Evidence mapping and overview of systematic reviews of the effects of acupuncture therapies

Abstract

Objective: To provide a route map regarding systematic reviews (SRs) of acupuncture therapies that will meet two goals: (1) to identify areas in which more or better evidence is required and (2) to identify acupuncture applications that, although proven effective, remain underused in practice, and thus warrant more effective knowledge dissemination.

Eligibility criteria: We included SRs that conducted meta-analyses (MAs) of randomised controlled trials (RCTs) for this overview.

Information sources: We searched for SRs without language restrictions from January 2015 to November 2020 in four Chinese electronic databases and Epistemonikos database. And we also searched for newly published RCTs that were eligible for selected best SRs in PubMed, Medline, Cochrane Central Register of Controlled Trials, Embase and four Chinese electronic databases from its lasted search dates to November 2020.

Synthesis of results: We reanalysed the selected MAs if new primary studies were added. We used random-effect model to calculate the overall effect.

Results: Our search identified 120 SRs published in the last 5 years addressing acupuncture therapies across 12 therapeutic areas and 77 diseases and conditions. The SRs included 205 outcomes and involved 138 995 participants from 1402 RCTs. We constructed 77 evidence matrices, including 120 SRs and their included RCTs in the Epistemonikos database. Seventy-seven SRs represented the effect estimate of acupuncture therapies. Finally, we system summarised the areas of possible underutilisation of acupuncture therapies (high or moderate certainty evidence of large or moderate effects), and the areas of warranting additional investigation of acupuncture therapies (low or very low certainty evidence of moderate or large effects).

Conclusion: The evidence maps and overview of SRs on acupuncture therapies identified both therapies with substantial benefits that may require more assertive evidence dissemination and promising acupuncture therapies that require further investigation.

Keywords: COMPLEMENTARY MEDICINE; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; THERAPEUTICS.

Figure 1

Flow chart of the publication-selection process. CBM, Chinese Biomedical Literature Database; CNKI, Chinese National Knowledge Infrastructure.

Figure 2

Country distribution of the first authors affiliation in all included systematic reviews.

Figure 3

Bubble plot. Note: each pie represents a therapeutic area. Pie size: number of randomised controlled trials (RCTs) (larger=more studies).

Figure 4

Large or moderate effects with high or moderate certainty evidence. ARR, absolute risk reduction; CI, confidence interval; C, control group; CoE, certainty of evidence assed using the Grading of Recommendations Assessment, Development and Evaluation approach; certainty of evidence assed using the Grading of Recommendations Assessment, Development and Evaluation approach; EA, electro-acupuncture; MA: manual acupuncture; NO, number; NRT, nicotine replacement therapy; RCT, randomised controlled trials; RH, rehabilitation; RR, relative risk; relative risk; SA, sham acupuncture; SC, standard care; SMD: standard mean difference; T, treatment group; WM: western medicine. Theasterisk(*) was used to present the effect estimate when a lower value indicated a better outcome.

Figure 5

Large effects with low or very low certainty evidence. AA, auricular acupuncture; ARR, absolute risk reduction; BEI: behavioral and educational interventions; C, control group; CI, confidence interval; CoE, certainty of evidence assed using the Grading of Recommendations Assessment, Development and Evaluation approach; EA, electro-acupuncture; MT music therapy; MA, manual acupuncture; NI, no intervention; NO, number; RCT, randomised controlled trials; RH rehabilitation; RR, relative risk; SA, sham acupuncture; SC, standard care; SMD, standard mean difference; T, treatment group; TENs, transcutaneous electrical nerve stimulation; UC, usual care; WM, western medicine. The asterisk(*) was used to present the effect estimate when a lower value indicated a better outcome.

Figure 6

Methodological quality: evaluation results of each A Measurement Tool to Assess Systematic Reviews question of included studies. N, no; PY, partial yes; Y, yes.

Figure 7

Digitised matrix: acupuncture for non-specific low back pain.

Figure 8

Digitised matrix: acupuncture for Rhinitis.