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Table 2 Characteristics and SIGN 50 score of included reviews grouped by TSR component

From: The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): a systematic review of reviews

Citation

Population

Type of acupuncture

Control

Outcomes relevant to TSR components

Number of relevant studies (total) included

Interpretation of results

How well was the study done to minimize bias?

Headache (n = 5)

Sun et al. [62]

3,916 subjects with chronic headache (migraine, tension-type or both)

electro

sham, pharmacologic, physiological, CAM

headache frequency/intensity, response rate

31(31) RCTs

Positive

++

Linde et al. [63]

1,151 subjects with migraine and tension-type headaches

traditional Chinese

no treatment, sham, pharmacologic, physiotherapy

headache diary, number of migraine days, migraine hours, frequency/duration of headache attack, headache severity, amount and type of rescue medication, nausea and vomiting frequency, pain intensity, number of pain days

22(22) RCTs

Positive

++

Linde et al. [64]

2,317 subjects with episodic and/or chronic tension-type headache

traditional Chinese

no treatment, sham, pharmacologic, physiological

analgesic usage, CGI, headache frequency/intensity/duration/location, global patient rating, PDI, VAS, CPG

11(11) RCTs

Positive

++

Melchart et al. [65]

(ND) subjects with recurrent headaches (tension-type, migraine, various)

manual, ear

sham, pharmacologic, physiological, no treatment, behavioral/psychosocial

headache attack frequency, global assessment of headache, number of days with headache, pain intensity, VAS

20(22) RCTsa

Positive, Poor methods

++

Granato et al. [66]

2,317 subjects with episodic or chronic tension-type headaches

manual

no treatment, sham, physiotherapy, CAM

frequency of analgesic use, number of headache days, VAS

11(11) RCTs

Positive

+

Chronic pain (n = 25)

White et al. [67]

2,362 subjects with knee pain

manual, electro

sham, behavioral/psychosocial, no treatment, pharmacologic

WOMAC, pain scales

13(13) RCTs

Positive

++

Kwon et al. [68]

1,891 subjects with peripheral joint osteoarthritis

manual, electro

no treatment, sham, behavioral/psychosocial, physiotherapy, pharmacologic

VAS, WOMAC, MPQ, NRS, TUGT, HSS knee function scale, walking/climbing stairs time, starting pain, night pain, walking pain, pain descending stairs, pain threshold, Lysholm Score, PGA, present pain intensity, stiffness, active knee flexion, passive range of movement, total pain, effective rate, recurrence rate, Lequesne indices

18(18) RCTs

Positive

++

Manheimer et al. [69]

176 subjects with low back pain

Western

sham, physiotherapy, no treatment, acupressure, pharmacologic

VAS, drug use, fit for work score, global score, physician assessment of functionality

4(33) RCTsb

Positive

++

Fu et al. [70]

7,173 subjects with neck pain

manual, electro

sham, no treatment, physiotherapy, CAM

MPQ, NDI, PDI, ROM, self-reported pain, VAS

14(14) RCTs

Positive

++

Ezzo et al. [71]

393 subjects with knee osteoarthritis

electro, manual

sham, no treatment, physiotherapy

pain, patient global assessment, physical function

7(7) RCTs and quasi-RCTs

Positive

++

Wang et al. [72]

536 subjects with rheumatoid arthritis

manual, electro

sham, pharmacologic

CRP, DAS28, duration of morning stiffness, ESR, GHQ, HAQ, SJC, VAS

8(8) RCTs

Inconclusive/Mixed

++

Jung et al. [73]

134 subjects with temporomandibular joint disorders

manual

sham

MO, NRS, muscle tenderness, VAS

6(7) RCTsa

Inconclusive/Mixed

++

Manheimer et al. [74]

3,498 subjects with osteoarthritis of the knee and/or hip

manual

sham, no treatment, other

WOMAC

16(16) RCTs

Inconclusive/Mixed

++

La Touche et al. [75]

401 subjects with temporomandibular disorders

manual, electro

no treatment, sham

ADL, Anamnestic Index, Anamnestic Questionnaire, articular sounds/stereostethoscope, CDS, distribution of pain, index for occlusal state, incisal and occlusal tooth wear, maximum interincisal opening, NRS, pain frequency, PPT, subjective dysfunction score, VAS

8(8) RCTs

Positive, Poor methods

++

Cho et al. [76]

808 subjects with temporomandibular disorders

manual, electro

sham, no treatment, pharmacologic, physiotherapy

clinical dysfunction scores, NAS, ROM, sounds/locking/deviation in opening of mouth, tenderness, presence/absence of a headache, overall improvement, VAS

