acupuncture for chronic fatigue syndrome

Acupuncture for chronic fatigue syndrome (Protocol)

Zhang W Liu Z Wu T Peng W

This is a reprint of a Cochrane protocol prepared and maintained by The Cochrane Collaboration and published in The Cochrane

Library 2009 Issue 2

httpwwwthecochranelibrarycom

Acupuncture for chronic fatigue syndrome (Protocol)

Copyright copy 2009 The Cochrane Collaboration Published by John Wiley amp Sons Ltd

T A B L E O F C O N T E N T S

1HEADER

1ABSTRACT

2BACKGROUND

3OBJECTIVES

3METHODS

5REFERENCES

6WHATrsquoS NEW

6HISTORY

6CONTRIBUTIONS OF AUTHORS

6DECLARATIONS OF INTEREST

6SOURCES OF SUPPORT

iAcupuncture for chronic fatigue syndrome (Protocol)


[Intervention Protocol]

Acupuncture for chronic fatigue syndrome

Wei Zhang1 Zhishun Liu1 Taixiang Wu2 Weina Peng1

1Department of Acupuncture and Moxibustion Chinese Academy of Traditional Chinese Medicine Beijing China 2 Chinese Cochrane

Centre Chinese EBM Centre West China Hospital Sichuan University Chengdu China

Contact address Wei Zhang Department of Acupuncture and Moxibustion Chinese Academy of Traditional Chinese Medicine

Guang An Men Hopital No5 Bei Xian Ge Street Beijing Xuanwu District 100053 China zhangwei_7108hotmailcom (Editorial

group Cochrane Depression Anxiety and Neurosis Group)

Cochrane Database of Systematic Reviews Issue 2 2009 (Status in this issue Unchanged)


DOI 10100214651858CD006010

This version first published online 19 April 2006 in Issue 2 2006 (Help document - Dates and Statuses explained)

This record should be cited as Zhang W Liu Z Wu T Peng W Acupuncture for chronic fatigue syndrome Cochrane Database of

Systematic Reviews 2006 Issue 2 Art No CD006010 DOI 10100214651858CD006010

A B S T R A C T

This is the protocol for a review and there is no abstract The objectives are as follows

Our objective is to conduct a systematic review and if possible a quantitative meta-analysis with any evidence collected from randomised

controlled trials and quasi-randomised trials of acupuncture for adults and children with chronic fatigue syndrome (CFS) In this way

we can assess the efficacy and safety of acupuncture therapy for CFS and test the hypothesis that acupuncture is more effective than

other interventions

1Acupuncture for chronic fatigue syndrome (Protocol)


B A C K G R O U N D

Chronic fatigue syndrome (CFS) is a clinically defined condi-

tion characterised by severe disabling fatigue and other symp-

toms including self-reported musculoskeletal pain sleep distur-

bance headaches and impairments in concentration and short-

term memory These symptoms as opposed to a debilitating but

nonspecific condition shared by many diseases are usually medi-

cally unexplained A diagnosis of chronic fatigue syndrome can be

made only after all the physical and psychiatric causes of chronic

fatigue have been excluded Because of the absence of objective

clinical signs CFS patients are often annoyed by the lack of un-

derstanding from others including medical professionals

Historically CFS has also been called Royal Free disease Iceland

disease neurasthenia myalgic encephalomyelitis (rsquoMErsquo) and post-

viral fatigue syndrome Nowadays the term CFS is widely adopted

for research in the field however sometimes rsquoMErsquo is also seen in

articles and textbooks

Epidemiological research in western countries has demonstrated

that the prevalence of CFS is 02-26 depending on the criteria

used (Wessely 1997 Steele 1998) In China it was reported in

2004 that among 2000 citizens interviewed in the cities of Beijing

and Baotou 198 of them had symptoms that were consistent

with CDC criteria of CFS (Zhang 2004)

In 1987 the US Centers for Disease Control and Prevention

(CDC) developed a diagnostic criteria of CFS These criteria were

updated in 1994 which widened their use (Fukuda 1994) The

Oxford criteria also called the British criteria is another opera-

tional criteria for research (Sharpe 1991) There are two important

differences between these definitions The British criteria insist

on the presence of mental fatigue the American criteria include

a requirement for several physical symptoms reflecting the belief

that chronic fatigue syndrome has an underlying immunological

or infective pathology

Etiologically the cause of chronic fatigue syndrome is poorly un-

derstood There has been some new work in virology immunol-

ogy and imaging which also holds promise but still does not pro-

vide any diagnostic test or a mechanism for the production of

symptoms of CFS (Sabin 2003)

