chuna manual therapy

chuna manual therapy

Gentle corrective force is applied to the spine in order to restore function to its surrounding tissues. This creates tension around the joint and hinders circulation to the area. Decreased circulation then leads to pain. Applying Chuna manipulation to stiff, tender areas of the body restores balance by relieving tension in the tissues. Circulation to the relevant areas is restored, and an increase in the range of motion is observed. Present and Future of Non-Invasive Treatment for Spine and Joint. November 30, 2018 Chuna Manual Therapy may be an unfamiliar term to some. If you haven’t heard of it yet, Chuna is a traditional Korean Medicine manipulation procedure applied to restore function and structural balance, especially to the musculoskeletal system, and thus treat various physiological and pathological conditions using a non-invasive approach. Chuna involves manual stimulation applied to the meridian system to correct malalignment and dysfunctions of the musculoskeletal system, thereby relieving pain and restoring normal physiological function. Musculoskeletal disorders such as spinal disc problems usually require continuous treatment for sustained treatment effects due to the structural and habitual life-style component of the disease. When national insurance coverage of Chuna is implemented in March 2019, it is expected to reduce the financial burden of Chuna treatment to half its current price. By correcting dysfunctions and malalignment of the joints, muscles, and spine, Chuna therapy reduces the pressure load on the intervertebral discs and surrounding tissue, which helps reduce pain caused by nerve root compression.http://cyi0571.com/cyjxfiles/gmrs680-2ck-manual.xml

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However, it may not be the only or most effective treatment option for that disorder or your symptoms, so it is recommended to receive examination and consultation with a licensed Korean Medicine doctor prior to Chuna treatment to be provided with a personal treatment and management plan appropriately tailored to your individual needs and symptoms. Its aim is to restore normal function to dysfunctional organ systems through the recovery of positional and structural balance. When our bones and joints are displaced from their normal position and become dysfunctional, the soft tissue surrounding the bones, ligaments and nerves, and fascia become congested and swell up. Muscles and ligaments also remain tense for prolonged periods of time in an attempt to return the bones to their original position, which leads to muscle soreness, further blood circulation anomalies and congestion, and pain. When the bones and joints are returned to their normal position, the bones, joints, and surrounding tissue regain normal function and movement, and thus the initial pain can be resolved. Its effects have been clinically and empirically proven over the course of many years, and I have worked hard for over 20 years to create a standardized manual therapy that can effectively treat back pain. Based on the traditional approach to Chuna therapy, I continued my research and studies in search of more effective methods to heighten its efficacy, and clinically applied them to verify their effects and safety.For example, we conducted a clinical study on the effects of integrative Korean Medicine treatment focused on Chuna manual therapy in patients with lumbar disc herniation. The long-term treatment effects were shown to be maintained even after 5 years. It is because patients are treated holistically with Korean Medicine through systematic evaluation and diagnosis of the whole body that Chuna therapy can be applied safely with good treatment effects.http://www.elektroserviscz.cz/files/gmrs862-manual.xml

For this reason, it is imperative that you receive Chuna treatment at a certified Korean Medicine medical institution. Present and Future of Non-Invasive Treatment for Spine and Joint Present and Future of Non-Invasive Treatment for Spine and Joint Jaseng Medical Foundation Celebrates 100th Grand Rounds Series. Chuna manual therapy (CMT) combines aspects of physiology, biodynamics of spine and joint motion, and basic theory of movement dynamics. This study aimed to test the comparative effectiveness and safety of CMT for non-acute LBP. Methods A three-arm, multicenter, pragmatic, randomized controlled pilot trial was conducted from 28 March 2016 to 19 September 2016, at four medical institutions. As this was a preliminary study, a well-powered (over 192 participants) two-arm (CMT versus UC) verification trial will be performed to assess the generalizability of these results. Trial registration Clinical Research Information Service (CRIS), KCT0001850. Registered on 12 March 2016. Chuna manual therapy (CMT) is a sub-specialty that seamlessly brings together aspects of physiology, biodynamics of spine and joint motion, and the basic theory of movement dynamics. On the basis of this medical plan, the Korean Ministry of Health and Welfare started a national insurance pilot project covering CMT in 65 traditional Korean medical institutions in 2017. Against this background, it is therefore important to prove the comparative effectiveness and safety of CMT. On the basis of high-quality clinical evidence on CMT, we conducted a pilot study to explore the feasibility of using CMT for LBP, because of social demand, to determine the effectiveness and safety value of CMT in treating non-acute LBP to lay the basis for a future well-designed, high-quality RCT.http://myscadichint.eklablog.com/fundamentals-of-database-systems-solutions-manual-pdf-a203732960

