Efficacy of acupuncture in reducing preoperative anxiety: a meta-analysis

Abstract

Background. Acupuncture has been shown to reduce preoperative anxiety in several previous randomized controlled trials (RCTs). In order to assess the preoperative anxiolytic efficacy of acupuncture therapy, this study conducted a meta-analysis of an array of appropriate studies. Methods. Four electronic databases (MEDLINE, EMBASE, CENTRAL, and CINAHL) were searched up to February 2014. In the meta-analysis data were included from RCT studies in which groups receiving preoperative acupuncture treatment were compared with control groups receiving a placebo for anxiety. Results. Fourteen publications (N = 1,034) were included. Six publications, using the State-Trait Anxiety Inventory-State (STAI-S), reported that acupuncture interventions led to greater reductions in preoperative anxiety relative to sham acupuncture (mean difference = 5.63, P < .00001, 95% CI [4.14, 7.11]). Further eight publications, employing visual analogue scales (VAS), also indicated significant differences in preoperative anxiety amelioration between acupuncture and sham acupuncture (mean difference = 19.23, P < .00001, 95% CI [16.34, 22.12]). Conclusions. Acupuncture therapy aiming at reducing preoperative anxiety has a statistically significant effect relative to placebo or nontreatment conditions. Well-designed and rigorous studies that employ large sample sizes are necessary to corroborate this finding.

Figure 1

Flow chart for included studies.

Figure 2

Risk of bias. Each risk of bias item presented as percentages across all included studies.

Figure 3

Methodological quality summary. Methodological quality indices for all included studies. “+” = low risk of bias, “−” = high risk of bias, and “?” = unclear risk of bias.

Figure 4

Forest plot of acupuncture efficacy in reducing preoperative anxiety. (a) STAI acupuncture versus sham acupuncture. (b) VAS acupuncture versus control groups. (c) Side effect acupuncture versus sham acupuncture. The term “STAIC” in part (a) indicates the State Anxiety Subscale of the State-Trait Anxiety Inventory in children. The term “events” in part (c) indicates the number of patients who reported adverse events including PONV. “Weight” refers to the contribution of each study to the side effects total.

Figure 5

Funnel plot of the mean difference (MD) in anxiety ratings between acupuncture treatment and control groups, versus standard error (SE).

Figure 6

Forest plot depicting various outcomes for postsurgical patient satisfaction. (a) VAS (satisfaction and discomfort after surgery). (b) Number of patients reporting a “good” level of treatment satisfaction.