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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.