Protocol for Alberta Innovative Disabilities Program (AIDP): Community-based Acupuncture Services Model to Meet the Recovery-oriented Needs of Persons with Disabilities

AIDP: Alberta Innovative Disability Program

CBA: Cost-benefit analysis

CEA: Cost-effectiveness analysis

CHREB: Conjoint Health Research Ethics Board

CRU: Clinical Research Unit

EQ-5D-5L: EuroQol 5 Dimension 5 Level

MYMOP®: Measure Yourself Medical Outcome Profile

PHN: Personal Health Number

QALY: Quality-adjusted years of life

WPAI: Work Productivity and Activity Impairment Questionnaire

TCM: Traditional Chinese Medicine

The United Nations Convention on the Rights of Persons with Disabilities defines persons with disabilities as including "those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others" [1]. According to Statistics Canada, about 27.0% of Canadians aged 15 years and above live with a disability. The prevalence of developmental disabilities has increased by 0.4% from 2017, representing 1.5% of the 2022 Canadian population [2].

Ensuring proper care for persons with disabilities can lead to significant social and economic benefits. The Institute for Work & Health estimated that full inclusion and accessibility of persons with disabilities would contribute $337.7 billion worth of economic benefits per year in Canada, equivalent to 17.6 percent of the national GDP in 2017 [3,4]. However, many persons with disabilities experience coexisting pain, mental health issues, and/or substance misuse, which can have negative impacts on their quality of life, employability, and re-employment. According to a Canadian Medical Association study, people with disabilities have a greater prevalence of chronic health issues and experience increased challenges to healthcare access [5]. Therefore, people with disabilities in Canada encounter a multitude of challenges including chronic health issues, access to healthcare, and barriers to employment. 

In January 2018, the Alberta Minister of Community and Social Services initiated a review of the provincial Persons with Developmental Disabilities (PDD) program [6]. The resulting Panel Review Report emphasized that co-occurring issues such as pain, mental health concerns, and substance misuse are often underdiagnosed and undertreated among PDD recipients. These unmet needs significantly impact their well-being and participation in the workforce. Service providers, government staff, and other organizations also identified major service gaps in the current PDD framework, particularly in addressing complex needs. The report recommended shifting from a crisis-driven model to one grounded in collaborative and proactive care. It also underscored the importance of implementing mechanisms to monitor service quality and ensure accountability in the use of PDD funding [6]. 

Individuals with disabilities are prone to a variety of secondary health issues that may significantly impact their everyday lives [7-14]. These issues include pain, mental health issues, addiction, exhaustion, sleep disturbances, bowel or bladder problems, and chronic conditions such as obesity. These afflictions can affect physical health, mental health, and emotional well-being [7]. Acupuncture has been shown to effectively relieve physical pain as well as treat certain mental health disorders [8-12]. Previous studies have also demonstrated its effectiveness in the treatment of digestive diseases and asthma [13,14]. More specifically, acupuncture has shown promising results in improving the symptoms associated with developmental disabilities such as autism spectrum disorder and intellectual disabilities [15-17]. Recent studies have demonstrated that acupuncture therapy may be a safe and effective treatment for individuals with developmental disabilities, particularly in reducing anxiety, aggression, and hyperactivity [18,19]. Recent systematic reviews and meta-analyses outline evidence that acupuncture may significantly improve scores on several measures of behavioral and cognitive function, including the Autism Behavior Checklist, the Childhood Autism Rating Scale, and the Aberrant Behavior Checklist [20,21]. By reducing all these aforementioned symptoms, individuals with disabilities may be better able to manage their conditions and improve their ability to participate in the workforce [22]. 

Furthermore, the COVID-19 pandemic has highlighted the need for accessible and inclusive disability services. People with disabilities have been disproportionately affected by the pandemic, with many facing isolation, reduced access to services, and decreased employment opportunities [23]. In this context, acupuncture can help build a more resilient and inclusive society that is better equipped to address the complex needs of people with disabilities in times of crisis. 

To address the gaps identified by the 2018 Alberta PDD Review Panel Report, we proposed the Alberta Innovative Disabilities Program (AIDP) as both a community service and an interventional research initiative. 

