Sham Acupressure Controls Used in Randomized Controlled Trials: A Systematic Review and Critique
Sham Acupressure Controls Used in Randomized Controlled Trials: A Systematic Review and Critique
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DOI：
10.1371/journal.pone.0132989
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发表时间：
2015-07-15
期刊：
影响因子：
3.7
通讯作者：
Molassiotis, Alexander
中科院分区：
文献类型：
--
作者：
Tan, Jing-Yu;Suen, Lorna K. P.;Molassiotis, Alexander
目的探讨现有穴位按摩试验中常用的假穴位按摩程序，评估不同类型的假穴位按摩干预是否会产生不同的治疗效果，并尽可能确定未来适当的假穴位按摩方法的发展方向。方法纳入比较真穴位按摩与假穴位按摩干预的随机对照试验。采用13个电子数据库查找自建库至2014年7月3日的相关研究。同时手动检索了8种补充和替代医学中文期刊以查找符合条件的文章。此外，还筛选了纳入论文的参考文献列表中列出的合格研究以及其他有关针压的相关系统评价，以进一步搜索任何可能合格的试验。使用 Cochrane Back Review Group 开发的偏倚风险评估工具评估纳入研究的方法学质量。采用描述性分析来总结治疗结果。结果纳入了 66 项研究，共有 7265 名受试者。纳入试验的方法学质量总体令人满意。确定了六种类型的假穴位按摩方法，“非穴位”刺激是最常用的假穴位，而穴位按摩装置是最常用的假治疗方法。穴位按摩疗法是治疗多种健康问题的有益方法，并且发现真正的穴位按摩组的治疗效果比假对照组更有效。不同的假穴位按摩方式与报告的治疗结果之间没有明确的关联。结论 临床实践和研究中已使用了多种多样的假穴位按摩对照。由于所分析的试验之间存在显着的临床异质性，因此无法得出不同的假手术替代方案是否与不同的治疗结果相关的可靠结论。一般推荐非穴位治疗，但应谨慎确定具体部位。对于在手或腿上使用单个假穴位的研究，建议在没有任何刺激的情况下，在主动干预的同一穴位上应用相同的穴位按摩装置。而对于疼痛研究，应避免刺激假穴位。
ObjectivesTo explore the commonly utilized sham acupressure procedures in existing acupressure trials, and to assess whether different types of sham interventions yield different therapeutic outcomes, and, as far as possible, to identify directions for the future development of an adequate sham acupressure method.MethodsRandomized controlled trials comparing true acupressure with sham interventions were included. Thirteen electronic databases were adopted to locate relevant studies from inception to July 3, 2014. Meanwhile, eight Chinese journals on complementary and alternative medicine were manually searched to locate eligible articles. In addition, eligible studies listed in the reference lists of the included papers and other related systematic reviews on acupressure were also screened to further search any potentially eligible trials. Methodological quality of the included studies was evaluated using the risk of bias assessment tool developed by the Cochrane Back Review Group. Descriptive analysis was adopted to summarize the therapeutic outcomes.ResultsSixty-six studies with 7265 participants were included. Methodological quality of the included trials was generally satisfactory. Six types of sham acupressure approaches were identified and "non-acupoint" stimulation was the most frequently utilized sham point while an acupressure device was the most commonly used approach for administering sham treatments. Acupressure therapy was a beneficial approach in managing a variety of health problems and the therapeutic effect was found to be more effective in the true acupressure groups than that in the sham comparative groups. No clear association could be identified between different sham acupressure modalities and the reported treatment outcomes.ConclusionsA great diversity of sham acupressure controls have been used in clinical practice and research. A solid conclusion whether different sham alternatives are related to different treatment outcomes cannot be derived because of significant clinical heterogeneity among the analyzed trials. Non-acupoints are generally recommended but the definite locations should be identified with caution. For studies using single sham acupoints on hands or legs, it is suggested to apply identical acupressure devices on the same acupoint as in the active intervention without any stimulation. While for studies on pain, stimulation of sham acupoints should be avoided.