The treatment of CFS is attracting more and more attention How-

ever so far no single pharmacological treatment has been shown

to be effective for people with CFS Two Cochrane systematic

reviews were published concerning cognitive behaviour therapy

for chronic fatigue syndrome in adults (Price 2003) and exercise

therapy for chronic fatigue syndrome (Edmonds 2004) They sug-

gested that cognitive behaviour therapy appears to be an effective

and acceptable treatment for adult out-patients with chronic fa-

tigue syndrome and encouraging evidence has demonstrated that

some patients may benefit from exercise therapy In 2002 clinical

practice guidelines for chronic fatigue syndrome were conducted

by a working group convened under the auspices of the Royal Aus-

tralasian College of Physicians (CFS workshop 2002) There the

management of CFS was described in detail Cognitive-behaviour

therapy and graded exercise were strongly supported (Level I and

Level II respectively) to be effective for some people with CFS

Acupuncture is a very important constituent of Traditional Chi-

nese Medicine (TCM) with a history of literature spanning over

2000 years Acupuncture is a therapy implemented by inserting

needles into certain points on the human body which are called

ldquoXue Weirdquo in Chinese Generally acupoints can be classified into

meridian points which are located on the pathway of a meridian

or so called ldquoJing Luordquo in Chinese and extra points which are dis-

covered through practical experience There are types of needling

methods other than the frequently used filiform needle such as fire

needle seven star needle three-edged needle (mainly for bleeding)

and so on With the development of technology electricity was

introduced into the stimulation method of acupuncture and now

electro-acupuncture is a very important type of acupuncture apart

from the traditional hand manipulation According to the location

where needling is carried out acupuncture can also be classified

into body acupuncture scalp acupuncture auricular acupuncture

and ankle-wrist acupuncture etc Acupuncture is not just a therapy

alone many centuries ago acupuncture developed into a discipline

which has its own theory and practice system It is believed in

TCM theory that acupuncture can strengthen the vital essence of

the human body which is called ldquoQirdquo in Chinese and remove the

blockage of channels There are a wide range of diseases that are

thought to benefit from treatment with acupuncture

According to our search of main medical and biological bibliogra-

phy databases both inside and outside China so far no study has

been done on acupuncture for CFS in any foreign institution In

China from a preliminary search we found 15 clinical trials on

the topic of acupuncture for CFS From a rough review of these

trials we can see that the quality of these were uneven however

some could provide evidence for further analysis All the Chinese

trials that had control groups got results of benefit in the acupunc-

ture group with success rates ranging from 8890 (Ni 2002) to

9429 (Liu 2004)

No research was done concerning the mechanism of acupuncture

for CFS with modern medical measures Traditionally it can be

explained as adjusting the balance of Yin-Yang and nourishing the

Qi and blood if a deficiency exists This explanation is based on the

theory of traditional Chinese medicine which stems from ancient

Chinese philosophy

So far the clinical application of acupuncture for CFS is mainly

based on experience and its effects have not been evaluated In

past decades acupuncture has gained more popularity both inside

and outside China because of its advantages of convenience econ-

omy and reports of effectiveness A precise evaluation of acupunc-

ture is required This review will assess the efficacy and safety of

acupuncture therapy for CFS



O B J E C T I V E S

Our objective is to conduct a systematic review and if possible a

quantitative meta-analysis with any evidence collected from ran-

domised controlled trials and quasi-randomised trials of acupunc-

ture for adults and children with chronic fatigue syndrome (CFS)

In this way we can assess the efficacy and safety of acupuncture

therapy for CFS and test the hypothesis that acupuncture is more

effective than other interventions

M E T H O D S

Criteria for considering studies for this review

Types of studies

Randomised controlled clinical trials and quasi-randomised trials

Types of participants

Patients with CFS according to the criteria of Centre for Disease

Control (CDC) (Fukuda 1994) Oxford (Sharpe 1991) ICD-

10 (WHO 1992) or any other validated criteria will be included

irrespective of gender race age and setting

Types of interventions

Any type of acupuncture therapy including body acupuncture

auricular acupuncture scalp acupuncture or electroacupuncture

will be considered The stimulation method can be hand manip-

ulation or electricity pulse Acupuncture methods without needle

insertion such as seed stimulation or seven-star needle will also be

included

The control interventions will be

(1) No intervention placebo acupuncture (using points very near

to normal acupuncture points but not the exact acupuncture

point) or sham acupuncture (using different acupuncture instru-

ments which can cause a similar sensation to acupuncture but are

not inserted into the skin) (Streitberger 1998)

