Sylvia Binting

Change in quality of life in the year following cardiac rehabilitation

The aim of the present study was to assess change in health-related quality of life (HRQoL) after cardiac rehabilitation in the usual care setting, and to determine predictors for change. In the Post Infarction Care Study, 2441 patients were consecutively included at admission to 18 inpatient cardiac rehabilitation centres following coronary events. HRQoL was assessed with the SF-36 questionnaire at baseline as well as 6 and 12 months after discharge. HRQoL improved significantly in patients after coronary artery bypass grafting (CABG) but not in patients after myocardial infarction. Significant baseline predictors for change of the SF-36 physical component summary (PCS) score were the exercise ECG result at admission (0.59 absolute change/10-watt increase; 95% CI: 0.39, 0.79), an income ≥ 1750 € (1.64; 95% CI: 0.35, 2.93), baseline PCS score (−0.63; 95% CI: −0.69, −0.57), and CABG as indication for admission (3.65; 95% CI: 2.27, 5.04). Significant predictors for change of the mental component summary (MCS) score were age (1.28/10-year increase; 95% CI: 0.62, 1.94), East Germany as area of residence (2.62; 95% CI: 1.32, 3.91), baseline MCS score (−0.58; 95% CI: −0.63, −0.52), and CABG as indication for admission (1.68; 95% CI: 0.36, 3.01). The identification of predictors of HRQoL in the present study may aid in the further development and evaluation of cardiac rehabilitation programmes.

Pulsatile dry cupping in patients with osteoarthritis of the knee - a randomized controlled exploratory trial

IntroductionCupping is used in various traditional medicine forms to relieve pain in musculoskeletal diseases. The aim of this study was to investigate the effectiveness of cupping in relieving the symptoms of knee osteoarthritis (OA).MethodsIn a two-group, randomized controlled exploratory pilot study patients with a clinically and radiological confirmed knee OA (Kellgren-Lawrence Grading Scale: 2-4) and a pain intensity > 40 mm on a 100 mm visual analogue scale (VAS) were included. 40 Patients were randomized to either 8 sessions of pulsatile dry cupping within 4 weeks or no intervention (control). Paracetamol was allowed on demand for both groups. Outcomes were the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the pain intensity on a VAS (0 mm = no pain to 100 mm = maximum intensity) and Quality of Life (SF-36) 4 and 12 weeks after randomization. Use of Paracetamol was documented within the 4-week treatment period. Analyses were performed by analysis of covariance adjusting for the baseline value for each outcome.Results21 patients were allocated to the cupping group (5 male; mean age 68 ± SD 7.2) and 19 to the control group (8 male; 69 ± 6.8). After 4 weeks the WOMAC global score improved significantly more in the cupping group with a mean of 27.7 (95% confidence interval 22.1; 33.3) compared to 42.2 (36.3; 48.1) in the control group (p = 0.001). After 12 weeks the WOMAC global score were still significantly different in favor for cupping (31.0 (24.9; 37.2) vs. 40.8 (34.4; 47.3) p = 0.032), however the WOMAC subscores for pain and stiffness were not significant anymore. Significantly better outcomes in the cupping group were also observed for pain intensity on VAS and for the SF-36 Physical Component Scale compared to the control group after 4 and 12 weeks. No significant difference was observed for the SF-36 Mental Component Scale and the total number of consumed Paracetamol tablets between both groups (mean 9.1, SD ± 20.0 vs. 11.5 ± 15.9).ConclusionIn this exploratory study dry cupping with a pulsatile cupping device relieved symptoms of knee OA compared to no intervention. Further studies comparing cupping with active treatments are needed.Trial registrationClinicaltrials.gov Identifier: NCT01057043

Use of complementary and alternative medicine by older adults – a cross-sectional survey

