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The effect of patient characteristics on acupuncture treatment outcomes: an individual patient data meta-analysis of 20,827 chronic pain patients in randomized controlled trials

The effect of patient characteristics on acupuncture treatment outcomes: an individual patient data meta-analysis of 20,827 chronic pain patients in randomized controlled trials
The effect of patient characteristics on acupuncture treatment outcomes: an individual patient data meta-analysis of 20,827 chronic pain patients in randomized controlled trials

Objectives: To optimally select chronic pain patients for different treatments, as it is of interest to identify patient characteristics that might moderate treatment effect. Our aim was to evaluate the impact of possible moderators on the effect of acupuncture treatment using a large data set. Methods: We used data from an individual patient data meta-analysis of high-quality randomized trials of acupuncture for chronic headache and migraine, osteoarthritis, and back, neck, and shoulder pain. Using meta-analytic trial-level and patient-level regression analyses, we explored the impact of 5 documented patient characteristics (patients' age at baseline, sex, pain duration, baseline pain severity and baseline psychological distress) on the effect of acupuncture. Results: A total of 39 trials met the inclusion criteria: 25 use sham-acupuncture controls (n=7097) and 25 non-acupuncture controls (n=16,041). Of the 5 patient characteristics analyzed, only baseline pain severity was found to potentially moderate the treatment effect of acupuncture, with patients reporting more severe pain at baseline experiencing more benefit from acupuncture compared to either sham-control or non-acupuncture control. Baseline psychological distress showed small treatment moderating effects, and results for sex were inconsistent. There was no strong evidence that age or duration of pain influenced the response to acupuncture. Discussion: Of 5 patient characteristics tested, we found only baseline severity of pain to potentially moderate the effect of acupuncture treatment. For clinical practice, the evidence from this analysis does not justify stratifying chronic pain patients into subgroups that should or should not receive acupuncture on the basis of these 5 characteristics. Future acupuncture trials should assess other potentially important effect moderators.

acupuncture, chronic pain, effect moderators, meta-analysis
0749-8047
428-434
Witt, Claudia M.
698f841b-08d3-4179-9aca-78968fbb35ed
Vertosick, Emily A.
23aa8973-57dd-4370-9032-ddf647f79f59
Foster, Nadine E.
2ca79c15-6ada-4b99-982c-f8abee19e628
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Linde, Klaus
72a255e6-2da6-4fd6-b9d9-452fba23de4d
Macpherson, Hugh
6485cd22-1dc3-4600-9e00-d3187e981663
Sherman, Karen J.
deb97429-5af6-4328-bede-ca755bf5f1da
Vickers, Andrew J.
e39cb4e7-1e87-47c3-a19e-c643ae9c884e
on behalf of the Acupuncture Trialists' Collaboration
Witt, Claudia M.
698f841b-08d3-4179-9aca-78968fbb35ed
Vertosick, Emily A.
23aa8973-57dd-4370-9032-ddf647f79f59
Foster, Nadine E.
2ca79c15-6ada-4b99-982c-f8abee19e628
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Linde, Klaus
72a255e6-2da6-4fd6-b9d9-452fba23de4d
Macpherson, Hugh
6485cd22-1dc3-4600-9e00-d3187e981663
Sherman, Karen J.
deb97429-5af6-4328-bede-ca755bf5f1da
Vickers, Andrew J.
e39cb4e7-1e87-47c3-a19e-c643ae9c884e

on behalf of the Acupuncture Trialists' Collaboration (2019) The effect of patient characteristics on acupuncture treatment outcomes: an individual patient data meta-analysis of 20,827 chronic pain patients in randomized controlled trials. Clinical Journal of Pain, 428-434. (doi:10.1097/AJP.0000000000000691).

Record type: Article

Abstract

Objectives: To optimally select chronic pain patients for different treatments, as it is of interest to identify patient characteristics that might moderate treatment effect. Our aim was to evaluate the impact of possible moderators on the effect of acupuncture treatment using a large data set. Methods: We used data from an individual patient data meta-analysis of high-quality randomized trials of acupuncture for chronic headache and migraine, osteoarthritis, and back, neck, and shoulder pain. Using meta-analytic trial-level and patient-level regression analyses, we explored the impact of 5 documented patient characteristics (patients' age at baseline, sex, pain duration, baseline pain severity and baseline psychological distress) on the effect of acupuncture. Results: A total of 39 trials met the inclusion criteria: 25 use sham-acupuncture controls (n=7097) and 25 non-acupuncture controls (n=16,041). Of the 5 patient characteristics analyzed, only baseline pain severity was found to potentially moderate the treatment effect of acupuncture, with patients reporting more severe pain at baseline experiencing more benefit from acupuncture compared to either sham-control or non-acupuncture control. Baseline psychological distress showed small treatment moderating effects, and results for sex were inconsistent. There was no strong evidence that age or duration of pain influenced the response to acupuncture. Discussion: Of 5 patient characteristics tested, we found only baseline severity of pain to potentially moderate the effect of acupuncture treatment. For clinical practice, the evidence from this analysis does not justify stratifying chronic pain patients into subgroups that should or should not receive acupuncture on the basis of these 5 characteristics. Future acupuncture trials should assess other potentially important effect moderators.

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More information

Accepted/In Press date: 15 January 2019
Published date: May 2019
Keywords: acupuncture, chronic pain, effect moderators, meta-analysis

Identifiers

Local EPrints ID: 433946
URI: http://eprints.soton.ac.uk/id/eprint/433946
ISSN: 0749-8047
PURE UUID: a1004db6-fb53-4100-b445-126d4bd243d1

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Date deposited: 06 Sep 2019 16:30
Last modified: 07 Oct 2020 01:07

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Contributors

Author: Claudia M. Witt
Author: Emily A. Vertosick
Author: Nadine E. Foster
Author: George Lewith
Author: Klaus Linde
Author: Hugh Macpherson
Author: Karen J. Sherman
Author: Andrew J. Vickers
Corporate Author: on behalf of the Acupuncture Trialists' Collaboration

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