Objectives This study aims to evaluate (1) the effect and safety of acupuncture in patients with knee osteoarthritis (KOA) and explore (2) whether the effect of acupuncture differed according to acupuncture type, acupuncture dose and follow-up time. Design Systematic review and pairwise and exploratory network meta-analysis. Setting PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals and Wanfang from inception to 13 November 2023. Participants Randomised controlled trials comparing acupuncture with sham acupuncture, non-steroidal anti-inflammatory drugs (NSAIDs), usual care or waiting list groups, intra-articular (IA) injection and blank groups in patients with KOA. Interventions Eligible interventions included manual acupuncture (MA) and electroacupuncture (EA). Main outcomes measures The primary outcome was pain intensity at the end of treatment. Results 80 trials (9933 participants) were included. Very low certainty evidence suggested that acupuncture may reduce pain intensity compared with sham acupuncture (standardised mean difference, SMD −0.74, 95% CI −1.08 to −0.39, corresponded to a difference in Visual Analogue Scale of −18.50 mm, −27.00 to −9.75), NSAIDs (SMD −0.86 to –1.26 to −0.46, corresponded to −21.50 mm, −31.50 to −11.50), usual care or waiting list groups (SMD −1.01, –1.47 to −0.54, corresponded to −25.25 mm, −36.75 to −13.50) and blank groups (SMD −1.65, –1.99 to −1.32, corresponded to −41.25 mm, −49.75 to −33.00), but not IA injection. Similar results were also found in other outcomes. For most of the subgroup analyses, acupuncture type, acupuncture dose and follow-up time did not show a significant relative effect. Only when compared with NSAIDs, a higher dose of acupuncture may provide greater pain relief (interaction p<0.001). The network meta-analysis revealed that electroacupuncture (SMD −0.75, 95% CI −1.34 to −0.17) had a greater effect on pain relief in patients with KOA compared with manual acupuncture. Conclusions The findings suggest that acupuncture may provide clinically important effects in reducing pain and improving physical function in patients with KOA, but the certainty of evidence was very low. Electroacupuncture and higher dose of acupuncture probably are two potential contributing factors. PROSPERO registration number CRD42021232177.

Introduction Knee osteoarthritis (KOA) is one of the leading causes of disability. The effectiveness of acupuncture for treating KOA remains controversial. This protocol describes the method of a systematic review and meta-analysis evaluating the effectiveness and safety of acupuncture for treating KOA. Methods and analysis Four English databases (PubMed, Embase, Cochrane Library databases and Web of Science) and four Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, and Wanfang) will be searched from the database inception to 1 September 2021. All randomised controlled trials related to acupuncture for KOA will be included. Extracted data will include publication details, basic information, demographic data, intervention details and patient outcomes. The primary outcome will be pain intensity. Risk of bias will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Article selection, data extraction and risk of bias assessment will be performed in duplicate by two independent reviewers. If the meta-analysis is precluded, we will conduct a descriptive synthesis using a best-evidence synthesis approach. The strength of recommendations and quality of evidence will be assessed using the Grading of Recommendations Assessment Development and Evaluation working group methodology. Ethics and dissemination Ethics approval is not required because individual patient data are not included. This protocol was registered in the international Prospective Register of Systematic Reviews on 25 February 2021. The systematic review and meta-analysis will be submitted for publication in a peer-reviewed journal. The findings will also be disseminated through conference presentations. Trial registration number CRD42021232177.

