The ' Characteristics of excluded studies ' table lists the studies that we excluded as well as the reasons for exclusion. The use of a sham acupuncture control that adequately blinds RCT participants to treatment assignment is probably the most important 'risk of bias' criterion in acupuncture RCTs. Additionally, the Haslam RCT had risks of bias associated with several other domains such as incomplete outcome data and selective reporting, and Sheng had risk of selection bias.
All the other trials were assessed as free of attrition and reporting bias see risk of bias tables in Characteristics of included studies and risk of bias graph, Figure 2. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
For four RCTs Fink ; Haslam ; Sheng ; Witt , there was incomplete reporting of SDs of change scores, and we needed to make assumptions to calculate these SDs for the changes from baseline analyses. Therefore, in calculating the mean changes, we assumed the baseline means and SDs for participants with only hip OA were the same as those of all participants i. OA of hip and knee participants , because the Witt publication reported that there were no significant baseline differences between participants with OA of the knee and participants with OA of the hip.
All of the RCTs were judged adequate on 'total number of sessions' and 'treatment frequency', except for Haslam in which each participant received one session per week over six weeks, which the assessors judged to be potentially insufficient for treating hip OA. The 'training and experience' of the RCTs' treating acupuncturists were only reported in two RCT publications Sheng ; White ; both described an adequate level of training and experience. The insertion sham acupuncture used the same number of points and the same depths as the true acupuncture group and the sham needles were inserted 5 cm away from the 'real points'.
This technique may have caused nonspecific endorphin release which has some effect on pain. And the sham points stimulated were also probably located at the twelve muscle region and twelve cutaneous region where qi and blood were distributed. The sham procedure may have created a mild physiological response, including an acupressure massage effect, because the sham devices were placed and left at the true acupuncture points.
For the sham TENS group, it was not an appropriate sham control for acupuncture. The sham TENS may also have created a mild physiological effect, because the electrodes were fixed to the skin of the true acupuncture points.
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Credibility of the blinding to treatment was assessed at 4 weeks after randomization end of treatment. However, the paper stated that "[a]cupuncture was carried out by a physician with sound knowledge of traditional acupuncture techniques.
No information regarding the training background and practice experience of this author was provided. No point selection was described. The training requirement was low. See: Summary of findings for the main comparison Acupuncture versus sham acupuncture for hip osteoarthritis ; Summary of findings 2 Acupuncture as an addition to the routine primary care that trial participants were receiving from their physicians versus routine primary physician care alone for hip osteoarthritis ; Summary of findings 3 Acupuncture versus advice plus exercise for hip osteoarthritis ; Summary of findings 4 Acupuncture as an addition to patient education versus patient education alone for hip osteoarthritis ; Summary of findings 5 Acupuncture versus NSAIDs for hip osteoarthritis.
See: summary of findings Table for the main comparison Summary of findings for the principal comparison: Acupuncture versus sham acupuncture for hip OA; summary of findings Table 2 Acupuncture as an addition to the routine primary care that trial participants were receiving from their physicians versus routine primary physician care alone for hip OA; summary of findings Table 3 Acupuncture versus advice plus exercise for hip OA; summary of findings Table 4 Acupuncture as an addition to patient education versus patient education alone for hip OA; and summary of findings Table 5 Acupuncture versus NSAIDs for hip OA.
The GRADE analysis indicated that the evidence for these two outcomes was of moderate quality, and each was downgraded one level for serious imprecision of results due to sparse data total population size was less than , for each outcome see summary of findings Table for the main comparison. The White trial only reported qualitatively that the quality of life score improved in both the true and sham acupuncture groups, with no significant differences between groups.
Because there was no benefit of acupuncture relative to sham acupuncture on the quality of life outcome in the methodologically sound White trial, and also because combining the 'negative' White quality of life data with the 'positive' Fink quality of life data would be unlikely to result in a statistically significant pooled benefit, the 'positive' findings of the Fink trial quality of life outcome were not reported in our Abstract, Summary of Findings table, or Plain Language Summary in order to avoid emphasizing a positive finding that was not representative of the included trials.
