Purpose This study evaluates the development of therapeutic alliance (TA) and its clinical influence on acupuncture treatments for Gulf War Illness (GWI).

Methods Data were collected from a 3.5-year US Army-funded randomized clinical trial (RCT) involving thirty-two experienced acupuncturists who provided individualized treatments over approximately six months. To measure improvements, paired-sample t-tests compared Working Alliance Inventory (WAI-SR) scores across task, bond, and goal factors from baseline to endpoint (6 months). Hierarchical linear regression analyses assessed the mediating effects of therapeutic alliance variables on pain and functional outcomes at the six-month mark.

Results Both groups had similar WAI-SR scores at the endpoint (6 months); however, initial scores in all three factors were lower in the low-dose (weekly acupuncture) group compared to the higher-dose (biweekly acupuncture) group. The weekly treatment group exhibited significant improvements in WAI-SR scores across all factors from baseline (2 months) to endpoint (6 months) (p < 0.01). Linear regression analyses indicated that biweekly treatments were associated with significantly lower pain levels at six months.

Conclusion These findings suggest that the frequency of acupuncture treatments influences the development of the therapeutic alliance and clinical outcomes.

The authors have declared no competing interest.

ClinicalTrials.gov NCT01305811

The data was compiled from the 3.5-year US Army-funded RCT supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Gulf War Illness Research Program under Award No. W81XWH-14-1-0533 and Grant number GW130028.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The data was compiled from the 3.5-year US Army-funded RCT supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Gulf War Illness Research Program under Award No. W81XWH-14-1-0533 and Grant number GW130028. The 3.5-year US Army-funded RCT was approved by the New England Institutional Review Board (IRB # 09-204).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Declarations: The data was compiled from the 3.5-year US Army-funded RCT supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Gulf War Illness Research Program under Award No. W81XWH-14-1-0533 and Grant number GW130028. The 3.5-year US Army-funded RCT was approved by the New England Institutional Review Board (IRB # 09-204). There were no awards, grants, funding, or IRB review boards for this TA review study. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.

All data produced in the present work are contained in the manuscript.