Grant Suzanne J, Smith Caroline A, de Silva Nimna, Su Chunxiang
University of Western Sydney, Penrith, New South Wales, Australia
University of Western Sydney, Penrith, New South Wales, Australia.
Integr Cancer Ther. 2015 May;14(3):258-70. doi: 10.1177/1534735415572879. Epub 2015 Apr 1.
The quality and dose of acupuncture used in a clinical trial affects the outcome, as with the quality and dose of any intervention. The dose of acupuncture treatment may be characterized by the frequency of treatment, needle type and depth, length of needle retention, point selection, and combination. The dose in trials of acupuncture has at times been described as low or inappropriate but is seldom assessed in systematic reviews of acupuncture trials. This article examines the research evaluating acupuncture for cancer-related fatigue to determine what characteristics of treatment may contribute to a quality acupuncture intervention.
English and Chinese language databases were searched from inception to December 2013 for randomized controlled trials of acupuncture for the treatment of cancer-related fatigue. Assessment of the quality of the acupuncture intervention was undertaken using the domains and items from the NICMAN framework.
Seven studies with a total of 690 patients were included. Four of the studies were designed as feasibility or pilot studies, and the other 3 studies were described as "effectiveness" trials. The treatment paradigm for the active intervention was based on traditional Chinese medicine in all studies, yet few of the studies were explicit as to how the active intervention was justified within a traditional Chinese medicine paradigm. Acupuncture point prescriptions were developed by a small consensus panel or based on typical points and/or "clinical experience." No discussion of traditional Chinese medicine theory or literature review was reported in any studies. Acupuncture point location was adequately described in 4 of the 7 studies. Frequency of treatment was twice per week in 2 studies; all others were once per week. Two studies did not apply needle manipulation or stimulation, and no justification was given.
The 7 trials reviewed meet some criteria for a quality acupuncture intervention. However, frequently elements of the intervention were not addressed, and it is possible that the dosage trialed was suboptimal. Systematic reviews of acupuncture are likely to continue to be inconclusive while comparisons are conducted of heterogeneous interventions without providing.
与任何干预措施的质量和剂量一样，临床试验中使用的针灸质量和剂量会影响结果。针灸治疗的剂量可通过治疗频率、针具类型和深度、留针时间、穴位选择和配伍来表征。针灸试验中的剂量有时被描述为低剂量或不适当，但在针灸试验的系统评价中很少进行评估。本文研究评估针灸治疗癌症相关疲劳的研究，以确定治疗的哪些特征可能有助于高质量的针灸干预。
检索英文和中文数据库，检索时间从建库至2013年12月，以查找针灸治疗癌症相关疲劳的随机对照试验。使用NICMAN框架中的领域和项目对针灸干预的质量进行评估。
纳入7项研究，共690例患者。其中4项研究设计为可行性或试点研究，另外3项研究被描述为“有效性”试验。在所有研究中，积极干预的治疗模式均基于传统中医，但很少有研究明确说明在传统中医模式下如何证明积极干预的合理性。穴位处方由一个小的共识小组制定或基于典型穴位和/或“临床经验”。所有研究均未报告对传统中医理论的讨论或文献综述。7项研究中有4项对穴位定位进行了充分描述。2项研究的治疗频率为每周两次；其他所有研究均为每周一次。2项研究未应用针刺手法或刺激，且未给出理由。
所综述的7项试验符合高质量针灸干预的一些标准。然而，干预的各个要素经常未得到解决，并且所试验的剂量可能不是最佳的。在对异质性干预措施进行比较而不提供的情况下，针灸的系统评价可能仍将没有定论。
