Factors Associated with the Magnitude Of acUpuncture treatment effectS (FAMOUS): a meta-epidemiological study of acupuncture randomised controlled trials
Wei-Juan Gang, Wen-Cui Xiu, Lan-Jun Shi, Qi Zhou, Ruimin Jiao, Jiwei Yang, Xiaoshuang Shi, Xiaoyue Sun, Zhao Zeng, Claudia M. Witt, Lehana Thabane, Ping Song, Long-Hui Yang, Gordon Guyatt, Zhiyun Zhang, Heng-Cong Li, Jing-Tao Shi, An-Li Chen, Zhengyang Qu, Ling Zou, Dong-Xiao Mou, Xiaoyu Wang, Qing-Quan Yu, Lizhen Chen, Yuting Huang, Tiago Pereira, Jason Chambers, C. Ho, Layla Bakaa, Kevin Loniewski, Kyle Tong, Jaryd Tong, Jared Dookie, Jie-wei Zhu, Malini Hu, Yujin Suk, Kay L. H. Wu, Luciane Cruz Lopes, Julia White, Tayler A. Buchan, Lauren Giustti Mazzei, Maíra Ramos Alves, Mariana Del Grossi Moura, Cristiane de Cássia Bergamaschi, Jing Meng, Cynthia Chan, Flávia Blaseck Sorrilha, Xiang-Hong Jing, Yuqing Zhang
Abstract
OBJECTIVE: To identify factors and assess to what extent they impact the magnitude of the treatment effect of acupuncture therapies across therapeutic areas. DATA SOURCE: Medline, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc, between 2015 and 2019. STUDY SELECTION: The inclusion criteria were trials with a total number of randomised patients larger than 100, at least one patient-important outcome and one of two sets of comparisons. DATA ANALYSIS: The potential independent variables were identified by reviewing relevant literature and consulting with experts. We conducted meta-regression analyses with standardised mean difference (SMD) as effect estimate for the dependent variable. The analyses included univariable meta-regression and multivariable meta-regression using a three-level robust mixed model. RESULTS: 1304 effect estimates from 584 acupuncture randomised controlled trials (RCTs) were analysed. The multivariable analyses contained 15 independent variables . In the multivariable analysis, the following produced larger treatment effects of large magnitude (>0.4): quality of life (difference of adjusted SMDs 0.51, 95% CI 0.24 to 0.77), or pain (0.48, 95% CI 0.27 to 0.69), or function (0.41, 95% CI 0.21 to 0.61) vs major events. The following produced larger treatment effects of moderate magnitude (0.2-0.4): single-centred vs multicentred RCTs (0.38, 95% CI 0.10 to 0.66); penetration acupuncture vs non-penetration types of acupuncture (0.34, 95% CI 0.15 to 0.53); non-pain symptoms vs major events (0.32, 95% CI 0.12 to 0.52). The following produced larger treatment effects of small magnitude (<0.2): high vs low frequency treatment sessions (0.19, 95% CI 0.03 to 0.35); pain vs non-pain symptoms (0.16, 95% CI 0.04 to 0.27); unreported vs reported funding (0.12, 95% CI 0 to 0.25). CONCLUSION: Patients, clinicians and policy-makers should consider penetrating over non-penetrating acupuncture and more frequent treatment sessions when feasible and acceptable. When designing future acupuncture RCTs, trialists should consider factors that impact acupuncture treatment effects.