Well-conducted systematic reviews (SRs) should in principle provide the most reliable evidence on the effectiveness of acupuncture. However, limitations on the methodological rigour of SRs may impact the trustworthiness of their conclusions. This cross-sectional study was aimed at evaluating the methodological quality of recent SRs of acupuncture.
The Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE were searched for SRs focusing on manual acupuncture or electro-acupuncture published during January 2018 and March 2020. Eligible SRs needed to contain at least one meta-analysis and be published in the English language. Two independent reviewers extracted the bibliographical characteristics of the included SRs with a pre-designed questionnaire and appraised the methodological quality of the reviews with the validated AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2). The associations between bibliographical characteristics and methodological quality ratings were explored using Kruskal-Wallis rank tests and Spearman’s rank correlation coefficients.
A total of 106 SRs were appraised. The results were as follows:
- one (0.9%) SR was of high methodological quality,
- no review (0%) was of moderate quality,
- six (5.7%) were of low quality,
- 99 (93.4%) were of critically low quality.
Only ten (9.4%) provided an a priori protocol, only four (3.8%) conducted a comprehensive literature search, only five (4.7%) provided a list of excluded studies, and only six (5.7%) performed a meta-analysis appropriately. Cochrane SRs, updated SRs, and SRs that did not search non-English databases had relatively higher overall quality. The vast majority (87.7%) of the 106 reviews included in this analysis originated from Asia. Conflicts of interest of the review authors were declared in only 2 of the 106 reviews.
The authors concluded that the methodological quality of SRs on acupuncture is unsatisfactory. Future reviewers should improve critical methodological aspects of publishing protocols, performing comprehensive search, providing a list of excluded studies with justifications for exclusion, and conducting appropriate meta-analyses. These recommendations can be implemented via enhancing the technical competency of reviewers in SR methodology through established education approaches as well as quality gatekeeping by journal editors and reviewers. Finally, for evidence users, skills in SR critical appraisal remain to be essential as relevant evidence may not be available in pre-appraised formats.
On this blog, I have often complained about the lack of critical input and the poor quality of systematic reviews of so-called alternative medicine (SCAM), particularly of acupuncture, and especially of Chinese reviews, and even more especially Chinese reviews of (mostly) Chinese studies. This new paper is a valuable confirmation of this fast-growing deficit.
One does not need to be a prophet to predict that this pollution of the literature with complete rubbish will have detrimental effects. Because poor reviews almost always draw an over-optimistic picture of the value of acupuncture, this phenomenon must seriously mislead the public. The end result will be that the public believes acupuncture to be effective.
I cannot help thinking that this is, in fact, the intended aim of the authors of such poor, false-positive reviews. Moreover, a glance at the subject areas of the reviews in the list below gives the impression that China is heavily promoting the idea that acupuncture is a panacea. Yet there is good evidence to show that acupuncture is little more than placebo therapy.
In my last post, I have reported that I am an author of many of the frequently-cited systematic acupuncture reviews. You might thus assume that I am a significant part of this pollution by rubbish reviews. This would, however, be an entirely wrong conclusion. The above analysis covers a period when my unit had already been closed, and I am thus not responsible for a single of the papers included in the above analysis.