To explore real-life clinical CMT treatment conditions, our first object was to conduct a pilot trial to test the comparative efficacy and safety of CMT as compared to conventional usual care (UC), by comparison of pain, functionality, and adverse events. The Chuna Research Network (CRN) comprised four Korean medical institutions (two university-based Korean medicine hospitals and two spine specialty hospitals) and several expert discussions were conducted to devise a pilot protocol for conducting a trial (once a month). This multicenter, pragmatic, randomized controlled pilot trial, with three parallel arms, was designed to explore the feasibility of a trial to evaluate the clinical efficacy, safety, and cost-effectiveness of using CMT in patients with non-acute LBP. The study protocol was registered with the Clinical Research Information Service (CRIS identifier KCT0001850, 12 March 2016). Other additional treatments (e.g., medications related to pain, acupuncture, procedures, or surgery) not specified in the protocol were not allowed during the 6-week intervention period. Study monitoring was carried out by the Contract Research Organization (CRO), which had no role in the research design and practice at each site. Subjects The study was conducted in four major Korean medicine hospitals in Korea (Pusan National University Korean Medicine Hospital, Kyung Hee University Korean Medicine Hospital at Gangdong, Jaseng Hospital of Korean Medicine, and Mokhuri Neck and Back Hospital) from 28 March 2016, to 19 September 2016. Patients were included in the study only when they met the following criteria: (1) non-acute LBP (with pain duration of 3?weeks or longer) requiring medical attention; (2) average numeric rating scale (NRS) score of more than 5 during the previous week; (3) aged from 19 to 70?years, inclusive; and (4) agreed to trial participation and provided written informed consent.http://ruciturent.eklablog.com/fundamentals-of-differential-equations-6th-edition-solutions-manual-na-a203732964

Briefly, the participants were recruited through advertisements, posters on hospital bulletin boards, and referrals from Korean Medicine doctors (KMDs) in hospitals. Potential participants were asked to answer questions and were evaluated by KMDs or by the clinical research coordinator to determine eligibility. If patients were eligible for trial participation in accordance with the inclusion and exclusion criteria, they were randomized per center and allocated to one of the three groups using block randomization (block size 3). A random sequence was generated by an independent statistician using SAS 9.3 (SAS Institute Inc., Cary, NC, USA). The participants enrolled at the four sites were randomly allocated to groups without stratification by site. Due to the dissimilarity of the interventions, blinding of physicians and participants to allocation of treatment groups was impossible, by nature of the interventions. Only outcome assessors, the statistician, and data analysts were blinded and conducted the outcome assessment in a separate room after treatments were performed by separate physicians. The electronic data that did not contain participants’ information or participants’ allocation were transferred to the statistician and data analysts. All allocations were concealed as far as possible. Usual care Participants assigned to the UC group were administered physiotherapy, oral medication, and 15-min structured education on LBP care. Participants were asked to record drug intake to monitor adherence, and medicine and physiotherapy usage type and frequency in a separate case report form. The duration and frequency of UC group treatment sessions were similar to those in the CMT group. Combined treatment with CMT and usual care Participants assigned to the concurrent CMT and UC group received UC treatment in addition to CMT treatment.

