Chen Jixin, Liu Aifeng, Zhou Qinxin, Yu Weijie, Guo Tianci, Jia Yizhen, Yang Kun, Niu Puyu, Feng Huichuan
Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China.
Int J Gen Med. 2021 Nov 19;14:8481-8494. doi: 10.2147/IJGM.S342435. eCollection 2021.
Acupuncture has been widely used in the clinical management of osteoarthritis of the knee (KOA). Many systematic reviews (SRs) and meta-analyses (MAs) have reported its effectiveness in relieving pain. This overview aimed to summarize SRs and MAs on the effectiveness and safety of acupuncture for KOA and evaluate their methodological and evidence quality of the included SRs and MAs.
We conducted a comprehensive literature search for SRs and MAs in four Chinese and four international databases from their inception until August 2021. Two researchers independently searched the reviews, extracted the data, and cross-checked the data. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool was used to evaluate the methodological quality of the included SRs and MAs. The Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence for the outcomes of the included SRs and MAs.
A total of 14 SRs and MAs were included. The evaluation results of the AMSTAR 2 tool showed that the methodological quality of all the 14 SRs and MAs was critically low. The principal causes are the lack of a pre-registration proposal and a list of excluded studies and justify the exclusions, the report on the sources of funding, and the reasons for the study designs for inclusion. The results of the GRADE evaluation showed 25 of 46 outcomes were very low-level evidence. Seventeen were of low level, four were of moderate level and none were of high level. Most outcomes were downgraded in quality of evidence mainly because of publication bias and imprecision.
The existing evidence suggests that acupuncture seems to be an effective and safe therapy for KOA. However, the deficiencies in the methodological quality and quality of evidence of the included SRs/MAs have limited the reliability of the conclusions. Therefore, further rigorous and comprehensive studies are warranted to verify the effectiveness and safety of acupuncture in KOA.
针灸已广泛应用于膝关节骨关节炎（KOA）的临床管理。许多系统评价（SRs）和荟萃分析（MAs）报告了其在缓解疼痛方面的有效性。本概述旨在总结关于针灸治疗KOA有效性和安全性的SRs和MAs，并评估所纳入SRs和MAs的方法学和证据质量。
我们在四个中文数据库和四个国际数据库中进行了全面的文献检索，检索时间从各数据库建库至2021年8月。两名研究人员独立检索综述、提取数据并交叉核对数据。使用系统评价方法学质量评估2（AMSTAR 2）工具评估所纳入SRs和MAs的方法学质量。使用推荐分级、评估、制定与评价（GRADE）系统评估所纳入SRs和MAs结局的证据质量。
共纳入14项SRs和MAs。AMSTAR 2工具的评估结果显示，所有14项SRs和MAs的方法学质量极低。主要原因包括缺乏预注册方案、排除研究清单及排除理由说明、资金来源报告以及纳入研究设计的理由。GRADE评估结果显示，46项结局中有25项为极低质量证据。17项为低质量，4项为中等质量，无高质量证据。大多数结局的证据质量被降级，主要原因是发表偏倚和不精确性。
现有证据表明，针灸似乎是一种治疗KOA有效且安全的疗法。然而，所纳入SRs/MAs的方法学质量和证据质量的缺陷限制了结论的可靠性。因此，有必要进行进一步严格和全面的研究，以验证针灸治疗KOA的有效性和安全性。
