A systematic review of reviews of systematic reviews of acupuncture
Acupuncture is one of the more popular forms of complementary and alternative medicine. Whilst the therapy has been the subject of many published trials, systematic reviews and reviews of reviews, the conclusions of these publications often have been inconsistent.
To systematically review reviews of reviews of acupuncture in an attempt to better understand existing contradictions in the literature.
The databases MEDLINE, Scopus and EbscoHost were searched using the keywords (systematic review) AND (acupuncture OR acupressure) for the period January 1991 to December 2011. The methodological quality of included reviews was assessed using a nine-item measure developed by the authors.
Eighteen reviews of reviews met the inclusion criteria; two reviews did not assess the methodological quality of the included reviews and only two rigorously assessed the quality of the primary studies included in the reviews. Quality of the reviews of reviews ranged from poor to excellent. Conclusions were positive for nausea and vomiting and some types of pain, but negative for smoking cessation.
Only two reviews of reviews allowed definitive conclusions to be drawn; that is, there is insufficient evidence to make positive recommendations. Further reviews, or reviews of reviews, are unlikely to break this impasse, owing to the combination of new and existing reviews or primary studies upon which they can draw. We therefore recommend that high-quality RCTs should be conducted in the areas where most promise has already been shown.