(2) Pharmacological treatments (herbal medicine or western

medicine such as antidepressant or combination of them)

(3) Cognitive behaviour therapy (CBT)

(4) Exercise therapy

(5) Any other interventions

Types of outcome measures

Primary outcome measure

Fatigue is the key characteristic of CFS so we will take fatigue

symptoms as the main outcome of this review (eg Chalder Fatigue

Scale (Chalder 1993) or any type of instrument considered to scale

fatigue)

Secondary outcome measures

(1) Mood such as depression (eg Hamilton Depression Rating

Scale (Hamilton 1960)) and sleep disturbance using any instru-

ment (eg sleep onset latency (SOL) and wakefulness after sleep

onset (WASO) (Buscemi 2005))

(2) Quality of life score (eg SF-36 (Garratt 2002))

(3) Other symptoms such as pain headache using any instrument

(eg Visual analog scale (VAS) (WSDLI 2002) or quality of life)

(4) Adverse effects (eg pain (VAS) bleeding broken needles)

Search methods for identification of studies

1 Electronic searches

We will search the following electronic databases irrespective of

language and publication status

a) The Cochrane Collaboration Depression Anxiety amp Neurosis

Controlled Trials Register (CCDANCTR-Studies)

b) The Cochrane Central Register of Controlled Trials (CEN-

TRAL) on The Cochrane Library (Issue 4 2004)

c) MEDLINE (1966-2004)

d) EMBASE (1998-2004)

e) Chinese Biomedical Database (1979-2004)

CCDANCTR-Studies will be searched using the following strat-

egy

Diagnosis = Chronic Fatigue

and

Intervention = Acupuncture

In the Cochrane Reviewersrsquo Handbook 422 [updated December

2003] a highly sensitive search strategy for identifying reports of

randomized controlled trials in MEDLINE is provided for review-

ers We will put its 5b2 Format for MEDLINE on Ovid web ver-

sion (1-29) into usage in order to locate randomized controlled

trials

Below is the further search strategy for MEDLINE

30 chronic fatigue syndrome or CFS

31 myalgic encephalomyelitis or ME

32 or30-31

33 acupuncture

34 acupuncture points

35 (electroacupuncture or electroacupuncture)tw

36 electroacupuncturetw

37 acupuncture$tw

38 acupointstw

39 meridians

40 or 33-39

41 29 and 32 and 40

2 Reference Lists

The reference lists of all identified papers will be searched for

further information

3 Personal Communication

We will contact authors for unpublished studies

Data collection and analysis

Eligibility



Two reviewers Zhang and Peng will independently decide on

eligibility

Data extraction

A data extraction form will be developed and study data will be

assessed and extracted independently by two reviewers (Zhang and

Peng) The following data will be extracted from each included

study

a) patientsrsquo demographic characteristics including maximum min-

imum and mean age

b) inclusion and exclusion criteria

c) type frequency treatment course of acupuncture therapy and

outcomes

d) type severity and number of adverse effects

e) number and reasons for dropouts withdrawals and lost to fol-

low-ups will also be recorded

Information not available in the reports of trials will be sought

from authors by email or telephone Extracted data will be reviewed

by the principal reviewer and discrepancies will be judged by an

arbitrator (Liu)

