I’m delighted to say that Santé-AF has recruited and trained six excellent practitioners – three acupuncturists and three nutritional therapists (NTs) – to carry out the Santé-AF therapy sessions.
When I say “training” – obviously we’re not training the practitioners to be practitioners! They are all, already, highly-trained, very skilled and experienced practitioners of either acupuncture or nutritional therapy. But we’re training them to be practitioners in the trial.
That might sound a bit odd – after all, this is a pragmatic trial, which means we’re setting out to replicate what happens “in real life”. So our practitioners are just doing what they normally do, aren’t they?
They are – as far as their work with participants goes. What happens during an appointment for a trial participant will be exactly the same as what happens in an ordinary appointment. But to work in the trial, our practitioners also have to pay extra-careful attention to things like reporting and safety. For instance, there are requirements to report their safety measures when working with people with AF, and for the acupuncturists in particular there are requirements to report their COVID-safe working practice for each appointment since they are face-to-face with the participants (unlike our nutritional therapists, who will be working online to minimise the risk of COVID transmission).
We are also asking our practitioners to share the details of the treatments and advice they give to each participant (who will be identified during the study by a code, to preserve their individual confidentiality). Practitioners will report these details, and the treatment approaches they’re using – so we’re training them in how to report those things accurately. That’s an important aspect of the trial, because we’re doing pragmatic intervention delivery – roughly translated, the practitioners aren’t using any kind of treatment protocol that tells them to use specific points (acupuncturists) or specific dietary strategies (nutritional therapists); they’re simply working as they work every day, selecting from a wide range of therapeutic strategies to tailor a course of treatment for each participant that responds to their unique, individualised needs and goals. So for instance, the acupuncturists might choose from a range of different techniques including massage, moxibustion (burning a Chinese herb close to the skin to warm an area of the body), or electroacupuncture (passing a low-level electrical current through the needles to intensify the effect). Similarly, the NTs might choose from a range of dietary strategies including diets aimed at weight loss, or behavioural strategies such as “mindful eating”, or specific diets to reduce hypertension or inflammation. But each different participant will get a different “treatment”, so it’s really important that we can capture data to understand the range of therapeutic responses that the practitioners use, and the reasons why they used them.
The difference between conventional and complementary medicine
This probably sounds a bit odd! After all, if you have atrial fibrillation, everyone is treated the same: if you went to a GP with atrial fibrillation, you’d get more or less the same medication, maybe a different dosage, but essentially it’s the same treatment for everyone? Well, that’s the difference between a conventional medical approach (treat the specific health condition) and a holistic approach (treat the patient as a whole). A GP or consultant will diagnose AF and follow a care pathway that’s broadly the same for everyone. It begins with medications and perhaps a bit of standardised lifestyle advice about diet and exercise; if the medications aren’t successful, the person will go on to procedures like electrical cardioversion (where the heart is stopped and restarted again to reset the rhythm) or ablation (where a soft catheter scrapes away the parts of the heart tissue thought to be causing the AF). If the AF doesn’t respond to these, or if it keeps coming back, the patient will continue to have those procedures until the point where they and the consultant agree that the patient should stop having them, a state known as permanent AF. Everyone – every single person across the world who has AF – is on a broadly similar care pathway to some degree or another, and for a lot of people it works well.
By comparison, if you sent everyone with AF to an acupuncturist or a nutritional therapist, each person would come away with a treatment plan that was tailored to them: the specifics of their history (including medical and mental health history), their living circumstances, their beliefs and attitudes, and what they want to achieve. So not everybody with AF will get electroacupuncture or massage if they see an acupuncturist, and not everybody with AF will be recommended a diet to reduce inflammation or lose weight if they see a nutritional therapist; it depends what the individual person needs, and what they want to achieve, looked at as a whole. So that’s why it’s important to know what all our practitioners are doing with all of their patients in the trial – we want to know the range and scope of the therapeutic interventions they were doing, and advising the trial participants to do.
Sharing knowledge with practitioners outside the trial
In addition to all the scheduled papers that will be published as part of the trial, we’re hopeful that at least a handful of good case studies will come out of Santé-AF. We’re also aiming to share our knowledge with the wider practitioner base once the study’s intervention period is over, perhaps in the form of a couple of case series articles that would go into practitioner-facing journals (rather than the academic journals that research is more usually published in). It’s not an objective of the study as such, but it matters to us that we make available to practitioners what information we have on how to work with atrial fibrillation; it won’t be the “effectiveness” data that normally comes out of a trial, but acupuncturists and nutritional therapists would still find it useful to understand what approaches might work for different kinds of patients.
We’re delighted that all our practitioners chose to be in the trial in order to develop their professional practice, and to work together as part of a team. Their contributions to our training were collaborative, thoughtful and imaginative – making the workshops a pleasure for us all. We’re looking forward very much to working with them!
To find out more about the individual practitioners on the Santé-AF trial, take a look at our Who We Are page.