The main goal of geriatric rehabilitation reconditioning following an acute illness is rapid restoration of normal activity. Key elements are pain control, restoration of bowel function, sleep, appetite and general well being, alongside physical activity. The aim of this retrospective study was to assess the effect of acupuncture as an adjunct to medical and physical rehabilitation in geriatric patients. The setting was a university-affiliated large city general hospital. The participants comprised 27 consenting consecutive patients in a subacute geriatric rehabilitation department. The interventions consisted of biweekly acupuncture treatment in conjunction with medical and physical therapy. The outcome measures of pain, appetite, quality of sleep, bowel function and general well being were assessed using a 10-point Likert scale at the onset and close of treatment. The results showed that a significant post-treatment improvement was seen in pain (p=0.005), appetite (p=0.0034), bowel function (p=0.029) and general well being (p=0.0012) scores in patients' treatment when compared with pretreatment baseline scores. The “quality of sleep” score showed a trend towards improvement (p=0.073). In conclusion, acupuncture may be beneficial as an adjunctive treatment in geriatric postacute illness rehabilitation. Randomized controlled trials are needed to further assess the role of acupuncture as part of treatment management for restoring normal physical activity in geriatric patients.

The main goal of geriatric rehabilitation following an acute illness is rapid restoration of normal activity [1, 2]. The key elements are pain control, restoration of bowel function, good sleep quality, appetite and general well being, as well as return to pre-illness physical capabilities. Emphasis has recently been placed on finding innovative multidisciplinary methods that can improve the care of elderly people who had suffered an acute illness [3, 4].

Originating 2500 years ago in China, acupuncture is one of the most widespread forms of complementary and alternative medicine (CAM) in the USA and Europe [5, 6, 7]. The general theory of acupuncture is based on the premise that disruptions of natural balanced energy flow (Qi) are responsible for disease pathogenesis. The use of acupuncture is aimed at correcting these imbalances and restoring health by the stimulation of anatomic points on the skin with thin metallic needles that are usually manipulated by the practitioner's hands or by electrical stimulation. The National Institutes of Health Consensus Panel on Acupuncture (1997) concluded that acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program for avoiding the use or reducing the dose of conventional medication [8].

The aim of this retrospective study was to investigate the effect of acupuncture as an adjuvant to medical and physical rehabilitation in a group of geriatric patients. Studies on morbidity and mortality predictors among geriatric patients have found that health self-assessment is a good indicator of both general health and well being, as well as a good predictor of mortality [9, 10, 11]. A positive perception of health is linked to improved recovery from severe illness [9], while individuals who perceive their own health as being poor have significantly higher rates of mortality [10, 11]. The link between self-assessment of health and outcome is independent of other objective parameters in the geriatric patient. Based on the results of this study, a phase II clinical randomized study was initiated to further explore the role of acupuncture in a geriatric rehabilitation setting.

2.1. Study design and participants

We retrospectively reviewed all patients treated by acupuncture at the Geriatric Rehabilitation Department in the Tel Aviv Sourasky Medical Center during 2003. All study participants were inpatients who had suffered an acute illness after surgery for falls resulting in a hip fracture either per trochanteric or subcapital. Three patients were rehabilitated after de-conditioning due to infection and long bed stays with or without neurologic damage. All patients treated were cognitively normal (Mini Mental Status Examination test scores above 24 and were not diagnosed as depressed).

2.2. Treatment

A team of accredited acupuncture practitioners selected acupuncture points on the basis of traditional Chinese medicine (TCM) treatment methods found to be effective for geriatric rehabilitation. The protocol points were chosen upon TCM diagnosis in order to recognize the meridians involved in each individual patient. The protocol was generally aimed to tonify the kidney, spleen and stomach Qi and to harmonize the liver. This commonly included the following points: ST-36, SP-6, LIV-3, LI-4, LI-10, and KID-3.

The standard acupuncture intervention entailed the insertion of exposable sterile 0.16 mm-thick needles manufactured by Seirin, Japan, and imported by Medicin Bom Company with Israeli Health Department approval. Acupuncture was performed after the skin was wiped with alcohol at the specific point. Needles were left in place for a period of 20 minutes and manually manipulated every 5 minutes.

