ABSTRACT

Background

In 2015 the Australian Government initiated a review into the clinical evidence underpinning every item in the publicly funded Medicare system, which included acupuncture. The Australian Acupuncture and Chinese Medicine Association Ltd responded by commissioning a review of the state of the evidence regarding acupuncture, with the focus on systematic reviews and meta-analyses. 

Methods

A search of PubMed and Cochrane Library for systematic reviews and meta-analyses from March 2013 to September 2016 was conducted. Three reviews from October 2016 to January 2017 were also included. Evidence levels were graded using NHMRC levels. Risk of bias was assessed using the Cochrane GRADE system where possible. 

Results

Of the 122 conditions reviewed, evidence of effect was found at various levels for 117 conditions. Five conditions were assessed as ‘no evidence of effect’. The level of evidence had increased for 24 conditions since the previous reviews. Evidence of safety and cost-effectiveness was identified. Numerous clinical guidelines recommend acupuncture even though the evidence falls below the highest level. The findings of the review are limited by the mounting evidence that sham/placebo controls used in acupuncture trials are not inert, which is likely to lead to a consistent underestimation of the true effect size of acupuncture interventions. 

Conclusions

Evidence of the highest level has demonstrated the validity of acupuncture as a relatively safe, effective, and cost-effective treatment for a range of conditions across a variety of clinical areas. The number of conditions for which moderate and strong positive evidence has emerged has increased over the 11-year period that this review examined. There is no longer a question of if acupuncture works or if its effects are due to the placebo effect. Future acupuncture research should be informed by a greater emphasis on pragmatic trials and studies into comparative effectiveness. 

Key words: acupuncture, evidence, systematic review, meta-analysis, clinical practice guideline.

针灸证据项目:背景、综述和影响

摘要

背景：2015年，澳大利亚政府发起了一个对公共资助的医疗保险体系中每个项目临床证据基础材料的检阅，其中就包括针灸。澳大利亚针灸和中医协会的回应是，对针灸的证据状况进行了审查，重点是系统的评价和元分析。

方法：从2013年3月到2016年9月，在PubMed和Cochrane图书馆进行了系统评价和元分析。2016年10月至2017年1月的三份综述也包括在内。证据水平使用NHMRC水平进行分级。在可能的情况下，使用Cochrane评分系统评估偏见风险。

结果：在研究的122个情况中，117个情况的证据效果处于不同的水平。五种情况被评估为“没有证据”。自先前回顾以来，已有24个情况的证据水平有所提高。安全性和成本效益的证据已确定。即使证据低于最高水平，许多临床指南还是都、推荐针灸。综述调查的结果是有限的，越来越多的模拟对照和安慰剂对照证据表明针灸试验并不是无效的，这很可能会导致对针灸干预的真实效果的持续低估。

结论：最高水平的证据表明，针灸作为一种相对安全、有效且具有成本效益的治疗方法，在不同的临床领域都是有效的。在这篇综述检测的11年间，温和有力的正面证据数量得到增加。现在已经不再有关于针灸是否有效或者它的效用是否来自安慰剂效应的问题。未来的针灸研究应该更注重实用试验和比较实效的研究。