The clinical questions of acupuncture-moxibustion(Acup-Mox)guidelines are complicated,including not only the curative effect of Acup-Mox intervention measures,but also the operational elements of Acup-Mox.This paper a...The clinical questions of acupuncture-moxibustion(Acup-Mox)guidelines are complicated,including not only the curative effect of Acup-Mox intervention measures,but also the operational elements of Acup-Mox.This paper aimed to put forward the idea and process of collecting clinical questions in developing international acupuncture clinical practice guidelines.The experience was collected and the idea of collecting clinical questions of Acup-Mox was formed through expert consultation and discussion in combination with expert opinions.Based on the characteristics of Acup-Mox discipline.This paper put forward the thinking of collecting elements of clinical questions following the intervention-population-outcome-control(I-P-O-C)inquiry process,according to the discipline of Acup-Mox.It was emphasized that in the process of collecting clinical questions,"treatable population"and"alleviable outcome indicators"for a specific Acup-Mox intervention with certain therapeutic effect should be focused on,so as to highlight the pertinence of clinical questions of AcupMox guidelines in terms of population and outcome elements.展开更多
Background: Low back pain(LBP) is a prevalent and debilitating condition that poses a significant burden on healthcare systems. Acupuncture has been proposed as a promising intervention for LBP, but the evidence suppo...Background: Low back pain(LBP) is a prevalent and debilitating condition that poses a significant burden on healthcare systems. Acupuncture has been proposed as a promising intervention for LBP, but the evidence supporting its specific effect is insufficient, and the use of sham acupuncture as a control in clinical trials presents challenges due to variations in sham acupuncture techniques and the magnitude of the placebo effect.Objective: To investigate the magnitude of the placebo response of sham acupuncture in trials of acupuncture for nonspecific LBP, and to assess whether different types of sham acupuncture are associated with different responses. Methods: Four databases including PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched through April 15, 2023, and randomized controlled trials(RCTs) were included if they randomized patients with LBP to receive acupuncture or sham acupuncture intervention. The main outcomes included the placebo response in pain intensity, back-specific function and quality of life. Placebo response was defined as the change in these outcome measures from baseline to the end of treatment. Random-effects models were used to synthesize the results, standardized mean differences(SMDs, Hedges’ g) were applied to estimate the effect size. Results: A total of 18 RCTs with 3,321 patients were included. Sham acupuncture showed a noteworthy pooled placebo response in pain intensity in patients with LBP [SMD –1.43, 95% confidence interval(CI) –1.95 to –0.91, I2=89%]. A significant placebo response was also shown in back-specific functional status(SMD –0.49, 95% CI –0.70 to –0.29, I2=73%),but not in quality of life(SMD 0.34, 95% CI –0.20 to 0.88, I2=84%). Trials in which the sham acupuncture penetrated the skin or performed with regular needles had a significantly higher placebo response in pain intensity reduction, but other factors such as the location of sham acupuncture did not have a significant impact on the placebo response.Conclusions: Sham acupuncture is associated with a large placebo response in pain intensity among patients with LBP. Researchers should also be aware that the types of sham acupuncture applied may potentially impact the evaluation of the efficacy of acupuncture. Nonetheless, considering the nature of placebo response, the effect of other contextual factors cannot be ruled out in this study.(PROSPERO registration No. CRD42022304416)展开更多
Background:Currently,more and more infertility couples are opting for combined acupuncture to improve success rate of in vitro fertilization(IVF).However,evidence from acupuncture for improving IVF pregnancy outcomes ...Background:Currently,more and more infertility couples are opting for combined acupuncture to improve success rate of in vitro fertilization(IVF).However,evidence from acupuncture for improving IVF pregnancy outcomes remains a matter of debate.Objective:To quantitatively summarized the evidence of the efficacy of acupuncture among women undergoing IVF by means of systematic review and meta-analysis.Methods:Four English(PubMed,Web of Science,EMBASE,and Cochrane Register of Controlled Clinical Trials)and Four Chinese databases(Wanfang Databases,Chinese National Knowledge Infrastructure,Chinese Science and Technology Periodical Database,and SinoMed)were searched from database inception until July 2,2023.Randomized controlled trials(RCTs)that evaluated the acupuncture’s effects for women undergoing IVF were included.The subgroup analysis was conducted with respect to the age of participants,different acupuncture types,type of control,acupuncture timing,geographical origin of the study,whether or not repeated IVF failure,and acupuncture sessions.Sensitivity analyses were predefined to explore the robustness of results.The primary outcomes were clinical pregnancy rate(CPR)and live birth rate(LBR),and the secondary outcomes were ongoing pregnancy rate and miscarriage rate.Random effects model with I^(2)statistics were used to quantify heterogeneity.Publication bias was estimated by funnel plots and Egger’s tests.Results:A total of 58eligible RCTs representing 10,968 women undergoing IVF for pregnant success were identified.Pooled CPR and LBR showed a significant difference between acupuncture and control groups[69 comparisons,relative risk(RR)1.19,95%confidence intervals(CI)1.12 to 1.25,I^(2)=0],extremely low evidence;23 comparisons,RR 1.11,95%CI 1.02 to 1.21,I^(2)=14.6,low evidence,respectively.Only transcutaneous electrical acupoint stimulation showed a positive effect on both CPR(16 comparisons,RR 1.17,95%CI 1.06 to 1.29;I^(2)=0,moderate evidence)and LBR(9 comparisons,RR 1.20,95%CI 1.04 to 1.37;I^(2)=8.5,extremely low evidence).Heterogeneity across studies was found and no studies were graded as high-quality evidence.Conclusion:Results showed that the convincing evidence levels on the associations between acupuncture and IVF pregnant outcomes were relatively low,and the varied methodological design and heterogeneity might influence the findings.(Registration No.PROSPERO CRD42021232430)展开更多
基金Supported by National Key R&D Program of China(Nos.2019YFC1712200 and 2019YFC1712201)。
文摘The clinical questions of acupuncture-moxibustion(Acup-Mox)guidelines are complicated,including not only the curative effect of Acup-Mox intervention measures,but also the operational elements of Acup-Mox.This paper aimed to put forward the idea and process of collecting clinical questions in developing international acupuncture clinical practice guidelines.The experience was collected and the idea of collecting clinical questions of Acup-Mox was formed through expert consultation and discussion in combination with expert opinions.Based on the characteristics of Acup-Mox discipline.This paper put forward the thinking of collecting elements of clinical questions following the intervention-population-outcome-control(I-P-O-C)inquiry process,according to the discipline of Acup-Mox.It was emphasized that in the process of collecting clinical questions,"treatable population"and"alleviable outcome indicators"for a specific Acup-Mox intervention with certain therapeutic effect should be focused on,so as to highlight the pertinence of clinical questions of AcupMox guidelines in terms of population and outcome elements.
