Systematic Reviews on Acupuncture

Systematic Reviews on Acupuncture

Tim H. Tanaka, Ph.D.
The Pacific Wellness Institute, Toronto, Ontario, Canada
Dept. Acupuncture Moxibustion, Tsukuba University of Technology, Japan

Updated January 18, 2011

With the exception of very few recent trials that contain a large number of patients, e.g., 17-21 most of the previous acupuncture trials suffer from the drawback of a small sample size.

Thus, there are a substantial number of previous studies that are considered under-powered and the results may be contaminated by a Type II error (false negative).  A systematic review attempts to systematically collect and analyze all published qualified clinical trials.  All previous studies of the same topic including data from small studies are pooled together and analyzed as if they were one study (meta-analysis). Thus, the systematic review is considered to be of highest quality of evidence in EBM.

It should be kept in mind, however, that the existence of contradicting evidence is not unusual in any medical discipline. The systematic review attempts to minimize such bias by using pre-determined criteria to qualify previous studies, yet this process itself is subject to bias.  It is therefore not uncommon to find contradicting conclusions from systematic reviews on the same research topic. Some researchers therefore, found it necessary to complete a “systematic review of systematic reviews”. 22-27

It is important to note that RCTs included in meta-analyses need to be conducted adequately with sufficient control and intervention protocols, otherwise, the conclusion of systematic review could be skewed.  The issue of publication bias should be also mentioned.  It has been indicated that certain countries tend to publish only positive studies.28 Nevertheless, the systematic review is considered the best evidence available in EBM, and healthcare practitioners and policy makers should pay close attention to these reviews.

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28. Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials 1998;19(2):159-66.

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