Quality assesment

Quality assessment will be carried out by two independent review-

ers (Zhang and Peng) and a third party (Liu) will be involved to

resolve any disagreement in case of occurrence

In line with the empirical evidence (Schulz 1995 Jadad 1996

Juni 2001 Kjaergard 2001) we intend to assess the methodolog-

ical quality as described by Kjaergard et al (Kjaergard 2001) and

Cochrane Reviewerrsquos Handbook 422

1) Method of randomisation

Treatments administered in a clinical trial should be selected by a

random process which allows each study participant to have the

same probability of receiving them and the investigators should

not be able to predict which treatment is next We will assess the

quality of the method of randomisation as follows

a) Adequate random number table computer randomization

tossing of a coin will be considered rsquoadequatersquo

b) Inadequate methods of allocation using odd-even numbers

patient social security numbers days of the week or medical record

numbers will be regarded as only pseudo- or quasi-random pro-

cesses instead of real randomization and will be considered inad-

equate

c) Unclear those who only used ldquorandomizationrdquo as a decoration

of article and no explanation available in articles will be regarded

as ldquounclearrdquo on randomization procedure

2) Allocation concealment

a) Adequate allocation concealment such as a central randomisa-

tion scheme by telephone or controlled by pharmacy numbered

or coded identical containers administered sequentially sequen-

tially numbered opaque sealed envelopes on site computer system

which can only be accessed after entering the characteristics of an

enrolled participant

b) Unclear authors did not report conditions of allocation con-

cealment or approach did not fall into one of the adequate mea-

sures Also sealed envelopes were not sequentially numbered or

opaque open list enrollment

c) Inadequate Alternation odd-even date of birth or week or case

record numbers

3) Blinding

Since blinding is not possible for treatment providers trials using

blinding for outcome assessors alone or together with blinding for

patients will be regarded as adequate

4) Follow-ups

Number and reason for dropouts withdrawals and fail to fulfill

follow ups should be described in articles

a) Good A rate of dropouts withdrawals and lost to follow ups

le 10

b) Acceptable A rate of dropouts withdrawals and lost to follow

ups le 20

c) Unacceptable A rate of dropouts withdrawals and lost to follow

ups gt20

Trials which meet the criteria of good or acceptable rate of

dropouts withdrawals and lost to follow ups will be included for

analysis

Data synthesis

First we will test for heterogeneity between trial results using a

standard chi-squared test and I-squared test to make sure that they

are appropriate to be combined

A meta-analysis will be implemented with the Cochrane Col-

laboration Review Manager (RevMan 43) software All the pri-

mary and secondary outcome measures under consideration will

be combined and analysed if there is evidence of homogeneity

(Pgt01) using a random effects model Results will be expressed as

relative risks (RR ratio of risk of treatment group vs that of con-

trol group) with their 95 confidence intervals for dichotomous

data For continuous variables measured with the same scale the

weighted mean differences ((WMD) the difference between treat-

ment and control pooled means at endpoint) along with their 95

confidence intervals will be calculated and standardised mean dif-

ference (SMD) will be calculated in case different scales are used

Sensitivity Analyses

We will implement a sensitivity analyses in order to explore the

influence of the following factors on effect size

(i) Repeating the analysis taking into account quality only trials

with adequate randomisation allocation concealment and blind-

ing will be included

(ii) Repeating the analysis excluding any trials with long duration

or large studies to establish how much they dominate the results

(iii) Repeat the analysis excluding trials using the following filters

diagnostic criteria (criterias except CDC ICD-10 and Oxford will

be excluded considering the prevalence) language of publication

(languages except English will be excluded because of the potential

inaccuracy in translation) Ethnic group (ethnic groups except

Asian will be excluded because most trials on acupuncture are

carried out in Asia especially China)



Subgroup Analyses

Here we will compare the effects between subgroups below

(i) different acupuncture types

(ii) different comparisons

Publication Bias

Potential biases will be investigated using the funnel plot We will

use a linear regression approach to measure funnel plot asymmetry

on the logarithm scale of the relative risk (RR)

R E F E R E N C E S

Additional references

Buscemi 2005

Buscemi N Vandermeer B Friesen C Bialy L Tubman M Ospina

M et alManifestations and management of chronic insomnia in adults

Evidence ReportTechnology Assessment no 125 Vol AHRQ Publica-

tion No 05-E021-2 Rockville MD Prepared by University of Al-

berta Evidence-based Practice Centre under contract C400000021

June 2005

CFS workshop 2002

CFS workshop Clinical Practice Guidelines-Chronic fatigue syn-

drome Clinical practice guidelines - 2002 MJA 20029 SupplS17ndash

S55

Chalder 1993

Chalder T Berelowitz G Pawlikowska T Development of a fatigue

scale Journal of Psychosomatic Research 199337(6)147ndash53

Edmonds 2004

Edmonds M McGuire H Price J Exercise therapy for chronic fa-

tigue syndrome The Cochrane Library 2004 Issue 3[Art No

CD003200 DOI 10100214651858CD003200pub2]

