Table 3. Summary of main findings of RCTs on acupuncture for erectile dysfunction.
| Outcome | No. of participant (No. of RCT) | Quality of the evidence | Relative effect (95% CI) | Anticipated absolute effect | |
|---|---|---|---|---|---|
| Risk with control | Risk difference with intervention (95% CI) | ||||
| Electronic acupuncture versus sham acupuncture | |||||
| Satisfaction of self-assessment rate | 30 (1) | ⨁○○○acd | RR 1.50 (0.71–3.16) | 400 per 1,000 | 200 more per 1,000 (116 more to 864 more) |
| Manual acupuncture versus sham acupuncture | |||||
| Satisfaction of self-assessment rate | 30 (1) | ⨁○○○acd | RR 7.53 (1.13–50.00) | 91 per 1,000 | 594 more per 1,000 (12 more to 1,000 more) |
| Acupuncture plus tadalafil tablet versus tadalafil tablet | |||||
| Cure rate | 152 (2) | ⨁⨁○○ac | RR 1.31 (1.00–1.71) | 467 per 1,000 | 145 more per 1,000 (0 more to 331 more) |
| IIEF-5 score | 152 (2) | ⨁⨁○○ac | N/A | MD 5.38 higher (4.46 higher to 6.29 higher) | |
| Acupuncture versus herb medicine | |||||
| Markedly improved on erectile function rate | 204 (3) | ⨁○○○acd | RR 1.51 (0.96–2.38) | 194 per 1,000 | 99 more per 1,000 (8 fewer to 268 more) |
| IIEF-5 score | 100 (1) | ⨁⨁○○ac | N/A | MD 4 higher (3.66 higher to 4.34 higher) | |
| Acupuncture plus herb medicine versus herb medicine | |||||
| Cure rate | 168 (2) | ⨁⨁○○ac | RR 1.36 (1.12–1.65) | 607 per 1,000 | 219 more per 1,000 (73 more to 395 more) |
| Markedly improved on erectile function rate | 601 (7) | ⨁○○○acd | RR 1.68 (1.31–2.17 | 164 more per 1,000 (75 more to 281 more) | |
| Satisfaction of self-assessment rate | 163 (2) | ⨁○○○abc | RR 1.67 (0.64–4.36) | 463 per 1,000 | 310 more per 1,000 (167 fewer to 1,557 more) |
| IIEF-5 score | 331 (3) | ⨁⨁○○ab | N/A | MD 3.53 higher (0.65 higher to 6.4 higher) | |
| Erectile angle | 228 (2) | ⨁○○○acd | N/A | MD 6.73 higher (4.1 higher to 9.36 higher) | |
GRADE Working Group grades of evidence. High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
RCT: randomized controlled trial, CI: confidence interval, IIEF: International Index of Erectile Function, RR: risk ratio, N/A: not applicable, MD: mean difference.
aRisk of bias: All the trials had high risk of performance bias for not blinding the participants. Methodological quality of these trials was graded as “high risk of bias,” due to the design of comparison (acupuncture therapy versus conventional medications) is difficult to blind personnel and participants. The trials also had unclear risk of performance bias for not reporting blinding the outcome assessor. bInconsistency; There is significantly statistical heterogeneity indicating by I2 value. cImprecision: For dichotomous outcomes, the total number of events is less than 300, for continuous outcomes, the total population size is less than 400 or pooled results included no effects. dIndirectness. For outcomes of satisfaction of self-assessment rate, markedly improved on erectile function rate, and erectile angle. This was not internationally applied outcome measures. ⊕: Very low quality of the evidence; ⊕⊕: Low quality of the evidence.