Treatments involved the same method, frequency, session length, total duration, and number of sessions as in the individual treatment groups. Outcomes For the primary outcome, we measured NRS scores of LBP levels for the previous week. NRS scores ranged from 0 to 10, with the higher number indicating greater pain intensity. The ODI questionnaire was used to measure LBP-related disability. It was composed of 10 questions, including questions on daily life, pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, and travelling. The PGIC consisted of 7-level answers, where lower numbers indicated lower treatment satisfaction. The EuroQol-5 dimensions (EQ-5D) health survey was also used to assess secondary outcomes. Each dimension was evaluated by 3-level answers, with the lower score indicating the patient has a better state of health. The maximum lumbar spine angle between a perpendicular line was measured on flexion, extension, lateral bending, and lateral rotation, using a goniometer. A 9-point Likert-scale credibility and expectancy questionnaire was used to assess treatment expectation at the first visit. Cost data were also investigated in this study, but the results of these investigations will be reported in a separate paper. All participants were followed up at 1, 3, and 4?weeks after the 6-week treatment periods. At each visit the participant was assessed before treatment, to record the outcomes of the previous treatment session. Differences in study participants’ characteristics were compared across subgroups using the chi-square test or Fisher’s exact test for categorical variables and analysis of variance or the Kruskal-Wallis test for continuous variables, as appropriate. The paired t test, independent t test, or Wilcoxon’s signed rank test were also employed to assess the differences between assessment points or between two groups.

Analysis of covariance was employed to reduce error from inequality at baseline, using the baseline value as a covariate. We used the Shapiro-Wilk test to check whether the data distribution was normal. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed and the last observed carried forward (LOCF) method was used to impute missing values. All statistical analyses were carried out using SPSS Statistics for Windows 22.0 (IBM Corp. Armonk, NY, USA) statistical software. All tests were two-tailed at the 5% significance level. A significance level of 5% (.All statistical analyses were performed blinded and independently by a statistician. If serious adverse events (SAEs) occurred during the study, unblinding was considered allowable and the physician would inform the relevant IRB and main study site (Pusan National University Korean Medicine Hospital) to decide whether the trial should be continued or terminated. Participants suffering AEs would receive appropriate medical attention and damage compensation. Results Figure 1 shows the flow of participants through the trial. There were 60 participants who responded to the recruitment materials, and 60 were eligible and allocated into three groups at four medical institutions, from 28 March 2016 to 19 September 2016. Four participants dropped out during the treatment period and another participant was eliminated after finishing all the treatments, because of loss to follow up. CMT, Chuna manual therapy; UC, usual care Full size image Table 1 shows the demographic features of the participants at baseline. Table 2 Comparison by treatment group at each assessment period Full size table There were 16 minor-to-moderate AEs that occurred during the trial, but there were no significant differences among the three groups in the frequency of AEs. However, there has been a shortage of well-designed clinical studies supporting its use.

Therefore, we conducted a pilot study to explore the feasibility of a study to evaluate the effectiveness and safety of CMT and to guide the design of a future better-powered full-scale RCT as a national funding project. Here we focused on calculating sample size and analyzing the validity of a future trial that could determine the actual effectiveness of CMT. We further observed whether CMT alone is more effective than UC alone for non-acute LBP in this regard. Changes in the mean ODI favored the use of CMT alone in terms of functional improvement in patients with LBP; this is plausible, as improvement in lumbar spine function is strongly related to pain relief. Therefore, we assumed that differences among the three groups represent a limitation of our pilot study, reflecting participants’ expectations and the bias caused by dissimilar interventions. We also calculated the appropriately powered sample size for a two-arm model. Based on the t test, with a 5% significance level, 80% power, and a 20% drop-out rate, the SD of the NRS score between two groups was presumed to be 3.3, based on an ITT analysis. According to these sample size calculations, a total of 194 participants (97 per group) would need to be recruited for this future trial. With such a two-arm model and the calculated sample size, a future verification trial would be better suited to evaluate the effectiveness and safety of using CMT in combination with UC for managing non-acute LBP in the real-life Korean clinical condition. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study.A review of studies of general patient populations.Acupuncture for chronic low back pain: protocol for a multicenter, randomized, sham-controlled trial. BMC Musculoskelet Disord. 2010;11:118. Article Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: a propensity score matched cohort study. PLoS One. 2017;12(5):e0177255.