基金the National Natural Science Foundation of China(No.82174234)the National Science Fund for Distinguished Young Scholars(No.81825024)。
文摘Background: Low back pain(LBP) is a prevalent and debilitating condition that poses a significant burden on healthcare systems. Acupuncture has been proposed as a promising intervention for LBP, but the evidence supporting its specific effect is insufficient, and the use of sham acupuncture as a control in clinical trials presents challenges due to variations in sham acupuncture techniques and the magnitude of the placebo effect.Objective: To investigate the magnitude of the placebo response of sham acupuncture in trials of acupuncture for nonspecific LBP, and to assess whether different types of sham acupuncture are associated with different responses. Methods: Four databases including PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched through April 15, 2023, and randomized controlled trials(RCTs) were included if they randomized patients with LBP to receive acupuncture or sham acupuncture intervention. The main outcomes included the placebo response in pain intensity, back-specific function and quality of life. Placebo response was defined as the change in these outcome measures from baseline to the end of treatment. Random-effects models were used to synthesize the results, standardized mean differences(SMDs, Hedges’ g) were applied to estimate the effect size. Results: A total of 18 RCTs with 3,321 patients were included. Sham acupuncture showed a noteworthy pooled placebo response in pain intensity in patients with LBP [SMD –1.43, 95% confidence interval(CI) –1.95 to –0.91, I2=89%]. A significant placebo response was also shown in back-specific functional status(SMD –0.49, 95% CI –0.70 to –0.29, I2=73%),but not in quality of life(SMD 0.34, 95% CI –0.20 to 0.88, I2=84%). Trials in which the sham acupuncture penetrated the skin or performed with regular needles had a significantly higher placebo response in pain intensity reduction, but other factors such as the location of sham acupuncture did not have a significant impact on the placebo response.Conclusions: Sham acupuncture is associated with a large placebo response in pain intensity among patients with LBP. Researchers should also be aware that the types of sham acupuncture applied may potentially impact the evaluation of the efficacy of acupuncture. Nonetheless, considering the nature of placebo response, the effect of other contextual factors cannot be ruled out in this study.(PROSPERO registration No. CRD42022304416)
基金Supported by the National Science Fund for Distinguished Young Scholars(No.81825024)。
文摘Background:Currently,more and more infertility couples are opting for combined acupuncture to improve success rate of in vitro fertilization(IVF).However,evidence from acupuncture for improving IVF pregnancy outcomes remains a matter of debate.Objective:To quantitatively summarized the evidence of the efficacy of acupuncture among women undergoing IVF by means of systematic review and meta-analysis.Methods:Four English(PubMed,Web of Science,EMBASE,and Cochrane Register of Controlled Clinical Trials)and Four Chinese databases(Wanfang Databases,Chinese National Knowledge Infrastructure,Chinese Science and Technology Periodical Database,and SinoMed)were searched from database inception until July 2,2023.Randomized controlled trials(RCTs)that evaluated the acupuncture’s effects for women undergoing IVF were included.The subgroup analysis was conducted with respect to the age of participants,different acupuncture types,type of control,acupuncture timing,geographical origin of the study,whether or not repeated IVF failure,and acupuncture sessions.Sensitivity analyses were predefined to explore the robustness of results.The primary outcomes were clinical pregnancy rate(CPR)and live birth rate(LBR),and the secondary outcomes were ongoing pregnancy rate and miscarriage rate.Random effects model with I^(2)statistics were used to quantify heterogeneity.Publication bias was estimated by funnel plots and Egger’s tests.Results:A total of 58eligible RCTs representing 10,968 women undergoing IVF for pregnant success were identified.Pooled CPR and LBR showed a significant difference between acupuncture and control groups[69 comparisons,relative risk(RR)1.19,95%confidence intervals(CI)1.12 to 1.25,I^(2)=0],extremely low evidence;23 comparisons,RR 1.11,95%CI 1.02 to 1.21,I^(2)=14.6,low evidence,respectively.Only transcutaneous electrical acupoint stimulation showed a positive effect on both CPR(16 comparisons,RR 1.17,95%CI 1.06 to 1.29;I^(2)=0,moderate evidence)and LBR(9 comparisons,RR 1.20,95%CI 1.04 to 1.37;I^(2)=8.5,extremely low evidence).Heterogeneity across studies was found and no studies were graded as high-quality evidence.Conclusion:Results showed that the convincing evidence levels on the associations between acupuncture and IVF pregnant outcomes were relatively low,and the varied methodological design and heterogeneity might influence the findings.(Registration No.PROSPERO CRD42021232430)