14(14) RCTs

Inconclusive/Mixed, Poor methods

++

Lee et al. [77]

606 subjects with rheumatoid arthritis

manual

sham, pharmacologic

ACR20, CRP, DAS, ESR, GHQ, HAQ, VAS, total effective rate, pain reduction, swelling index, number of swollen joints

8(8) RCTs

Inconclusive/Mixed, Poor methods

++

Sim et al. [78]

442 subjects with carpal tunnel syndrome

manual, laser

sham, pharmacologic, CAM

CMAP, D4MNSCV, D4UNSCV, DML, DSL, GSS, MNCV, NCS, night pain, parethesia, responder rate, SNAP, SSS, W-P SNCV

6(6) RCTs

Inconclusive/Mixed, Poor methods

++

Liu et al. [79]

506 subjects with trigeminal neuralgia

manual, electro

pharmacologic

cure rates

12(12) RCTs

Inconclusive/Mixed, Poor methods

++

Langhorst et al. [80]

385 subjects with fibromyalgia syndrome

manual, electro

sham

FIQ, MPQ, VAS

7(7) RCTs

Inconclusive/Mixed, Poor methods

++

Zhu et al. [81]

67 subjects with endometriosis

ear

CAM

dysmenorrhea score, therapeutic effect

1(1) RCT

Negative, Poor methods

++

van Tulder et al. [82]

542 subjects with chronic lower back pain

manual, electro

sham, no treatment, pharmacologic

ADL, global improvement, Lasoque test, pain score, Schober Test, VAS

11(11) RCTs

Negative, Poor methods

++

ter Riet et al. [83]

(ND) subjects with chronic pain

manual

sham, pharmacologic, acupuncture

ND

51(51) CCTs

Negative, Poor methods

++

Mayhew et al. [84]

166 subjects with fibromyalgia

traditional Chinese, electro

sham, no treatment, other

analgesics usage, dolorimetry of tender and control points, FIQ, morning stiffness, MPI, regional pain score, VAS

5(5) RCTs

Negative, Poor methods

++

Porter et al. [85]

486 subjects with fibromyalgia

electro, manual

sham, no treatment, pharmacologic

physical, psychological and quality of life outcomes

7(7) RCTs, 2(2) CCTs

Positive

+

Ernst et al. [86]

(ND) subjects with chronic pain

ND

manual, electro, ear

ND

30(30) SRs

Positive

+

White et al. [87]

2,362 subjects with osteoarthritis of the knee

electro, manual

sham, no treatment, physiologic, pharmacologic

NRS, PPI, VAS, WOMAC

13(13) RCTs

Positive

+

La Touche et al. [88]

83 subjects with temporomandibular disorders

manual

sham

electronic axiography, incisor opening and lateral movement, manual palpitation, NRS, pain distribution, pressure algometer, temporomandibular joint sounds/stereo-stethoscope, VAS

4(4)RCTs

Inconclusive/Mixed

+

Ernst [89]

437 subjects with osteoarthritis

manual, electro

sham, no treatment, pharmacologic, physiotherapy

analgesic usage, functioning, knee pain threshold, self-reported pain ratings, subjective improvement and ROM, tenderness, VAS

13(13) RCTs

Inconclusive/Mixed

+

Manheimer et al. [90]

1,154 subjects with osteoarthritis

manual, electro

sham, no treatment

WOMAC

11(11) RCTs

Inconclusive/Mixed

+

Casimiro et al. [91]

84 subjects with rheumatoid arthritis

manual, electro

sham, pharmacologic

analgesic usage, CRP, ESR, pain reduction, number of swollen/tender joints, VAS

2(2) RCTs

Inconclusive/Mixed, Poor methods

+

Substance abuse (n = 7)

Cho et al. [92]

1,062 subjects with alcohol dependence

ear, ear electro

no treatment, sham, pharmacologic, non-pharmacologic

abstinent rate, alcohol usage, AWSS, breath analyzer, CIWA, completion rates, relapse rates

10(11) RCTsa

Inconclusive/Mixed, moor Methods

++

Gates et al. [93]

1,433 subjects with cocaine or crack dependence

ear

sham, no treatment

ASI, cocaine use, HCCS, urine toxicology

7(7) RCTs

Negative, Poor methods

++

White et al. [94]

3,486 subjects with tobacco addiction

manual, electro

sham, no treatment, behavioral/psychosocial, pharmacologic

complete smoking cessation

14(14) RCTs

Negative, Poor methods

++

D'Alberto et al. [95]

