Are acupuncture and related therapies effective for treating acute ankle sprains?
Date of publication of the systematic review: June 2014
Design
Systematic review of 20 randomized controlled trials (RCTs).
Participants
2012 adult patients with acute ankle sprains, irrespective of the method of diagnosis. The reviewers did not report mean age and gender proportion of the participants.
Intervention
Acupuncture and related therapies included manual acupuncture, ear acupuncture, electroacupuncture, warm needle therapy, fire needle acupuncture, acupressure and non-penetrating acupuncture point stimulation. The needle retention time ranged from 1 minute 40 minutes. The total number of acupuncture sessions ranged from 1 to 30.
Comparator
Comparison 1: Acupuncture and related therapies versus no treatment;
Comparison 2: Acupuncture and related therapies plus standard treatment versus standard treatment alone. The standard treatment included standard physical therapy, external application of a topical NSAID, oral Chinese herbal drugs, external application of Chinese herbal drugs, electrophysiotherapy and a combination of several treatments;
Comparison 3: Acupuncture and related therapies versus standard treatment or non-surgical intervention. Definition of standard treatment was referred to comparison 2 and non-surgical intervention included hot- or cold-water application, ice-pack application, over-the-counter (OTC) Chinese herbal patch applications, immobilization with an elastic bandage, external application of topical NSAIDs, Tuina, blood-letting therapy, TDP far-infrared lamp radiation, cold and hot external applications and oral administration of Chinese herbal medication, external application of a Chinese herbal spray and partial immobilization using an elastic bandage.
Major Outcomes
Outcome 1: Improvement rate, which refers to the ratio of the number of improved participants with acute ankle sprains to the total number of participants: cure means improvement in both clinical symptoms, such as pain and swelling of the ankle joint, and recovery of ankle function to the participant's pre-injury health status, measured at the end of the treatment.
Settings
The reviewers did not state whether the studies were conducted in inpatient or outpatient settings.
Comparison    Acupuncture and related therapies versus no treatment
Main Results
Compared to no treatment, acupuncture and related therapies significantly cured patients with improved ankle sprains (risk ratio (RR): 20.34, 95% CI: 4.27 to 96.68).
Comparison 1: Acupuncture and related therapies versus no treatment among patients with acute ankle sprains
Outcomes (units) No. of studies (Total no. of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) RR (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (61) Not reported/31 Not reported/30 Not applicable because there is only 1 study. 20.34 (4.27 to 96.68) Moderate
Keys: SD= standard deviation; RR: risk ratio; CI: confidence interval.
Comparison    Acupuncture and related therapies plus standard treatment versus standard treatment alone
Main Results
Compared to standard treatment alone, acupuncture and related therapies plus standard treatment did not significantly provide improvement for patients with acute ankle sprains (pooled RR: 1.32, 95% CI: 0.95 to 1.84).
Comparison 2: Acupuncture and related therapies plus standard treatment versus standard treatment alone among patients with acute ankle sprains
Outcomes (units) No. of studies (Total no. of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) Pooled RR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 8 (751) Not reported/396 Not reported/355 98% 1.32 (0.95 to 1.84) 0.10 High
High Keys: SD= standard deviation; RR: risk ratio; CI: confidence interval.
Comparison    Acupuncture and related therapies versus standard treatment or non-surgical intervention
Main Results
Compared to standard treatment or non-surgical intervention, acupuncture and related therapies did not significantly cure patients with acute ankle sprains (pooled RR: 1.07, 95% CI: 0.94 to 1.22).
Comparison 3: Acupuncture and related therapies versus standard treatment or non-surgical intervention among patients with acute ankle sprains
Outcomes (units) No. of studies (Total no. of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) Pooled RR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 11 (1006) Not reported/509 Not reported/497 92% 1.07 (0.94 to 1.22) 0.30 High
Keys: SD= standard deviation; RR: risk ratio; CI: confidence interval.
Comparison    Acupuncture and related therapies versus no treatment
Main Results
Compared to no treatment, acupuncture and related therapies significantly cured patients with improved ankle sprains (risk ratio (RR): 20.34, 95% CI: 4.27 to 96.68).
Comparison 1: Acupuncture and related therapies versus no treatment among patients with acute ankle sprains
Outcomes (units) 1 (NA)
No. of studies (Total no. of participants) 1 (61)
Mean score (SD)/ No. of participants Intervention Not reported/31
Comparator Not reported/30
RR (95% CI) 20.34 (4.27 to 96.68)
Overall quality of evidence* Moderate
Keys: SD= standard deviation; RR: risk ratio; CI: confidence interval.
Comparison    Acupuncture and related therapies plus standard treatment versus standard treatment alone
Main Results
Compared to standard treatment alone, acupuncture and related therapies plus standard treatment did not significantly provide improvement for patients with acute ankle sprains (pooled RR: 1.32, 95% CI: 0.95 to 1.84).
Comparison 2: Acupuncture and related therapies plus standard treatment versus standard treatment alone among patients with acute ankle sprains
Outcomes (units) 1 (NA)
No. of studies (Total no. of participants) 8 (751)
Mean score (SD)/ No. of participants Intervention Not reported/396
Comparator Not reported/355
Pooled RR (95% CI) 1.32 (0.95 to 1.84)
p value 0.10
Overall quality of evidence* High
High Keys: SD= standard deviation; RR: risk ratio; CI: confidence interval.
Comparison    Acupuncture and related therapies versus standard treatment or non-surgical intervention
Main Results
Compared to standard treatment or non-surgical intervention, acupuncture and related therapies did not significantly cure patients with acute ankle sprains (pooled RR: 1.07, 95% CI: 0.94 to 1.22).
Comparison 3: Acupuncture and related therapies versus standard treatment or non-surgical intervention among patients with acute ankle sprains
Outcomes (units) 1 (NA)
No. of studies (Total no. of participants) 11 (1006)
Mean score (SD)/ No. of participants Intervention Not reported/509
Comparator Not reported/497
Pooled RR (95% CI) 1.07 (0.94 to 1.22)
p value 0.30
Overall quality of evidence* High
Keys: SD= standard deviation; RR: risk ratio; CI: confidence interval.
Conclusion
Benefits
This study showed that acupuncture and related therapies may provide significant improvement for patients with acute ankle sprains when compared to no treatment. The overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. Acupuncture and related therapies may not be a significantly better complement or alternative to standard treatment or non-surgical intervention, and significant heterogeneity of the results existed. For outcome 1 in these two comparisons, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
Only one included study reported adverse events. In this study, no adverse events occurred in the acupuncture group but three participants in the OTC Chinese herbal patches group reported skin problems, such as erosion and papules, at the attachment sites.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/24953665
The synopsis is based on the following article:
Kim TH, Lee MS, Kim KH, Kang JW, Choi TY, Ernst E. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst Rev. 2014 Jun 23;(6):CD009065.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.