Systematic review of acupuncture therapy for musculoskeletal disorders of the extremities

Study Type: Systematic review
OE Level of Evidence: 3
Journal Level of Evidence: N/A
A total of 15 randomized controlled trials (RCTs) were included in this systematic review to determine the efficacy and safety of different forms of acupuncture in the management of musculoskeletal disorders. Ten trials reported on musculoskeletal disorders of the upper extremities: three on carpal tunnel syndrome; two on lateral epicondylitis; four on shoulder pain; and one on general upper extremity pain. Five trials reported Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Ontario Ministry of Finance and the Financial Services Commission of Ontario, Canada Research Chairs program, Aviva Canada
Conflicts: Other
Why was this study needed now?
Musculoskeletal disorders of the extremities are frequent, and can result in substantial decrease in quality of life. Acupuncture therapy is an alternative treatment for musculoskeletal disorders that is commonly used, though evidence clearly supporting its use in these conditions is lacking. Previous systematic reviews have reported mixed conclusions with regards to the efficacy of acupuncture therapies depending on the anatomical location of the injury, and the quality of these reviews has been inadequate. Therefore, the present study was warranted to verify whether or not acupuncture therapies provide beneficial functional and pain outcomes for patients with musculoskeletal disorders of the extremities.
What was the principal research question?
Are acupuncture therapies effective and safe for patients with musculoskeletal disorders of the extremities?
Data Source: MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials databases were searched using Ovid, and CINAHL database was searched using EBSCO for all relevant articles published up to January 16 2015. Reference lists from relevant systematic reviews were manually searched for possible missed articles.
Index Terms: A detailed list the search strategy is included in the appendix of the article.
Study Selection: Eligibility criteria included: randomized controlled trials, cohort studies, and case-control studies of the English language; a minimum of 30 patients per treatment arm or a sample size of at least 100 patients; patient populations with musculoskeletal disorders in the extremities; a grade I or II sprain/strain according to criteria of the American Academy of Orthopaedic Surgeons; non-specific shoulder, elbow, wrist, hip, knee, ankle, and/or foot pain; tendonitis; tendinopathy; tendinosis; and at least one of the following reported outcomes: self-reported recovery, functional recovery, pain intensity, health-related quality of life, or adverse events. Fifteen (15) RCTs were found to be eligible for inclusion.
Data Extraction: Data was extracted by one reviewer and independently checked by two other reviewers.
Data Synthesis: Quantitative pooling of data was not completed in this review due to heterogeneity. All included studies were assessed qualitatively. Minimal clinically important differences (MCIDs) were used to assess the clinical significance of reported results. To achieve a significant MCID, between group differences of 2/10 should be obtained on the numeric rating scale, 14/100mm on the visual analogue scale (VAS) for upper extremity injuries, 20/100mm VAS for patellofemoral pain syndrome, 19/100mm VAS for plantar fasciitis, 9/80 points on the lower extremity functional scale, 12/100 points on the Victorian Institute of Sport Assesment-Achilles questionnaire, 13/100 for pain outcomes on the Foot Health Status questionnaire, 1/5 on the symptom severity subscale of the Carpal Tunnel Syndrome questionnaire, 10.2/100 on the Disabilities of the Arm, Shoulder and Hand questionnaire, 18/100 on the Shoulder Pain and Disability Index, 6kg in grip strength using the JAMAR dynamometer (Lafayette Instrument Company, Lafayette, IN), 0.47 for the functional outcome subscale on the Boston Carpal Tunnel Syndrome questionnaire, and 0.14 for the symptom severity subscale of the Boston Carpal Tunnel Syndrome questionnaire.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.