There was no statistically significant difference for mental quality of life Analysis 2. For the quality of life outcome, in the acupuncture plus patient education group, the pretest median score was 2.
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Information on safety was reported in four RCTs Fink ; Haslam ; White ; Witt , but there was limited reporting and heterogeneous reporting methods. None reported any serious adverse events attributed to acupuncture. Two RCTs reported minor side effects of acupuncture, which were primarily minor bruising, bleeding, or pain at needle insertion sites White ; Witt No RCTs reported on the outcome withdrawals due to adverse events see Table 3.
Only mention of side effects or adverse events was in following sentence in Results section: "During the study course, no side effects occurred. Only mention of side effects or adverse events was in following sentence in Discussion section: "Participants were compliant with treatment and there were no reported side effects. Fink and Haslam both reported that no side effects occurred, so it was assumed that no adverse events serious or otherwise occurred in these two trials. The publication did not report the number of side effects for participants specifically with hip OA.
It was also not clear whether the numbers reported in the publications as included in the table above were the numbers of side effects in each group or the numbers of participants in each group who had side effect s. For the acupuncture vs. Solo tres ECA informaron resultados al seguimiento a largo plazo, pero las tasas de desgaste fueron muy altas, por lo que la evidencia sobre los efectos del tratamiento a largo plazo fue incompleta.
Los resultados de este ECA reciente controlado con acupuntura simulada White apoyaron los resultados del ECA controlado con acupuntura simulada anterior Fink y proporcionan evidencia adicional de que la acupuntura no es superior a la acupuntura simulada para la OA de la cadera. Comparison 1 Acupuncture vs. Comparison 2 Acupuncture as addition to routine primary physician care vs. Comparison 3 Acupuncture vs. Comparison 4 Acupuncture vs. Comparison 5 Acupuncture vs. Comparison 6 Acupuncture as addition to routine primary physician care vs.
Comparison 7 Acupuncture vs.
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Los datos descargados solo pueden visualizarse con programa Review Manager. Saltar al contenido Cookies. Contraer todo Desplegar todo. Objetivos Evaluar los efectos beneficiosos y perjudiciales de la acupuntura en los pacientes con OA de la cadera. Resultados principales Se incluyeron seis ECA con participantes. Summary of findings. Open in table viewer Summary of findings for the main comparison.
Acupuncture versus sham acupuncture for hip osteoarthritis. Open in table viewer Summary of findings 2. Acupuncture as an addition to the routine primary care that trial participants were receiving from their physicians versus routine primary physician care alone for hip osteoarthritis. Open in table viewer Summary of findings 3. Acupuncture versus advice plus exercise for hip osteoarthritis. Open in table viewer Summary of findings 4. Acupuncture as an addition to patient education versus patient education alone for hip osteoarthritis. Open in table viewer Summary of findings 5.
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Open in figure viewer Descargar como PowerPoint Figure 1. Open in table viewer Table 1. Characteristics of randomized controlled trials of acupuncture for hip osteoarthritis. Open in figure viewer Descargar como PowerPoint Figure 2. Open in table viewer Table 2.
Acupuncture adequacy assessments of included studiesa. TENS: transcutaneous electrical nerve stimulation a Two independent acupuncturists, LL and XS, assessed acupuncture as adequate in terms of the choice of acupuncture points, treatment duration and needling technique for all trials except for the Witt trial, a pragmatic trial for which the point selection and needling technique were entirely at the discretion of the treating physician. Open in figure viewer Descargar como PowerPoint Figure 3.
Open in table viewer Table 3. Adverse events in the acupuncture and control groupsa. Figuras y tablas -. Summary of findings for the main comparison.
Summary of findings 2. Double jeu - Milady. Featured Books. De dokter E. Todd Contemporary.