Is manual acupuncture plus usual care effective in reducing posttraumatic stress disorder symptoms as compared to usual care alone?
Date of publication of randomized controlled trial: December 2014
Design
Randomized controlled trial (RCT).
Participants
55 patients (mean age range: 25.1 to 44.5 years, male%: 69.1%) with posttraumatic stress disorder (PTSD). They had to score ≥ 30 on the PTSD Checklist (PCL) and meet criteria for PTSD on the Clinician Administered PTSD Scale (CAPS).
Intervention
Manual acupuncture treatment was performed twice a week for a duration of 4 weeks. The treatment course consisted 8 sessions and it lasted for 60 minutes per session. Usual PTSD care, including medications and psychotherapy, were provided for all patients.
Comparator
Comparison: Manual acupuncture plus usual PTSD care versus usual PTSD care alone.
Major Outcomes
Outcome 1: Change in PTSD symptom severity as measured by PCL from baseline to week 4;
Outcome 2: Change in PTSD symptom severity as measured by PCL from baseline to week 8;
Outcome 3: Change in PTSD symptom severity as measured by PCL from baseline to week 12;
Outcome 4: Change in PTSD symptom severity as measured by CAPS from baseline to week 12.
Settings
This trial was conducted in an outpatient setting.
Comparison    Manual acupuncture plus usual PTSD care versus usual PTSD care alone
Main Results
In manual acupuncture plus usual PTSD care group, mean PCL score significantly decreased from 58.1 ± 11.4 at baseline to 38.8 ± 11.6 (p<0.0001) at week 4. The reduction was maintained at 37.8 ± 15.0 (p<0.0001) at week 8 and 37.7 ± 15.9 (p<0.0001) at week 12. In usual PTSD care alone group, the mean PCL scores reduced by 4 points from 55.4 ± 12.0 at baseline to 51.5 ± 12.2 (p<0.01) at week 4, and slightly increased to 53.8 ± 14.7 (p=0.35) at week 8 and exhibited a small decrease to 45.8 ± 13.9 (p<0.001) at week 12. Besides, mean CAPS score significantly reduced by -35.0 ± 20.26 in manual acupuncture plus usual PTSD group when compared to -10.9 ± 20.8 in usual PTSD care alone group at week 12.
Comparison: Manual acupuncture plus usual PTSD care versus usual PTSD care alone for patients with PTSD
Outcomes (units) No. of studies (Total number of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1(55) 38.8 (11.6) / 28 51.5 (12.2)/ 27 Not applicable as there is only 1 trial. Not reported Not reported Low
2 (NA) 1(55) 37.8 (15.0)/ 28 53.8 (14.7)/ 27 Not applicable as there is only 1 trial. Not reported Not reported Low
3 (NA) 1(55) 37.7 (15.9)/ 28 45.8 (13.9) / 27 Not applicable as there is only 1 trial. Not reported Not reported Low
4 (NA) 1(55) -35.0 (20.26) / 28 -10.9 (20.8) / 27 Not applicable as there is only 1 trial. Not reported <0.0001 Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Manual acupuncture plus usual PTSD care versus usual PTSD care alone
Main Results
In manual acupuncture plus usual PTSD care group, mean PCL score significantly decreased from 58.1 ± 11.4 at baseline to 38.8 ± 11.6 (p<0.0001) at week 4. The reduction was maintained at 37.8 ± 15.0 (p<0.0001) at week 8 and 37.7 ± 15.9 (p<0.0001) at week 12. In usual PTSD care alone group, the mean PCL scores reduced by 4 points from 55.4 ± 12.0 at baseline to 51.5 ± 12.2 (p<0.01) at week 4, and slightly increased to 53.8 ± 14.7 (p=0.35) at week 8 and exhibited a small decrease to 45.8 ± 13.9 (p<0.001) at week 12. Besides, mean CAPS score significantly reduced by -35.0 ± 20.26 in manual acupuncture plus usual PTSD group when compared to -10.9 ± 20.8 in usual PTSD care alone group at week 12.
Comparison: Manual acupuncture plus usual PTSD care versus usual PTSD care alone for patients with PTSD
Outcomes (units) 1 (NA) 2 (NA) 3 (NA) 4 (NA)
No. of studies (Total number of participants) 1(55) 1(55) 1(55) 1(55)
Mean (SD)/ No. of participants Intervention 38.8 (11.6) / 28 37.8 (15.0)/ 28 37.7 (15.9)/ 28 -35.0 (20.26) / 28
Comparator 51.5 (12.2)/ 27 53.8 (14.7)/ 27 45.8 (13.9) / 27 -10.9 (20.8) / 27
MD (95% CI) Not reported Not reported Not reported Not reported
p value Not reported Not reported Not reported <0.0001
Overall quality of evidence* Low Low Low Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Conclusion
Benefits
This study showed that additional acupuncture plus usual PTSD care may provide significant effect in reducing PTSD symptom severity when compared to usual PTSD care alone. For all outcomes, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events related to acupuncture or usual PTSD care were observed or reported in the study.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25397825
The synopsis is based on the following article:
Engel CC, Cordova EH, Benedek DM, Liu X, Gore KL, Goertz C, et al. Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder. Medical Care. 2014 Dec 1;52:S57-64.


* 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.