Ishizaki Naoto, et al.. Japanese Acupuncture and Moxibustion; 2018; Vol.14(1): 8-14

Original Research

Selection of healthcare services and satisfaction with acupuncture andmoxibustion for musculoskeletal problems in Japan: sub-analysis data fromthe Nation-wide Cross-Sectional Survey Research.
ISHIZAKI Naoto1), FUKUDA Fumihiko2), YANO Tadashi3)1) Course of Acupuncture and Moxiustion, Faculty of Health Sciences, Tsukuba University of Technology2) Department of Clinical Acupuncture and Moxibustion, Meiji University of Integrative Medicine
3) Meiji University of Integrative Medicine
Abstract
In a nation-wide survey on acupuncture and moxibustion which was conducted in March 2007 in Japan, selectionof treatment modality including acupuncture and moxibustion by those who had musculoskeletal problems such as
low back pain, shoulder stiffness or knee pain as well as satisfaction with the treatment was investigated. Overall
utilization of acupuncture and/or moxibustion in the past 12 month was 4.6% of the respondents, while lifetime experience was 21.3%. The most frequently utilized treatment by the subjects with low back pain , shoulder stiffness andknee pain was medication or injection in hospital (172/450, 38.2%), amma/massage/shiatsu (119/259, 45.9%) andmedication or injection in hospital (105/191, 55.0%), respectively. While utilization of acupuncture and/or
moxibustion for low bakck pain, shoulder stiffness and knee pain was the fourth, third and fourth highest, satisfaction
rate of the users with the treatment was the highest (low back pain[77/105, 73.3%] and knee pain[23/27, 85.1%]) or
the second highest (shoulder stiffness[47/64, 73.4%]) among the treatment modalities used by the patients. It is suggested that healthcare providers could encourage patients to use acupuncture and moxibustion when they were notsatisfied with conventional approach for musculoskeletal problems.
Key words: Acupuncture and Moxibustion; satisfaction; low back pain; shoulder stiffness; knee pain
I. Introduction
The authors had been conducted annual nationwide
surveys every year from 2003 through 2007 and in 2012
on the utilization of acupuncture in Japan in which
respondents were encouraged to fill a questionnaire
regarding use of acupuncture and moxibustion.
According to the series of surveys, annual utilization ofacupuncture in the nation from 2003 to 2006 were 6.5%,
4.8%, 6.4%, and 6.7% respectively, while experience intheir life time were estimated as 26.7%, 19.4%, 24.4%
and 25.4%, respectively1). Respondents who had utilized
acupuncture and/or moxibustion tended to be older thanthose who had no experience. We had also found fromthe surveys that acupuncture was mainly used formusculoskeletal symptoms (81.6% of respondents), anda breakdown of the musculoskeletal symptoms showedthat top three symptoms for which acupuncture wassought by the patients were low back pain (50.9%),
shoulder stiffness (35.9%) and knee pain (12.0%).

Corresponding author: Ishizaki Naoto,Musculoskeletal problem is one of the most common
and costly health problems and considerable number ofthe patient with chronic low back pain seek
complementary or alternative medical (CAM) care2).
Results of a survey in the U.S. indicated that highknowledge of the therapy significantly influencepatients' willingness to try it for their back pain3).
Although apploximately 60% of the residents havemoderate or higher knowledge of acupuncture andmoxibustion4) and more than 20% of the population had
one or more experience in their lifetime in Japan1), it isstill unclear that how many percent of the patients withmusculoskeletal problems have tried acupuncture and/or
moxibustion and whether they had satisfied with thetreatment, as compared with the other health caremodalities.
In the present study, we intended to clarify thesequestions through further analysis of a nation-wide
survey which was conducted in 2007.

