South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Gastroenterology dept, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China.
BMJ Open. 2022 Feb 24;12(2):e058834. doi: 10.1136/bmjopen-2021-058834.
To systematically summarise acupuncture-related Clinical Practice Guidelines (CPGs)'s clinical and methodological characteristics and critically appraise their methodology quality.
We summarised the characteristics of the guidelines and recommendations and evaluated their methodological quality using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument.
Nine databases were searched from 1 January 2010 to 20 September 2020.
We included the latest version of acupuncture CPGs, which must have used at least one systematic review addressing the benefits and harms of alternative care options to inform acupuncture recommendations.
Reviewers, working in pairs, independently screened and extracted data. When there are statistical differences among types of CPGs, we reported the data by type in the text, but when not, we reported the overall data.
Of the 133 eligible guidelines, musculoskeletal and connective tissue diseases proved the most commonly addressed therapeutic areas. According to the AGREE II instrument, the CPG was moderate quality in the domain of clarity of scope and purpose, clarity of presentation, the rigour of development, stakeholder involvement and low quality in editorial independence, and applicability. The study identified 433 acupuncture-related recommendations; 380 recommended the use of acupuncture, 28 recommended against the use of acupuncture and 25 considered acupuncture but did not make recommendations. Of the 303 recommendations that used Grading of Recommendations Assessment, Development and Evaluation to determine the strength of recommendations, 152 were weak recommendations, 131 were strong recommendations, of which 104 were supported by low or very low certainty evidence (discordant recommendations).
In the past 10 years, a large number of CPGs addressing acupuncture interventions exist. Although these guidelines may be as or more rigorous than many others, considerable room for improvement remains.
系统总结针灸相关临床实践指南（CPG）的临床和方法学特征，并批判性评估其方法学质量。
我们总结了指南和推荐的特征，并使用评估指南研究和评估 II（AGREE II）工具评估了其方法学质量。
从 2010 年 1 月 1 日至 2020 年 9 月 20 日，我们在 9 个数据库中进行了搜索。
我们纳入了最新版本的针灸 CPG，这些 CPG 必须至少使用了一项系统评价，以评估替代护理方案的利弊，为针灸推荐提供信息。
审查员两人一组独立筛选和提取数据。当 CPG 类型之间存在统计学差异时，我们在文本中按类型报告数据，但当不存在差异时，我们报告总体数据。
在 133 项符合条件的指南中，肌肉骨骼和结缔组织疾病是最常涉及的治疗领域。根据 AGREE II 工具，该 CPG 在范围和目的的明确性、表述的清晰性、开发的严谨性、利益相关者的参与以及编辑独立性和适用性方面质量中等。研究确定了 433 项与针灸相关的建议；380 项建议使用针灸，28 项建议不使用针灸，25 项考虑使用针灸但未提出建议。在使用推荐评估、制定和评估分级来确定建议强度的 303 项建议中，152 项为弱建议，131 项为强建议，其中 104 项得到低或非常低确定性证据的支持（不一致建议）。
在过去的 10 年中，存在大量针对针灸干预措施的 CPG。尽管这些指南可能与许多其他指南一样严格，甚至更严格，但仍有很大的改进空间。
