Approach to Assess Adequacy of Acupuncture in Randomized Controlled Trials: A Systematic Review

ObjectiveTo summarize and identify the available instruments/methods assessing the adequacy of acupuncture in randomized controlled trials (RCTs) for proposing a new improved instrument.MethodsA systematic literature search was carried out in 7 electronic databases from inception until 21st November 2022. Any study evaluating the adequacy or quality of acupuncture, specifying specific acupuncture treatment-related factors as criteria of subgroup analysis, or developing an instrument/tool to assess the adequacy or quality of acupuncture in an RCT was included. Basic information, characteristics and contents of acupuncture adequacy assessment were presented as frequencies and percentages.ResultsForty studies were included in this systematic review. Thirty-five studies (87.50%) were systematic reviews, none of which used formal methods to develop the assessment instruments/methods of acupuncture adequacy; of 5 methodological studies, only 1 study used a relatively formal method. Thirty-two studies (82.05%) assessed the components of acupuncture, while 7 (17.95%) assessed the overall quality of acupuncture. An independent assessment instrument/method was used to assess acupuncture adequacy in 29 studies (74.35%), whereas as one part of a methodological quality assessment scale in 10 (25.65%). Only 9 (23.00%) studies used the assessment results for subgroup analysis, sensitivity analysis or the criteria for inclusion in the meta-analysis.ConclusionAssessment contents for adequacy or quality of acupuncture in RCTs hadn't still reached consensus and no widely used assessment tools appeared. The methodology of available assessment instruments/scales is far from formal and rigorous. A new instrument/tool assessing adequacy of acupuncture should be developed using a formal method.

Automated summary

The objective of this study is to summarize and identify the available instruments/methods to assess the adequacy of acupuncture in randomized controlled trials (RCTs) and propose a new improved instrument. A systematic literature search was conducted, and 40 studies were included in this systematic review. The findings indicate that there is no consensus on the assessment contents for adequacy or quality of acupuncture in RCTs, and no widely used assessment tools have emerged. It is recommended to develop a new instrument to assess the adequacy of acupuncture using a formal method.