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Ishizaki Naoto, et al.. Japanese Acupuncture and Moxibustion; 2018; Vol.14(1): 8-142) shoulder stiffness and 3) knee pain and whether they
had satisfied with the treatment used. Since the time andthe number of questions was limited in the survey, satisfaction with the treatment was obtained simply as binary
answers (yes or no). The options for the treatment werecategorized as conventional medicine, osteopathy/chiropractic, amma/massage/shiatsu, acupuncture
and moxibustion, herbal medicine (kampo) prescribedby physician, over the counter kampo, aromatherapy andothers.

Ⅱ．METHODS
1. Subjects and Sampling Methods
The data was collected as part of omnibus surveys
which were conducted by a research company (Central
Research Cervices, Inc. Tokyo, Japan) in March 2007
with the support of Public Interest Incorporated
Foundation for Training and Licensure Examination inAmma-Massage-Acupressure, Acupuncture and Moxibustion (Toyo Ryoho Kenshu Siken Zaidan)5) . The
subjects of the survey were individuals whose age was
20 years or older and who were randomly selected fromJapanese population. The data were collected as a part ofomnibus questionnaire that was brought to theindividuals by interviewers. The subjects were thenasked to answer closed-ended questions regarding usageof and satisfaction with acupuncture and/or moxibustion
treatment. Sampling method of the survey was asfollowing: All municipalities in Japan were divided
geographically into 12 blocks, which was further
stratified into 30 areas according to the city scale (major
cities, cities, and towns or villages). From the 30 areas
stratified, 157 local areas were selected in the randommanner according to the population size to obtain 10-14
samples from a local point, which will be a total of 2,000
samples.

Ⅲ．Results

2. Questions Asked
Questions in the survey included overall utilization ofacupuncture and/or moxibustion within the past 12
month and lifetime experience as well as basic characteristics of the respondents such as age, gender, educationlevel and occupation. Also, we asked whether they had
sought any health care services for one or more of thefollowing musculoskeletal problems: 1) low back pain,

1. Utilization of acupuncture and/or moxibustion by
the respondents
Of the 2,000 individuals visited by the interviewers,
1,315 (65.8%) responded. Of those responded, 60(4.6%) had visited acupuncture clinic in the past 12
month, while 279 (21.3%) reported their lifetime experience including their own use at home (Table 1). Mean
(SD) age of the respondents with and without experience

3. Statistical Analysis
Percentages in the descriptive statistics were provided
with the 95% confidence intervals (95% CIs) whichwere estimated based on binomial distribution. Fisher’s
exact test was performed to detect significant differences
between proportions where necessary. Student's t-test
was performed in order to detect significant difference inmean age of the respondents with and without experience of acupuncture and/or moxibustion. Differenceswere considered statistically significant when type I
error (α) was <5% under null hypothesis. All the computation was performed with R statistical software package (ver. 3.5.0) 6).

Table 1 Utilization of acupuncture/moxibustion by respondents
overallexperiencemennumber

(%)a

age
mean

(SD)

currently under treatment

20

(1.5)

63

within 12 monthmore than 1 year ago

40
160

(3.1)
(12.2)

10
53

(0.8)
(4.1)

subtotalb, c

279

none

1029

women

number(%)aagemean (SD)

(10)

5

(0.8)

60

56
55

(14)
(17)

11
77

(1.8)
(12.6)

52
55

(12)
(13)

8
23

(21.3)

56(15)(78.7)

51d

(17)

7

(0.5)

58

(17)

5

(0.8)

53

(18)

2

(0.3)

71

(10)

1315

-

52

(17)

614

(46.7)

52

(18)

701

(53.3)

51(16)

number

(%)a

(8)

15

53
56

(16)
(18)

(1.3)
(3.8)

52
57

124

(20.4)

485(79.6)

age
mean

(SD)

(2.1)

64

(11)

29
83

(4.1)
(11.9)

58
54

(13)
(16)

(13)
(12)

2
30

(0.3)
(4.3)

54
53

(7)
(14)

56

(16)

155

(22.2)

56

(15)

51

(18)

544

(77.8)