1,356 subjects with cocaine abuse or dependence

ear

sham, CAM

CCQ, urine toxicology

6(6) RCTs

Inconclusive/Mixed

+

White et al. [96]

1,433 subjects with smoking addiction

ear, electro

behavioral/psychosocial, pharmacologic, no treatment, acupuncture, CAM

quit rates

13(13) RCTs

Inconclusive/Mixed

+

ter Riet et al. [97]

(ND) subjects addicted to cigarette smoking, heroin, or alcohol

manual, electro

ND

acupuncture effectiveness

22(22) CCTs

Negative

+

Mills et al. [98]

1,747 subjects with cocaine addiction

ear

CAM, pharmacologic, behavioral/psychosocial

ASI, frequency/amount of cocaine use, HCCS, HDIRS, self-reported effectiveness, treatment effects, urine assays

9(9) RCTs

Negative

+

Sleep disturbance (n = 6)

Cao et al. [99]

3,811 subjects with insomnia

rolling, scalp, ear, abdominal

no treatment, CAM, sham, pharmacologic

duration and quality of sleep, MQ, PFS, PSQI, SDRS, sleep quality, SSDS, SRSS, VAS

46(46) RCTs

Positive

++

Chen et al. [100]

673 subjects with insomnia

ear

no treatment, sham, pharmacologic

actigraphic monitoring, ISI, MQ, PSQI, sleeping hours

6(6) RCTs

Inconclusive/Mixed

++

Yeung et al. [101]

1,956 subjects with insomnia

manual

sham, no treatment, pharmacologic

NRS, MQ, ISI, AIS, PSQI, SDRS, SSDS, PSG, wrist actigraph monitoring, overnight polysomnogram, VAS

20(20) RCTs

Inconclusive/Mixed

++

Huang et al. [102]

1,355 subjects with insomnia

manual, ear, intradermal, rolling

sham, pharmacologic, education

AIS, ISI, PSQI, PFS, sleep diary, sleep time, wrist actigraph monitoring

2(3) RCTs, 8(9) CCTs, 18(18) case seriesa

Positive, Poor methods

++

Cheuk et al. [103]

300 subjects with insomnia

electro, traditional Chinese, contemporary

no treatment, sham

self-rated insomnia scale, sleep disturbance on numerical scale, ISI, AIS, MQ, actigraphy monitoring

4(7) RCTsa

Positive, Poor methods

++

Lee et al. [104]

842 subjects with insomnia

ear (needle, SV seeds taping, magnetic pearls)

sham, no treatment, pharmacologic

NST, Pittsburgh Sleep Diary, sleep efficiency, sleep quality, Karolinska Sleep Diary, 4-point Sleep Score, self-satisfaction scale

10(10) RCTs

Inconclusive/Mixed, Poor methods

+

Depression (n = 6)

Zhang et al. [105]

1,680 subjects with MDD and PSD

manual, electro, ear

sham, no treatment, pharmacologic

HAM-D

35(35) RCTs

Positive

++

Fan et al. [106]

2,757 subjects with depression or depressive disorders

manual

sham, pharmacologic

CGI, DSI, efficacy rate, HAM-D, SCL-90, SDS

19(20) RCTsa

Positive

++

Mukaino et al. [107]

509 subjects with depression

manual, electro

no treatment, sham, pharmacologic

BRMS, CGI, HRSD

7(7) RCTs

Inconclusive/Mixed

++

Wang et al. [108]

447 subjects with major depression or depressive neurosis

manual, electro

sham

HAM-D

7(8) RCTsa

Inconclusive/Mixed, Poor methods

++

Smith et al. [109]

2,782 subjects with depression

abdominal, manual

sham, no treatment, pharmacologic

assessment of improvement, BDI, CGI, cure rates, HAM-D, HRSD, medication usage, Melancholia Scale, remission rates

29(30) RCTsa

Inconclusive/Mixed, Poor methods

++

Leo et al. [110]

666 subjects with depression

verum, manual, ear, traditional Chinese, electro

no treatment, sham, CAM

BDI, CES-D, CGI, HAM-D

9(9) RCTs

Inconclusive/Mixed

+

Anxiety (n = 1)

Pilkington et al. [111]

1,201 subjects with anxiety or an anxiety disorder

traditional Chinese, Western medical, ear, electro

sham, behavioral/psychosocial, pharmacologic

anesthesia dose, CGI, cure rates, HAM-A, MMPI, MYPAS, patient/observer assessment of anxiety, STAI, VAS, X-1

8(10) RCTs, 2(2) CCTsa

Positive

++

Cognitive function (n = 1)

Zhao et al. [112]

