Acupuncture Treatment for Hip Pain: A Systematic Review and Meta-Analysis

Round 1

Reviewer 1 Report

General considerations:

The order of exposition of the articles is not clear. by dates, by treatment groups?

I can´t locate the work of Zhuanping (10) with the bibliographic citation given in the paper.

In the analysis of the study presented to us for assessment, it shows that there are several heterogeneous aspects:

-Different acupuncture points (hip, auricular, foot, Ashi points, ...).

-Different acupuncture sessions (periodicity, number, ...)

-Different acupuncture needles (size, thickness, depth, site of application, ...)

-Different assessment scales (VAS, WOMAC, Harris score, SF-36).

-The conventional medical treatment (drugs, doses, guidelines, mode of administration, ...) is not specified.

-The mode of randomization is not specified.

 

 

In short, in this meta-analysis the studies cannot be compared on the basis of the same measurement or assessment parameters, the same tests are not used or the same variables are not analyzed, the same treatments are not performed, the same pathologies are not assessed, and the same means or places of action are not used.

The conclusions of this review or meta-analysis should be that there is insufficient information for a recommendation of treatment with acupuncture in patients with hip pain in its different causes. Randomized clinical trials in specific pathologies with homogeneous protocols are needed to assess whether acupuncture is effective for the control or improvement of pain and other parameters in patients with hip pain.

 

 

 

Particular considerations:

Line 155. It says: "ST31, GB29, GB30, and LI4 were used in these two studies". Actually they have been used in two studies but each point in different studies (in total in 4 studies: ST31 in 8 and 12, GB29 in 7 and 8, GB30 in 7 and 12, GB34 in 7 and 12 and LI4 in 7 and 10).

Line 214: Specify that the results of AT versus CM have been studied in patients who did not undergo hip arthroplasty surgery.

Line 223: Specify that one study was before arthroplasty intervention (Ronghua) and one after intervention (Li).

Line 257: Specify that in another study there was no improvement in pain. Different scales were compared.

Line 268: It is not true that no side effects were reported in Witt's study (11) on page 3491 of his article it is specified "SIde effects. In 5.2% of the patients (n=184), a total of 219 side effects were reported after the patients had acupuncture (66% minor local bleeding or hematoma, 5% pain at the site of needle insertion, 4% vegetative symptoms, and 25% other). No life-threatening side effects were reported".

Line 310. It says: "...TCM treatment can be an alternative treatment method", actually the conclusions of that article are: "Acupuncture probably has little or no effect in reducing pain or improving function relative to sham acupuncture in people wuth hip osteoarthritis. ... these reported benefits are likely due at least partially to RCT participants greater expectations of benefict from acupuncture".

Line 318: The articles referred to to corroborate the above statement do not say that, but say that in theory its effect could be explained by the release of opioid mediators and also refers to electroacupuncture, not to acupuncture without stimulation, as well differentiates the reference 20 cited by the authors.

Line 323 and 324: It is not true that the 12 studies specify the use of Ashi, ST31, GB29 and GB30 points, as described in their wording.

Line 331, 332 and 333: Studies performed with needles larger than 50 mm were (4/11) 36% not 50% and of those reporting insertion depth 75% (3/4) were equal to or greater than 30 mm (not cm).

Line 333: Whenever puncture is performed in these areas, is it always performed at that depth? It does not specify in which points the needles were inserted at that depth. 

Line 340: Specify that this review did not draw conclusions favorable to acupuncture treatment for the treatment of hip pain caused by osteoarthritis.

Line 344: It says Sin's and would be Shin's.

Line 426: Change Journal of Bone and Joint Surgery to J Bone Joint Surg.

Line 432: The citation is ...2018, Issue 5. Art. No. CD013020.

Line 434: Change Journal of Korean Medicine Rehabilitation to J Korean Medd Rehabi.

Line 437: Change Acupuncture in Medicine to Acupunct Med.

Line 445: Change Clinical Medicine Research and Practice to abbreviated.

Line 464: Change Acupuncture & Electro-Therapeutics Research to Acupunct Electrother Res

Line 472: Change Acupuncture in Medicine to Acupunct Med.

Line 478: Change Acupuncture in Medicine to Acupunct Med.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The authors conducted a systematic review that investigates the effectiveness of acupuncture on hip pain. Overall, the article provides a reasonable overview of the subject, but some minor issues need to be addressed:

 

Abstract:

Line 15: “Acupuncture treatment (AT) is an effective treatment for pain relief; however, no systematic reviews have reported on AT for hip pain.”

The sentence (the sweeping statement) should be rephrased for better clarity and coherence.

 1. Introduction

Line 51: The therapeutic modality, “Chuna” is not widely known outside of Korea. I would suggest adding a short explanation (Korean-style manual therapy)

2. Materials and Methods

The study was properly reported according to PRISMA guidelines; however, some essential information is lacking. For instance, it would be helpful to state what is already known about the specific types of acupuncture to be studied and whether there are any differences in their effects (e.g., auricular vs localized acupuncture). Please review PRISMA Extension for Acupuncture.

Ideally, auricular acupuncture and general body acupuncture should be studied separately because the mechanism of action between auricular and localized neuromuscular types of acupuncture are quite different."

Table 1 Characteristics of the included studies

Footnote “AA: auricular acupressure” is somewhat misleading because I believe that studies [15-18] administered manual pressure on small press pins, which is technically different from acupressure. Although there are some auricular acupressure studies on hip pain, they were not included in this review.

 4. Discussion

Line 336: “Auricular acupuncture is known to enhance the analgesic effect through continuous stimulation and is used for various types of pain treatment in clinical practice.” [citation needed].

 5. Conclusions

The authors only stated a conclusion regarding auricular acupuncture, which is not coherent. There is no mention of auricular acupuncture in the Introduction; the term abruptly appears in the Method section.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

I would like to congratulate the authors on this paper, I feel it is a good contribution to the literature. I have just a few comments

1.) Lines 54 through 56

the authors state that no systematic reviews have been conducted on acupuncture for Hip pain, however, twice in the review the authors cite a systematic review of acupuncture for hip OA. OA was included as a condition that fit inclusion criteria

 

Manheimer, E.; Cheng, K.; Wieland, L.S.; Shen, X.; Lao, L.; Guo, M.; Berman, B.M. Acupuncture for Hip Osteoarthritis. Cochrane Database of Systematic Reviews 2018,

doi:10.1002/14651858.CD013 010

 

This citation is also duplicated as [5 ] and [23]. I would suggest rewording the comment in your introduction

 

2) The conclusion is too brief and does not tie together the strong components of the results and discussion. I would suggest adding another small paragraph to make this section consistent with the other well done components of this study.

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

To insist that the results are inconsistent due to the variability of the studies.

Agree with the corrections made.