50(16)

saw practitioner

self application at home
within 12 monthmore than 1 year ago

don’t know
totalca: denominator (1308, 609 and 699 for men and women respectively) for calculation of the percentage was defined as the total respondents except who answered ‘do not know’
b: total of those who had experienced acupuncture in any form sometime in their life
c: summation of each column in the total/subtotal number will not be equal to the total number of the respondents because of multiplied answers
d: p<0.001 v.s. those with experience of acupuncture and/or moxibustion by Student's t-test
Difference in the proportion of utilization between men and women are found when compared in terms of the period of within 12 month (including current usage) (16/609 in men v.s. 44/699 inwomen, p=0.0014) , however the difference was not significant in their lifetime experience (124/609 in men v.s. 155/699 in women, p=0.4568) (Fisher's exact test).

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Ishizaki Naoto, et al.. Japanese Acupuncture and Moxibustion; 2018; Vol.14(1): 8-14

of acupuncture in their life time were 56 (15) and 51(17), indicating statistical significance (P<0.01). There
was a significant difference in utilization of acupuncture
and/or moxibustion within 12 month between men andwomen, but not in their lifetime experience.
Characteristics of the subjects by experience of treatment for low back pain, shoulder stiffness, and knee pain
are summarized in Table 2. Among the three kinds ofmusculoskeletal symptoms, low back pain (LBP) was
the highest for which the subjects sought some kind ofhealth care services (34.2%, 95%CI,31.7-36.9%), followed by shoulder stiffness (19.7%, 95%CI, 17.622.0%) and knee pain (14.5%, 95%CI, 12.7-16.5%).
Also, number of the subjects who reported more than
two symptoms for which heath care services was sought
were highest for combination of low back pain andshoulder stiffness (8.8%, 95%CI, 7.3-10.4%), followedby combination of low back pain and knee pain (4.7%,

95%CI, 3.6-6.0) and that of shoulder stiffness and knee
pain (1.1%, 95%CI, 0.6-1.9%). Those who experienced
use of healthcare services for all of the three symptoms
was 3.7% (95%CI, 2.8-4.9%).
2. Experience of musculoskeletal problems and satisfaction with the treatment used
Table 3 shows kind of treatment used by the patients
who had experienced low back pain sometimes in theirlife time. Of 450 who experienced low back pain andsought some kind of treatment, 287 (63.8%) used one
kind, 109 (24.2%) used two kinds and 54 (12.0%) used
more than three kinds of treatment for the problem.
Among those who used some kind of treatment for low
back pain, 172 (38.2%, 95%CI, 33.7-42.9%) used medication or injection in Western medical hospital. Osteopathy or Chiropractic (35.3%, 95%CI, 30.9-39.9%), rehabilitation in Western medical hospital (24.4%, 95%CI,

Table 2 Characteristics of the subjects by clinical symptoms for which healthcare services were sought
condition

a

LBP

SS

KP

LBP and SS

LBP and KP

SS and KP

ALL

none

overallnumber
(M/F)
%
b
(M/F)
95%CI

450
(216/234)
34.2(35.2/33.3)
31.7-36.9

259(74/185)
19.7(12.1/26.4)
17.6-22.0

191(62/129)
14.5(10.0/18.4)
12.7-16.5

115(34/81)
8.8(5.5/11.6)
7.3-10.4

62(28/34)4.7(4.6/4.9)
3.6-6.015(1/14)
1.1(0.2/2.0)
0.6-1.949(15/34)3.7(2.4/4.9)
2.8-4.9705(355/350)
53.7(57.9/49.9)
50.9-56.4

1315(614/701)
100.0(100.0/100.0)-

mean[SD] age(M/F)
coccupation

55 [16](56[16]/53[16])54[15](57[16]/52[14])59[16](56[19]/60[15])53[15](61[14]/50[14])60[16](56[17]/62[15])63[9](73[-]/62[9])58[16](57[20]/58[14])49[17](50[18]/49[16])52[17](52[18]/51[16])A/F/F

9(2.0)

3(1.2)

6(3.1)

0(0.0)

3(4.8)

