Systematic review of systematic reviews of acupuncture published 1996–2005

Abstract

-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.

Evaluation of the Scope and Quality of Systematic Reviews on Nonpharmacological Conservative Treatment for Patellofemoral Pain Syndrome

“…Because the objective of a systematic review is to provide the reader with easily accessible high-quality information, 69 the quality of each systematic review needs to be evaluated before the conclusions or recommendations can be properly considered. Lower-quality reviews may include articles with known sources of bias 22 and introduce bias in their own methodological process, making conclusions potentially invalid. There is currently no consensus as to a rating scale to use when evaluating the quality of a systematic review.…”

Patient-centred medicine

“…As Wonderling suggests, 1 we now have the necessary evidence to sustain this practice but initially the change came about based on the politics of expediency rather than clinical evidence or health economics. 2 The idea that any government and much of the medical profession has ever decided health policy solely based upon science cannot be sustained on present evidence from randomised placebo controlled studies, even in relation to surgical intervention. 3,4 …”

A Blinded Randomised Trial of Acupuncture (Manual and Electroacupuncture) Compared with a Non-Penetrating Sham for the Symptoms of Osteoarthritis of the Knee

“…13;14 Systematic reviews have concluded that there is limited evidence that acupuncture is more effective than no treatment for chronic pain. [15][16][17] However, the authors of a meta-analysis of acupuncture for peripheral osteoarthritis stated that 'sham-controlled RCTs suggest effects of acupuncture for pain control in patients with peripheral joint osteoarthritis'. 18 A recent systematic review reported that acupuncture, when it meets criteria for adequate treatment, is significantly superior to sham acupuncture for chronic knee pain.…”