An Overview of Cochrane Reviews in Acupuncture

背景：從70年代早期開始西方國家即以臨床試驗評估針灸的臨床療效，這些試驗的結果也紛紛被系統回顧所引用。目的：針對Cochrane review的結果進行全面性的回顧。方法：我們利用網路搜索Cochrane資料庫，搜索時段為1996年到2008年3月。針灸與針灸相關療法臨床療效的Cochrane review被納入分析。回顧報告的下列特點將被評估：納入的試驗類型與數目、病人類型、治療與對照設計、主要結果測量以及reviewer的結論。討論：總共獲得24篇評估針灸或其相關療法療效的Cochrane review，其中有11篇（46%）評估神經與骨骼肌肉系統疾病的療效。大多數Cochrane review納入的研究為RCT（randomizedcontrolled trials，隨機對照試驗），不過這些RCT的設計具有可觀的異質性與複雜性。Cochranereview顯示針灸對於化療後的噁心嘔吐與手術後噁心具有療效。對於頸部疾患、頭痛與慢性下背痛可能有效，但是需要更多較高品質的研究支持。不過大部分的Cochrane review因為RCT數量不夠或品質較差，而被報告為證據不足或無結論。結論：除了化療後的噁心嘔吐與手術後噁心外，大多數評估針灸臨床療效的Cochranereview被報告為證據不足或無結論。若要對針灸的臨床療效做成明確的結論，更多品質較好的RCT是需要的。Background: Many clinical trials have been conducted in the West since the early 1970s to investigate the clinical effects of acupuncture. Results from these trials have been synthesized in systematic reviews. Objective: To assess the results of Cochrane reviews in acupuncture. Methods: We performed a comprehensive computerized literature search in the Cochrane database. The literature search period covered 1996 to Mar 2008. Cochrane reviews in clinical effects of acupuncture and acupuncture-related therapy were included. The features of review were assessed: number and type of included trails, type of participants, treatment and control design, main outcome measures, main conclusion of the reviewer. Results: Totally 24 papers were Cochrane reviews focusing on the clinical effects of acupuncture and acupuncture-related therapy. Eleven reviews (46%) covered neurological diseases and musculoskeletal disorders. The vast majority of trials included in these reviews were RCTs, but study design of RCT showed considerable heterogeneity and complexity. For chemotherapy-induced nausea or vomiting, and post-operative nausea, the results were considered positive. For neck disorders, idiopathic headache and chronic low back pain, the evidence was considered promising, but more and better- quality research was needed. Most Cochrane reviews of acupuncture were reported as insufficient evidence or inconclusive result because of inadequate number or lower methodological quality of included RCTs. Conclusions: Most Cochrane reviews in the clinical effects of acupuncture were reported as insufficient evidence or inconclusive result, except for chemotherapy-induced nausea or vomiting, and post-operative nausea. More better-quality RCTs of acupuncture are needed if clear conclusions are to be drawn about clinical effects of acupuncture.