Article Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011, Issue 2. Art. No.: CD008112. 8. Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care.Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.Research trends on Chuna treatment in Korean Medicine: Focused on type of clinical trials, published year, academic journals and treatment technique for each used parts. National survey on the use of Korean medicine and Korean herbal medicine. Seoul: Korea Ministry of Health and Welfare, Korea Institute for Health and Social Affairs; 2011. 11-1352000-000547-12.1-554. 14. Park J, Kwon SM. Determinants of the utilization of oriental medical services by the elderly.A study to prepare the health insurance coverage for Chuna manual therapy. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts.Comparative effectiveness and cost-effectiveness of Chuna manual therapy versus conventional usual care for nonacute low back pain: study protocol for a pilot multicenter, pragmatic randomized controlled trial (pCRN study). Trials. 2017;18(1):26. Article The survey on the standardization of Chuna manual technique for operating RCT of non-acute low back pain.A survey among Korea Medicine doctors (KMDs) in Korea on patterns of integrative Korean Medicine practice for lumbar intervertebral disc displacement: preliminary research for clinical practice guidelines. BMC Complement Altern Med. 2015;15(1):432. Article Integrative package for low back pain with leg pain in Korea: a prospective cohort study.Validation in the cross-cultural adaptation of the Korean version of the Oswestry Disability Index.

Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases.A comparative review of four preference-weighted measures of health-related quality of life.Reliability of a measure of total lumbar spine range of motion in individuals with low back pain.KTL wrote the manuscript. EHH, JHC, IHH, KBN, and JHL helped to conceive the trial. BCS, the principal investigator, conceived and controlled the whole process of the trial and revised the manuscript. JYJ, KWK, MRK, and MHL recruited the patients and conducted the trial. NKK acted as an economic evaluation expert and clinical trial expert. JHL supervised the trial. All authors read and approved the final manuscript. Corresponding author Correspondence toThe pilot study was registered on the Clinical Research Information Service (CRIS) on 17 March 2016 (registration number KCT0001850). The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. Download citation Received: 22 January 2018 Accepted: 18 March 2019 Published: 15 April 2019 DOI: Keywords Chuna manual therapy Comparative effectiveness research Low back pain Pilot study Randomized controlled trial. Published by Elsevier. This is an open access article under the CC BY-NC-ND license ( ). This article has been cited by other articles in PMC. Abstract The objectives of this study were to summarize the curriculum, history, and clinical researches of Chuna in Korea and to ultimately introduce Chuna to Western medicine. Information about the history and insurance coverage of Chuna was collected from Chuna-related institutions and papers. Data on Chuna education in all 12 Korean medicine (KM) colleges in Korea were reconstructed based on previously published papers. All available randomized controlled trials (RCTs) of Chuna in clinical research were searched using seven Korean databases and six KM journals.