BackgroundVery little is known about complementary and alternative medicine (CAM) use by older adults in Germany. The aim of this study was to investigate the use of CAM and other health promoting substances (e.g., herbal teas) by older adults of at least 70 years of age.MethodsA cross-sectional questionnaire study was conducted among persons of ≥70 years from metropolitan Berlin and rural parts of Brandenburg, Germany. Recorded were: demographics, current use of CAM, medical diagnoses, users’ opinions and preferences.ResultsA total of 400 older adults, living as ‘self-reliant’ (n = 154), ‘home care service user’ (n = 97), or ‘in nursing home’ (n = 149), and with the legal status ‘without guardian’ (n = 355) or ‘with guardian’ (n = 45) were included (mean age 81.8 ± 7.4 years, 78.5% female). Any type of CAM used 61.3% of respondents (dietary supplements 35.5%, herbal medicines 33.3%, and external preparations 26.8%); 3.0% used drug-interaction causing preparations. Usage was based on recommendations (total 30.3%; in 20.0% by friends or family and 10.4% by pharmacists), own initiative (27.3%), and doctors’ prescription (25.8%). Participants with legal guardian took almost solely prescribed dietary supplements. Of the others, only half (58.7%) informed their general practitioner (GP) of their CAM use. Participants expected significant (44.9%) or moderate (37.1%) improvement; half of them perceived a good effect (58.7%) and two-thirds (64.9%) generally preferred a combination of CAM and conventional medicine. More than half (57.9%) stated that they could neither assess whether their CAM preparations have side effects, nor assess what the side effects might be. Strongest predictors for CAM use were two treatment preferences (vs. ‘conventional only’: ‘CAM only’, OR = 3.98, p = 0.0042 and ‘CAM + conventional’, 3.02, 0.0028) and the type of health insurance (‘statutory’ vs. ‘private’, 3.57, 0.0356); against CAM use two subjective assessments predicted (vs. ‘CAM causes no harm’: ‘CAM causes harmful drug interactions’, 0.25, 0.0536 and ‘I cannot assess side effects’, 0.28, 0.0010).ConclusionOlder German adults frequently use CAM. They perceived it as an effective complement to conventional medicine, but are not sufficiently informed about risks and benefits.

Mindful Walking in Psychologically Distressed Individuals: A Randomized Controlled Trial

Background. The aim of this randomized, controlled study was to investigate the effectiveness of a mindful walking program in patients with high levels of perceived psychological distress. Methods. Participants aged between 18 and 65 years with moderate to high levels of perceived psychological distress were randomized to 8 sessions of mindful walking in 4 weeks (each 40 minutes walking, 10 minutes mindful walking, 10 minutes discussion) or to no study intervention (waiting group). Primary outcome parameter was the difference to baseline on Cohens Perceived Stress Scale (CPSS) after 4 weeks between intervention and control. Results. Seventy-four participants were randomized in the study; 36 (32 female, 52.3 ± 8.6 years) were allocated to the intervention and 38 (35 female, 49.5 ± 8.8 years) to the control group. Adjusted CPSS differences after 4 weeks were −8.8 [95% CI: −10.8; −6.8] (mean 24.2 [22.2; 26.2]) in the intervention group and −1.0 [−2.9; 0.9] (mean 32.0 [30.1; 33.9]) in the control group, resulting in a highly significant group difference (P < 0.001). Conclusion. Patients participating in a mindful walking program showed reduced psychological stress symptoms and improved quality of life compared to no study intervention. Further studies should include an active treatment group and a long-term follow-up.

Berufliche wiedereingliederung nach kardiologischer rehabilitation

SummaryReturn to work in patients after cardiac rehabilitationObjectives: The objectives of the present study were to determine prospectively return to work and its predictors in patients after cardiac rehabilitation. Methods: Patients were enrolled at admission to inpatient cardiac rehabilitation centres (n = 18). Primary indications for admission were myocardial infarction, coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. Results: We included 2441 consecutive patients (1907 men, mean age: 60 ± 10 years; 534 women, mean age: 65 ± 10 years). A total of 43% of all patients had been actively employed before the event. Of these patients, 65% had returned to work six months and 67% 12 months after cardiac rehabilitation. Successful return to work after 12 months was significantly predicted by younger age, non-manual work, self-employment, a higher physical and mental quality of life, and a better exercise ECG result. Conclusions: Return to work is predicted by sociodemographic factors, quality of life, and the exercise ECG at the rehabilitation centre. The determination of early predictors for return to work may aid to identify patients particularly at risk for failure to return to work.