As a community service, AIDP offers evidence-based acupuncture treatments free of charge to individuals with diverse disabilities. The program aims to alleviate the negative impacts of coexisting chronic conditions such as pain and mental health challenges through acupuncture interventions. By improving overall wellness, functioning, self-esteem, resilience, and social inclusion, AIDP ultimately seeks to enhance the employability and re-employment potential of individuals with disabilities. 

As an interventional research program, AIDP has the following objectives: 

• To evaluate the clinical effectiveness of acupuncture for individuals with disabilities using patient-centered outcome measures
• To assess the cost-effectiveness and cost-benefit of acupuncture services for this population

Inclusion Criteria 

Alberta residents who are living with a disability and coping with chronic health conditions such as pain and mental health issues, including those:

• Currently enrolled in the Alberta Persons with Developmental Disabilities (PDD) or Family Support for Children with Disabilities (FSCD) program; or
• Able to submit an AIDP Eligibility Verification Form (Appendix A) completed by an appropriate medical professional that specifically identifies the disability.

Exclusion Criteria

• Those uncomfortable with undergoing acupuncture treatment.

Patient Recruitment

The project will utilize various outreach strategies, aiming to reach a diverse group of participants. These strategies include social media platforms, an AIDP website, and posters and flyers distributed in public areas such as community centers, libraries, and health clinics. The project will also collaborate with civil society organizations such as disability advocacy groups, community centers, and disability service providers to help recruit participants. In addition, conventional medical doctors will be enlisted to assist in identifying participants who may benefit from the study. Collaboration with primary care physicians, psychologists, and psychiatrists will help improve accessibility and reach a wider range of individuals.

Intervention

The AIDP treatment team consists of licensed practitioners trained in Canada and the US with at least 5 years of experience and an established track record in interventional acupuncture programs (median 10 years, range 5-20 years) [24-26]. 

Participants will receive individualized Traditional Chinese Medicine (TCM) style acupuncture treatment that focuses on specific needs and symptoms the individual is experiencing. As discussed earlier, TCM style acupuncture has been shown to be safe and effective in treating a wide range of chronic health problems for those with disabilities, including pain and mental health issues [8-22]. Given that the study aims to assess acupuncture intervention as it is typically performed in clinical practice, point selection for each participant will be individualized and based on general acupuncture and TCM principles. The treatment for each participant may also be modified over the course of the treatment program to accommodate any changing symptom patterns, health conditions, and/or responses to treatment. 

Traditional clinic-based models have often excluded individuals with disabilities due to transportation and mobility barriers. To address these challenges, we have adopted flexible service delivery models from the outset, offering in-clinic, on-site, and hybrid options to enhance accessibility and inclusion. As part of our approach, we have developed partnerships with several civil society organizations that provide residential services for those living with disabilities, allowing us to deliver mobile acupuncture services directly at clients’ residences or program locations. Our team collaborates closely with program managers to ensure trust, comfort, and continuity of care, making therapeutic support more responsive to clients’ unique needs and living contexts. 

During the initial consultation session, the practitioner will ask detailed inquiry. In Traditional Chinese Medicine (TCM), inquiry is one of the Four Diagnostic Methods and involves asking detailed questions to understand the patient's overall condition. Practitioners typically begin with the chief complaint and then explore the history of the present illness, including the onset, nature, duration, location of symptoms, and any relieving or aggravating factors. They also ask about the patient's past medical history, such as chronic illnesses, surgeries, trauma, or medication use. Lifestyle and daily habits are explored, including sleep quality, daily routine, physical activity, appetite, dietary preferences, and bowel and urinary habits. Emotional state is a key area, with attention to anxiety, depression, irritability, or other stress-related factors. For women, additional questions are asked about menstruation (cycle, flow, color, pain), pregnancy history, postpartum recovery, and menopausal symptoms. For children, questions cover feeding, growth, sleep, urination, defecation, and emotional behavior. Inquiry also helps assess patterns of cold or heat and deficiency or excess—such as sensitivity to temperature, sweating, thirst, or tongue coating. Family history of diseases and current treatments, including reactions to herbal or conventional medicines, are also considered. This holistic questioning process is essential for identifying the root pattern of imbalance and tailoring treatment accordingly [27]. 

