Evidence-based Research On The Reporting Guideline Of Acupuncture Systematic Review And Meta-analysis

Background and objectives:As high-quality evidence,systematic reviews and meta analyses(SR/MAs)could achieve better statistical power to draw a more precise conclusions and provide suff-icient evidence for recommendations in clinical practice guidelines.In the field of acupuncture,high quality SR/MAs play a critical role in informing clinical practice,improving the patient condition and avoiding medical resources waste.Transparency and completeness are essential for high quality SR/MAs.With the growing number of acupuncture SR/MAs on various topics,however,more and more studies indicated that the reporting quality of acupuncture SR/MAs is generally low,and the acupuncture intervention details are especially lack.Reporting guideline is an important approach to improve the reporting quality.To develop an appropriate reporting guideline for acupuncture SR/MAs,we cooperated with the PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)working group and employed the theory and methodology of evidence-based medicine to develop the PRISMA for Acupuncture(PRISMA-A).Methods:To start,we reviewed the existing standards used to assess the reporting quality of acupuncture SR/MAs through literature review.We also collected the main quality concerns of acupuncture SR/MAs disclosed in these studies.After this,we investigated the behavior and attitude of users of acupuncture evidence by questionnaire survey and collected potential items of PRISMA-A proposed by them.Then,we generated an initial checklist combining the information and items from the first two parts.The initial checklist was then circulated into the 3-round Delphi survey for rating and collecting comments.Following the Delphi survey,a group of multidisciplinary experts attended a one-day consensus meeting to determine the final checklist of items.In addition,the international review group and the PRISMA working group was consulted to improve the PRISMA-A checklist.Finally,the reliability and applicability of PRISMA-A were analyzed through pilot test.Results:The analysis of 19 studies evaluating the quality of acupuncture SR/MAs found that ten(52.63%)studies used OQAQ(Oxman-Guyatt Overview Quality Assessment Questionnaire)to assess the methodological quality,and seven(36.84%)used A Measurement Tool to Assess systematic Reviews(AMSTAR);five(26.32%)studies used PRISMA to analyze their reporting quality and two(10.53%)used the Standards for Reporting Interventions in Clinical Trials of Acupuncture(STRICTA),the reporting guideline for acupuncture clinical trial.The reporting quality of acupuncture details was especially poor.From the survey,we received 251 questionnaires from acupuncture evidence user,which found 43.03%of them are not satisfied with the reporting in current acupuncture evidence including SR/MAs.Meanwhile,the average score among respondents exceeded 7.5(out of 10)on reporting items for acupuncture SR/MAs.The results informed us what is needed in acupuncture SR/MAs.During the consensus process,a group of 29 multidisciplinary panelists were involved in the three rounds of Delphi survey,and 14 experts were involved in the face-to-face meeting.Five international review experts reviewed the full manuscript and gave comments to the checklist,and 13(23.21%)authors of acupuncture SR/MAs commented on the checklist in pilot test.Finally,the PRISMA-A checklist was finalized with five new extended items,six modified items,and 21 general items from the original PRISMA checklist.After the development process,we used the PRISMA-A checklist to analyze the reporting quality of 228 acupuncture SR/MAs published from 2016 to 2018,of which the results indicated that the reporting rates on the target disease diagnostic criteria(traditional medicine or western medicine),specific types of acupuncture intervention,outcome measurements,and the sensation information of acupuncture(De-qi)were 57.46%,67.11%,47.81%and 18.86%,respectively.Conclusion:Both the reporting quality and methodological quality of acupuncture SR/MAs still need to be improved,especially on the details of acupuncture intervention.Many users of acupuncture evidence were not satisfied with the information reported by acupuncture research,hoping that acupuncture SR/MAs could report more information on acupuncture-related details.Thus,it is pressing to develop reporting guideline for acupuncture SR/MAs.Referred to the international recognized methods,we developed PRISMA-A reporting guideline with the help from the PRISMA working group and international peers.Using the PRISMA-A to analyze the reporting quality of acupuncture SR/MAs in the latest three years,we found PRISMA-A is reliable and usable for assessing the reporting of acupuncture SR/MAs and could reflect the characteristics of acupuncture SR/MAs appropriately.In conclusion,the PRISMA-A reporting guideline could promote the transparency and completeness of the reporting of acupuncture SR/MAs,thus provide reliable evidence to clinicians and enable better decision making and healthcare.