Аннотация
Aim: The aim of this review is to examine the evidence for acupuncture's
effectiveness as a depression intervention. Unlike other reviews,
which consider methodological concerns relevant to all experimental
evaluations, this review focuses on the scope of studies, and uses
a PICO (patients, intervention, comparison, and outcome) structure
to determine what can potentially be learned from primary studies
that have already been screened for methodological quality by reviewers.
Discussion: The review identified a number of study limitations.
(i) Patients: majority of trial reports have not described a rationale
for the selection of patients or inclusion/exclusion criteria. Prognostic
indicators were not reported and there were also concerns about the
generalizability of study populations. (ii) Intervention: most trials
investigate poorly rationalized standardized acupuncture protocols
thus quality of care may be an issue and generalizability to routine
clinical practice is a main concern. In trials using other methods
generalizability is also poor. (iii) Comparisons: concerns were raised
about using therapeutically inappropriate acupuncture. (iv) Outcomes:
short-term focus and the narrow range of outcomes explored. According
to more recent systematic review evidence it is probable the shortcomings
identified in the PICO review have not been addressed by subsequent
research. The concept of model validity, proposed by other researchers,
is discussed, and suggestions put forward about complex intervention
evaluation methods, which may be better suited to evaluating acupuncture
care. Conclusion: Uncertainty remains about the value of acupuncture
care, as it is routinely practiced in the West, and this uncertainty
has not been resolved by trials to date. Existing evaluations may
however be useful for guiding decisions about the value of specific
techniques for patients with depression.
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