0(0.0)

2(4.1)

18(2.6)29(2.2)C/I

64(14.2)

46(17.7)22(11.5)

18(15.7)6(9.7)

2(13.3)9(18.4)74(10.5)

162(12.3)

office worker

66(14.7)42(16.2)

12(6.3)21(18.3)3(4.8)

0(0.0)

6(12.2)125(17.7)

209(15.9)

laboror84(18.7)45(17.4)

37(19.4)

18 (15.7)

11(17.7)4(26.7)5(10.2)163(23.1)

286(21.7)

I/A

11(2.4)5(1.9)

5(2.6)

3(2.6)

2(3.2)

0(0.0)

2(4.1)

25(3.5)37(2.8)Housewife

113(25.1)

84(32.4)

62(32.5)40(34.8)

16(25.8)7(46.7)14(28.6)

165(23.4)

333(25.3)

Student5(1.1)

2(0.8)

4(2.1)

1(0.9)

2(3.2)

0(0.0)

1(2.0)

20(2.8)26(2.0)no occupation

98(21.8)32(12.4)

43(22.5)

14(12.2)

19(30.7)2(13.3)10(20.4)

115(16.3)

233(17.7)1314(613/701)1314(613/701)1315(614/701)1314(613/701)1314(613/701)1314(613/701)1314(613/701)1314(613/701)1315(614/701)

effective answer
(M/F)

d

A/F/F: agriculture, forestry and fisheries, C/I: commerce and industry, I/A: independent or administrative, LBP: low back pain, SS: Shoulder Stiffness, KP: knee pain.
a: number of the subjects with multiple symptoms are also included in those in the single symptoms; those after exclusion of subjects with multiple symptoms in LBP, SS and KP are 224, 80 and 64, respectively.
b: proportion of the respondents who experienced treatment for the condition within the sex group.
c: data are provided as number of the respondent (proportion within the group).
d: number of effective answers were determined by subtracting a respondent who answered "don't know" regarding utilization of healthcare services for LBP and SS.

Table 3 Experience of treatment for low back pain
Treatment Used

number

95% CI

(%)

lower

upper

M/F

mean age (SD)edication or injection in hospital

172(38.2)

33.7

42.9

83/89

60 (15)osteopathy / chiropractic

159(35.3)

30.9

39.9

74/85

50 (15)rehabilitation in hospital

110(24.4)

20.5

28.7

58/52

57 (16)

acupuncture/ moxibustion

105(23.3)

19.5

27.5

53/52

57 (16)amma / massage / shiatsu

103(22.9)

19.1

27.1

51/52

56 (16)

kampo prescribed by physician

8

(1.8)

0.8

3.5

5/3

60 (17)

kampo (OTC)

5

(1.1)

0.4

2.6

0/5

57(14)

aromatherapy

2

(0.4)

0.0

1.6

0/2

48 (18)others

21

(4.7)

7/14

52 (18)overalla450-

216/234

55(16)

2.9
-

7.0
-

a: summation of the number will not be equal to the total number of the respondents (450) because of multiplied answers.

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Ishizaki Naoto, et al.. Japanese Acupuncture and Moxibustion; 2018; Vol.14(1): 8-14

20.5-28.7%) were the second and the third highest utilization. Acupuncture and/or moxibustion was the fourthutilization among the subjects who were suffered fromlow back pain and used some kind of health care services (23.3%, 95%CI, 19.5-27.5%).
Table 4 shows number of the subjects who satisfied
with the treatment utilized for their low back pain.
Among 105 subjects who utilized acupuncture and/or
moxibustion for their low back pain, 77 (73.3%, 95%CI,
63.8-81.5%) answered that they were satisfied with thetreatment. This was the highest percentage among all
treatment modalities used. Osteopathy or Chiropractic(71.1%, 95%CI, 63.4-78.0%) and amma/massage/shiatsu(65.0%, 95%CI, 55.0-74.2%) was the second and thethird highest, respectively.
Table 5 shows utilization of treatment by the subjects
who experienced shoulder stiffness. Of 259 subjects who
answered they had utilized one or more treatment forshoulder stiffness. Amma / massage / shiatsu was thehighest (45.9%, 95%CI, 39.8-52.2%), followd by osteopathy/chiropractic (28.2%, 95%CI, 22.8-34.1%) and
acupuncture and/or moxibustion (24.7%, 95%CI, 19.530.4%).