Patients were usually treated for a period of 2–3 weeks in these facilities. The treatment was administered twice weekly, in addition to conventional therapy. Acupuncture treatment was stopped when patients were discharged from hospital upon being able to walk independently with a walker. The patients were recommended to continue regular medication and ambulatory physiotherapy according to standard medical protocols.

2.3. Measurements

Our primary outcome measures were changes in the degree of pain, quality of appetite, quality of sleep, nature of bowel function, and general well being. The evaluation was assessed using a 10-point Likert scale at baseline and again at the end of treatment.

2.4. Statistical analysis

Comparison between the two sets of results was performed using the Wilcoxon signed rank test. Significance was set at p < 0.05. All statistical analyses were performed using SAS version 9.13 for Windows.

The records from 27 consecutive patients in the geriatric rehabilitation department, who underwent acupuncture treatment, were analyzed for the study. Table 1 lists the baseline characteristics of these patients. Analyses of the pre- and post-treatment scores showed a statistically significant improvement in the categories of pain (p = 0.005), appetite (p = 0.0034), bowel function (p = 0.029), and general well being (p = 0.0012) in patients after the final treatment (Table 2). There was a trend of improvement in the score for the quality of sleep (p = 0.098). No acupuncture-related adverse effects were reported at any time.

*Data are presented as n (%). SD = standard deviation..

&md=tbl&idx=1' data-target="#file-modal"">Table 1

Baseline data on patients (n =27) receiving acupuncture in a subacute geriatric rehabilitation department^*.

Age, mean ± SD(yr)	79.5 ± 8.3
Males	5 (18.5)
Females	22 (81.5)
Musculoskeletal disorders	24 (88.9)
Other disorders	3 (11.1)
Number of treatments, mean SD	3.6 ± 1.9

*Data are presented as n (%). SD = standard deviation..

*Data are presented as mean ± standard deviation..

&md=tbl&idx=2' data-target="#file-modal"">Table 2

Change in the scores for bowel function, quality of sleep, appetite, and general well being before and after acupuncture treatment^*.

	Before treatment	After treatment	p
Pain	6.33 ± 3.01	5.11 ± 3.28	0.005
Bowel function	5.3 ± 3.4	4.15 ± 3.25	0.029
Appetite	5.15 ± 2.9	3.56 ±2.38	0.0034
Sleep	4.81 ± 2.04	4.33 ± 2.39	0.098
Well being	5.48 ± 2.98	3.96 ± 2.94	0.0012

*Data are presented as mean ± standard deviation..

The results of this study demonstrate that traditional Chinese acupuncture may be effective for enhancing physical function in elderly individuals following acute illness. Little attention has been paid to investigating the role of acupuncture in geriatric patients, with the existing publications mainly assessing the efficacy and side effects of acupuncture after an acute stroke [12, 13]. We believe this to be the first study to evaluate the efficacy of acupuncture in a general elderly patient population being treated in a department of rehabilitation.

Many studies have explored the physiologic processes underlying the clinical effects of acupuncture [14, 15, 16, 17, 18, 19], among them being: the local effects on brain function [15, 16]; the release of neuro-chemicals, such as endogenous opioids [17]; or segmental nervous system effects (gate theory) [18, 19]. Further translational studies are required to identify the mechanism underlying the beneficial effects of acupuncture observed in this study.

The main goal of geriatric rehabilitation following an acute illness is rapid restoration of normal activity. Key elements in this process are pain control, restoration of bowel function, quality of sleep, appetite and general well being, and return to pre-illness levels of physical activity. We showed that patients who received an average of 3–4 acupuncture treatments administered together with conventional therapy significantly improved the scores in four out of five of these domains.

Our findings are consistent with previous studies demonstrating a beneficial role of acupuncture in a variety of conditions, including osteoarthritis [20, 21], adult postoperative and chemotherapy nausea and vomiting, and in postoperative dental pain [8].

We did not see any adverse effects caused by acupuncture needles in our geriatric patients, in agreement with large scale studies in which side effects associated with acupuncture tended to be uncommon, mild and reversible [22, 23].

We demonstrated that acupuncture treatment is safe and may be effective adjunctive therapy to conventional care for geriatric inpatients. Based on this pilot study, a randomized controlled trial is currently ongoing at the Tel-Aviv Sourasky Medical Center to further assess the role of acupuncture as part of treatment management for restoring normal physical activity in geriatric patients.