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Hempel S, Taylor SL, Solloway MR, et al. Evidence Map of Acupuncture [Internet]. Washington (DC): Department of Veterans Affairs (US); 2014 Jan.

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Evidence Map of Acupuncture [Internet].

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SUMMARY AND LIMITATIONS

This broad overview of the evidence base on acupuncture included 183 systematic reviews published since 2005. The most secondary literature and primary research is available for the clinical indication Pain. The most promising evidence for the effectiveness of acupuncture was also identified for this outcome. However, it should be noted that we did not review the evidence base with standard evidence synthesis methods (ie, a systematic review). This broad evidence map only estimated the research volume and effectiveness of acupuncture judging from published reviews. We had no control over the scope, inclusion criteria, or methodological rigor of the reviews. Across reviews there is overlap as individual primary studies have contributed to multiple reviews (most prominently in the systematic reviews on pain) and reviews differed widely (in selected areas reviews on the same topic included between one versus 72 studies). Furthermore, the choice of comparator is the subject of an ongoing scientific debate and adds to the complexity of the evidence base on acupuncture.

Evidence maps are only meant as a broad overview over the evidence base indicating in which areas research has been conducted. This report was not designed to inform policies regarding the use of acupuncture or precluding acupuncture for specific conditions within the VA. More detailed and definitive answers, as well as information on differences in effects based on the type of acupuncture intervention, the type of comparator, competing outcomes, or the study design, can only be obtained by carrying out individual systematic reviews for each of the numerous clinical indications. Full systematic reviews would involve targeted electronic searches, inclusion screening titles and abstracts and full text publications to identify primary research studies, numerous steps to minimize reviewer errors and bias such as screening in duplicate, extracting the outcomes of interest from each available primary study for an independent meta-analysis, differentiating comparators and intervention modalities and other potential moderators in subgroup and meta-regressions, quality assessing the included studies, synthesizing the available studies, and evaluating the overall body of evidence in detail. Finally, assessments to evaluate the value of acupuncture need to take into account multiple factors such as the clinical efficacy, risks and benefits compared to standard treatment, costs and cost-effectiveness, as well as patient satisfaction and patient preferences for a particular clinical diagnosis.

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