THE ACUPUNCTURE EVIDENCE PROJECT: BACKGROUND, OVERVIEW, AND IMPLICATIONS
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.
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.
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.
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.