Summary of findings 3. Acupuncture compared to usual care for chronic nonspecific low back pain.
| Acupuncture compared to usual care for chronic nonspecific low back pain | ||||||
| Patient or population: chronic nonspecific low back pain Setting: outpatient clinics or inpatient units, in hospitals or the community Intervention: acupuncture Comparison: usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk with usual care | Corresponding risk with acupuncture | |||||
| Pain intensity VAS (0 to 100; 0 = no pain, 100 = worst pain) Follow‐up: immediately after; < 7 days after the end of the sessions |
The mean pain intensity in the usual care groups immediately after the sessions was 57.1 points (SD 16.5) | The MD was 10.26 points lower in the acupuncture groups (17.11 lower to 3.40 lower) | Not applicable | 1054 (5 RCTs) | ⊕⊕⊝⊝ LOWa,b | The difference did not meet the predefined clinically relevant change. |
| Back‐specific functional status HFAQ (0 to 100; 0 = disabled, 100 = full function) Follow‐up: immediately after; < 7 days after the end of the sessions |
The mean back‐specific function immediately after the sessions was 56.3 points (SD 20.8) | The MD was 9.78 points higher in the acupuncture groups (3.54 higher to 16.02 higher) | Not applicable | 1381 (5 RCTs) | ⊕⊕⊝⊝ LOWa,b | The corresponding risk estimated using SMD was ‐0.47 (95% CI ‐0.77 to ‐0.17). The difference did not meet the predefined clinically relevant change. |
| Quality of life (QoL) – physical health SF‐12 (0 to 100; 0 = poor QoL, 100 = high QoL) Follow‐up: short term; 8 days to 3 months |
The mean QoL – physical health – in the usual care group in the short term was 36.1 points (SD 8.9) The mean QoL – mental health – in the usual care group in the short term was 48.6 points (SD 11.6) |
The MD was 4.20 points higher in the acupuncture group (2.82 higher to 5.58 higher) The MD was 1.90 points higher in the acupuncture group (0.25 higher to 3.55 higher) |
Not applicable Not applicable |
731
(1 RCT) 731 (1 RCT) |
⊕⊕⊕⊝
MODERATEc ⊕⊕⊕⊝ MODERATEc |
The authors of this study did not provide the total results of the SF‐12, only the subgroups. The difference did not meet the predefined clinically relevant change. The authors of this study did not provide the total results of the SF‐12, only the subgroups. |
| QoL: mental health SF‐12 (0 to 100; 0 = poor QoL, 100 = high QoL) Follow‐up: short term; 8 days to 3 months | ||||||
| Adverse events Self‐reported Follow‐up: immediately after; < 7 days after the end of the sessions |
Study population | RR 3.34 (0.36 to 30.68) | 74 (1 RCT) | ⊕⊕⊝⊝ LOWc,d | One study reported three adverse events (2 pain and 1 circulation problem) in the acupuncture group and one in the usual care group (persisting pain). | |
| 26 per 1000 | 86 per 1000 (9 to 787) | |||||
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* The risk in the acupuncture group (and its 95% CI) was based on the assumed risk in the sham intervention group and the relative effect of the acupuncture (and its 95% CI). When there was more than one study for an outcome, we chose the sham control group mean from the included study that had the most representative study population and the largest weighting in the overall result in Review Manager 5. For pain and back‐specific functional status, this was Haake 2007 in the immediate term. CI: confidence interval; MD: mean difference; SMD: standardized mean difference; SD: standard deviation; RR: risk ratio; RCTs: randomized controlled trials; VAS: Visual Analog Scale; HFAQ: Hannover Function Ability Questionnaire; SF‐12: Short Form Health Survey. | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: 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 certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
aDowngraded one level for risk of bias (performance, attrition, and selection bias). bDowngraded one level for inconsistency (I² ≥ 75%) that could only be partly explained. cDowngraded one level for risk of bias (performance and attrition bias). dDowngraded one level for imprecision (CI included a null effect).