List of included systematic reviews
ID | Included systematic reviews |
1 | Acupuncture for primary insomnia: An updated systematic review of randomized controlled trials |
2 | Efficacy and safety of acupuncture for essential hypertension: A meta-analysis |
3 | Acupuncture for the treatment of sudden sensorineural hearing loss: A systematic review and meta-analysis: Acupuncture for SSNHL |
4 | Effectiveness of Acupuncturing at the Sphenopalatine Ganglion Acupoint Alone for Treatment of Allergic Rhinitis: A Systematic Review and Meta-Analysis |
5 | Acupuncture and clomiphene citrate for anovulatory infertility: a systematic review and meta-analysis |
6 | Acupuncture for primary trigeminal neuralgia: A systematic review and PRISMA-compliant meta-analysis |
7 | Acupuncture as an adjunctive treatment for angina due to coronary artery disease: A meta-analysis |
8 | Conventional treatments plus acupuncture for asthma in adults and adolescent: A systematic review and meta-analysis |
9 | Optimizing acupuncture treatment for dry eye syndrome: A systematic review |
10 | Acupuncture using pattern-identification for the treatment of insomnia disorder: a systematic review and meta-analysis of randomized controlled trials |
11 | Efficacy and Safety of Auricular Acupuncture for Cognitive Impairment and Dementia: A Systematic Review |
12 | Acupuncture for cognitive impairment in vascular dementia, alzheimer’s disease and mild cognitive impairment: A systematic review and meta-analysis |
13 | Effectiveness of pharmacopuncture for cervical spondylosis: A systematic review and meta-analysis |
14 | Acupuncture combined with swallowing training for poststroke dysphagia: a meta-analysis of randomised controlled trials |
15 | Scalp acupuncture treatment for children’s autism spectrum disorders: A systematic review and meta-analysis |
16 | Acupuncture for Post-stroke Shoulder-Hand Syndrome: A systematic review and meta-analysis |
17 | Systematic review of acupuncture for the treatment of alcohol withdrawal syndrome |
18 | Acupuncture for hip osteoarthritis |
19 | Clinical Benefits of Acupuncture for the Reduction of Hormone Therapy-Related Side Effects in Breast Cancer Patients: A Systematic Review |
20 | Combination therapy of scalp electro-acupuncture and medication for the treatment of Parkinson’s disease: A systematic review and meta-analysis |
21 | Acupuncture for migraine: A systematic review and meta-analysis |
22 | Acupuncture to Promote Recovery of Disorder of Consciousness after Traumatic Brain Injury: A Systematic Review and Meta-Analysis |
23 | Acupuncture Compared with Intramuscular Injection of Neostigmine for Postpartum Urinary Retention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
24 | Acupuncture for the relief of hot flashes in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials and observational studies |
25 | Effectiveness and Safety of Acupuncture for Perimenopausal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
26 | Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis |
27 | Electroacupuncture as an adjunctive therapy for motor dysfunction in acute stroke survivors: A systematic review and meta-analyses |
28 | Acupuncture for Acute Pancreatitis: A Systematic Review and Meta-analysis |
29 | Acupuncture for chronic fatigue syndrome: a systematic review and meta-analysis |
30 | Compare the efficacy of acupuncture with drugs in the treatment of Bell’s palsy: A systematic review and meta-analysis of RCTs |
31 | The effectiveness and safety of acupuncture for the treatment of myasthenia gravis: a systematic review and meta-analysis of randomized controlled trials |
32 | Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials |
33 | The effectiveness of acupuncture therapy in patients with post-stroke depression: An updated meta-analysis of randomized controlled trials |
34 | Fire needling for herpes zoster: A systematic review and meta-analysis of randomized clinical trials |
35 | Comparison between the Effects of Acupuncture Relative to Other Controls on Irritable Bowel Syndrome: A Meta-Analysis |
36 | Manual Acupuncture for Optic Atrophy: A Systematic Review and Meta-Analysis |
37 | Effect of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis: A systematic review and meta-analysis |
38 | The Effect of Acupuncture in Breast Cancer-Related Lymphoedema (BCRL): A Systematic Review and Meta-Analysis |
39 | The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis |
40 | The maintenance effect of acupuncture on breast cancer-related menopause symptoms: a systematic review |
41 | The effectiveness of acupuncture in the management of persistent regional myofascial head and neck pain: A systematic review and meta-analysis |
42 | Acupuncture for the Treatment of Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis |
43 | The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis |
44 | Effects of dry needling trigger point therapy in the shoulder region on patients with upper extremity pain and dysfunction: a systematic review with meta-analysis |
45 | Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis |
46 | The effectiveness and safety of acupuncture for patients with atopic eczema: a systematic review and meta-analysis |
47 | Comparing verum and sham acupuncture in fibromyalgia syndrome: a systematic review and meta-analysis |
48 | Acupuncture for symptomatic gastroparesis |
49 | The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis |
50 | Acupuncture Versus Sham-acupuncture: A Meta-analysis on Evidence for Non-immediate Effects of Acupuncture in Musculoskeletal Disorders |
51 | Acupuncture Treatment for Post-Stroke Dysphagia: An Update Meta-Analysis of Randomized Controlled Trials |