960 subjects with vascular dementia

manual, electro, targets, ear

sham, pharmacologic

ADL, FAQ, HDS, MMSE-R, overall function

9(10) RCT, 1(1) quasi- RCTa

Inconclusive/Mixed, Poor methods

++

Fatigue (n = 1)

Wang et al. [113]

1,826 participants with chronic fatigue syndrome

manual, electro

pharmacologic, CAM

improvement in chronic fatigue symptoms, FAI, SCL-90, CFIDS Disability Scale

22(27) Clinical Trials, 9(13) RCTsa

Positive, Poor methods

_

  1. aSome studies included in the reviews were excluded because they did not utilize manual acupuncture at recognized acupuncture points (that is, laser acupuncture, acupressure, needling of trigger points); bnumber of chronic pain studies may actually be higher; review only reported number of chronic pain studies not combined in meta-analysis instead of total number of chronic pain studies. Acu, acupuncture; AWSS, Alcohol-Withdrawal Syndrome Scale; ACR20, American College of Rheumatology Criteria; ADL, Activities of Daily Living; ASI, Addiction Severity Index; AIS, Athens Insomnia Index; BDI, Beck Depression Inventory; BRMS, Beck Melancholia Scale; CCT; controlled clinical trial; CCQ, Cocaine Craving Questionnaire; CCS, clinical case series; CDS, Clinical Dysfunction Score; CIWA, Clinical Institute Withdrawal Assessment; CES-D, Center for Epidemiological Study of Depression; CFIDS Disability Scale, Chronic Fatigue/Immune Dysfunction Syndrome Disability Scale; CPG, von Korff Chronic Pain Grading Scale; CGI, clinical global impression; CMAP, compound muscle action potential; CRP, C-reactive protein; D4MNSCV, 4th digit median nerve sensory nerve conduction velocity; D4UNSCV, 4th digit ulnar nerve sensory nerve conduction velocity; DAS, Disease Assessment Scale; DAS28, Disease Activity Scale in 28 Joints; DML, distal motor latency; DSI, Depression Status Inventory; DSL, Distal Sensory Latency; ESR, erythrocyte sedimentation rate; FAI, Fatigue Assessment Instrument; FAQ, Functional Activities Survey; FIQ, Fibromyalgia Impact Questionnaire; GHQ, General Health Questionnaire; GSS, Global Symptom Score; HDIRS, Halikas Drug Impairment Rating Scale; HAM-A, Hamilton Anxiety Scale; HAM-D, Hamilton Depression Rating Scale; HAQ, Health Assessment Questionnaire; HDS, Hasegawa Dementia Scale; HRSD, Hamilton Rating Scale for Depression; HSS, Hospital for Special Surgery; ISI, Index of Severity of Insomnia; JOA, Japanese Orthopedic Association Measure; MDD, Major Depressive Disorder; MMPI. Minnesota Multiphasic Personality Inventory; MMSE, Mini Mental State Examination; MNCV, motor nerve conduction velocity; MPI, Multidisciplinary Pain Inventory; MPQ, McGill Pain Questionnaire; MQ, Morning Questionnaire; MYPAS, Modified Yale Preoperative Anxiety Scale; NCS, Nerve Conduction Studies; ND, not described; NDI, Neck Disability Index; NAS, Numerical Analog Scale; NRS, Numeric Rating Scale; NST, nocturnal sleep time; ODI, Oswestry Disability Index; PDI, Pain Disability Index; PGA, Patient Global Assessment; PFS, Piper Fatigue Scale; PPI, Present Pain Index; PPT, pressure pain threshold; PSD, post-stroke depression; PSG, polysomnography; PSQI, Pittsburgh Sleep Quality Index; RCT, randomized controlled trial; ROM, range of motion; RDS, Roland Disability Score; SCL-90, Symptom Checklist-90; SDRS, Sleep Dysfunction Rating Scale; SDS, Self-rating Depression Scale; SJC, swollen joint count; SNAP, sensory nerve action potential; SRSS, Self-Rating Sleep Scale; SSDS, Self-Rating Sleep Dysfunction Scale; SSS, Symptom Severity Score; STAI, State-Trait Anxiety Inventory; TUGT, Timed Up and Go Test; VAS, Visual Analogue Scale; WOMAC, Western Ontario MacMaster Osteoarthritis Index; W-P SNCV, Wrist Palm Sensory Nerve Conduction Velocity.
  2. Timed Up and Go Test; VAS, Visual Analogue Scale; WOMAC, Western Ontario MacMaster Osteoarthritis Index; W-P SNCV, Wrist Palm Sensory Nerve Conduction Velocity.