Physical examinations will assess any existing areas of pain, the color of the participant's tongue and face, and the strength, rhythm, and quality of the radial pulse. Based on these assessments, the practitioner will propose an individualized acupuncture treatment plan for each participant using established treatment protocols as a guideline [24]. The goal of this intervention is to provide a holistic approach to improving the overall health and quality of life of participants by addressing each participant's specific needs. 

In AIDP, acupuncture treatment protocols will be designed based on established evidence as well as the clinical expertise of both local and international acupuncture experts. The treatment plan for a single complaint typically spans one to three months, with sessions scheduled once or twice per week, resulting in approximately 12 to 24 acupuncture treatments administered by licensed practitioners. The exact duration of treatment is specific to each participant, depending on the nature and severity of their concerns and the observed effectiveness of the intervention. As a community service initiative, AIDP strives to serve as many individuals as possible while maintaining a reasonable standard of treatment outcomes. All interventions provided through AIDP are free of charge to participants.

Before the initial consultation session, participants and/or their guardians will be provided with patient and/or guardian consent forms. These forms will be constructed using templates provided by the Conjoint Health Research Ethics Board at the University of Calgary and provide comprehensive information about what to expect during the initial consultation and subsequent treatment sessions in AIDP. They also outline the potential benefits and risks for the participants, how risks are managed, the participants’ rights, how collected information will be managed to ensure patient confidentiality, and the contact information of the project and ethics board.

Data Collection

Validated survey instruments measuring various aspects of health and well-being will be used for data collection (see 2.6 Outcome Measures and Table 1). To ensure the confidentiality and security of participant information, we will be using REDCap, a secure web application for building and managing online surveys and databases. REDCap will be hosted by the Clinical Research Unit (CRU), a core research support center at the University of Calgary.

At the first consultation session, participants will be asked to answer questions from an online questionnaire on REDCap. This questionnaire will collect basic demographic information such as age and gender, as well as the participant's Alberta Personal Health Number (PHN) and information on health, productivity, and quality of life. Medical records will not be accessed at this stage. Following completion of treatment, participants will again be asked to answer questions from an online questionnaire on REDCap. This will help us monitor the treatment's effect and evaluate participant outcomes.

Outcome Measures

To evaluate the clinical outcomes of AIDP services, our study will utilize MYMOP®, a patient-centered outcome measure (PCOM). Developed in 1996, MYMOP® is individual- and problem-specific; MYMOP® captures what an individual patient considers the two most important symptoms associated with a specific problem and an activity of daily living that is affected by these symptoms [28,29]. Moreover, MYMOP® evaluates overall well-being and is suitable for individuals experiencing various types of health-related problems, including physical, mental, and/or social. Additionally, MYMOP® identifies medication usage related to the issue and whether individuals wish to reduce it [30]. Studies have shown that MYMOP® is simple to administer, sensitive to clinical change, effective in measuring clinical efficacy, can be used in acute or chronic conditions, and improves patient-practitioner communication [29,31,32]. In addition, we will measure productivity using the Work Productivity and Activity Impairment questionnaire (WPAI) and quality of life using EQ-5D-5L [33,34]. 

Finally, patients' general healthcare utilization will be measured through self-reported inpatient, outpatient, emergency department, and prescription drug utilization. The patients will self-report the number and frequency of their medication intake, in addition to how often they had contact with different healthcare providers, hospitalizations, and ER visits in the previous three months. This will help determine whether healthcare visits and prescriptions are related to the same problem for which AIDP therapy was initiated. The outcome measures are presented in table 1.

Table 1: Outcome measures for AIDP program.

Data Analysis

Data analysis will be conducted using STATA statistical software (College Station, TX). Descriptive statistics will be used to define changes in patient-centered outcome measures, productivity, quality of life, and healthcare utilizations between baseline and completion of treatment. Paired t-tests will be utilized to determine significant differences in these outcomes before and after treatment.

Cost-Effectiveness Analysis (CEA) and Cost-Benefit Analysis (CBA) will be used to evaluate the economic impact of the AIDP program. Both analyses will utilize per-patient costs. The study will also assess long-term benefits by using short-term indicators and estimates of the economic cost of diseases based on previous literature.