52 | Effectiveness of Acupuncture Used for the Management of Postpartum Depression: A Systematic Review and Meta-Analysis |
53 | Clinical effects and safety of electroacupuncture for the treatment of post-stroke depression: a systematic review and meta-analysis of randomised controlled trials |
54 | Placebo effect of acupuncture on insomnia: a systematic review and meta-analysis |
55 | Acupuncture for Chronic Pain-Related Insomnia: A Systematic Review and Meta-Analysis |
56 | Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis |
57 | Warm needle acupuncture in primary osteoporosis management: a systematic review and meta-analysis |
58 | Acupuncture for overactive bladder in adults: a systematic review and meta-analysis |
59 | Traditional acupuncture for menopausal hot flashes: A systematic review and meta-analysis of randomized controlled trials |
60 | The effectiveness of acupuncture for osteoporosis: A systematic review and meta-analysis |
61 | Long-term effects of acupuncture for chronic prostatitis/chronic pelvic pain syndrome: Systematic review and single-Arm meta-Analyses |
62 | Does acupuncture the day of embryo transfer affect the clinical pregnancy rate? Systematic review and meta-analysis |
63 | Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials |
64 | Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis |
65 | Is Acupuncture Effective for Improving Insulin Resistance? A Systematic Review and Meta-analysis |
66 | Efficacy of acupuncture in the management of post-apoplectic aphasia: A systematic review and meta-analysis of randomized controlled trials |
67 | Acupuncture for lumbar disc herniation: a systematic review and meta-analysis |
68 | Traditional Chinese acupuncture and postpartum depression: A systematic review and meta-analysis |
69 | Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis |
70 | Acupuncture Therapy for Functional Effects and Quality of Life in COPD Patients: A Systematic Review and Meta-Analysis |
71 | Electroacupuncture for Reflex Sympathetic Dystrophy after Stroke: A Meta-Analysis |
72 | The Effect of Patient Characteristics on Acupuncture Treatment Outcomes |
73 | The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis |
74 | Role of acupuncture in the treatment of insulin resistance: A systematic review and meta-analysis |
75 | Appropriateness of sham or placebo acupuncture for randomized controlled trials of acupuncture for nonspecific low back pain: A systematic review and meta-analysis |
76 | Evidence of efficacy of acupuncture in the management of low back pain: a systematic review and meta-analysis of randomised placebo- or sham-controlled trials |
77 | The effects of acupuncture on pregnancy outcomes of in vitro fertilization: A systematic review and meta-analysis |
78 | Acupuncture for migraine without aura: a systematic review and meta-analysis |
79 | Acupuncture for acute stroke |
80 | Acupuncture at Tiaokou (ST38) for Shoulder Adhesive Capsulitis: What Strengths Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
81 | Acupuncture for hypertension |
82 | The effect of acupuncture on Bell’s palsy: An overall and cumulative meta-analysis of randomized controlled trials |
83 | Effects of acupuncture on cancer-related fatigue: a meta-analysis |
84 | Acupuncture for adults with overactive bladder |
85 | Electroacupuncture for Postoperative Urinary Retention: A Systematic Review and Meta-Analysis |
86 | Meta-Analysis of Electroacupuncture in Cardiac Anesthesia and Intensive Care |
87 | Acupuncture therapy improves health-related quality of life in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis |
88 | The effect of acupuncture on the quality of life in patients with migraine: A systematic review and meta-analysis |
89 | Cognitive improvement effects of electro-acupuncture for the treatment of MCI compared with Western medications: A systematic review and Meta-analysis 11 Medical and Health Sciences 1103 Clinical Sciences |
90 | Oriental herbal medicine and moxibustion for polycystic ovary syndrome: A meta-analysis |
91 | The Effect of Acupuncture and Moxibustion on Heart Function in Heart Failure Patients: A Systematic Review and Meta-Analysis |
92 | Acupuncture therapy for the treatment of stable angina pectoris: An updated meta-analysis of randomized controlled trials |
93 | Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis |
94 | Effects of moxibustion on pain behaviors in patients with rheumatoid arthritis: A meta-analysis |
95 | Acupuncture Treatment for Chronic Pelvic Pain in Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
96 | The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis |
97 | Acupuncture for postherpetic neuralgia systematic review and meta-analysis |
98 | Acupoint selection for the treatment of dry eye: A systematic review and meta-analysis of randomized controlled trials |
99 | Warm-needle moxibustion for spasticity after stroke: A systematic review of randomized controlled trials |
100 | Acupuncture for menstrual migraine: a systematic review |
101 | The efficacy of acupuncture for stable angina pectoris: A systematic review and meta-analysis |
102 | Acupuncture and weight loss in Asians: A PRISMA-compliant systematic review and meta-analysis |
103 | Effects of Acupuncture on Breast Cancer-Related lymphoedema: A Systematic Review and Meta-Analysis |
104 | Acupuncture for infertile women without undergoing assisted reproductive techniques (ART): A systematic review and meta-analysis |
105 | Moxibustion for alleviating side effects of chemotherapy or radiotherapy in people with cancer |
106 | Acupuncture for stable angina pectoris: A systematic review and meta-analysis |
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