Acupuncture for treatment of irritable bowel syndrome

Byungmook Lim; Eric Manheimer; Lixing Lao; Eric Ziea; Julia Wisniewski; Jianping Liu; Brian M Berman

doi:10.1002/14651858.CD005111.pub2

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Analysis 1.1

Comparison 1 Acupuncture versus sham acupuncture, Outcome 1 Global symptom score (Short‐term outcome ‐ end of treatment).

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Analysis 1.2

Comparison 1 Acupuncture versus sham acupuncture, Outcome 2 Increased Barostat rectal sensory thresholds (Short‐term outcome ‐ end of treatment).

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Analysis 1.3

Comparison 1 Acupuncture versus sham acupuncture, Outcome 3 Responder rate from 'Patient determined treatment success' & 'Global symptom score' (End of treatment).

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Analysis 1.4

Comparison 1 Acupuncture versus sham acupuncture, Outcome 4 General well‐being (After 1st session: i.e., Before cross‐over).

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Analysis 1.5

Comparison 1 Acupuncture versus sham acupuncture, Outcome 5 Abdominal pain (After 1st session: i.e., Before cross‐over).

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Analysis 1.6

Comparison 1 Acupuncture versus sham acupuncture, Outcome 6 Defecation difficulties (After 1st session: i.e., Before cross‐over).

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Analysis 1.7

Comparison 1 Acupuncture versus sham acupuncture, Outcome 7 Diarrhea (After 1st session: i.e., Before cross‐over).

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Analysis 1.8

Comparison 1 Acupuncture versus sham acupuncture, Outcome 8 Alternating diarrhea and constipation (After 1st session: i.e., Before cross‐over).

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Analysis 1.9

Comparison 1 Acupuncture versus sham acupuncture, Outcome 9 Bloating (After 1st session: i.e., Before cross‐over).

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Analysis 1.10

Comparison 1 Acupuncture versus sham acupuncture, Outcome 10 Symptom improvement assessed by blinded clinician (Short‐term outcome ‐ end of treatment).

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Analysis 2.1

Comparison 2 Ear acupuncture versus western medication, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).

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Analysis 3.1

Comparison 3 Acupuncture versus psychotherapy, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).

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Analysis 3.2

Comparison 3 Acupuncture versus psychotherapy, Outcome 2 No symptom recurrence (6 month after treatment).

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Analysis 4.1

Comparison 4 Acupuncture plus psychotherapy versus psychotherapy, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).

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Analysis 4.2

Comparison 4 Acupuncture plus psychotherapy versus psychotherapy, Outcome 2 No symptom recurrence (6 month after treatment).

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Analysis 5.1

Comparison 5 Acupuncture versus herbal medication, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).

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Table 1. Linde Internal Validity Scale (LIVS): items

LIVS items	scoring of items
1. Treatment allocation a) randomized stated b) not randomized c) no or unclear information	1 0 0
2. Randomized concealment a) adequate (e.g., central randomization, coded drugs etc.) b) probably adequate (e.g., sealed envelope) c) other: d) inadequate concealment e) no or unclear information	1 .5 depends 0 0
3. Baseline comparability a) important baseline factors listed and comparable b) baseline comparability fairly credible c) important baseline differences d) no or unclear information	1 .5 0 0
4. Blinding of patients a) placebo/control indistinguishable b) blinding only stated c) placebo likely to be distinguishable d) patients not blinded e) no or unclear information	1 .5 0 0 0
5. Blinding of evaluators a) blinding described and likely to be successful b) blinding only stated c) evaluators not blinded d) no or unclear information	1 .5 0 0
6. Handling of withdrawals a) no or minimal withdrawals/drop‐outs b) less than 20% loss to follow up and intent‐to‐treat‐analysis c) careful handling/description of withdrawals, substantial bias d) major flaws e) no or unclear information	1 1 .5 0 0

Table 1. Linde Internal Validity Scale (LIVS): items

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Table 2. Linde Internal Validity Scale: score

Study ID	1.	2.	3.	4.	5.	6.	LIVS score
Fireman 2001	1	0	0	1	1	.5	3.5
Forbes 2005	1	.5	1	1	1	.5	5
Liao 2000	1	0	0	0	0	0	1
Liu 1995	1	0	0	0	0	0	1
Liu 1997	1	0	0	0	0	0	1
Lowe 2000	1	0	.5	.5	.5	0	2.5

Table 2. Linde Internal Validity Scale: score

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Table 3. Jadad Quality of Methodology Scale: items

Quality items

1A. Was the study described as randomized?

