Skip to main content

Advertisement

SpringerLink
Log in

Approach to Assess Adequacy of Acupuncture in Randomized Controlled Trials: A Systematic Review

  • Literature Research
  • Published:
Chinese Journal of Integrative Medicine Aims and scope Submit manuscript

Abstract

Objective

To summarize and identify the available instruments/methods assessing the adequacy of acupuncture in randomized controlled trials (RCTs) for proposing a new improved instrument.

Methods

A systematic literature search was carried out in 7 electronic databases from inception until 21st November 2022. Any study evaluating the adequacy or quality of acupuncture, specifying specific acupuncture treatment-related factors as criteria of subgroup analysis, or developing an instrument/tool to assess the adequacy or quality of acupuncture in an RCT was included. Basic information, characteristics and contents of acupuncture adequacy assessment were presented as frequencies and percentages.

Results

Forty studies were included in this systematic review. Thirty-five studies (87.50%) were systematic reviews, none of which used formal methods to develop the assessment instruments/methods of acupuncture adequacy; of 5 methodological studies, only 1 study used a relatively formal method. Thirty-two studies (82.05%) assessed the components of acupuncture, while 7 (17.95%) assessed the overall quality of acupuncture. An independent assessment instrument/method was used to assess acupuncture adequacy in 29 studies (74.35%), whereas as one part of a methodological quality assessment scale in 10 (25.65%). Only 9 (23.00%) studies used the assessment results for subgroup analysis, sensitivity analysis or the criteria for inclusion in the meta-analysis.

Conclusion

Assessment contents for adequacy or quality of acupuncture in RCTs hadn’t still reached consensus and no widely used assessment tools appeared. The methodology of available assessment instruments/scales is far from formal and rigorous. A new instrument/tool assessing adequacy of acupuncture should be developed using a formal method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Witt CM. Clinical research on acupuncture—concepts and guidance on efficacy and effectiveness research. Chin J Integr Med 2011;17:166–172.

    Article  PubMed  Google Scholar 

  2. Lee IS, Chae Y. A bibliometric analysis of acupuncture research trends in acupuncture in medicine. Acupunct Med 2019;37:375–377.

    Article  CAS  PubMed  Google Scholar 

  3. Ma Y, Dong M, Zhou K, Mita C, Liu J, Wayne PM. Publication trends in acupuncture research: a 20-year bibliometric analysis based on PubMed. PLoS One 2016;11:e0168123.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Prady SL, Burch J, Crouch S, MacPherson H. Insufficient evidence to determine the impact of patient preferences on clinical outcomes in acupuncture trials: a systematic review. J Clin Epidemiol 2013;66:308–318.

    Article  PubMed  Google Scholar 

  5. Birch S. An exploration with proposed solutions of the problems and issues in conducting clinical research in acupuncture [Dissertation]. Exeter: University of Exeter;1997.

    Google Scholar 

  6. West S, King V, Carey TS, Lohr KN, McKoy N, Sutton SF, et al. Systems to rate the strength of scientific evidence. Evid Rep Technol Assess (Summ) 2002;47:1–11.

    Google Scholar 

  7. Higgins JPT, Thomas J, Chandler J, Cumpston M, eds. Cochrane handbook for systematic reviews of interventions version 6.2 (updated February 2021). Cochrane. Available at: https://www.training.cochrane.org/handbook.

  8. Savović J, Jones HE, Altman DG, Harris RJ, Jüni P, Pildal J, et al. Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials. Ann Intern Med 2012;157:429–438.

    Article  PubMed  Google Scholar 

  9. Dyrvig AK, Kidholm K, Gerke O, Vondeling H. Checklists for external validity: a systematic review. J Eval Clin Pract 2014;20:857–864.

    Article  PubMed  Google Scholar 

  10. Ter Riet G, Kleijnen J, Knipschild P. A meta-analysis of studies into the effect of acupuncture on addiction. Br J Gen Pract 1990;40:379–382.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Linde K, Worku F, Stör W, Wiesner-Zechmeister M, Pothmann R, Weinschütz T, et al. Randomized clinical trials of acupuncture for asthma—a systematic review. Forsch Komplemetärmed 1996;3:148–155.

