In treating lateral tendinopathy, acupuncture may be more effective in short-term follow-up compared to medicine or steroid injections, but the differences of effectiveness were small, and the outcome parameter called “clinical efficacy rate” was poorly described. No reliable conclusion can be drawn on the effect of acupuncture vs. sham acupuncture due to poor quality of studies. Conclusions about long-term effectiveness cannot be drawn due to short follow-up times.
The results were based on meta-analysis of 10 RCTs with high risk of bias, and on meta-analysis of 14 RCTs (10 of acupuncture, and 4 of electroacupuncture, compared with sham or placebo acupuncture or electroacupuncture or other control intervention) with low to high risk of bias and high heterogeneity.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| «Zhou Y, Guo Y, Zhou R ym. Effectiveness of Acupunc...»1 | MA of RCTs | 796 patients from 10 RCTs diagnosed with lateral epicondylitis, 431 in intervention group and 365 in control group | Acupuncture therapy (manual or electroacupuncture) compared with sham acupuncture or medicine or blocking therapy (steroid injections) | Clinical efficacy rate and VAS | High |
| «Navarro-Santana MJ, Sanchez-Infante J, Gómez-Chigu...»2 | MA of RCTs | 506 patients from 10 RCTs with lateral epicondylalgia (or lateral elbow pain/epicondylitis/tennis
elbow/lateral elbow tendinopathy 218 patients from 4 RCTs with lateral epicondylalgia (or lateral elbow pain/epicondylitis/tennis elbow/lateral elbow tendinopathy |
Needle/manual acupuncture including auricular acupuncture compared with sham or placebo
or control or another active intervention Needle/manual electroacupuncture compared with sham or placebo or combined with tui na (Chinese massage in 1 study) |
Primary outcome: Pain intensity or related disability Secondary outcome: hand-grip strength |
High risk of bias in blinding of therapist, or participants, or due to incomplete outcome data |
RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis, VAS= visual analogue scale
| Reference | Comments |
|---|---|
| «Zhou Y, Guo Y, Zhou R ym. Effectiveness of Acupunc...»1 | Most included studies were of poor methodological quality: risk of bias was related to randomization, allocation concealment, blinding, and reporting of dropouts, and in addition to publication bias. The studies had mostly small sample sizes and outcome measures were not consistent. In addition, the intensity of the treatment varied. The concept of "clinical efficacy rate" was poorly determined. The clinical efficacy rate was reported in 8 trials and visual analogue scale in 6 trials. |
| «Navarro-Santana MJ, Sanchez-Infante J, Gómez-Chigu...»2 | According to PEDRO scale methodological quality of all trials ranged from 5 to 8 out of 10 points. However, no trial was able to blind therapist, and 50% of trials could not blind participants. Clinical heterogeneity of acupuncture trials may have led to inconsistent results (In 5 trials comparison with sham acupuncture and in 5 trials different therapies (sham laser, manual therapy, shockwave therapy, conventional treatment with rest, NSAIDs, bracing exercise) |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: low. The level of evidence is downgraded due to study limitations, inconsistency and imprecision. | |||||
| «Zhou Y, Guo Y, Zhou R ym. Effectiveness of Acupunc...»1 | 2 RCTs, acupuncture vs. sham acupuncture 68/62 | no follow-up | 58 (85) | 31(50) | Risk ratio 1.95 (0.78, 4.90) |
I= intervention; C=comparison; CI=confidence interval
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean difference (95% CI) |
|---|---|---|---|
| Level of evidence: low. The level of evidence is downgraded due to study limitations, inconsistency and imprecision. | |||
| «Zhou Y, Guo Y, Zhou R ym. Effectiveness of Acupunc...»1 | 2 RCTs, acupuncture vs. sham acupuncture 48/47 | no follow-up | -1.32 (-3.24, 0.60) |
I= intervention; C=comparison; CI=confidence interval
| Reference | Number of studies and number of patients (I/C) | Follow-up time | SMD (95% CI) |
|---|---|---|---|
| Level of evidence: low. The level of evidence is downgraded due to inconsistency in both trial groups, and due to imprecision in electroacupuncture studies. | |||
| «Navarro-Santana MJ, Sanchez-Infante J, Gómez-Chigu...»2 | 7 RCTs of acupuncture 194/186 | 0–12–24 weeks or more | -0.66 (95% CI -1.22 to -0.1) |
| 4 RCTs of electroacupuncture 108/109 |
0–12 weeks | -0.08 (95% CI -0.99 to 0.83 | |
I= intervention; C=comparison; CI=confidence interval; Standardized mean difference
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Std, Mean Difference (95% CI) |
|---|---|---|---|
| Level of evidence: moderate. The level of evidence is downgraded due to study limitations, inconsistency and imprecision. | |||
| «Navarro-Santana MJ, Sanchez-Infante J, Gómez-Chigu...»2 | 7 RCTs of acupuncture 225/221 | 0–12–24 weeks or more | -0.51 (95% CI -0.91 to -0.11) |
I= intervention; C=comparison; CI=confidence interval
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Std, Mean Difference (95% CI) |
|---|---|---|---|
| Level of evidence: moderate in acupuncture trials, low in electroacupuncture trials. The level of evidence is downgraded due to inconsistency and imprecision. | |||
| «Navarro-Santana MJ, Sanchez-Infante J, Gómez-Chigu...»2 | 6 RCTs of acupuncture 287/266 | 0–12–24 weeks or more | 0.36 (95% CI 0.16 to 0.57 |
| 2 RCTs of electroacupuncture 19/20 | 0–12 weeks | 0.34 (95% CI -0.29 to 0.98) | |
I= intervention; C=comparison; CI=confidence interval