A Web-based Survey Research on Improving and Utilizing Korean Medicine Clinical Practice Guideline for Ankle Sprain

Ji-Eun Lee; Jin-Bong Choi; Do-Hyeong Kim; Hyun-Jin Jeong; Jae-Hong Kim; Lee, Ji-Eun; Choi, Jin-Bong; Kim, Do-Hyeong; Jeong, Hyun-Jin; Kim, Jae-Hong

doi:10.13048/jkm.19013

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

Original Article

The Journal of Korean Medicine 2019; 40(2): 1-16.

Published online: June 30, 2019

DOI: https://doi.org/10.13048/jkm.19013

A Web-based Survey Research on Improving and Utilizing Korean Medicine Clinical Practice Guideline for Ankle Sprain

Ji-Eun Lee¹

, Jin-Bong Choi¹

, Do-Hyeong Kim¹

, Hyun-Jin Jeong³

, Jae-Hong Kim²

¹Department of Korean Rehabilitation, College of Korean Medicine, Dong-Shin University

²Department of Korean Internal Medicine, College of Korean Medicine, Dong-Shin University

³Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Dong-Shin University

Correspondence to: 김재홍, 광주광역시 남구 월산동 동신대 부속 광주한방병원 침구의학과, Tel: +82-62-350-7209, Fax: +82-62-350-7551, E-mail: nahonga@hanmail.net

Received April 17, 2019 Revised May 16, 2019 Accepted May 21, 2019

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

Keywords: Ankle Sprain, Korean Medicine Practice Guideline, Web-based Survey Research

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
Sex	653(76.7)				200(23.4)				Total
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

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

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

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