Extrapolation errors in Liu et al.'s CAM integrative review of health care professionals in New Zealand.

This letter is to highlight errors made by Liu et al. in their 2020 paper in BMC Complementary Medicine and Therapies, "Complementary and alternative medicine-practice, attitudes, and knowledge among healthcare professionals in New Zealand: an integrative review". Substantial errors in their citation of the recent research and methodology by McDowell, Kohut & Betts (2019) pertaining to the practice of acupuncture in New Zealand by physiotherapists are presented. The actual results of McDowell et al.'s work and the true state of acupuncture use by their sample group is reported.

Safe acupuncture and dry needling during pregnancy: New Zealand physiotherapists' opinion and practice.

OBJECTIVE: Acupuncture guidelines have advised caution when treating women during pregnancy, because historical "forbidden" acupuncture points are believed to stimulate miscarriage or early labor. Despite recent research demonstrating that acupuncture is a useful and safe treatment tool for pregnancy-related low-back pain (LBP) and pelvic girdle pain (PGP), it is postulated that fear of miscarriage and subsequent blame by association, restricts its provision. More recently, an increase in dry needling (DN) courses for physiotherapists has potentiated the rapid growth in DN practice in New Zealand (NZ). Many dry needlers do not consider DN to be a form of acupuncture; it is unknown if they have similar safety concerns. METHODS: NZ registered physiotherapists practicing acupuncture and/or DN were invited to participate in an electronic survey to examine their practice and level of understanding in regard to safe needling during pregnancy. RESULTS: Of 124 respondents, only 60 (48%) would needle pregnant women, with a further 66% of those still expressing safety concerns. NZ physiotherapists practicing DN only, were more likely to needle areas related to "forbidden" points in all trimesters. However, overall, NZ physiotherapists were less likely to needle "forbidden" points than their UK peers. CONCLUSION: Conflicting literature and a "fear of blame" influences NZ physiotherapists' decisions to offer needling (both acupuncture and DN) during pregnancy. Further training in this field is recommended to ensure safe practice and adequate provision of acupuncture treatment options for pregnant women suffering musculoskeletal pain, such as LBP and PGP. Further research, particularly into DN, for women during pregnancy, is warranted.

Mulligan Concept manual therapy: standardizing annotation.

Quality technique documentation is integral to the practice of manual therapy, ensuring uniform application and reproducibility of treatment. Manual therapy techniques are described by annotations utilizing a range of acronyms, abbreviations and universal terminology based on biomechanical and anatomical concepts. The various combinations of therapist and patient generated forces utilized in a variety of weight-bearing positions, which are synonymous with Mulligan Concept, challenge practitioners existing annotational skills. An annotation framework with recording rules adapted to the Mulligan Concept is proposed in which the abbreviations incorporate established manual therapy tenets and are detailed in the following sequence of; starting position, side, joint/s, method of application, glide/s, Mulligan technique, movement (or function), whether an assistant is used, overpressure (and by whom) and numbers of repetitions or time and sets. Therapist or patient application of overpressure and utilization of treatment belts or manual techniques must be recorded to capture the complete description. The adoption of the Mulligan Concept annotation framework in this way for documentation purposes will provide uniformity and clarity of information transfer for the future purposes of teaching, clinical practice and audit for its practitioners.