CEA will measure health benefits using Quality-Adjusted Life Years (QALYs). The CEA ratio will be calculated by dividing the per capita cost of the intervention by the average improvement in quality of life. A lower CEA ratio indicates higher cost-effectiveness, while a higher ratio suggests lower cost-effectiveness.

For CBA, the Economic Burden of Illness literature will be used to estimate cost savings. The study will focus on improvements in patient-centered outcomes, such as pain reduction and mental health benefits. These improvements will be translated into economic benefits by considering reductions in direct costs (e.g., hospital, physician, medication, and institutional care expenses) and indirect costs (e.g., quality of life, productivity loss due to disability, and premature mortality).

By comparing the costs and benefits of the AIDP program, policymakers may gain insights into potential cost savings from integrating acupuncture into disability service systems. This analysis will provide valuable information on both the cost-effectiveness and cost-benefit of the AIDP program, guiding future healthcare policy decisions.

Data Confidentiality and Privacy

Our study places a high priority on ensuring the confidentiality and privacy of participants. We will take strict measures to keep all personal information secure and follow a Data Management Plan to ensure that identifiable information is handled with utmost care. To this end, we will store personal contact information separately from health information and assign a unique code to replace any personally identifiable information. All data will be accessible only to project team members, CHREB representatives, and funding agencies for quality assurance purposes. We will adhere to professional codes of ethics and legislation and keep participant information for a minimum of seven years after the study. 

Additionally, our study will utilize the REDCap data platform from the Clinical Research Unit (CRU) at the University of Calgary for distribution and data storage of surveys. The CRU has all necessary data sharing and storage agreements with Alberta Health Services in place, and their server is physically located on the University of Calgary campus, ensuring participant information is not subject to other stipulations such as the US Patriot Act. The Conjoint Health Research Ethics Board (CHREB) and authorized representatives from the University of Calgary may access identifiable medical/clinical records or research records held at the University of Calgary for quality assurance purposes, with the participant's consent. 

The study team will maintain the confidentiality of participant research records, except where required by law (e.g. disclosed child abuse or neglect). Access to medical/clinical records and research records will only be authorized with the participant's consent, and any legal requests will be handled accordingly.

Timeline (Table 2)

Ethics Review 

The AIDP study, which involves human participants, has received ethical clearance from the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary with ethics ID: REB 21-2050.

The AIDP protocol paper presents a study aimed at assessing the effectiveness and cost-effectiveness of acupuncture treatment as an alternative approach to disability service systems. The study's results will have crucial implications for healthcare policymakers, disability service providers, and individuals with disabilities seeking effective treatment. 

The study's outcomes will be instrumental in informing healthcare policy and decision-making. It will provide valuable insights into the effectiveness of the AIDP program and its potential cost savings. This program has the potential to reduce the burden on the healthcare system by offering a more effective and cost-efficient alternative to traditional disability service systems. 

Additionally, the study has implications for individuals with disabilities seeking treatment for chronic health issues. The AIDP program could provide a suitable and accessible treatment option that addresses the complex needs of individuals with disabilities. This approach could lead to an improvement in the quality of life of these individuals by addressing physical, mental, and emotional needs. 

However, some limitations of the study must be considered. First, AIDP is a government-funded community service and intervention research program; it is not a randomized controlled trial. Second, the study relies on self-reported data, which could be subject to response and recall bias. Finally, AIDP only evaluates short-term outcomes, and long-term follow-up studies may be necessary to fully assess the effectiveness of the AIDP program. However, we will collect each patient’s provincial personal health number (PHN), which serves as a unique patient identifier enabling future studies to link AIDP data with administrative databases. This linkage will facilitate a more reliable evaluation of the impact of AIDP on patient outcomes and healthcare utilization.

In conclusion, the AIDP protocol paper outlines a study assessing the clinical and cost-effectiveness of an acupuncture treatment program for individuals with disabilities. This program may provide valuable insights into the needs of individuals with disabilities and the potential benefits of acupuncture for this population, serving as an alternative approach to current disability service systems. The study could provide a foundation for future research into the effective treatment of disability-related pain and mental health as well as inform future healthcare policy and decision-making.

