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Letter to the Editor

2018; 11(5): 269-272

Published online October 1, 2018 https://doi.org/10.1016/j.jams.2018.06.002

Copyright © Medical Association of Pharmacopuncture Institute.

A Quality Model to Select Patients in Cupping Therapy Clinics: A New Tool for Ensuring Safety in Clinical Practice

Tamer Aboushanab*, Saud AlSanad

Master of Child Health and Nutrition, National Center for Complementary and Alternative Medicine, Ministry of Health, Saudi Arabia
National Center for Complementary and Alternative Medicine, Ministry of Health, Saudi Arabia
College of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Al-Nada, Riyadh, Saudi Arabia

Correspondence to:Tamer Aboushanab

Received: April 27, 2018; Accepted: June 1, 2018

Abstract

Cupping therapy is a popular treatment in various countries and regions, including Saudi Arabia. Cupping therapy is regulated in Saudi Arabia by the National Center for Complementary and Alternative Medicine, Ministry of Health. The authors recommend that this quality model to select patients in cupping clinics - version 1 (QMSPCC-1)—be used routinely as part of clinical practice and quality management in cupping clinics. The aim of the quality model is to ensure the safety of patients and to introduce and facilitate quality and auditing processes in cupping therapy clinics. Clinical evaluation of this tool is recommended. Continued development, reevaluation and reassessment of this tool are important.

Keywords: Cupping therapy, Hijama, Quality, Safety, Model

1. Introduction

Cupping therapy is a traditional and complementary medicinal practice and is one of the oldest healing techniques. It is popular across various countries and regions, such as China, India, Saudi Arabia, Malaysia, Central Europe, and Africa [1].

There are numerous types of cupping therapy, such as wet, dry, massage, flash, magnetic, and water cupping. Cupping types can be classified according to five categories: technique, power of suction, method of suction, added therapy, and condition and area treated. Some studies have reported the efficacy of cupping therapy in the treatment of pain-related conditions [2].

Cupping therapy is regulated in Saudi Arabia by the National Center for Complementary and Alternative Medicine, Ministry of Health.

2. Safety of cupping therapy

Cupping therapy is a relatively safe practice; however, some adverse events related to cupping practice have been reported [3]. These adverse events are classified as preventable and nonpreventable. Preventable adverse events include scar formation, burns, bullae formation, abscesses, skin infections, pruritus, anemia, and panniculitis. [2] Most of these adverse events can be prevented by effective training and following infection controls and good practice guidelines [4]. Developing and using a quality model for selecting patients is an important step toward the safe practice of cupping therapy and the standardization of treatment methods.

Cupping therapy is contraindicated for patients with cancer, renal failure, hepatic failure, and bleeding disorders. Furthermore, it is also contraindicated for direct use on varicose veins and for patients using a pacemaker or anticoagulants. Precaution should be taken for patients with skin grafts, skin infections, abscesses, diabetic neuropathy, and extreme hunger or satiation and those using herbs with anticoagulant effects [5].

3. The quality model for selecting patients

The authors recommend that the quality model to select patients in cupping clinics - version 1 (QMSPCC-1)—be used routinely as a part of clinical practice and quality management. We hypothesize that by using QMSPCC-1, the selection process of patients suitable for cupping therapy will be enhanced. Performing cupping therapy exclusively on suitable patients will protect others from unnecessary adverse events. Completing the checklist for each patient will automate the process of patient evaluation, thus avoiding missing any data or any evaluation steps.

A patient arriving at a cupping (Hijama) clinic should be evaluated carefully by a cupping therapy practitioner. Medical history should be obtained. Vital signs should be measured. All cupping contraindications are excluded, and general physical examination is performed. If the patient has any abnormality or contraindication, the cupping therapy practitioner should refer the patient to a medical specialist. If the patient is suitable for cupping, the cupping therapy practitioner should let the patient read and sign the informed consent. If the patient signs the informed consent, the practitioner should prepare the patient for the cupping session. If the patient refuses to sign the consent for any reason, the cupping practitioner should terminate the session. If the answer is “No” to any part of the checklist tool, then the practitioner should reevaluate, refer, or terminate the session. The flow chart of the procedure is shown in Fig. 1. The checklist tool is shown in Fig. 2.

Figure 1. Selection process flow chart (QMSPCC-1).

Figure 2. Checklist auditing tool (QMSPCC-1).

4. Clinical importance

The use of this tool will introduce quality assurance to cupping clinics. It will facilitate supervision, auditing, and coaching processes at cupping clinics. Furthermore, it will have an impact on ensuring the safety of patients. Finally, following the process and filling the tool items for each patient will transform these good clinical processes into an automated, error-free procedure.

5. Conclusion

The aim of the quality model to select patients in cupping clinics - version 1 (QMSPCC-1)—is to ensure the safety of patients and to introduce and facilitate quality and auditing processes to cupping therapy clinics.

Clinical evaluation of this tool is recommended. Continued development, revaluation, and reassessment of this tool are important.

Declaration of interest


No.

Fig 1.

Figure 1.Selection process flow chart (QMSPCC-1).
Journal of Acupuncture and Meridian Studies 2018; 11: 269-272https://doi.org/10.1016/j.jams.2018.06.002

Fig 2.

Figure 2.Checklist auditing tool (QMSPCC-1).
Journal of Acupuncture and Meridian Studies 2018; 11: 269-272https://doi.org/10.1016/j.jams.2018.06.002

There is no Table.

References

  1. Michalsen A, Bock S, Lüdtke R, Rampp T, Baecker M, Bachmann J, et al. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial. J Pain 2009 Jun 1:601-8.
    Pubmed CrossRef
  2. Aboushanab TS, AlSanad S. Cupping therapy: an overview from a modern medicine perspective. J Acupunct Meridian Stud 2018 Feb 7:83-7.
    Pubmed CrossRef
  3. Kim TH, Kim KH, Choi JY, Lee MS. Adverse events related to cupping therapy in studies conducted in Korea: a systematic review. Eur J Integr Med 2014 Aug 1:434-40.
    CrossRef
  4. Al-Bedah AM, Shaban T, Suhaibani A, Gazzaffi I, Khalil M, Qureshi NA. safety of cupping therapy in studies conducted in twenty one century: a review of literature. BJMMR 2016;15(8):1-12.
    CrossRef
  5. Cupping therapy regulation rules for practitioners and facilities. Saudi Arabia: National Center for Complementary and Alternative Medicine, Ministry of Health; 2015. p. 14.