Acupuncture has been widely utilized for irritable bowel syndrome (IBS). However, heterogeneity is large among therapeutic strategies and protocols. The aim of this study was to propose some down-to-earth recommendations and establish an optimized protocol for acupuncture practice in IBS. A panel of 74 traditional Chinese medicine (TCM) acupuncturists participated in clinical issue investigation. Subsequently, systematic reviews concerning acupuncture for IBS were screened within 3 databases. An initial consensus questionnaire was formed from the results of clinical issue investigation and literature review. Ultimately, a Delphi vote was carried out to determine these issues. 30 authoritative experts with extensive experience were requested to respond with agreement, neutrality, or disagreement for the items. Consensus achievement on a given item was defined as greater than 80% agreement. Following a 2-round Delphi survey, there were 19 items reaching consensus; of which 5 items (26.32%) achieved thorough consensus, and significant agreement was reached for the other 14 items. These items can be classified into the 3 major domains: 1) clinical outcomes that acupuncture can bring for favorable intervention population (5 items), 2) suitable therapeutic principles and parameters of acupuncture (13 items), 3) possible adverse events in the treatment (1 item). Without any ready-made guidelines and lacking of homogeneity in the published literatures, such expert consensus could be valuable for TCM acupuncturists in daily practice and patients with IBS to obtain appropriate and standardized acupuncture treatment. In addition, it also points out the clinical focus which need to be further explored in future trials.

Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders. Although the available evidence for its efficacy is inconclusive, acupuncture is used as an alternative therapy for KOA. The aim of this trial is to determine the efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for KOA. This is a study protocol for a randomised, three-arm, multicentre, clinical trial. A total of 480 patients with KOA will be randomly assigned to the electro-acupuncture group, the manual acupuncture group or the sham acupuncture group in a 1:1:1 ratio. All patients will receive 24 sessions over 8 weeks. Participants will complete the trial by visiting the research centre at week 26 for a follow-up assessment. The primary outcome is the success rate: the proportion of patients achieving a minimal clinically important improvement, which is defined as ≥2 points on the numerical rating scale and ≥6 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score at week 8 compared with baseline. Secondary outcomes include the numerical rating scale, WOMAC score, global patient assessment and quality of life at weeks 4, 8, 16 and 26 after randomisation. This trial may provide high-quality evidence for the efficacy of acupuncture in the treatment of KOA. The results of this study will be published in peer-reviewed journals. ClinicalTrials.gov, NCT03274713 . Registered on 20 November 2017.

This study aims to determine whether 3 sessions per week of acupuncture treatment is superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. This is a two parallel-group, assessor-blinded, randomized controlled trial. Sixty patients with knee osteoarthritis (Kellgren–Lawrence grade II or III) will be recruited and randomly allocated to receive 24 or 8 sessions (group M or group L) of acupuncture treatment in a 1:1 ratio. Patients in group M will receive 3 sessions per week of acupuncture for 8 weeks. Patients in group L will receive acupuncture once per week for 8 weeks. The primary outcome is the response rate—the percentage of patients achieving a decrease ≥ 2 points on a numerical rating pain scale and a decrease ≥ 6 points in the Western Ontario and McMaster Universities Osteoarthritis Index function score at 8 weeks compared with baseline. Secondary outcomes include pain, function, overall effect, quality of life, and treatment credibility and expectancy. Three sessions per week of acupuncture treatment may be superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. Results of the study will be of great importance for the guidelines of clinical therapy. Clinicaltrials.gov, NCT03359603 . Registered on 1 December 2017.

Background Chronic Sciatica is a disabling condition causing considerable medical, social and financial implications. Currently, there is no recognised long-term effective treatment to alleviate sciatica. Acupuncture has been widely used for treating chronic pains with persistent analgesic effects. We aim to evaluate the efficacy and safety of acupuncture for chronic sciatica with follow-up in 52 weeks. Methods and analysis This is a multicenter randomised sham-controlled trial. A total of 216 patients with chronic sciatica will be enrolled and randomly assigned to the acupuncture or sham acupuncture group. There will be 10 treatment sessions applied in 4 weeks with frequency decreased over time. Patients will complete follow-ups during 52 weeks. The primary outcomes are changes in leg pain intensity and disability from baseline to week 4. Secondary outcomes include back pain intensity, frequency and bothersomeness, quality of life, and global perceived effect. Adverse events will be recorded in detail. Ethics and dissemination Ethical approval of this trial was granted from the ethics committee of Beijing University of Chinese Medicine and all study centres (No. 2020BZYLL0803). Written informed consent will be obtained from enrolled patients. Trial results will be disseminated in peer-reviewed publications. Trial registration number ChiCTR2100044585 (Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 24 March 2021); preresults.