The first evidence map for acupunture identified promising therapies
We combined evidence mapping and an overview approach to provide the first evidence map for acupuncture therapies across all therapeutic areas. An evidence map is considered to be a particularly useful tool for evidence-based decision-making and evidence-based policy development.
Our Methodology Team assessed 120 systematic reviews (SRs) published in the last 5 years, addressing acupuncture therapies across 77 diseases and conditions. The SRs included 138.995 participants from 1.402 randomized control trials (RCTs).
Acupuncture is one of the most accepted alternative therapies among clinicians and patients. In the last 30 to 40 years, its application has extended to treat a wide variety of diseases and conditions. According to a World Health Organization 2013 report, acupuncture use was recognized in 103 of the 194 member states.
Along with the increase in the practice of acupuncture, clinical research on the therapeutic effects of this traditional chinese medicine has also grown. In order to summarize the existing evidence on acupuncture, we partnered with the Guangzhou University of Chinese Medicine, the Guang’anmen Hospital, the Academy of Chinese Medical Sciences, The University of Nottingham Ningbo, the Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine and the Department of Health Research Methods, Evidence, and Impact from McMaster University. The purpose of our work was to identify both promising acupuncture therapies that require further investigation and therapies with demonstrated substantial benefits that may require more assertive evidence dissemination.
Effective interventions at risk of underutilisation:
- Lactation within 24 hours after delivery
- Poststroke aphasia
- Myofascial pain (pain relief)
- Vascular dementia
- Neck, shoulder, and non-specific low-back pain
- Fibromyalgia syndrome
- Allergic rhinitis.
Promising but unproven interventions warranting further research:
- Peptic ulcer
- Urinary infection
- Smoking cessation
- Lactation within 24 and 72 hours after delivery.
Plenty of evidence but of poor quality
Our initial query resulted in 3.427 articles about acupuncture therapies, that we screened on title and abstract. Next, we assessed the full text of 614 of them. Following the selection criteria, we included 120 systematic reviews (SRs) to perform the analysis. It is noteworthy that 119 of the 120 SRs are rated as having ‘low’ or ‘critically low’ quality.
We detected the following therapeutic areas with high or moderate certainty of evidence:
- Improvement in functional communication of patients who had poststroke aphasia
- Reduction in myofascial pain
- Increased lactation success rate within 24 hours postdelivery
- Relief of neck pain and shoulder pain
- Reduction in the severity of vascular dementia symptoms
- Relief of fibromyalgia-related pain and non-specific low back pain
- Improvement of allergic rhinitis nasal symptoms.
On the other hand, we identified areas with low or very low certainty of evidence:
- Reduction in the length of first flatus and defecation in postoperative ileus after abdominal surgery
- Reduction in pain of poststroke shoulder–hand syndrome
- Increase in motor function and reduction in spasm symptoms of patients who had poststroke spastic hemiplegia
- Improvement in sleep quality of patients with insomnia disorder, patients with haemodialysis and menopausal women
- Reduction in neurogenic pain
- Improvement in the symptoms of autism spectrum disorder in children
- Reduction in the severity of migraine pain
- Improvement in quality of life of migraine patients
- Reduction in the severity of carpal tunnel syndrome pain and tic symptoms in patients with tic disorder
- Reduction in sciatica pain
- Improvement in quality of life and constipation symptoms of patients with functional dyspepsia
- Reduction in the severity of pain and voiding symptoms
- Rmprovement in quality of life of patients with chronic prostatitis
- Increase in abstinence rate for smoking in short and long terms
- Reduction in severity of opioid craving and depression in opioid use disorder
- Reduction in body mass index in patients with obesity
- Improvement in success rate of lactation within 24 and 72 hours after delivery
- Improvement in the overall symptoms of chronic pelvic pain syndrome
- Reduction in severity of pain and menstrual symptoms of dysmenorrhoea
- Improvement in pregnancy rate among infertile women.
Then, we selected the best SR to provide the most up-to-date effect estimate and its corresponding certainty of evidence. For the best SRs, we used a bubble plot to display therapeutic areas, their corresponding SRs, RCTs and the type of acupuncture tested. Of the 77 reviews, neurology is the content area most frequently represented (33.8%), with a number of areas in the vicinity of 10% (oncology, connective tissue diseases, gastrointestinal disorders, mental health, obstetrics, gynaecology and women’s health), and others 5.2% or less (periprocedural care, genitourinary disorders, eye disorders, ear, nose, and throat disorders, nutrition and metabolic disorders, pregnancy or intended pregnancy).
To date, no other evidence maps or overview of SRs summarising evidence regarding acupuncture therapies exist. Evidence mapping is a relatively novel method for the overview of SRs and is particularly suitable for areas where a large number of SRs exist and overlap across diseases and conditions because it helps to define future research and knowledge dissemination priorities.