Satisfaction with treatments utilized by the subjects
for shoulder stiffness is summarized in Table 6.
Amma/massage/shiatsu was the highest in percentage ofthe subjects who satisfied with the therapy for shoulder
stiffness (73.9%, 95%CI, 65.1-81.6%). Acupuncture
and/or moxibustion was the second highest (73.4%,
95%CI, 60.9-83.7%), which was followed by osteopathy/chiropractic (68.5%, 95%CI, 56.6-78.9).
The most utilized treatment by the subjects for knee
pain was medication or injection in hospital (55.0%,
95%CI, 47.6-62.2%), which was followed by rehabilita
tion in hospital (30.9%, 95%CI, 24.4-38.0%) and osteopathy/chiropractic and acupuncture and/or moxibustion (14.1%, 95%CI, 9.5-19.9%) (Table 7).
In contrast to the relatively smaller utilization, satisfaction with acupuncture for knee pain was the highest
among therapies used for knee pain (85.1%, 95%CI,
66.3-95.8%), followed by kampo prescribed by physician (80.0%, 95%CI, 28.4-99.5%) and osteopathy andchiropractic (77.8%, 95%CI, 57.7-91.4%) (Table 8).

Table 4 Number of the subjects who satisfied with the treatment used for low back pain
Treatment Used

95% CI

number/total(% satisfied)acupuncture / moxibustion

77/105(73.3)

osteopathy / chiropractic

113/159

amma / massage / shiatsu

67/103

medication or injection in hospital

101/172(58.7)

51.0

66.2

rehabilitation in hospital

59/110(53.6)

43.9

63.2

kampo prescribed by physician

4/8(50.0)

15.7

84.3

aromatherapy

1/2(50.0)

1.3

98.7

kampo (OTC)
others

lower
63.8

upper
81.5

(71.1)

63.4

78.0(65.0)

55.0

74.2

2/5

(40.0)

52.7

85.3

12/21

(57.1)

34.0

78.2

Table 5 Experience of any kind of treatment for shoulder stiffness
95% CI
M/F
mean age (SD)
lower
upper
amma / massage / shiatsu
119(45.9)
39.8
52.2
39/80
54(15)
osteopathy / chiropractic
73(28.2)
22.8
34.1
16/57
47(14)
acupuncture / moxibustion
64(24.7)
19.5
30.4
22/42
55(15)
medication or injection in hospital
53(20.5)
15.7
25.9
13/40
60(12)
rehabilitation in hospital28(10.8)
7.3
15.2
10/18
58(16)
kampo (OTC)
7
(2.7)
1.1
5.5
3/4
55(16)
kampo prescribed by physician
3
(1.2)
0.2
3.3
2/1
54(11)
aromatherapy
0
(0.0)
0.0
1.4
0/0
others
7
(2.7)
1.1
5.5
2/5
51(13)
totala259
74/18554(15)
a: summation of the number will not be equal to the total number of the respondents (259) because of multiplied answers.
Treatment Used

number(%)

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Ishizaki Naoto, et al.. Japanese Acupuncture and Moxibustion; 2018; Vol.14(1): 8-14

Table 6 Number of the subjects who satisfied with the treatment used for shoulder stiffness
Treatment Used

number/total(% satisfied)amma / massage / shiatsu
acupuncture / moxibustion

88/11947/64

osteopathy / chiropractic
kampo prescribed by physician
rehabilitation in hospital
medication or injection in hospital
kampo (OTC)aromatherapy
others

