Article type
Abstract
Background: In sham acupuncture-controlled clinical trials assessing the efficacy of acupuncture, although sham acupuncture techniques are different from those of verum acupuncture, the same acupuncture points are often used for sham and verum acupuncture despite acupuncture point specificity, raising the question of whether sham acupuncture is an appropriate placebo.
Objectives: The objective of this study was to examine the effects of acupuncture according to the needling points of sham acupuncture (same or different between sham and verum acupuncture) for knee osteoarthritis
Methods: Ten databases were searched to identify randomized controlled trials (RCTs) comparing the effects of acupuncture with those of sham acupuncture or waiting list (WL) on knee osteoarthritis. Sham acupuncture was classified as using the same acupuncture points as those in verum acupuncture (SATV) or using sham points (SATS). A frequentist network meta-analysis (NMA) was conducted. The certainty of evidence for NMA findings was assessed.
Results: Ten RCTs involving 1628 participants were included. Verum acupuncture was significantly superior to SATS (standardized mean difference (SMD) -0.41, 95% confidence interval (CI) -0.74 to -0.08) but not different from SATV (SMD 0, 95% CI -0.54 to 0.54) in terms of pain reduction. Additionally, SATV was significantly superior to WL (SMD -0.67, 95% CI -1.31 to -0.04). The risk of bias affecting the comparisons between the verum and sham acupuncture was generally low. The certainty of evidence was moderate to low.
Conclusions: For patients with knee osteoarthritis, the effect of sham acupuncture may be different depending on the points needled. Sham acupuncture needling at the same points as those in acupuncture was not a true placebo control for assessing the efficacy of acupuncture, which leads to an underestimation of the efficacy of verum acupuncture.
*This study analyzed the clinical trial data involving humans.
Objectives: The objective of this study was to examine the effects of acupuncture according to the needling points of sham acupuncture (same or different between sham and verum acupuncture) for knee osteoarthritis
Methods: Ten databases were searched to identify randomized controlled trials (RCTs) comparing the effects of acupuncture with those of sham acupuncture or waiting list (WL) on knee osteoarthritis. Sham acupuncture was classified as using the same acupuncture points as those in verum acupuncture (SATV) or using sham points (SATS). A frequentist network meta-analysis (NMA) was conducted. The certainty of evidence for NMA findings was assessed.
Results: Ten RCTs involving 1628 participants were included. Verum acupuncture was significantly superior to SATS (standardized mean difference (SMD) -0.41, 95% confidence interval (CI) -0.74 to -0.08) but not different from SATV (SMD 0, 95% CI -0.54 to 0.54) in terms of pain reduction. Additionally, SATV was significantly superior to WL (SMD -0.67, 95% CI -1.31 to -0.04). The risk of bias affecting the comparisons between the verum and sham acupuncture was generally low. The certainty of evidence was moderate to low.
Conclusions: For patients with knee osteoarthritis, the effect of sham acupuncture may be different depending on the points needled. Sham acupuncture needling at the same points as those in acupuncture was not a true placebo control for assessing the efficacy of acupuncture, which leads to an underestimation of the efficacy of verum acupuncture.
*This study analyzed the clinical trial data involving humans.