Impact of acupuncture on antihistamine use in patients suffering seasonal allergic rhinitis: secondary analysis of results from a randomised controlled trial

Background Seasonal allergic rhinitis (SAR) is a common disease that has detrimental effects on the quality of life (QoL) of affected individuals. Approximately 18% of patients try to alleviate their symptoms through acupuncture. The ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) study (ClinicalTrials.gov registration no. NCT00610584) assessed the impact of acupuncture on SAR, showing significant improvements in rhinitis-specific QoL (RQoL) and in rescue medication (RM) use. Objective A secondary analysis of SAR patients’ use of antihistamine. Methods Patients were randomised into three study groups: acupuncture plus RM, sham acupuncture plus RM, and RM alone. The patients documented their medication use before and during the intervention period (8 weeks). The main outcome was the number of days with antihistamine use. Statistical analyses were conducted using parametric and non-parametric tests. The robustness of the results was tested by sensitivity analyses using non-parametric bootstrapping. Results The data from 414 patients were analysed. The acupuncture group used antihistamines significantly less often compared with the other groups (acupuncture vs sham acupuncture: mean difference −4.49 days, p=0.01; acupuncture vs RM: mean difference −9.15 days, p<0.001). Approximately 38% of the acupuncture group did not use any antihistamine in contrast to only 16% in the RM group. The pre-post comparison suggested that the acupuncture patients did not need to increase the days of antihistamine use to alleviate their symptoms, unlike the other groups. Conclusions Acupuncture appeared to significantly reduce the number of days of antihistamine use while improving RQoL and SAR symptoms; it can therefore be considered a valuable, additional treatment option for patients with SAR. Trial Registration Number NCT00610584; Post-results.

Acupuncture in Patients with Allergic Asthma: A Randomized Pragmatic Trial

BACKGROUND Although the available evidence is insufficient, acupuncture is used in patients suffering from chronic asthma. The aim of this pragmatic study was to investigate the effectiveness of acupuncture in addition to routine care in patients with allergic asthma compared to treatment with routine care alone. METHODS Patients with allergic asthma were included in a randomized controlled trial and randomized to receive up to 15 acupuncture sessions over 3 months or to a control group receiving routine care alone. Patients who did not consent to randomization received acupuncture treatment for the first 3 months and were followed as a cohort. All trial patients were allowed to receive routine care in addition to study treatment. The primary endpoint was the asthma quality of life questionnaire (AQLQ, range: 1-7) at 3 months. Secondary endpoints included general health related to quality of life (Short-Form-36, SF-36, range 0-100). Outcome parameters were assessed at baseline and at 3 and 6 months. RESULTS A total of 1,445 patients (mean age 43.8 [SD 13.5] years, 58.7% female) were randomized and included in the analysis (184 patients randomized to acupuncture and 173 to control, and 1,088 in the nonrandomized acupuncture group). In the randomized part, acupuncture was associated with an improvement in the AQLQ score compared to the control group (difference acupuncture vs. control group 0.7 [95% confidence interval (CI) 0.5-1.0]) as well as in the physical component scale and the mental component scale of the SF-36 (physical: 2.5 [1.0-4.0]; mental 4.0 [2.1-6.0]) after 3 months. Treatment success was maintained throughout 6 months. Patients not consenting to randomization showed similar improvements as the randomized acupuncture group. CONCLUSIONS In patients with allergic asthma, additional acupuncture treatment to routine care was associated with increased disease-specific and health-related quality of life compared to treatment with routine care alone.

The Effect of Attending Steiner Schools during Childhood on Health in Adulthood: A Multicentre Cross-Sectional Study