The authors want to acknowledge the invaluable contributions of all AIDP acupuncture treatment team members, as well as staff members at the Huatuo Clinic and the Alberta College of Acupuncture and Traditional Chinese Medicine (ACATCM). Their dedication and efforts have ensured successful treatment delivery and completion of AIDP.

The study design was conceived by ML, YT, and BX. ML, YT, XX, YC, and BX developed the research questions and methods. YT and XX developed the treatment protocols. ML, XX, YC, and BX contributed to the design and implementation of patient recruitment. ML, BL, and LP designed the survey questionnaire. Treatment and data collection are being completed by XX and NX. LP manages the AIDP project account on REDCap, conducts data management, and performs data analysis. The first draft of the manuscript was written by ML and SS, LP and JQ contributed to further revisions of the manuscript.

The research protocol of the AIDP study has received ethical approval from the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary (Ethics ID: REB 21-2050), ensuring compliance with guidelines and regulations. Prior to participation, all study participants and their legal guardians/parents will provide written informed consent.v

Since no datasets were generated or analyzed in the current study, data sharing is not applicable to this article.

The authors declare that they have no competing interests.

This study received funding from the Civil Society Fund of the Government of Alberta/Community and Social Services.

1. Government of Canada (2022) Disability inclusion: A reference guide for Canadian federal organizations. Government of Canada, Canada.
2. Infographic: New Data on Disability in Canada (2022). Canada.ca. Government of Canada/ Gouvernement du Canada, Canada.
3. The economic benefits of a fully accessible and Inclusive Canada (2025) Institute for Work & Health. The economic benefits of a fully accessible and Inclusive Canada, Canada.
4. Tompa E, Mofidi A, Jetha A, Lahey P, Buettgen A (2022) Development and implementation of a framework for estimating the economic benefits of an accessible and inclusive society. Equality, Diversity and Inclusion: An International Journal 41: 318-339.
5. Marks MB, Teasell R (2006) More than ramps: Accessible health care for people with disabilities. CMAJ, Canada.
6. Alberta Council of Disability Services (ACDS) (2025) ACDS Survey 2020: COVID-19 Impact on CDS Workforce. ACDS, Canada.
7. Government of Alberta (2019) Views of the Persons with Developmental Disabilities program: Successes, Challenges and Opportunities-- Report of the PDD Review Panel. Community and Social Services, Canada.
8. Patil S, Sen S, Bral M, Reddy S, Bradley KK, et al. (2016) The role of acupuncture in pain management. Current pain and headache reports 20: 1-8.
9. Ning Z, Lao L (2015) Acupuncture for pain management in evidence-based medicine. Journal of Acupuncture and Meridian Studies 8: 270-273.
10. Chen T, Zhang WW, Chu YX, Wang YQ (2020) Acupuncture for pain management: molecular mechanisms of action. The American journal of Chinese medicine 48: 793-811.
11. Amorim D, Amado J, Brito I, Fiuza SM, Amorim N, et al. (2018) Acupuncture and electroacupuncture for anxiety disorders: a systematic review of the clinical research. Complementary therapies in clinical practice 31: 31-37.
12. Armour M, Smith CA, Wang LQ, Naidoo D, Yang GY, et al. (2019) Acupuncture for depression: a systematic review and meta-analysis. Journal of clinical medicine 8: 1140.
13. Fang J, Wang D, Zhao Q, Hong Y, Jin Y, et al. (2015) Brain-gut axis modulation of acupuncture in functional dyspepsia: a preliminary resting-state fcMRI study. Evidence-based complementary and alternative medicine 2015: 860463.
14. Li M, Zhang X, Bao H, Li C, Zhang P (2017) Acupuncture for asthma: protocol for a systematic review. Medicine 96: 7296.
15. Yang XY, Yang NB, Huang FF, Ren S, Li ZJ (2021) Effectiveness of acupuncture on anxiety disorder: a systematic review and meta-analysis of randomised controlled trials. Annals of general psychiatry 20: 1-4.
