5. Adequacy of acupuncture.
| Study | Choice of acupoints | Number of sessions | Treatment duration | Treatment frequency | Needling technique | Acupuncturist experience | Adequacy of sham or placebo intervention | Adequate number of sessions or dose of the control group |
| Brinkhaus 2006Brinkhaus 2006 | Adequate; but point selection at the discretion of different acupuncturists may introduce unexpected variables | Adequate | Adequate | Adequate | Adequate | Adequate | Probably adequate, as the needling insertion was away from the low back area; the best sham would be non‐insertion | Adequate |
| Carlsson 2001 | Adequate; however, point selection during the increase from 8 points to 14 to 18 should be clearly indicated | Don't know; no information provided on the total sessions | Adequate | Don't know; no information provided on the total sessions | Adequate | Adequate | Placebo intervention with mock TENS is a valid sham | Don't know. Sufficient information not given |
| Cesare 2011 | Inadequate; they did not use commonly used points BL23, BL25 | Inadequate; 4 sessions only | Don't know; no information provided | Inadequate; treatment once a week seems insufficient | Don't know; no mention of acupuncture techniques in the paper | Adequate | No sham or placebo | Don't know. Study comparing two acupuncture techniques |
| Chen 2010 | Adequate | Inadequate; 5 sessions may not be sufficient to provide adequate medical benefit | Inadequate; 15 minutes of intervention is not sufficient | Inadequate; once a week treatment for 5 weeks is not sufficient | Adequate | Don't know; no information provided | TENS without current induction is a good sham | Adequate |
| Chen 2016 | Adequate | Adequate | Adequate | Adequate | Adequate | Don't know; no information provided | No sham or placebo | Don't know. Botulinum toxin type A was the control |
| Cherkin 2009 | Adequate; standard acupuncture protocol is adequate. individualized acupuncture is possibly adequate, based on their training background | Adequate | Adequate | Adequate | Adequate; due to adequate training of acupuncturists | Adequate | Simulated acupuncture without actual needle insertion is a good sham | Adequate |
| Cho 2013 | Adequate | Don't know; no information provided | Adequate | Don't know; no information provided | Adequate | Adequate | Adequate; semi‐blunt needles were used without penetration | Don't know. No information given on control group's session |
| Grant 1999 | Don't know whether this protocol is adequate or not | Adequate | Adequate | Adequate | Don't know; no information on needling technique provided | Don't know; information on physiotherapist's experiences in acupuncture not provided | No sham or placebo control | Don't know. Parallel study comparing acupuncture and TENS |
| Haake 2007 | Don't know; list of acupuncture points not provided | Adequate | Adequate | Adequate | Adequate | Don't know; no mention of acupuncturist's training or experience | Not an adequate sham; acupuncture needle insertion avoiding non‐acupuncture points or meridians may still be considered Ashi points or trigger points | Adequate |
| Hunter 2012 | Adequate; used auricular acupuncture points | Adequate | Adequate | Adequate | Adequate | Don't know; no mention of acupuncture training | No sham for auricular acupuncture | Don't know. Exercise was the control |
| Itoh 2009 | Adequate | Don't know; no mention of numbers of sessions of treatment | Inadequate; 15‐minute treatment per session may provide insufficient benefit | Don't know; no mention of frequency of treatments | Adequate | Adequate | No sham | Adequate Non‐treatment group was control |
| Kerr 2003 | Adequate | Adequate; 6 sessions | Adequate | Inadequate; once a week treatment is insufficient | Adequate | Adequate; a chartered physiotherapist, trained in acupuncture, carried out all treatments |
Non‐functioning TENS intervention as placebo is viable | Adequate |
| Leibing 2002 | Don't know; no information provided | Adequate | Adequate | Adequate | Adequate | Don't know; only the institution where physician obtained his degrees provided; no mention of acupuncture training or background | Not an adequate sham; although needles were inserted superficially, at a distance from real acupuncture points, they may still provide some health benefit similar to needling Ashi points | Adequate |
| Li 2017 | Adequate | Adequate | Adequate | Adequate | Adequate | Don't know; no information provided on acupuncturist | No sham or placebo used | The study compared two styles of acupuncture |
| Lin 2010 | Adequate | Adequate | Adequate | Adequate | Adequate | Don't know; no information provided on acupuncturist | No sham or placebo used | Don't know. The study compared effects of different interventions |