1B. If answer to above is yes, was method of generating randomization sequence appropriate?

2A. Was the study described as double blind?

2B. If answer to above is yes, was the method of double blinding appropriate?

3. Was there a description of dropouts and withdrawals?

Note: A+B+C+D+E = possible 5 points on Jadad scale. Low quality = 0 to 2; high quality = 3 to 5.

Table 3. Jadad Quality of Methodology Scale: items

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Table 4. Jadad Methodological Quality Scale: score (Yes=1, No=0)

Study ID	1A	1B	2A	2B	3	Jadad score
Fireman 2001	1	0	1	1	1	4
Forbes 2005	1	1	1	1	1	5
Liao 2000	1	0	0	0	0	1
Liu 1995	1	0	0	0	0	1
Liu 1997	1	0	0	0	0	1
Lowe 2000	1	0	1	1	0	3

Table 4. Jadad Methodological Quality Scale: score (Yes=1, No=0)

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Comparison 1. Acupuncture versus sham acupuncture

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Global symptom score (Short‐term outcome ‐ end of treatment) Show forest plot	1	59	Std. Mean Difference (IV, Fixed, 95% CI)	0.09 [‐0.43, 0.60]

2 Increased Barostat rectal sensory thresholds (Short‐term outcome ‐ end of treatment) Show forest plot	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	1.31 [0.71, 2.41]

3 Responder rate from 'Patient determined treatment success' & 'Global symptom score' (End of treatment) Show forest plot	2	109	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.83, 1.98]

4 General well‐being (After 1st session: i.e., Before cross‐over) Show forest plot	1	25	Std. Mean Difference (IV, Fixed, 95% CI)	0.55 [‐0.26, 1.35]

5 Abdominal pain (After 1st session: i.e., Before cross‐over) Show forest plot	1	23	Std. Mean Difference (IV, Fixed, 95% CI)	0.73 [‐0.12, 1.58]

6 Defecation difficulties (After 1st session: i.e., Before cross‐over) Show forest plot	1	13	Std. Mean Difference (IV, Fixed, 95% CI)	0.84 [‐0.32, 1.99]

7 Diarrhea (After 1st session: i.e., Before cross‐over) Show forest plot	1	11	Std. Mean Difference (IV, Fixed, 95% CI)	0.22 [‐0.97, 1.41]

8 Alternating diarrhea and constipation (After 1st session: i.e., Before cross‐over) Show forest plot	1	14	Std. Mean Difference (IV, Fixed, 95% CI)	0.83 [‐0.28, 1.94]

9 Bloating (After 1st session: i.e., Before cross‐over) Show forest plot	1	20	Std. Mean Difference (IV, Fixed, 95% CI)	0.21 [‐0.67, 1.09]

10 Symptom improvement assessed by blinded clinician (Short‐term outcome ‐ end of treatment) Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	1.54 [0.81, 2.94]

Comparison 1. Acupuncture versus sham acupuncture

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Comparison 2. Ear acupuncture versus western medication

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Symptom improved (Short‐term outcome ‐ end of treatment) Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.94, 2.34]

Comparison 2. Ear acupuncture versus western medication

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Comparison 3. Acupuncture versus psychotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Symptom improved (Short‐term outcome ‐ end of treatment) Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.87, 1.26]

2 No symptom recurrence (6 month after treatment) Show forest plot	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	2.25 [0.80, 6.36]

Comparison 3. Acupuncture versus psychotherapy

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Comparison 4. Acupuncture plus psychotherapy versus psychotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Symptom improved (Short‐term outcome ‐ end of treatment) Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.2 [1.03, 1.39]

2 No symptom recurrence (6 month after treatment) Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	3.26 [1.22, 8.69]

Comparison 4. Acupuncture plus psychotherapy versus psychotherapy

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Comparison 5. Acupuncture versus herbal medication

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Symptom improved (Short‐term outcome ‐ end of treatment) Show forest plot	1	132	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [1.00, 1.31]

Comparison 5. Acupuncture versus herbal medication

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