    Google Scholar 

  12. Ernst E, White AR. Acupuncture for back pain: a meta-analysis of randomized controlled trials. Arch Intern Med 1998;158:2235–2241.

    Article  CAS  PubMed  Google Scholar 

  13. MacPherson H, White A, Cummings M, Jobst K, Rose K, Niemtzow R. Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations. Complement Ther Med 2001;9:246–249.

    Article  CAS  PubMed  Google Scholar 

  14. Svenkerud S, MacPherson H. The impact of STRICTA and CONSORT on reporting of randomised control trials of acupuncture: a systematic methodological evaluation. Acupunct Med 2018;36:349–357.

    Article  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gang WJ, Meng X, Jing XH. Assessing the adequacy of acupuncture in clinical trials: current status and suggestions. Chin Acupunct Moxibust 2019;39:229–233.

    Google Scholar 

  17. Manyanga T, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, et al. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med 2014;14:312.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev 2009:Cd001218.

  19. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev 2009:Cd007587.

  20. Lee JH, Choi TY, Lee MS, Lee H, Shin BC, Lee H. Acupuncture for acute low back pain: a systematic review. Clin J Pain 2013;29:172–185.

    Article  PubMed  Google Scholar 

  21. Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin BC, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev 2016;4:Cd007587.

    PubMed  Google Scholar 

  22. Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev 2016;2016:Cd001218.

    PubMed  PubMed Central  Google Scholar 

  23. Molsberger A, Böwing G. Acupuncture for pain in locomotive disorders. Critical analysis of clinical studies with respect to the quality of acupuncture in particular. Schmerz 1997;11:24–29.

    Article  CAS  PubMed  Google Scholar 

  24. White AR, Ernst E. A trial method for assessing the adequacy of acupuncture treatments. Altern Ther Health Med 1998;4:66–71.

    CAS  PubMed  Google Scholar 

  25. Sun N, Tu JF, Lin LL, Li YT, Yang JW, Shi GX, et al. Correlation between acupuncture dose and effectiveness in the treatment of knee osteoarthritis: a systematic review. Acupunct Med 2019;37:261–267.

    Article  PubMed  Google Scholar 

  26. Hao XA, Xue CC, Dong L, Zheng Z. Factors associated with conflicting findings on acupuncture for tension-type headache: qualitative and quantitative analyses. J Altern Complement Med 2013;19:285–297.

    Article  PubMed  Google Scholar 

  27. Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 2000;86:217–225.

    Article  PubMed  Google Scholar 

  28. Ezzo J, Hadhazy V, Birch S, Lao L, Kaplan G, Hochberg M, et al. Acupuncture for osteoarthritis of the knee: a systematic review. Arthritis Rheum 2001;44:819–825.

    Article  CAS  PubMed  Google Scholar 

  29. Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analysis: acupuncture for low back pain. Ann Intern Med 2005;142:651–663.

    Article  PubMed  Google Scholar 

  30. White A, Foster NE, Cummings M, Barlas P. Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology (Oxford) 2007;46:384–390.

    Article  CAS  PubMed  Google Scholar 

  31. White A, Cummings M, Barlas P, Cardini F, Filshie J, Foster NE, et al. Defining an adequate dose of acupuncture using a neurophysiological approach—a narrative review of the literature. Acupunct Med 2008;26:111–120.

    Article  PubMed  Google Scholar 

  32. Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev 2013;2013:Cd007070.

    PubMed  PubMed Central  Google Scholar 

  33. Manheimer E, Linde K, Lao L, Bouter LM, Berman BM. Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med 2007;146:868–877.

    Article  PubMed  Google Scholar 

  34. Furlan AD, van Tulder MW, Cherkin DC, Tsukayama H, Lao L, Koes BW, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev 2005;1:Cd001351.

    Google Scholar 

  35. Ezzo J, Richardson MA, Vickers A, Allen C, Dibble S, Issell BF, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev 2006;2:CD002285.

