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BMC Medicine
Published in: BMC Medicine 1/2010

Open Access 01-12-2010 | Research article

How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials

Authors: Klaus Linde, Karin Niemann, Antonius Schneider, Karin Meissner

Published in: BMC Medicine | Issue 1/2010

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Abstract

Background

While several recent large randomized trials found clinically relevant effects of acupuncture over no treatment or routine care, blinded trials comparing acupuncture to sham interventions often reported only minor or no differences. This raises the question whether (sham) acupuncture is associated with particularly potent nonspecific effects. We aimed to investigate the size of nonspecific effects associated with acupuncture interventions.

Methods

MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials and reference lists were searched up to April 2010 to identify randomized trials of acupuncture for any condition, including both sham and no acupuncture control groups. Data were extracted by one reviewer and verified by a second. Pooled standardized mean differences were calculated using a random effects model with the inverse variance method.

Results

Thirty-seven trials with a total of 5754 patients met the inclusion criteria. The included studies varied strongly regarding patients, interventions, outcome measures, methodological quality and effect sizes reported. Among the 32 trials reporting a continuous outcome measure, the random effects standardized mean difference between sham acupuncture and no acupuncture groups was -0.45 (95% confidence interval, -0.57, -0.34; I2 = 54%; Egger's test for funnel plot asymmetry, P = 0.25). Trials with larger effects of sham over no acupuncture reported smaller effects of acupuncture over sham intervention than trials with smaller nonspecific effects (β = -0.39, P = 0.029).

Conclusions

Sham acupuncture interventions are often associated with moderately large nonspecific effects which could make it difficult to detect small additional specific effects. Compared to inert placebo interventions, effects associated with sham acupuncture might be larger, which would have considerable implications for the design and interpretation of clinical trials.
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Metadata
Title
How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials
Authors
Klaus Linde
Karin Niemann
Antonius Schneider
Karin Meissner
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2010
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-8-75

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