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Meta-Analysis
. 2021 Aug;39(4):309-317.
doi: 10.1177/0964528420959089. Epub 2020 Dec 10.

Do the effects of acupuncture vary between acupuncturists? Analysis of the Acupuncture Trialists' Collaboration individual patient data meta-analysis

Andrew J Vickers  1 , Emily A Vertosick  1 , George Lewith  2 , Hugh MacPherson  3 , Nadine E Foster  4 , Karen J Sherman  5 , Dominik Irnich  6 , Claudia M Witt  7   8   9 , Klaus Linde  10 ; Acupuncture Trialists’ Collaboration
Affiliations
Meta-Analysis

Do the effects of acupuncture vary between acupuncturists? Analysis of the Acupuncture Trialists' Collaboration individual patient data meta-analysis

Andrew J Vickers et al. Acupunct Med. 2021 Aug.

Abstract

Objectives: The degree to which the effects of acupuncture treatment vary between acupuncturists is unknown. We used a large individual patient dataset of trials of acupuncture for chronic pain to assess practitioner heterogeneity.

Methods: Individual patient data linked to identifiable acupuncturists were drawn from a dataset of 39 high-quality trials of acupuncture, where the comparators were either sham acupuncture or non-acupuncture controls, such as standard care or waitlist. Heterogeneity among acupuncturists was assessed by meta-analysis.

Results: A total of 1206 acupuncturists in 13 trials were included. Statistically significant heterogeneity was found in trials with sham-control groups (p < 0.0001) and non-acupuncture control groups (p <0.0001). However, the degree of heterogeneity was very small, with the observed distribution of treatment effects virtually overlapping that expected by chance. For instance, for non-acupuncture-controlled trials, the proportion of acupuncturists with effect sizes half a standard deviation greater or less than average was expected to be 34%, but was observed to be 37%. A limitation is that the trials included a relatively limited range of acupuncturists, mainly physician-acupuncturists.

Discussion: Although differences in effects between acupuncturists were greater than expected by chance, the degree of variation was small. This suggests that most chronic pain patients in clinical practice would have similar results to those reported in high-quality trials; comparably, we did not find evidence to suggest that greater standardization of acupuncture practice would improve outcomes. Further research needs to be conducted exploring variability using a sample of acupuncturists with a broader range of practice styles, training and experience.

Keywords: acupuncture; acupuncturist variability; chronic pain; practitioner variability; secondary analysis.

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Conflict of interest statement

Disclosures: The authors have no competing interests and nothing to disclose.

Figures

Figure 1.
Figure 1.
Difference between expected and observed complication rates between surgeons, adapted from Bianco et al.(52)
Figure 2.
Figure 2.
Distribution of observed and expected acupuncturist effect sizes in non-acupuncture-controlled trials, N=226.
Figure 3.
Figure 3.
Distribution of observed and expected acupuncturist effect sizes in sham-controlled trials, N=65.
See this image and copyright information in PMC

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