Fukuda 1994

Fukuda K Straus SE Hickie I The chronic fatigue syndrome a

comprehensive approach to its definition and study Annals of Inter-

nal Medicine 1994121953ndash9

Garratt 2002

Garratt A Schmidt L Mackintosh A et alQuality of life measure-

ment bibliographic study of patient assessed health outcome mea-

sures British Medical Journal 2002June 15324(7351)1417

Hamilton 1960

Hamilton M A rating scale for depression Journal of Neurology and

Neurosurgery 19602356ndash62

Jadad 1996

Jadad AR Moore RA Carroll D Jenkinson C Reynolds DJ Gav-

aghan DJ et alAssessing the quality of reports of randomized clini-

cal trials is blinding necessary Controlled Clinical Trials 199617

1ndash12

Juni 2001

Juni Peter Altman DG Egger M Assessing the quality of controlled

clinical trials BMJ 2001323(7303)42ndash6

Kjaergard 2001

Kjaergard LL Villumsen J Gluud C Reported methodologic quality

and discrepancies between large and small randomized trials in meta-

analyses Annals of Internal Medicine 2001135(11)982ndash9

Liu 2004

Liu J Acupuncture with herbs for CFS Journal of Chinese Clinical

medicine 20045(3)113ndash4

Ni 2002

Ni K Acupuncture with herbs for 35 cases of CFS Journal of Fujian

College of TCM 200212(4)22ndash3

Price 2003

Price JR Couper J Cognitive behaviour therapy for chronic fatigue

syndrome in adults The Cochrane Library 2003 Issue 4[Art No

CD001027 DOI 10100214651858CD001027pub2]

Reid 2000

Reid S Chalder T Extracts from ldquoClinical Evidencerdquo BMJ 2000

320292ndash6

Sabin 2003

Sabin TD An approach to chronic fatigue syndrome in adults Neu-

rologist 20039(1)28ndash34

Schulz 1995

Schulz KF Chalmers I Hayes RJ Altman DG Empirical evidence of

bias dimensions of methodological quality associated with estimates

of treatment effects in controlled trials JAMA 1995273408ndash12

Sharpe 1991

Sharpe M Archard L Banatvala J Borysiewicz LK Clare AW David

A Chronic fatigue syndrome guidelines for research Journal of the

Royal Society of Medicine 199184(2)118ndash21

Steele 1998

Steele L Dobbins JG Fukuda K Reyes M Randall B Koppelman

M The epidemiology of chronic fatigue in San Francisco American

Journal of Medecine 1998105(suppl 3A)83ndash90S

Streitberger 1998

Streitberger K Kleinhenz J Introducing a placebo needle into

acupuncture research The Lancet 1998352364ndash365

Wessely 1997

Wessely S Chalder T Hirsch S Wallace P Wright D The prevalence

and morbidity of chronic fatigue and chronic fatigue syndrome a

prospective primary care study American Journal of Public Health

199787(Not known)1449ndash55



WHO 1992

World Health Organisation The ICD-10 Classification of Mental and

Behavioural Disorders Geneva World Health Organisation 1992

WSDLI 2002

Washington State Department of Labor and Industries Guidelines for

outpatient prescription of oral opioids for injured workers with chronic

non-cancer pain Olympia Washington Washington State Depart-

ment of Labor and Industries 2002

Zhang 2004

Zhang R Epidemiological study on CFS Chinese journal of rehabil-

itation medicine 200419(4)296ndash7lowast Indicates the major publication for the study

W H A T rsquo S N E W

31 October 2008 Amended Converted to new review format

H I S T O R Y

Protocol first published Issue 2 2006

C O N T R I B U T I O N S O F A U T H O R S

Wei Zhang designed and wrote the protocol Zhang will participate in the whole review procedure including data extraction contacting

editors statistical analysis quality assessment and completion of the review Zhishun Liu checked the protocol and gave comments

Weina Peng and Wei Zhang will extract data and assess quality In case of disagreement between the two data extractors Wu will advise

on methodology and Liu will work as arbitrator

D E C L A R A T I O N S O F I N T E R E S T

Not known

S O U R C E S O F S U P P O R T

Internal sources

bull Department of Acupuncture and Moxibustion Guang An Men Hospital Chinese Academy of TCM China



External sources

bull No sources of support supplied



T A B L E O F C O N T E N T S

1HEADER

1ABSTRACT

2BACKGROUND

3OBJECTIVES

3METHODS

5REFERENCES

6WHATrsquoS NEW

6HISTORY

6CONTRIBUTIONS OF AUTHORS

6DECLARATIONS OF INTEREST

6SOURCES OF SUPPORT

iAcupuncture for chronic fatigue syndrome (Protocol)