As a result, during the modern Chuna era, one of the three periods of Chuna, which also include the traditional Chuna era and the suppressed Chuna era, Chuna developed considerably because of a solid Korean academic system, partial insurance coverage, and the establishment of a Chuna association in Korea. All of the KM colleges offered courses on Chuna-related subjects (CRSs); however, the total number of hours dedicated to lectures on CRSs was insufficient to master Chuna completely. Overall, 17 RCTs were reviewed. Of the 14 RCTs of Chuna in musculoskeletal diseases, six reported Chuna was more effective than a control condition, and another six RCTs proposed Chuna had the same effect as a control condition. One of these 14 RCTs made the comparison impossible because of unreported statistical difference; the last RCT reported Chuna was less effective than a control condition. In addition, three RCTs of Chuna in neurological diseases reported Chuna was superior to a control condition. In conclusion, Chuna was not included in the regular curriculum in KM colleges until the modern Chuna era; Chuna became more popular as the result of it being covered by Korean insurance carriers and after the establishment of a Chuna association. Meanwhile, the currently available evidence is insufficient to characterize the effectiveness of Chuna in musculoskeletal and neurological diseases. After obtaining consent from these authors, we reexamined, reconstructed, and translated the contents of the study. 2.1.3. Data on clinical research of Chuna A survey of the electronic literature was conducted in April 2013 using seven Korean databases (Korean Studies Information, DBpia, the Korea Institute of Science and Technology Information, the Research Information Service System, KoreaMed, the National Assembly Library, and the Oriental Medicine Advanced Searching Integrated System). The search terms were “Chuna” or “manipulation.

” We also manually searched six KM journals, which include the Journal of Oriental Rehabilitation Medicine, the Journal of Korean Chuna Manual Medicine for Spine and Nerves, the Journal of Korean Acupuncture and Moxibustion, the Korean Journal of Meridian and Acupoint, the Journal of Oriental Medicine, and the Korean Journal of Physiology and Pathology (searched from their inception to April 2013). Prospective randomized clinical trials (RCTs) related to Chuna for any types of diseases were included for analysis. The main outcome measure was pain reduction in clinical studies of musculoskeletal diseases, and improvement of neurological symptoms in neurological diseases. The overall result was classified as either (1) positive when Chuna was significantly more effective than the control condition in at least one of the outcome measures, (2) neutral when there was no significant difference between Chuna and the control condition, or (3) negative when Chuna was significantly less effective than the control condition. Results with p Trials were eligible for inclusion if Chuna was the sole treatment or an adjunct to other treatment. Control conditions were no treatment, drug treatment, and any other type of intervention. We excluded non-RCTs, uncontrolled observational studies, and case studies. Disagreements between raters were resolved through discussion between the coauthors as necessary. Four authors (T.-Y.P., D.-C.C., E.-H.H., and K.-H.H.) extracted the data systematically using predefined standardized criteria according to the medical condition, treatment interventions, main outcome measure, intergroup differences, and authors’ conclusions. An assessment of each study's quality was conducted by two reviewers (T.-Y.P. and T.-W.M.) and was based on the Cochrane risk of bias criteria, including random sequence generation, allocation concealment, patient blinding, assessor blinding, reporting dropout or withdrawal, and selective outcome reporting. 3.?

Results and discussion 3.1. History and insurance coverage of Chuna Physical manipulation of the body has been used to cure human ailments since ancient times. Although its origins remain unclear, manual procedures are evident in Thai artwork dating back as far as 4000 years. 7 The history of Chuna is divided into the following three periods: the traditional Chuna era (ancient times through 1945), the suppressed Chuna era (1945 through the 1980s), and the modern Chuna era (the 1990s through the present). The history of Chuna and its coverage by insurance carriers are fully explained in Table 1. No Anma or Chuna-related publications existed during the traditional Chuna era. However, some books (Eui-Bang-Yoo-Chui, Hwal-In-Sim-Bang, and Dong-Eui-Bo-Gam) recorded Tao Yin, Anma, and Angyo as health-preservation techniques without using Chuna-related terminology. 11 During the Japanese colonial era (the suppressed Chuna era), Anma was permitted only for the blind. In the modern Chuna era, Chuna-related terminology appeared for the first time, and Chuna techniques that had historically been handed down to others by individuals or groups were integrated to develop the Chuna practice. In 1991, the KSCMM was launched and the Ministry of Health and Society legalized Chuna 14 (Chuna manual therapy is a type of traditional KM, and some of Chuna methods are similar or identical to chiropractic techniques. KM doctors may even use a chiropractic table when applying Chuna to patients) in 1994. Since 1995, Chuna has been accepted as an official part of the curriculum in KM colleges. Furthermore, the journal of the KSCMM has been published biannually since 2000. 15 In 2002, Chuna was approved as a nonpayment item 10 by the National Health Insurance, and in 2005, it was approved for coverage by automobile insurance. 16 Table 1 History and insurance coverage of Chuna. Regarding Chuna-related subjects, the term Tao Yin appeared in a health preservation-related book.

