Are Acupuncture Therapies Effective for the Management of Musculoskeletal Disorders of the Extremities? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
Authors: Jocelyn Cox, DC
Study Design
Systematic review.
Background
Acupuncture is a commonly used treatment for musculoskeletal disorders (MSDs); however, little is known about the effectiveness of acupuncture therapies for the management of MSDs.
Objective
To summarize and evaluate the available research on the effectiveness and safety of acupuncture therapies for MSDs of the extremities.
Methods
We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials for the period January 1990 to January 2015 for randomized controlled trials (RCTs), cohort and case-control studies. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. A best-evidence synthesis was performed to synthesize results from included studies. Results from low risk of bias studies were synthesised in a sensitivity analysis to determine the impact of excluding high risk of bias studies.
Results
The search strategy revealed 5180 articles, of which 15 finally met the inclusion criteria: 10 RCTs had low risk of bias and 5 RCTs had high risk of bias. The studies with low risk of bias suggest that traditional needle acupuncture: for carpal tunnel syndrome (CTS) is superior to oral steroids (one RCT; 77 participants) and may be superior to vitamin B1 and B6 supplements (one RCT; 64 participants); and is superior to exercise for Achilles tendinopathy (one RCT; 64 participants). Traditional needle acupuncture does not provide important benefit compared with placebo for upper extremity pain (one RCT; 128 participants), or compared with no intervention for patellofemoral pain (one RCT; 75 participants). The evidence is inconclusive suggesting no important effectiveness of traditional needle acupuncture for shoulder pain (2 RCTs; 849 participants). Studies with low risk of bias suggest that electroacupuncture: may be superior to placebo for shoulder injuries (one RCT; 130 participants); and may not be importantly superior to night splinting for persistent CTS (one RCT; 78 participants). Finally, studies with low risk of bias suggest that dry needling may be superior to placebo for plantar fasciitis (one RCT, 84 participants). Studies with high risk of bias consistently suggest that acupuncture interventions are superior to other treatments. Our sensitivity analysis suggest that including high risk of bias studies would have impacted our evidence synthesis. Specifically, it would have provided support for the management of shoulder pain. Moreover, including high risk of bias studies would suggest that traditional needle acupuncture interventions may be effective for the management of lateral epicondilitis and piriformis syndrome.
Conclusion
Our qualitative syntheses suggest that the effectiveness of acupuncture interventions is inconsistent for the management of MSDs of the extremities. Traditional needle acupuncture may be beneficial for CTS and Achilles tendinopathy but not beneficial for non-specific upper extremity pain and patellofemoral syndrome. Electroacupuncture may be effective for shoulder injuries and similar to night wrist splint for CTS. The effectiveness of dry needling for plantar fasciitis is equivocal.
Level of Evidence
Therapy, 1a. J Orthop Sports Phys Ther, Epub 26 Apr 2016. doi:10.2519/jospt.2016.6270