95% CI(73.9)(73.4)

lower
65.1
60.9

upper
81.6
83.7

50/73
2/3

(68.5)(66.7)

56.6
9.4

78.9
99.2

18/28
28/53
3/7
0/0

(64.3)(52.8)(42.9)
(0.0)

44.1
38.6
9.9
0.0

81.4
66.7
81.6
1.4

3/7

(42.9)

9.9

81.6

Table 7 Experience of treatment for knee pain
Treatment Used

95% CI
lower
upper
47.6
62.2
24.4
38.0
9.5
19.9
9.5
19.9

number(%)

medication or injection in hospital
rehabilitation in hospitalosteopathy / chiropractic
acupuncture / moxibustion

105
59
27
27

(55.0)(30.9)(14.1)(14.1)

amma / massage / shiatsu
kampo prescribed by physician

245(12.5)
(2.6)

8.2
0.9

kampo (OTC)aromatherapy

4
0

(2.1)
(0.0)

0.6
0.0

M/F

mean age (SD)

32/73
21/38
8/19
8/19

60(16)
58(20)
56(15)
58(14)

18.1
6.0

10/14
2/3

62(17)
73(15)

5.3
1.9

0/4
0/0

62(8)
−

others
7
(3.7)
1.5
7.4
4/3
total
191
62/129summation of number will not equal to the total number of the respondents (191) because of multiplied answers

Table 8 Number of the subjects who satisfied with the treatment used for knee pain

acupuncture/ moxibustion
kampo prescribed by physician
osteopathy / chiropracticamma / massage / shiatsu
rehabilitation in hospital

23/27
4/5
21/27
17/24
39/59

(85.1)(80.0)(77.8)(70.8)(66.1)

95% CI
lower
upper
66.3
95.8
28.4
99.5
57.7
91.4
48.9
87.3
52.6
77.9

medication or injection in hospital
kampo (OTC)aromatherapy
others

66/1051/4
0/0
2/7(62.9)(25.0)(0.0)(28.6)

52.9
0.6
−
3.7

Treatment Used

number

(%)

72.1
80.5
−
71.0

-61(25)59(16)

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Ishizaki Naoto, et al.. Japanese Acupuncture and Moxibustion; 2018; Vol.14(1): 8-14

Ⅳ．Discussion
Our present data showed that the utilization ofacupuncture and/or moxibustion in Japanese populationin 2007 appeared to be slightly decreased from those in
the previous years1). However, according to the similar
statistics based on the research in 2012, the utilization
within a year seemed to be increasd again7). When
compared with the other countries, the percentage is still
higher than those in the U.S.8) and in Austraria9), while
similar10) or higher utilization is reported in somecountries in Europe11). In contrast, lifetime experience ofacupuncture and/or moxibustion of our subjects still
remained at more than 20%, which was considered as
relatively high percentage.
Although acupuncture and moxibustion is one of the
popular traditional medicines in Japan, satisfaction of thepatients who used the remedy is still unclear.
Satisfaction with the treatment may vary between
countries and regions, according to sociodemographic
factors and pathological condition for which acupuncture
and moxibustion were sought by the patients. It istherefore useful to investigate utilization and satisfaction
with the treatment by countries/regions and specificcondition of the patients.
According to our previous nation-wide survey
research, the most common condition for which
acupuncture and/or moxibustion was utilized was
musculoskeletal problems and low back pain was themost frequent condition among the problem, followedby shoulder stiffness and knee pain1) .
The effect of acupuncture and moxibustion on themusculoskeletal disorders such as low back pain,
shoulder stiffness and knee pain were assessed in several
studies and some of them proven beneficial effects ofacupuncture12-14).
Results of a study in the United States indicated that
41.2% of the LBP population used CAM in the previous
year of the 2012 National Health Interview Survey andacupuncture was utilized by 2.4% of the population2).
According to the study, more than 80% of the subject
who utilized acupuncture for low back pain felt some ormore benefit. The study provided encouraging result
regarding benefit of acupuncture for low back pain in an
actual society setting.
However, because health care service environment
varies between countries and the local government,
statistics of the individual country/region may provide
different information. In addition, similar statistics of theother popular conditions such as shoulder stiffness andknee pain remains unclear.
In the present study, of 450 subjects who had sought
any kind of healthcare for low back pain, 172 (38.2%,
95%CI, 33.7-42.9%) had visited hospital and beenprescribed some kind of medication or injection byphysician. Although acupuncture and/or moxibustion
was the fourth highest (23.3%, 95%CI, 19.5-27.5%)

