Linde Klaus, Niemann Karin, Meissner Karin
Institute of General Practice, Technische Universität München, Munich, Germany.
Forsch Komplementmed. 2010 Oct;17(5):259-64. doi: 10.1159/000320374. Epub 2010 Sep 7.
A recent Cochrane review on placebo interventions for all kinds of conditions found that 'physical placebos' (which included sham acupuncture) were associated with larger effects over no-treatment control groups than 'pharmacological placebos'. We re-analyzed the data from this review to investigate whether effects associated with sham acupuncture differed from those of other 'physical placebos'.
All trials included in the Cochrane review as investigating 'physical placebos' were classified as investigating either (sham) acupuncture or other physical placebos. The latter group was further subclassified into groups of similar interventions. Data from the Cochrane review were re-entered into the RevMan 5 software for meta-analysis. The primary analysis was a random-effects analysis of trials reporting continuous outcomes of trials that used either sham acupuncture or other physical placebos.
Out of a total of 61 trials which reported a continuous outcome measure, 19 compared sham acupuncture and 42 compared other physical placebos with a no-treatment control group. The trials re-analyzed were highly heterogeneous regarding patients, interventions and outcomes measured. The pooled standardized mean difference was -0.41 (95% confidence interval -0.56, -0.24) between sham acupuncture and no treatment and -0.26 (95% CI -0.37, -0.15) between other physical placebos and no treatment (p value for subgroup differences = 0.007). Significant differences were also observed between subgroups of other physical placebos.
Due to the heterogeneity of the trials included and the indirect comparison our results must be interpreted with caution. Still, they suggest that sham acupuncture interventions might, on average, be associated with larger effects than pharmacological and other physical placebos.
最近一项关于各种疾病安慰剂干预措施的Cochrane综述发现，“物理安慰剂”（包括假针灸）与无治疗对照组相比，比“药物安慰剂”具有更大的效果。我们重新分析了该综述中的数据，以研究与假针灸相关的效果是否与其他“物理安慰剂”不同。
Cochrane综述中所有作为“物理安慰剂”研究纳入的试验，被分类为研究（假）针灸或其他物理安慰剂。后一组进一步细分为类似干预措施的组。Cochrane综述的数据被重新输入RevMan 5软件进行荟萃分析。主要分析是对报告使用假针灸或其他物理安慰剂的试验连续结果的试验进行随机效应分析。
在总共61项报告了连续结局测量的试验中，19项比较了假针灸，42项将其他物理安慰剂与无治疗对照组进行了比较。重新分析的试验在患者、干预措施和测量的结局方面具有高度异质性。假针灸与无治疗之间的合并标准化平均差为-0.41（95%置信区间-0.56，-0.24），其他物理安慰剂与无治疗之间的合并标准化平均差为-0.26（95%置信区间-0.37，-0.15）（亚组差异的p值=0.007）。在其他物理安慰剂的亚组之间也观察到了显著差异。
由于纳入试验的异质性和间接比较，我们的结果必须谨慎解释。尽管如此，它们表明假针灸干预措施平均而言可能比药物和其他物理安慰剂具有更大的效果。
