Are Sham Acupuncture Interventions More Effective than (Other) Placebos? A Re-Analysis of Data from the Cochrane Review on Placebo Effects
Are Sham Acupuncture Interventions More Effective than (Other) Placebos? A Re-Analysis of Data from the Cochrane Review on Placebo Effects
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DOI：
10.1159/000320374
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发表时间：
2010-01-01
影响因子：
--
通讯作者：
Meissner, Karin
中科院分区：
文献类型：
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作者：
Linde, Klaus;Niemann, Karin;Meissner, Karin
背景和目的：最近科克伦对各种情况下的安慰剂干预进行了综述，发现“物理安慰剂”（包括假针灸）与“药理安慰剂”相比，与无治疗对照组相比，效果更大。我们重新分析了这篇综述的数据，以调查假针灸的效果是否与其他“物理安慰剂”的效果不同。研究方法：科克伦综述中纳入的所有研究“物理安慰剂”的试验都被归类为研究（假）针灸或其他物理安慰剂。后一组被进一步细分为类似干预措施组。将来自科克伦综述的数据重新输入RevMan 5软件进行荟萃分析。主要分析是对使用假针灸或其他物理安慰剂的试验进行随机效应分析，这些试验报告了连续的结果。结果如下：在总共61项报告了连续结果测量的试验中，19项比较了假针灸，42项比较了其他物理安慰剂与无治疗对照组。重新分析的试验在患者、干预措施和测量的结局方面高度异质。假针灸和未治疗之间的合并标准化平均差异为-0.41（95%置信区间-0.56，-0.24），其他物理安慰剂和未治疗之间为-0.26（95% CI-0.37，-0.15）（亚组差异的p值= 0.007）。在其他物理安慰剂亚组之间也观察到显著差异。结论：由于纳入试验的异质性和间接比较，我们的结果必须谨慎解释。尽管如此，他们认为，假针灸干预可能，平均而言，与药物和其他物理安慰剂相比，具有更大的影响。
Background and Objective: A recent Cochrane review on placebo interventions for all kinds of conditions found that 'physical placebos' (which included sham acupuncture) were associated with larger effects over no-treatment control groups than 'pharmacological placebos'. We re-analyzed the data from this review to investigate whether effects associated with sham acupuncture differed from those of other 'physical placebos'. Methods: All trials included in the Cochrane review as investigating 'physical placebos' were classified as investigating either (sham) acupuncture or other physical placebos. The latter group was further subclassified into groups of similar interventions. Data from the Cochrane review were re-entered into the RevMan 5 software for meta-analysis. The primary analysis was a random-effects analysis of trials reporting continuous outcomes of trials that used either sham acupuncture or other physical placebos. Results: Out of a total of 61 trials which reported a continuous outcome measure, 19 compared sham acupuncture and 42 compared other physical placebos with a no-treatment control group. The trials re-analyzed were highly heterogeneous regarding patients, interventions and outcomes measured. The pooled standardized mean difference was -0.41 (95% confidence interval -0.56, -0.24) between sham acupuncture and no treatment and -0.26 (95% CI -0.37, -0.15) between other physical placebos and no treatment (p value for subgroup differences = 0.007). Significant differences were also observed between subgroups of other physical placebos. Conclusion: Due to the heterogeneity of the trials included and the indirect comparison our results must be interpreted with caution. Still, they suggest that sham acupuncture interventions might, on average, be associated with larger effects than pharmacological and other physical placebos.