Li Xiao-qian, Tao Kun-ming, Yang Ge-liang, Zhou Qing-hui, Ling Chang-quan
Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China.
Department of Anesthesiology and Intensive Care Unit, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China.
Acupunct Med. 2016 Apr;34(2):84-9. doi: 10.1136/acupmed-2015-010876. Epub 2015 Nov 2.
By reviewing the assessment of internal validity in relevant systematic reviews (SRs), the aim of this study was to identify how critical appraisals of risk of bias (RoB) inform the synthesis of evidence in SRs of acupuncture for pain relief.
SRs were searched in Medline, EMBASE, and the Cochrane Database of SRs from their inception to 30 December 2014. Only SRs of acupuncture for pain relief were included. Basic information, types of RoB appraisal tool, whether or not there was domain-level assessment of RoB, whether or not the reviews ranked studies by RoB, plus whether or not (and, if so, how) RoB appraisal was incorporated into the synthesis were determined.
A total of 91 SRs met the inclusion criteria and were included in the final analysis. Over half of the SRs (85, 64.8%) used standard tools, such as the Jadad quality score and the Cochrane RoB tool, followed by adapted tools (n=23, 25.3%). Of the 85 SRs that assessed RoB, 29 (34.1%) presented domain-level assessment and 71 SRs (83.5%) included ranking of the studies based on RoB assessment. Of these 71, 35 (49.4%) used a cut-off threshold score and 26 (36.6%) required all criteria sum-up. Of the 85 SRs that assessed RoB, 48 (56.5%) incorporated RoB appraisal into the data synthesis.
Although most SRs of acupuncture for pain relief conducted some form of RoB assessment, nearly half of them failed to incorporate the RoB assessment into the synthesis.
通过回顾相关系统评价（SR）中内部效度的评估，本研究旨在确定对偏倚风险（RoB）的批判性评价如何为针灸缓解疼痛的SR中的证据综合提供信息。
在Medline、EMBASE和Cochrane系统评价数据库中检索从建库至2014年12月31日的SR。仅纳入针灸缓解疼痛的SR。确定基本信息、RoB评估工具类型、是否存在RoB的领域水平评估、评价是否按RoB对研究进行排序，以及RoB评估是否（若如此，如何）纳入证据综合。
共有91项SR符合纳入标准并纳入最终分析。超过半数的SR（85项，64.8%）使用标准工具，如Jadad质量评分和Cochrane RoB工具，其次是改编工具（23项，25.3%）。在85项评估RoB的SR中，29项（34.1%）进行了领域水平评估，71项SR（83.5%）纳入了基于RoB评估的研究排序。在这71项中，35项（49.4%）使用了截断阈值分数，26项（36.6%）要求所有标准求和。在85项评估RoB的SR中，48项（56.5%）将RoB评估纳入了数据综合。
虽然大多数针灸缓解疼痛的SR进行了某种形式的RoB评估，但其中近一半未能将RoB评估纳入证据综合。