chosen modality by the subjects, satisfaction rate withthe treatment was the highest among the healthcare
options (77/105, 73.3%, 95%CI, 63.8-81.5%).
Also, satisfaction rate with acupuncture and/or
moxibustion treatment was the second highest among
the options for shoulder stiffness (47/64, 73.4%, 95%CI,
60.9-83.7%) and those for knee pain was the highest(23/27, 85.1%, 95%CI, 66.3-95.8%). These results
suggest that most of the subjects who used acupuncture
had found some beneficial effect of the therapy for themusculoskeletal disorders in an actual situation. In fact,
results of an RCT study indicates that acupuncture havebetter effects for low back pain when compared withconventional medicine15). A systematic review which
involved 27 studies on the effect of acupuncture for neckdisorders13) suggests that acupuncture provides shortterm relief in the symptom. However, whether the neckcondition included in the review article are comparablewith the "shoulder stiffness" in the present study because
the condition is not clearly defined although it iscommonly used expression for the stiffed neck muscles
among Japanese population. Sufficient satisfaction rateby the subjects who utilized acupuncture and/or
moxibustion for knee pain in the present study was also
encouraging because the effect of acupuncture forchronic knee pain is still controversial16,17).
Although the result of the present study provides
encouraging statistics regarding satisfaction of thepatients who utilized acupuncture for popular
musculoskeletal conditions in an actual situation, readers
should take account of limitation to interpret the resultsof the present study: 1) Classification of the condition
according to severity of each condition or appropriate
diagnosis is unknown and we could not take thoseaccount in the analysis. Because patients with severer
condition may likely to visit orthopedists than the other
health care providers, difference in the severity ofconditions between the subjects who utilized different
treatment modality may have influenced the satisfaction.
2) Some of the subjects experienced more than one
healthcare service and some did not. This violate
independency of the satisfaction rate between options
and make direct comparison difficult. 3) Numbers of thesubjects in each treatment modality were insufficient tomaintain sufficient power of the statistical inference andto interpret the results.
Further study is necessary to improve these limitations
with a setting that the sufficient number of subjects whoare properly diagnosed by physician are eligible andrandomly allocated to one of these options.
Our present study suggest that acupuncture and/or
moxibustion may have beneficial effect as a treatment
modality for common musculoskeletal disorders in termsof overall satisfaction of the patients.

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Ishizaki Naoto, et al.. Japanese Acupuncture and Moxibustion; 2018; Vol.14(1): 8-14

Ⅴ．Conclusions
1. We investigated selection of treatment modality by
patients who were suffered from musculoskeletal
problems such as low back pain, shoulder stiffness
or knee pain, as well as satisfaction with the treatment.
2. The most frequently utilized treatment by the subjects with low back pain, shoulder stiffness and knee
pain was medication or injection in hospital(172/450, 38.2%), amma/massage/shiatsu (119/259,
45.9%) and medication or injection in hospital(105/191, 55.0%), respectively.
3. Proportion of the patients who satisfied with acupuncture for low back pain [77/105, 73.3%] andknee pain [23/27, 85.1%] was the highest and thatfor shoulder stiffness was the second highest [47/64,
73.4%] among those with the treatment modalities
utilized for these conditions.
Acknowledgement
This study was founded by Foundation for Training
and Licensure Examination in Amma-MassageAcupressure, Acupuncture and Moxibustion (Toyo
Ryoho Kenshu Siken Zaidan)5) in 2007.
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