[Objective]To investigate if "Japanese acupuncture treatment"is effective for "Japanese patients with lower back pain"by reviewing randomized controlled trials (RCTs) of acupuncture conducted in Japan.
[Methods]Using several databases in Japan, such as Igaku Chuo Zasshi (Japana Centra Revuo Medicina) and PubMed, we searched for RCTs conducted in Japan. In addition, we collected RCTs by a manual search of 5 journals published in Japan. These included the Journal of the JSAM, Kampo Medicine, etc. Then, we examined the abstracts of all RCTs and sorted them according to inclusion and exclusion criteria. After that, we evaluated the quality of extracted RCTs by calculating Modified Jadad Quality Scores and Modified Charmers Scores. Lastly, we performed meta-analysis (MA) using Cochrane Review Manager 5.
[Results]We extracted 19 RCTs. For the Modified Jadad Quality Score 2012, the highest score was 5, the lowest was 1, and the average was 3.5. For the Modified Charmers Score, RCTs with scores over 50 numbered only two, and the average score was 34. In addition, we performed three subgroup meta-analyses:(1) MA of five RCTs, to compare the effect of a retained needle technique with that of sham acupuncture evaluated by a visual analogue scale;VAS (standardized mean difference:SMD -1.79 [95%CI -2.89, -0.69];P = 0.001), (2) MA of three RCTs to compare the effect of retained needle with that of sham acupuncture, evaluated with the Roland Morris Disability Questionnaire;RMDQ (SMD -1.23[95%CI -2.07, -0.38];P = 0.004), and (3) MA of three RCTs to compare the effect of a sparrow-pecking technique with that of sham acupuncture, evaluated by VAS (SMD -0.49 [95%CI -0.98, -0.00];P = 0.05). The results revealed the superiority of real over sham acupuncture for all three subgroup MA.
[Conclusion]Our results demonstrated that evaluations with Modified Jadad Scores were relatively high, but those with an advanced method using Modified Charmers Scores were not satisfactory, indicating a need for further improvement regarding the quality of clinical trials. Although MA revealed that real acupuncture was more effective than sham acupuncture, the RCTs that we extracted in this study were conducted by very few researchers, suggesting the possibility of bias. Therefore, more clinical trials by a variety of researchers are needed to confirm the effectiveness of acupuncture for LBP in Japan.