(21.8) 375(28.1) 162(12.1) 142(10.6) 186(13.9) 151(11.3) 8(0.6) 7(0.5) 13(1.0) 1335
Num of Tx over 10 281(23.0) 337(27.5) 141(11.5) 101(8.3) 176(14.4) 158(12.9) 5(0.4) 11(0.9) 14(1.1) 1224
Korean medicine clinic 386(21.9) 48(27.6) 210(11.9) 137(7.8) 266(15.1) 231(13.1) 10(0.6) 15(0.9) 23(1.3) 1764
Hospital 135(23.7) 160(28.1) 62(10.9) 81(14.2) 68(11.9) 55(9.6) 3(0.5) 2(0.4) 4(0.7) 570

Num: number, Tx: treatment

참고문헌

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