    Google Scholar 

  36. Vickers AJ, Cronin AM, Maschino AC, Lewith G, Macpherson H, Victor N, et al. Individual patient data metaanalysis of acupuncture for chronic pain: protocol of the Acupuncture Trialists’ Collaboration. Trials 2010;11:90.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Manheimer E, Cheng K, Wieland LS, Min LS, Shen X, Berman BM, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2012;5:Cd005111.

    PubMed  Google Scholar 

  38. Grant SJ, Smith CA, de Silva N, Su C. Defining the quality of acupuncture: the case of acupuncture for cancer-related fatigue. Integr Cancer Ther 2015;14:258–270.

    Article  CAS  PubMed  Google Scholar 

  39. Ter Riet G, Kleijnen J, Knipschild P. Acupuncture and chronic pain: a criteria-based meta-analysis. J Clin Epidemiol 1990;43:1191–1199.

    Article  CAS  PubMed  Google Scholar 

  40. Kleijnen J, Ter Riet G, Knipschild P. Acupuncture and asthma: a review of controlled trials. Thorax 1991;46:799–802.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. D’Alberto A. Auricular acupuncture in the treatment of cocaine/crack abuse: a review of the efficacy, the use of the National Acupuncture Detoxification Association protocol, and the selection of sham points. J Altern Complement Med 2004;10:985–1000.

    Article  PubMed  Google Scholar 

  42. Smith CA, Zaslawski CJ, Cochrane S, Zhu X, Zheng Z, Loyeung B, et al. Reliability of the NICMAN Scale: an instrument to assess the quality of acupuncture administered in clinical trials. Evid Based Complement Alternat Med 2017;2017:5694083.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Armour M, Ee CC, Hao J, Wilson TM, Yao SS, Smith CA. Acupuncture and acupressure for premenstrual syndrome. Cochrane Database Syst Rev 2018;8:Cd005290.

    PubMed  Google Scholar 

  44. Nash J, Armour M, Penkala S. Acupuncture for the treatment of lower limb diabetic peripheral neuropathy: a systematic review. Acupunct Med. 2019;37:3–15.

    Article  PubMed  Google Scholar 

  45. Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, et al. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev 2020;2:Cd009232.

    PubMed  Google Scholar 

  46. Smith CA, Zaslawski CJ, Zheng Z, Cobbin D, Cochrane S, Lenon GB, et al. Development of an instrument to assess the quality of acupuncture: results from a Delphi process. J Altern Complement Med 2011;17:441–452.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. PLoS Med 2010;7:e1000217.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Flay BR. Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med 1986;15:451–474.

    Article  CAS  PubMed  Google Scholar 

  49. Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev 2010;1:CD001977.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China

    Lan-jun Shi, Zi-yu Tian, Xiao-yi Hu, Wen-cui Xiu, Rui-min Jiao, Xiang-yu Hu, Wei-juan Gang & Xiang-hong Jing

  2. Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China

    Nicola Robinson

  3. School of Health and Social Care, London South Bank University, London, SE1OAA, UK

    Nicola Robinson

Authors
  1. Lan-jun Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zi-yu Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiao-yi Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wen-cui Xiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rui-min Jiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiang-yu Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nicola Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wei-juan Gang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xiang-hong Jing
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Shi LJ and Gang WJ contributed to the conception and design of the study. Shi LJ, Jiao RM, Xiu WC, Hu XYa, Hu HYb and Tian ZY contributed to study selection, data extraction and analysis. Shi LJ contributed to writing the draft. Gang WJ, Robinson N, and Jing XH revised the manuscript critically for important intellectual content. All data were generated in-house, and no paper mill was used. All authors agree to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Wei-juan Gang.

Additional information

Conflict of Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Supported by the National Natural Science Foundation of China (No. 81973968) and the China Academy of Chinese Medical Sciences (Nos. GH201901 and 2020YJSZX-1)

Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, Lj., Tian, Zy., Hu, Xy. et al. Approach to Assess Adequacy of Acupuncture in Randomized Controlled Trials: A Systematic Review. Chin. J. Integr. Med. 29, 730–737 (2023). https://doi.org/10.1007/s11655-023-3691-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11655-023-3691-3

Keywords

Search

Navigation