Background It is speculated that attending Steiner schools, whose pedagogical principles include an account for healthy psycho-physical development, may have long-term beneficial health effects. We examined whether the current health status differed between former attendees of German Steiner schools and adults from the general population. Furthermore, we examined factors that might explain those differences. Methods We included former Steiner school attendees from 4 schools in Berlin, Hanover, Nuremberg and Stuttgart and randomly selected population controls. Using a self-report questionnaire we assessed sociodemographics, current and childhood lifestyle and health status. Outcomes were self-reports on 16 diseases: atopic dermatitis, allergic rhinitis, bronchial asthma, chronic obstructive pulmonary disease (COPD), cardiac arrhythmia, cardiac insufficiency, angina pectoris, arteriosclerosis, hypertension, hypercholesterolemia, osteoarthritis, rheumatism, cancer, diabetes, depression and multiple sclerosis. Furthermore, participants rated the symptom burden resulting from back pain, cold symptoms, headache, insomnia, joint pain, gastrointestinal symptoms and imbalance. Unadjusted and adjusted odds ratios were calculated for each outcome. Results 1136 Steiner school attendees and 1746 controls were eligible for analysis. Both groups were comparable regarding sex, age and region, but differed in nationality and educational status. After adjusting for possible confounders, we found statistically significant effects of Steiner school attendance for osteoarthritis (OR 0.69 [0.49–0.97]) and allergic rhinitis (OR 0.77, [0.59–1.00]) as well as for symptom burden from back pain (OR 0.80, [0.64–1.00]), insomnia (OR 0.65, [0.50–0.84]), joint pain (OR 0.62, [0.48–0.82]), gastrointestinal symptoms (OR 0.76, [0.58–1.00]) and imbalance (OR 0.60, [0.38–0.93]). Conclusions The risk of most examined diseases did not differ between former Steiner school attendees and the general population after adjustment for sociodemographics, current and childhood lifestyle features, but symptom burden from some current health complaints was reported less by former Steiner school attendees. Results must be interpreted with caution since the analysis was exploratory.

Akupunktur bei Patienten mit allergischer Rhinitis: Analyse der Studienintervention und Syndrommuster der randomisierten Multicenter Studie (ACUSAR)

ZusammenfassungHintergrundIn der DFG-geförderten ACUpuncture in Seasonal Allergic Rhinitis (ACUSAR) Studie bei Patienten mit allergischer Rhinitis war Akupunktur wirksamer im Vergleich zu Sham-Akupunktur und zu einer Kontrollgruppe, die nur Bedarfsmedikation erhielt. In diesem Artikel werden die Studienintervention, die zugrunde liegenden theoretischen Überlegungen der Chinesischen Medizin und auch die Lehren für weitere Studien und die Praxis dargestellt.StudiendesignDreiarmige, randomisierte, kontrollierte Multicenter-Studie mit einem Follow-up von 16 Wochen im ersten Jahr und weiteren acht Wochen im Folgejahr.StudienzentrenSechs Kliniken bzw. Universitätsambulanzen und 32 Privatpraxen in Deutschland.StudieninterventionInsgesamt wurden 422 Patienten mit saisonaler allergischer Rhinitis und nachgewiesener Allergie gegen Birken- und Gräserpollen in drei Gruppen randomisiert: Die Akupunkturgruppe erhielt zwölf semi-standardisierte Behandlungen (vier obligatorische Punkte, mindestens drei von acht fakultativen Basis-Punkten und mindestens drei andere lokale, Ohr- oder Fernpunkte und bei Bedarf eine „Rescue“ Medikation (RM) (Cetirizin). Die Sham-Akupunkturgruppe wurde zwölfmal an Nicht-Akupunkturpunkten genadelt (genau vorgegebene Punkte, streng oberflächliche Nadelung, beidseits mindestens fünf bis sieben Punkte) und konnte RM einnehmen, die Wartelistengruppe erhielt acht Wochen nur RM und wurde dann nach dem Akupunkturschema behandelt. Die Studienintervention wurde im Rahmen eines Delphi-Prozesses festgelegt, an dem fünf Experten von zwei größeren Akupunkturgesellschaften und drei Experten in Studienmethodologie teilnahmen.ErgebnisseDie häufigsten Syndromdiagnosen waren „Wind-Kälte“ und „Wind-Hitze“ im Funktionskreis (FK) Lunge mit je 37 % der Patienten. Bei der Behandlung der Akupunkturgruppe wurden die vorgegebenen obligatorischen Basispunkte in 97 % der Behandlungen genadelt (Di 4, Di 11, Di 20, EX-KH 3 Yintang). Gb 20, Le 3, Ma 36, Lu 7 und Mi 6 waren die am häufigsten gewählten optionalen Akupunkturpunkte. Durchschnittlich wurden in einer Akupunkturbehandlung 15,7 (± 2,5) Nadeln gesetzt, bei der Behandlung mit Sham-Akupunktur 10,0 (± 1,6).SchlussfolgerungIn der Akupunkturgruppe entsprachen die gestellten Diagnosen sowie die Punkteauswahl den klinischen Erfahrungen in der Behandlung der SAR. In der Akupunkturgruppe wurden mehr Akupunkturnadeln als in der Sham-Akupunkturgruppe eingesetzt. Beides sind mögliche Gründe für die höhere Wirksamkeit der Verum-Akupunktur in dieser Studie.AbstractBackgroundAcupuncture was efficient and superior to sham acupuncture and a control group in the ACUpuncture in Seasonal Allergic Rhinitis (ACUSAR) trial. The article aims to inform about the study intervention, the underlying therapeutic ideas and clinical consequences.DesignThree-armed, randomized, controlled multi-center-trial with a 16-week follow-up during the SAR season in the first trial year and an 8 week follow-up during the SAR season in the following year.SettingOutpatient or private clinics in Germany.Intervention422 Patients with seasonal allergic rhinitis on birch and grass pollen have been randomized to fall into 3 groups: 12 sessions of semi-standardised acupuncture plus rescue medication (RM, Cetirizine) or 12 sessions of sham acupuncture plus RM or RM alone during the initial two months of the study. Study intervention was defined in a Delphi consensus procedure including five experts from two major German acupuncture associations and three experts on trial methodology and statistics. A consensus between the need for standardisation and individualisation was defined using a semi-standardised treatment in the acupuncture group: 4 obligatory acupuncture points, ≥ 3 out of 8 facultative basic points and ≥ 3 facultative local or distant acupuncture points. Sham acupuncture consisted in superficial needling of at least 5 of 7 predefined, bilateral, distant non-acupuncture points. Needling characteristics such as point location, needling time, manipulation and achieved ‘De Qi’ had to be documented after each session.ResultsCM syndrome diagnoss reported most frequently were Wind-Cold invading the lung’ and ‘Wind-Heat invading the lung’ (37 % each). In the acupuncture group all basic obligatory points were used in 97 % of cases (LI 4, LI 11, LI 20, EX-HN 3 Yintang). The most frequently used basic optional acupuncture points were GB 20, LIV 3, ST 36, LU 7 and SP 6. The total number of needles used was higher in the acupuncture group (15.7 ± 2.5) compared to the sham acupuncture group (10.0 ± 1.6).ConclusionsCM syndrome diagnoses and point selection in the acupuncture group of the trial corresponded to clinical experiences in CM treatment of SAR. Point location and a higher number of needles in the acupuncture group compared to the sham acupuncture group may have influenced the positive trial results.