16. Lee MS, Choi TY, Shin BC, Ernst E (2012) Acupuncture for children with autism spectrum disorders: a systematic review of randomized clinical trials. Journal of autism and developmental disorders 42: 1671-1683.
17. Lo SY (2012) Diagnosis, treatment and prevention of autism via meridian theory. The American Journal of Chinese Medicine 40: 39-56.
18. Hanson E, Kalish LA, Bunce E, Curtis C, McDaniel S, et al. (2007) Use of complementary and alternative medicine among children diagnosed with autism spectrum disorder. Journal of autism and developmental disorders 37: 628-636.
19. Senel HG (2010) Parents' views and experiences about complementary and alternative medicine treatments for their children with autistic spectrum disorder. Journal of Autism and Developmental Disorders 40: 494.
20. Lee B, Lee J, Cheon JH, Sung HK, Cho SH, et al. (2018) The efficacy and safety of acupuncture for the treatment of children with autism spectrum disorder: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine 2018: 1057539.
21. Wang L, Peng JL, Qiao FQ, Cheng WM, Lin GW, et al. (2021) Clinical Randomized Controlled Study of Acupuncture Treatment on Children with Autism Spectrum Disorder (ASD): A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med 2021: 5549849.
22. Davis RT, Badger G, Valentine K, Cavert A, Coeytaux RR (2018) Acupuncture for chronic pain in the Vermont Medicaid population: A prospective, pragmatic intervention trial. Global advances in health and medicine 7: 2164956118769557.
23. Seth A, Edwards M, Milaney K, Zwicker J (2022) How governments could best engage community organizations to co-design covid-19 pandemic policies for persons with disabilities. The School of Public Policy Publications, SPP Research Paper 58: 2087-2097.
24. Lu M, Sharmin S, Yang G, Tao Y, Xia X, et al. (2025) Protocol for Alberta Complementary Health Integration Project (ABCHIP): Meeting the Pain and Mental Health Care Needs under COVID-19 for Vulnerable Populations. Under review at Acupuncture in Medicine.
25. Lu M, Sharmin S, Yang G, Tao Y, Xia X, et al. (2025) Effectiveness of Acupuncture in Treating Patients with Chronic Pain and Mental Health Concerns: the results of the Alberta Complementary Health Integration Project (ABCHIP). Under review at Frontiers in Neurology.
26. Lu M, Sharmin S, Yang G, Tao Y, Xia X, et al. (2025) Economic Evaluation of Acupuncture in Treating Patients with Pain and Mental Health Concerns: the results of the Alberta Complementary Health Integration Project (ABCHIP). Under review at Frontiers in Public Health.
27. Maciocia G (2015) The foundations of Chinese medicine: A comprehensive text for acupuncturists and Elsevier Churchill Livingstone, USA.
28. Mirza S, Salisbury C, Hopper C, Foster N, Montgomery A (2013) Comparing sensitivity to change of two patient-reported outcome measures in a randomised trial of patients referred for physiotherapy services. Trials 14: 50.
29. Polus BI, Kimpton AJ, Walsh MJ (2011) Use of the measure your medical outcome profile (MYMOP2) and W-BQ12 (Well-Being) outcomes measures to evaluate chiropractic treatment: an observational study. Chiropractic & manual therapies 19: 7.
30. Paterson C, Langan CE, McKaig GA, Anderson PM, Maclaine GD, et al. (2000) Assessing patient outcomes in acute exacerbations of chronic bronchitis: the measure your medical outcome profile (MYMOP), medical outcomes study 6-item general health survey (MOS-6A) and EuroQol (EQ-5D). Quality of Life Research 9: 521-527.
31. Hull SK, Page CP, Skinner BD, Linville JC, Coeytaux RR (2006) Exploring outcomes associated with acupuncture. Journal of Alternative & Complementary Medicine 12: 247-254.
32. Paterson C (1996) Measuring outcomes in primary care: a patient generated measure, MYMOP, compared with the SF-36 health survey. BMJ 312: 1016-1020.
33. Reilly MC, Zbrozek AS, Dukes EM (1993) The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics 4: 353-365.
34. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, et al. (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of life research: an international journal of quality-of-life aspects of treatment, care and rehabilitation 20: 1727-1736.