Table 3.
GRADE Quality Grading of 14 SRs and MAs of Acupuncture for KOA
| Author(Year) | Outcomes (n) | Limitations | Inconsistency | Indirectness | Imprecision | Publication Bias | Quality of Evidence |
|---|---|---|---|---|---|---|---|
| Chai (2009)37 | Apparent rate (4) | −1① | 0 | 0 | 0 | −1⑤ | Low |
| WOMAC score (2) | −1① | 0 | 0 | 0 | −1⑤ | Low | |
| WOMAC pain scores (2) | −1① | 0 | 0 | 0 | −1⑤ | Low | |
| WOMAC stiffness score (2) | −1① | 0 | 0 | 0 | −1⑤ | Low | |
| WOMAC daily activity score (2) | −1① | 0 | 0 | 0 | −1⑤ | Low | |
| Cao (2012)38 | AT versus SA for pain and function, short-term (10) | −1① | −1② | 0 | 0 | −1⑤ | Very Low |
| AT versus SA for pain and function, long-term (4) | −1① | 0 | 0 | −1③ | −1⑤ | Very Low | |
| AT versus UC for pain and function, short-term (6) | −1① | −1② | 0 | 0 | −1⑤ | Very Low | |
| AT versus UC for pain and function, long-term (4) | −1① | 0 | 0 | −1③ | −1⑤ | Very Low | |
| AT versus WS for pain and function, short-term (5) | −1① | −1② | 0 | 0 | −1⑤ | Very Low | |
| Lu (2012)39 | Total efficacy rate (10) | −1① | 0 | 0 | 0 | −1④ | Low |
| Lu (2015)40 | Short-term total efficacy rate (8) | −1① | −1② | 0 | 0 | 0 | Low |
| Long-term total efficacy rate (2) | −1① | 0 | 0 | 0 | 0 | Moderate | |
| Short-term cure rate (4) | −1① | 0 | 0 | 0 | 0 | Moderate | |
| Adverse effect (2) | −1① | 0 | 0 | 0 | 0 | Moderate | |
| Lin (2016)41 | Short-term WOMAC physical function scores (10) | −1① | −2② | 0 | −1③ | 0 | Very Low |
| Long-term WOMAC physical function scores (5) | −1① | −2② | 0 | 0 | 0 | Very Low | |
| Short-term WOMAC pain scores (11) | −1① | −2② | 0 | −1③ | 0 | Very Low | |
| Long-term WOMAC pain scores (5) | −1① | −2② | 0 | −1③ | 0 | Very Low | |
| Zhao (2016)42 | Efficacy rate (13) | −1① | 0 | 0 | 0 | −1⑤ | Low |
| Adverse effect (1) | −1① | 0 | 0 | 0 | −1⑤ | Low | |
| Hu (2016)43 | Efficacy rate (8) | −1① | 0 | 0 | 0 | −1⑤ | Low |
| WOMAC score (2) | −1① | −1② | 0 | 0 | −1⑤ | Very Low | |
| Guo (2018)44 | Total efficacy rate (11) | −1① | 0 | 0 | 0 | −1④ | Low |
| WOMAC score (2) | −1① | −2② | 0 | −1③ | −1④ | Very Low | |
| Cao (2019)45 | Short-term efficacy rate (9) | −1① | 0 | 0 | 0 | 0 | Moderate |
| Kong (2019)46 | Efficacy rate (16) | −1① | 0 | 0 | 0 | −1④ | Low |
| VAS score (14) | −1① | −2② | 0 | 0 | −1⑤ | Very Low | |
| Lysholm knee score (11) | −1① | −2② | 0 | 0 | −1⑤ | Very Low | |
| WOMAC score (5) | −1① | −2② | 0 | 0 | −1⑤ | Very Low | |
| Zheng (2020)47 | Efficacy rate (8) | −1① | 0 | 0 | 0 | −1⑤ | Low |
| VAS score (7) | −1① | −2② | 0 | 0 | −1⑤ | Very Low | |
| Lysholm knee score (7) | −1① | −2② | 0 | 0 | −1⑤ | Very Low | |
| Wang (2020)48 | AT versus NA for pain reduction (11) | −1① | −2② | 0 | −1③ | 0 | Very Low |
| AT versus NA for physical function improvement (10) | −1① | −2② | 0 | −1③ | 0 | Very Low | |
| AT versus SA for pain reduction (12) | −1① | −2② | 0 | −1③ | 0 | Very Low | |
| AT versus SA for physical function improvement (12) | −1① | −2② | 0 | −1③ | 0 | Very Low | |
| Fan (2020)49 | Total efficacy rate (19) | −1① | 0 | 0 | 0 | −1④ | Very Low |
| Lysholm knee score (4) | −1① | −2② | 0 | 0 | −1④ | Very Low | |
| VAS score (11) | −1① | −2② | 0 | 0 | −1④ | Very Low | |
| WOMAC score (16) | −1① | −2② | 0 | 0 | −1④ | Very Low | |
| Adverse effect (8) | −1① | 0 | 0 | −1③ | −1④ | Very Low | |
| Yang (2021)50 | total efficacy rate (10) | −1① | 0 | 0 | −1③ | 0 | Low |
| Short-term cure rate (10) | −1① | 0 | 0 | −1③ | 0 | Low | |
| Adverse effect (1) | −1① | 0 | 0 | −1① | 0 | Low | |
| JOA score (3) | −1① | 0 | 0 | −1③ | 0 | Low |
Notes: ①The design of the experiment with a large bias in random, distributive hiding or blind; ②The confidence interval overlaps less, the heterogeneity test P is very small, and the I2 is larger; ③Confidence interval is not narrow enough; ④Funnel graph asymmetry; ⑤Fewer studies are included and there may be greater publication bias.
Abbreviations: AT, acupuncture therapy; NA, no acupuncture; SA, sham acupuncture; UC, usual care; WS, waiting list; WOMAC, Western Ontario and Mcmaster Universities Arthritis Index; VAS, Visual Analog Scale; JOA, Japanese Orthopaedic Association.