Chuna was passed down by individuals or specific practitioner groups. The terms Chuna and Anma were coused during the Ming dynasty. Since the Qing dynasty, the term Chuna has been used to describe the integrated practice of these and other related terms. Approximately 1550 Hwal-In-Sim-Bang described Tao Yin In 1610 Dong-Eui-Bo-Gam addressed Tao Yin, Anma, Angyo The evolution of manipulation therapy was hampered by a conservative social atmosphere. Anma was taught to the blind as a form of vocational education Suppressed Chuna era From 1945 to the 1980s The evolution of Chuna training courses was hampered. Anma was permitted only for blind practitioners. Modern Chuna era 1991 The Korean Society of Chuna Manual Medicine for Spine and Nerves was established. Chuna practices that were traditionally passed down by individuals or groups were formally integrated. Chuna educational textbooks were published for the first time in 2002, then in 2006 and 2011. Chuna was approved as a nonpayment item by National Health Insurance in 2002 Chuna was approved for covered by automobile insurance carriers in 2005. Henceforward, Anma was introduced into Korea and Japan from China. Anma practitioners use common massage techniques such as kneading, rubbing, tapping, and shaking. KM, Korean medicine. Traditional Chuna therapy resulted from various clinical experiences, but modern Chuna, which basically is based on traditional Chuna, represents the combination of traditional practice and modern scientific knowledge in fields such as anatomy, physiology, and pathology. 11, 12, 13 Chuna has evolved by integrating aspects of Chinese Tuina, American chiropractic and osteopathy, and Japanese manipulation techniques. 14 3.2. Education of CRSs in Korea All of the KM colleges in Korea (11 private colleges and 1 national college) were found to include CRSs in their curricula. Generally, CRS included Chuna, oriental rehabilitation medicine (ORM), and musculoskeletal oriental medicine (MOM).

A detailed CRS curriculum for each KM college is presented in Table 2. Of the 12 colleges, eight belonged to Classification I, which meant that the curriculum contained an independent Chuna lecture that was not merged with ORM or MOM. The remaining colleges belonged to Classification II, which meant that the Chuna lecture was merged with ORM or MOM. It is very important for KM colleges to be equipped with CRS courses pertaining to its practice and theory as opposed to general clinical practice (GCP). The CRS practice should not be included as a part of GCP training because manual therapies such as Chuna require specific training. The CRS in three of the KM colleges was offered as an elective, but in the remaining nine schools, CRS was a mandatory subject. The total number of lecture units allocated to CRS (A) ranged from four to eight, whereas the total number of lecture units (B) ranged from 172 to 273 units in the entire 6-year curriculum. The ratio of A to B (less than 3.33 over the entire curriculum) is too small; at least 30 subjects are included in the curricula of KM colleges. This deficiency is striking, especially when compared with the World Health Organization (WHO) manipulation guidelines, 17 which require a total of 4465 hours over 4 years of full-time study. To compensate for the shortage of CRS lessons in the KM curriculum, the KSCMM annually offers a Chuna training course (approximately 126 hours for 1 year 15 ) for KM doctors. In the near future, a specialized curriculum that has a sufficient number of lesson hours devoted to Chuna must be established. Table 2 Education on Chuna-related subjects for all 12 colleges in Korea. Classification I includes an independent Chuna lecture that is not combined with ORM or MOM. However, in Classification II, there is no independent Chuna lecture. Of these studies, 804 were excluded. The exclusion criteria are described in Figure 1.