A trial method for assessing the adequacy of acupuncture treatments.

OBJECTIVE To develop a method for assessing the adequacy of acupuncture techniques used in controlled clinical trials. DATA SOURCES Searches were performed on MEDLINE, the Cochrane Controlled Trials Register, and CISCOM. Six acupuncture experts used a visual analog scale to rate the trials on the adequacy of the information they provided and the adequacy of acupuncture treatment. STUDY SELECTION Studies were included if they reported (1) a controlled trial in which dry needles were inserted into the skin and the process was described as "acupuncture" by the author(s), and (2) the use of this treatment for any type of back pain in humans. DATA EXTRACTION Blinded extracts from 15 controlled clinical trials including verbatim descriptions of the subjects, acupuncture technique, control intervention, and outcome measures. DATA SYNTHESIS Considerable variation was observed in the scores awarded by the acupuncture experts. Overall interrater reliability was low; however, a good correlation was seen among the ratings of 4 assessors. An assessment of adequacy did not depend on whether points were selected by tenderness, whether a choice of points was offered, whether needle sensation was elicited, or how many needles were used. CONCLUSIONS This method of assessing adequacy grouped 15 controlled clinical trials of acupuncture according to their average scores. The method may not be reliable in other situations because adequacy scores were inconsistent, possibly indicating problems with the scale. Modifications for making the scale more reliable are suggested.