1. The 2nd International Conference on Quality Medication in Prophetic Medicine (April 5 - 7, 2016) King Abdulaziz University بسم الله الرحمن الرحيم

2. Dear our colleagues and our respected guests Thank you very much for attending our presentation and conference

3. Effect of Wet Cupping on the Quality of Life of Adult Patients with Chronic Medical Conditions at King Abdulaziz University: A Quasi-experimental study

4. Prof Nahla Khamis Ibrahim Prof. of Epidemiology at KAU Prof. of Epidemiology at HIPH, Alex University, Egypt. MBBCh, MPH, PhD, DHPE & JMHPE ( Maastricht University). Peer Reviewer and Editor in Several International Journals Member of Shiekh Yousef Abdul-Latif Jameel Prophetic Medicine Chair Member of the Scientific Committee of the Conference

5. Acknowledgment I would like to thank all our great team  Prof Soad K. Al Jaouni (Head of the Conference)  Dr Eman El Fiky  Dr Samiha Murad  Prof. Abdullah M. Kaki  Prof Sawsan M. Rohaiem  Prof Mohamad H. Qari  Dr Laila M. Tabsh,  Prof Adel A Aljawhar  All doctors and nurses participated in the study, and Ms Rasha Special thanks to Special thanks to  Sheikh Yousef Abdul –Latif Jameel for funding

6. Background Nowadays, there is a worldwide growing interest in the Complementary and Alternative Medicine (CAM). CAM is considered an effective method for disease prevention, treatment of Non-Communicable Diseases (NCDs) and improvement of Health Related Quality of Life (HRQOL)

7. Background Cupping therapy, either wet or dry cupping, is an ancient method of treatment that was extensively used in several societies It was recommended in the Islam by Prophet Mohamed صلى الله عليه وسلم

8. Background Wet cupping is widely used for acute/chronic inflammation, infectious diseases, and immune system disorders. Within the last few years, an interest in conventional cupping has emerged with growing evidence that it may be effective for various pain conditions

9. Background A glass cup is utilized to create suction over a painful area after the creation of skin incisions. It is hypothesized that this procedure sucks “congested” blood out of the skin. So, increasing blood and lymphatic circulation and relieving pain. Clinical studies during last 50 years found that cupping is effective for pain reduction.

10. Background In recent years, HRQOL has increasingly used as a parameter for assessment of different treatment outcomes. HRQOL typically includes the concepts of wellbeing, function, life satisfaction, health and disability. It refers to “aspects of life that make life particularly fulfilling and worthwhile”.

11. Background Despite the growing evidence of the effects of wet cupping, no adequate interventional studies have been conducted to assess the effects of wet cupping on chronic medical conditions in Jeddah.

12. Objectives To assess the effects of wet cupping on the HRQOL of patients with chronic medical conditions who were referred to Sheikh YAJ Cupping Clinic from different specialty clinics at the KAUH, Jeddah.

13. Materials and Methods Period: 2013-2014 Sample size: 629 cases 309 : Intervention 320: control Study design: Quasi- experimental study Data collection: WHOQOL BREF

14. Target population Patients referred with chronic medical conditions to cupping clinic (629 patients) Control (320) Intervention group (Eligibility criteria) (A total of 309 patients) Pre-test "HRQOL" I ntervention Cupping therapy Post-test After 1 month "HRQOL"

15. . WHOQOL- BREF is the most widely used WHOQOL instrument. It has good validity and reliability Pre-test (WHO QOL BREF)

16. Core components of the WHO BREF HRQoL assessment 1. Physical/functional component 2. Psychological/emotional 3. Social 4. Environmental component Environmental Component

17. Intervention Wet cupping was done by a certified physician Under strict sterile technique The physician used the patients' pain diagram and physical examination to identify the areas of pain

18. Patients' pain diagram

19. Intervention (Cupping)

20. . Post-test (WHO QOL BREF)

21. Outcome measures Primary outcome: Change (improvement) in the scoring of HRQOL domains of WHOQOL-BREF from the baseline level (before cupping) to one month after cupping. Change (improvement) in the scoring of the HRQOL in the intervention compared to the control group after one month of cupping. Secondary outcome: Decreasing the different types of pain of patients with chronic medical conditions.

