Systematic review of systematic reviews of acupuncture published 1996-2005

Pain Research and Nuffield, Department of Anaesthetics, The Churchill, Oxford.
Clinical medicine (London, England) (Impact Factor: 1.49). 07/2006; 6(4):381-6. DOI: 10.7861/clinmedicine.6-4-381
Source: PubMed


Systematic reviews of acupuncture have tended to support its use, but few applied rigorous inclusion criteria. We tested the credibility of conclusions of systematic reviews of acupuncture published since 1996 by applying rigorous inclusion criteria. Reinterpretation used randomised and double blind trials with valid outcomes or design, and with information available from at least four trials or from 200 patients. Qualified support for acupuncture was originally reported in 12 out of 35 systematic reviews, and strong support was found in another six. Applying stricter inclusion criteria, however, showed that none of the 35 reviews supported acupuncture, predominantly because there were too few patients in the randomised, double blind studies. Six reviews with more than 200 patients in randomised, double blind studies had good evidence of no benefit. Systematic reviews of acupuncture have overstated effectiveness by including studies likely to be biased. They provide no robust evidence that acupuncture works for any indication.

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    • "With the evidence based perspective being increasingly applied to complementary and alternative medicine (CAM) in the past decade, a wide variety of condition-focused systematic reviews have evaluated randomized controlled trials (RCTs) of acupuncture. MEDLINE alone lists over 170 of such reviews through 2009, many of which have, in turn, been summarized and analyzed [4] [5] [6] [7] [8] [9] [10]. As noted in these overviews, systematic reviews of acupuncture have employed a heterogeneous group of quality assessment instruments, that vary from the 5-item Jadad scale [11] and a modified 6-item Jadad scale [12] [13] [14], to the Cochrane Collaboration guidelines [15] and a range of broader scales containing up to 27 items [16]. "
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    ABSTRACT: The present study describes the development of a comprehensive quality of reporting assessment tool and its application to acupuncture RCTs from 1997-2007. This Oregon CONSORT STRICTA Instrument (OCSI) is based on the revised CONSORT guidelines as modified by the STRICTA recommendations for acupuncture trials. Each of the resulting 27 OCSI items were applied to English language prospective RCTs that compared acupuncture, using manual and/or electro-stimulation, to no treatment, a sham procedure, or usual biomedical care. The 333 RCTs that met inclusion criteria were dispersed among 27 countries and 141 journals. Mean quality of reporting score for all articles was 63.0% (SD 16.5). Mean OCSI scores revealed a 30.9% improvement over the ten-year period (P < .001). Our findings suggest that to enhance quality of reporting, authors should better attend to seven specific OCSI items in three categories: practitioner training, adverse events, and aspects of randomization and blinding (n = 5). The broad diversity in geographical origin, publication site and quality of reporting, viewed in light of the considerable room for improvement in mean OCSI scores, emphasizes the importance of making STRICTA as well as CONSORT more widely known to journals and to the acupuncture research community.
    Evidence-based Complementary and Alternative Medicine 01/2011; 2011(1741-427X). DOI:10.1155/2011/183910 · 1.88 Impact Factor
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    • "Though systematic reviews are considered the highest form of evidence, many have been shown to be misleading because of common errors [6] [13]. Only half of systematic reviews assess trial quality , and only half of those used trial quality in sensitivity analysis [11]. "
    Pain 09/2010; 150(3):386-9. DOI:10.1016/j.pain.2010.05.011 · 5.21 Impact Factor
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    • "Industry sponsored meta-analyses uniformly recommended use of the experimental drug, and gave more favourable conclusions than the equivalent Cochrane reviews, despite the comparable effect sizes. It appears that a similar bias may be present in the acupuncture literature; an earlier systematic review of acupuncture systematic reviews suggested a trend for reviewers with affiliation to a department of complementary medicine to conclude in favour of acupuncture (Derry et al., 2006). "
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    ABSTRACT: Acupuncture is one of the most widely used and broadly researched of the complementary and alternative therapies, but high-quality trials generally show no benefit over sham acupuncture. Many would view this result as evidence of ineffectiveness for this intervention. This discussion article focuses on the report of a large multicenter randomized controlled trial of acupuncture for chronic low-back pain (CLBP) in the lay and academic press, the ensuing discussion, and its impact on both clinical practice and service provision. The authors suggest that interpretive bias has affected reporting, leading to questionable conclusions and advocacy in favor of this form of care that may exceed the evidence. They also suggest that a lack of understanding of research into the placebo effect may have contributed to confusion in the interpretation of these trials.
    Evaluation &amp the Health Professions 12/2009; 32(4):393-409. DOI:10.1177/0163278709353394 · 1.91 Impact Factor
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