| Meng 2003 | Adequate | Adequate | Adequate | Adequate | Adequate | Adequate; anesthetist certified in acupuncture carried out the treatments | No sham or placebo used | Don't know. Standard therapy as directed by primary physicians |
| Molsberger 2002 | Adequate | Adequate | Adequate | Adequate | Adequate | Don't know; no mention of the length of training in China | Needle insertion as a sham is not an optimal option; application of needles superficially, at non‐acupuncture points, may still produce local anesthetic effects | Adequate |
| Nie 2005 | Adequate | Don't know; only 5 sessions of the treatment were given | Don't know; no mention of treatment duration for each session | Adequate | Adequate | Don't know; no information provided | No sham or placebo control | Don't know. The study compared regular acupuncture and acupuncture + heated needles |
| Pach 2013 | Adequate | Adequate | Adequate | Adequate | Adequate | Adequate | No sham or placebo used | Don't know |
| Pan 2005 | Adequate | Adequate | Don't know; no mention of treatment duration | Adequate | Adequate | Don't know; no information provided | No sham or placebo control | Don't know. It is not applicable |
| Pérez‐Palomares 2010 | Adequate; acupuncture needle placement shown in picture corresponds to Huatuojiaji points from L2 to L5 | Adequate | Adequate | Adequate | Adequate | Don't know; no mention of acupuncturist | No sham or placebo used | Don't know. It is not applicable |
| Shankar 2010 | Adequate | Adequate | Adequate | Adequate | Adequate | Adequate | No sham or placebo | Don't know. The conventional therapy was the control |
| Tsukayama 2002 | Don't know; only 2 acupuncture points clearly mentioned; no explanation given on the choices of points | Inadequate; 4 treatments are not sufficient | Inadequate; 15‐minute treatment is not sufficient to produce satisfactory outcome | Adequate | Adequate | Don't know; no mention of practitioner's training | No sham or placebo | Don't know. The TENS intervention was the control |
| Ushinohama 2016 | Adequate | Inadequate; only 1 session was given | Adequate | Inadequate; only 1 session | Adequate | Adequate; "This therapist had 11 years of experience using EA as treatment for LBP". |
Simulated acupuncture without actual needle insertion is a good sham | Inadequate. The sham intervention contained only one session |
| Wang 2016a | Don't know; only tender points were needled | Inadequate; only 1 session was given | Inadequate; a 10‐minute session treatment is not enough | Inadequate; only 1 session was given | Adequate | Adequate; an experienced and licensed physician conducted the treatment | No sham or placebo | Don't know. The study compared the treatment effect of three diameters of needles for LBP |
| Weiss 2013 | Adequate; a pragmatic study that mimics daily practice; the protocol prescribed by the acupuncturist whose training is adequate | Don't know; total number of treatments not mentioned | Adequate | Adequate | Adequate; a qualified acupuncturist should be able to provide adequate needling technique | Adequate | No sham or placebo | Don't know. Standardized 21‐day inpatient rehabilitation program was control |
| Witt 2006 | Don't know; acupuncture protocols were not standardized; no mention of choice of acupuncture points | Adequate | Don't know; no information on duration | Adequate | Don't know; no information provided | Inadequate; 140 hours of training probably is not enough | No sham or placebo | Don't know. Routine care was control |
| Yuan 2009 | Adequate; prescribed by acupuncturist who had adequate training | Adequate | Adequate | Adequate | Adequate | Adequate | No sham or placebo | Don't know. Parallel study comparing different number of treatments per week |
| Yuan 2016 | Adequate | Adequate | Adequate | Adequate | Inadequate; no manipulation during the treatment | Don't know; no information provided | Simulated acupuncture without actual needle insertion is a good sham | Adequate |
| Yun 2012a | Adequate | Adequate | Adequate | Adequate | Adequate | Adequate | No sham or placebo | Don't know. Usual care was control |
| Yun 2012 | Adequate | Adequate | Adequate | Adequate | Adequate | Adequate | No sham or placebo | Don't know. Usual care was control |
| Zaringhalam 2010 | Adequate | Adequate | Adequate | Adequate | Adequate | Adequate | No sham or placebo | Don't know. It is not applicable |
| Zhao 2012 | Adequate | Inadequate; although total sessions are sufficient, 2 weeks of treatment seems too short |
Adequate | Adequate | Adequate | Don't know; no information provided | No sham or placebo | Don't know. Parallel study comparing two acupuncture techniques and medium frequency electrostimulation |
EA: electroacupuncture; LBP = low back pain; TENS: transcutaneous electrical nerve stimulation