22. Methods Ethical statement : The study was conformed with the standards of Helsinki Declaration. Ethical approval was taken from IRB of KAUH with Ref No. 851-12. A written informed consent was taken from each patient Trial registration number in the WHO: IRCT2015050322060N1. Ethical statement : The study was conformed with the standards of Helsinki Declaration. Ethical approval was taken from IRB of KAUH with Ref No. 851-12. A written informed consent was taken from each patient Trial registration number in the WHO: IRCT2015050322060N1. Statistical analysis : Descriptive statistics were done Inferential statistics were done (Paired t –test, Student’s t- test).

23. Results

24. Causes for referral to the cupping clinic for patients who received cupping therapy.

25. Types of pain among referred cases for cupping

26. Effect of Wet cupping on different types of Pain

27. Effect of Wet cupping on different variables

28. Comparison between the intervention and control group

29. Figure. 2. Box-plots of the scores’ changes in the four HRQOL domains before and after cupping therapy for patients, in the intervention group, with chronic medical conditions at King Abdulaziz University Hospital.

30. Discussion To the best of our knowledge it is the first intervention study done with large sample size to assess wet cupping in Jeddah Our study revealed significant improvements in the most of the HRQOL domains, particularly the physical function after therapy It relieve almost all types of pain after cupping. This agree with results from Berlin study, Germany, which was done among patients with chronic non specific neck pain).

31. Discussion In South Korea, a pilot study conducted for 32 participants provided preliminary data on the effectiveness and safety of wet cupping for pain management; however, their results need to be confirmed by a larger study

32. Conclusion & Recommendation Wet cupping (Hijama) improved the HRQOL, particularly the physical health, of patients with chronic medical conditions after cupping compared to before it. It improved most of the HRQOL domains in the intervention compared the control groups.

33. Conclusion & Recommendation Cupping may be considered an effective treatment modality and a part of comprehensive medical treatment for different chronic disorders, including pain. It is more effective for women and non-smokers than for men and smokers. We recommend that wet cupping should be performed at most of the medical centers for relieving pain and improving HRQOL.

34. References 1. Kummet CM, Spector ML, Dawson DV, et al. Patterns of complementary and alternative medicine (CAM) use among dental patients. J Public Health Dent. 2015;75(2):109-117. 2Refaat B, El-Shemi AG, Ebid AA, Ashshi A, BaSalamah MA. Islamic Wet Cupping and Risk Factors of Cardiovascular Diseases: Effects on Blood Pressure, Metabolic Profile and Serum Electrolytes in Healthy Young Adult Men. Alternative & Integrative Medicine. 2014; 3:151-158. 3Bhalerao MS, Bolshete PM, Swar BD, et al. Use of and satisfaction with complementary and alternative medicine in four chronic diseases: a cross-sectional study from India. Natl Med J India. 2013;26(2):75-78. 4Kim JI, Lee MS, Lee DH, Boddy K, Ernst E. Cupping for treating pain: a systematic review. Evid Based Complement Alternat Med. 2011;2011:467014. 5Ahmadi A, Schwebel DC, Rezaei M. The efficacy of wet-cupping in the treatment of tension and migraine headache. Am J Chin Med. 2008;36(1):37-44.

35. عن ابي هريرة رضي الله عنه قال : قال رسول الله صلى الله عليه وسلم : " أخبرني جبريل أن الحجم أنفع ما تداوى به الناس " وقال رسول الله صلى الله عليه وسلم : " خير ما تداويتم به الحجامة ”

36. Thank you for working together for applying Prophetic Medicine Treatment