Cochrane reviews of acupuncture are dated, do not account for the specific effects of sham controls and likely underestimate the efficacy of acupuncture therapy.

BACKGROUND

Because Cochrane reviews represent a quality standard for systematic reviews, we sought to clarify to what extent Cochrane reviews of acupuncture characterize the potential and problematic specific effects of sham acupuncture.

METHODS

We imported records of Cochrane acupuncture reviews into Covidence and independently selected reviews with at least one included study comparing manual acupuncture to sham acupuncture. Dual data extraction for eligible reviews included review author expertise, evaluation of intervention adequacy, use of STRICTA guidelines, characterization of sham methods, and whether specific effects of sham were discussed relative to needle penetration, point selection or use of a sham device.

RESULTS

Of the 56 reviews with acupuncture in the title, 16 were ineligible. Of the 40 included reviews, 28 were published in or before 2018. Most reviews had an author with acupuncture trial expertise; however, assessment of intervention adequacy was rarely conducted, STRICTA guidelines were rarely utilized, and reporting of sham acupuncture methods was commonly either missing or lacking rigor. While 20/40 reviews acknowledged the controversy regarding sham as an active and therefore inadequate control, no reviews incorporated this into their conclusions.

CONCLUSION

Most Cochrane reviews of acupuncture therapy are dated and are also not current relative to the science of acupuncture biomechanism and the impact of 'active' sham arms. The handling of sham controls, combined with a lack of evaluation of verum intervention adequacy, contravenes a clear research standard and indicates that the efficacy of acupuncture is likely underestimated in Cochrane reviews.