Akupunktur bei Patienten mit allergischer Rhinitis – Analyse der Studienintervention und Syndrommuster der randomisierten Multicenter-Studie ACUSAR@@@Acupuncture in Patients with Allergic Rhinitis – An Analysis of the Study Intervention and Syndrome Patterns in the Randomised Multi-Centre-Trial ACUSAR

ZusammenfassungHintergrund: In der DFG-geförderten „ACUpuncture in Seasonal Allergic Rhinitis“- (ACUSAR-) Studie bei Patienten mit allergischer Rhinitis war Akupunktur wirksamer im Vergleich zu Sham-Akupunktur und zu einer Kontrollgruppe, die nur Bedarfsmedikation erhielt. In diesem Artikel werden die Studienintervention, die zugrunde liegenden theoretischen Überlegungen der chinesischen Medizin und auch die Lehren für weitere Studien und die Praxis dargestellt.Studiendesign: Dreiarmige, randomisierte, kontrollierte Multicenter-Studie mit einem Follow-up von 16 Wochen im ersten Jahr und weiteren 8 Wochen im Folgejahr.Studienzentren: 6 Kliniken bzw. Universitätsambulanzen und 32 Privatpraxen in Deutschland.Studienintervention: Insgesamt wurden 422 Patienten mit saisonaler allergischer Rhinitis und nachgewiesener Allergie gegen Birken- und Gräserpollen in 3 Gruppen randomisiert: Die Akupunkturgruppe erhielt 12 semi-standardisierte Behandlungen (4 obligatorische Punkte, mindestens 3 von 8 fakultativen Basis-Punkten und mindestens 3 andere lokale Ohr- oder Fernpunkte) und bei Bedarf eine „Rescue“-Medikation (RM) (Cetirizin). Die Sham-Akupunktur-Gruppe wurde 12-mal an Nicht-Akupunktur-Punkten genadelt (genau vorgegebene Punkte, streng oberflächliche Nadelung, beidseits mindestens 5−7 Punkte) und konnte RM einnehmen, die Wartelisten-Gruppe erhielt 8 Wochen lang nur RM und wurde dann nach dem Akupunktur-Schema behandelt. Die Studienintervention wurde im Rahmen eines Delphi-Prozesses festgelegt, an dem fünf Experten von zwei größeren Akupunkturgesellschaften und drei Experten in Studienmethodologie teilnahmen.Ergebnisse: Die häufigsten Syndrommuster waren „Wind-Kälte“ (algor venti, fenghan) und „Wind-Hitze“ (calor venti, fengre) im Funktionskreis (Fk) „Lunge“ (o. pulmonalis, fei) mit je 37 % der Patienten. Bei der Behandlung der Akupunkturgruppe wurden die vorgegebenen obligatorischen Basispunkte in 97 % der Behandlungen genadelt (Di4/IC4 [«Vereinte Täler», hegu], Di11/IC11 [„Gekrümmter Teich“, quchi], Di20/IC20 [„Empfangen der Wohlgerüche“, yingxiang] und Ex-HN 3/Ex1 [„Siegelhalle“, yintang]). Gb20/F20 („Teich des Windes“, fengchi), H3/Le3 („Die mächtige große Straße“, taichong), S36/Ma36 („Dritter Weiler am Fuß“, zusanli), Lu7/P7 („Reihe von Lücken“, lieque) und L6/Mi6 („Die Verbindung der drei Yin“, sanyinjiao) waren die am häufigsten gewählten optionalen Akupunkturpunkte. Durchschnittlich wurden in einer Akupunkturbehandlung 15,7 (± 2,5) Nadeln gesetzt, bei der Behandlung mit Sham-Akupunktur 10,0 (± 1,6).Schlussfolgerung: Die Untersuchung der Studienintervention zeigt, dass in der Akupunkturgruppe die Studienintervention der chinesischen Syndromdiagnose entsprechend ausgerichtet war. Insgesamt wurden in der Akupunkturgruppe mehr Akupunkturnadeln als in der Sham-Akupunktur-Gruppe eingesetzt. Beides sind mögliche Gründe für die Wirksamkeit der Akupunktur in dieser Studie.AbstractBackground: Acupuncture was efficient and it was superior to sham acupuncture and a waiting list control in the ACUpuncture in Seasonal Allergic Rhinitis (ACUSAR) trial. This article aims to inform about the study intervention, the underlying therapeutic ideas and the clinical consequences.Design: A three armed, randomized, controlled multi-centre-trial with a 16-week follow-up during the SAR season in the first trial year and an 8 week follow-up during the SAR season in the following year.Setting: Outpatient or private clinics in Germany.Intervention: 422 patients with seasonal allergic rhinitis on birch and grass pollen have been randomised in 3 groups: 12 sessions of semi-standardised acupuncture plus rescue medication (RM, Cetirizine) or 12 sessions of sham acupuncture plus RM or RM alone during the initial two months of the study. Study intervention was defined in a Delphi consensus procedure including five experts from two major German acupuncture associations and three experts on trial methodology and statistics. A consensus between the need for standardisation and individualisation was defined in using a semi-standardised treatment in the acupuncture group: 4 obligatory acupuncture points, ≥3 out of 8 facultative basic points and ≥3 facultative local or distant acupuncture points, but an individual choice of additional body or ear acupuncture points was possible. Sham acupuncture consisted of superficial needling of at least 5 of 7 predefined, bilateral, distant non-acupuncture points. Needling characteristics such as point location, needling time, manipulation and achieved ‘De Qi’ had to be documented after each session and before the first treatment.Results: The CM syndrome diagnose most frequently reported was ‘Wind-Cold invading the lung’ (37%) and ‘Wind-Heat invading the lung’ (37% each). In the acupuncture group all basic obligatory points were used in 97% of cases (L.I. 4, L.I. 11, L.I. 20, EX-HN 3 YINTANG), the most frequently used basic optional acupuncture points were GB 20, LIV 3, ST 36, LU7 and SP6. The total number of needles used was with 15.7 ± 2.5 higher in the acupuncture group compared to 10.0 ± 1.6 in the sham acupuncture group.Conclusions: CM syndrome diagnoses and point selection in the acupuncture group of the trial corresponded to clinical experiences in CM treatment of SAR. Beside point location, a higher number of needles in the acupuncture group compared to the sham acupuncture group may have influenced the positive trial results.