As an important approach to secondary research, Meta-analysis provides researchers with a means to supplement evidence. However, though being considered the highest level of evidence, the application of Meta-analysis in acupuncture faces challenges. Despite a substantial number of acupuncture Meta-analyses exists, the varied quality creates the confusion in evidence body. To improve methodological quality, the key issues have been explored in the design, implementation, and reporting of acupuncture Meta-analyses. Before setting up the design, the emphasis should be laid on the prioritization of scientific questions and the feasibility of Meta-analysis methods. During the design, special attention should be given to the development of detailed and transparent methods. In the implementation phase, the importance of researchers’ knowledge base and the standardized use of relevant tools should be highlighted. In reporting, the completeness of results should be emphasized, particularly in conclusion formation, with full consideration of evidence quality and clinical significance. The above recommendations of this review aim to provide methodological support for improving the quality of acupuncture Meta-analyses.
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Open Access
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Open Access
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To summarize and evaluate the existing evidence on acupuncture-assisted in vitro fertilization-embryo transfer (IVF-ET), to survey clinicians and patients regarding gaps between the evidence and clinical concerns, and to identify directions for future clinical research.
Randomized controlled trials (RCTs) of acupuncture-assisted IVF-ET were retrieved from CNKI, SinoMed, VIP, WanFang, PubMed, Embase, and Cochrane Library from inception through December 31, 2024. Two researchers independently screened the literature and extracted data. The methodological quality of the included studies was assessed using the Risk of Bias (ROB) 1.0 tool. Questionnaires, developed based on prior research and expert discussions, were distributed to clinicians and patients. Discrepancies between the evidence and clinical priorities were analyzed across the population, intervention, comparison and outcome dimensions.
A total of 143 RCTs with potential risks of bias were included. Questionnaires were completed by 103 clinicians and 108 patients. Comparisons reveal that elderly patients (>35 years old), patients with long-standing infertility (>5 years), and patients undergoing frozen embryo transfer are more focused on by clinicians, but the evidence supporting these concerns is limited. In acupuncture modalities, filiform needles have strong evidence and high recognition；moxibustion and ear acupuncture attract patients’ attention but have limited evidence, while transcutaneous electrical acupoint stimulation shows the opposite pattern. Regarding acupuncture timing and frequency, doctors focus on the pre-oocyte retrieval, the retrieval-to-transfer, and post-embryo transfer periods, with low evidence in some periods. High-evidence scenarios (≥3 pre-oocyte retrieval, 1 post-embryo transfer) receive moderate-to-low doctors’ attention. For control measures, comparisons with Western and Chinese medicine attract doctors’ attention but with limited evidence；blank controls show the opposite trend. In terms of outcomes, live birth rate attracts attention but has limited evidence. Mental health outcomes have little evidence and show substantial disparities between doctor and patient priorities. Complications have weak evidence yet high doctors’ focus. Clinical pregnancy rate aligns more closely with doctor-patient attention.
Future studies should enhance the quality of RCTs, broaden the range of included samples, and perform stratified analyses. High-quality trials are needed to evaluate the efficacy and safety of different interventions, determine the optimal acupuncture timing and frequency, and design clinically relevant control groups. Outcome measures should be expanded, and long-term follow-up should be emphasized to advance acupuncture’s value in assisted reproduction.
To reveal the gap between the evidence of systematic reviews (SRs) and clinical concerns by systematically summarizing the evidence on acupuncture and moxibustion for frozen shoulder and investigating the concerns and needs of clinicians in treatment with acupuncture and moxibustion for this disease.
The articles of SR and Meta-analysis on acupuncture and moxibustion for frozen shoulder were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase and Cochrane Library, starting from the inception of each database up to December 31st, 2022. Two researchers screened the articles and extracted data independently. Using AMSTAR-2, the methodological quality of the included studies was evaluated. Based on systematic reviews and expert discussion, a questionnaire on clinical concerns of acupuncture and moxibustion for frozen shoulder was developed and distributed to clinicians. The discrepancies between the evidence and clinical concerns were compared from 5 dimensions, including population, interventions, control measures, outcome indicators and review time points.
The evidence gaps existed between SRs and clinical concerns. In the existing studies, the needs of personalized treatment were not fully considered in terms of different syndromes/patterns of frozen shoulder and stages of illness, the outcome indicators were not employed properly, the time for outcome measurement was vague, the control groups were set up outside of standardization, and the methodological quality was lower.
It is suggested that future studies should improve the quality of methodology, lay more consideration to different patient groups, optimize outcome indicators and standardize the setting of control groups, so as to better meet the needs of patients and achieve the best match between evidence and clinicians' needs.
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