DOI 10100214651858CD006010




A B S T R A C T





other interventions



B A C K G R O U N D






















































































9429 (Liu 2004)






Chinese philosophy










O B J E C T I V E S








M E T H O D S


Types of studies













included

















fatigue)


















c) MEDLINE (1966-2004)

d) EMBASE (1998-2004)



egy


and







trials




32 or30-31

33 acupuncture




37 acupuncture$tw

38 acupointstw

39 meridians

40 or 33-39

41 29 and 32 and 40

2 Reference Lists


further information




Eligibility




eligibility

Data extraction




study


imum and mean age



outcomes







arbitrator (Liu)

Quality assesment




















equate
















record numbers

3) Blinding




4) Follow-ups




le 10


ups le 20


ups gt20



analysis

Data synthesis

































Subgroup Analyses




Publication Bias




R E F E R E N C E S


Buscemi 2005






June 2005

CFS workshop 2002



S55

Chalder 1993



Edmonds 2004



CD003200 DOI 10100214651858CD003200pub2]

Fukuda 1994




Garratt 2002




Hamilton 1960



Jadad 1996




1ndash12

Juni 2001



Kjaergard 2001




Liu 2004



Ni 2002



Price 2003



CD001027 DOI 10100214651858CD001027pub2]

Reid 2000


320292ndash6

Sabin 2003



Schulz 1995




Sharpe 1991




Steele 1998




Streitberger 1998



Wessely 1997







WHO 1992



WSDLI 2002





Zhang 2004





H I S T O R Y








Not known


Internal sources




External sources














DOI 10100214651858CD006010




A B S T R A C T





other interventions



B A C K G R O U N D






















































































9429 (Liu 2004)






Chinese philosophy










O B J E C T I V E S








M E T H O D S


Types of studies













included

















fatigue)


















c) MEDLINE (1966-2004)

d) EMBASE (1998-2004)



egy


and







trials




32 or30-31

33 acupuncture




37 acupuncture$tw

38 acupointstw

39 meridians

40 or 33-39

41 29 and 32 and 40

2 Reference Lists


further information




Eligibility




eligibility

Data extraction




study


imum and mean age



outcomes







arbitrator (Liu)

Quality assesment




















equate
















record numbers

3) Blinding




4) Follow-ups




le 10


ups le 20


ups gt20



analysis

Data synthesis

































Subgroup Analyses




Publication Bias




R E F E R E N C E S


Buscemi 2005






June 2005

CFS workshop 2002



S55

Chalder 1993



Edmonds 2004



CD003200 DOI 10100214651858CD003200pub2]

Fukuda 1994




Garratt 2002




Hamilton 1960



Jadad 1996




1ndash12

Juni 2001



Kjaergard 2001




Liu 2004



Ni 2002



Price 2003



CD001027 DOI 10100214651858CD001027pub2]

Reid 2000


320292ndash6

Sabin 2003



Schulz 1995




Sharpe 1991




Steele 1998




Streitberger 1998



Wessely 1997







WHO 1992



WSDLI 2002





Zhang 2004





H I S T O R Y








Not known


Internal sources




External sources




B A C K G R O U N D






















































































9429 (Liu 2004)






Chinese philosophy










O B J E C T I V E S








M E T H O D S


Types of studies













included

















fatigue)


















c) MEDLINE (1966-2004)

d) EMBASE (1998-2004)



egy


and







trials




32 or30-31

33 acupuncture




37 acupuncture$tw

38 acupointstw

39 meridians

40 or 33-39

41 29 and 32 and 40

2 Reference Lists


further information




Eligibility




eligibility

Data extraction




study


imum and mean age



outcomes







arbitrator (Liu)

Quality assesment




















equate
















record numbers

3) Blinding




4) Follow-ups




le 10


ups le 20


ups gt20



analysis

Data synthesis

































Subgroup Analyses




Publication Bias




R E F E R E N C E S


Buscemi 2005






June 2005

CFS workshop 2002



S55

Chalder 1993



Edmonds 2004



CD003200 DOI 10100214651858CD003200pub2]

Fukuda 1994




Garratt 2002




Hamilton 1960



Jadad 1996




1ndash12

Juni 2001



Kjaergard 2001




Liu 2004



Ni 2002



Price 2003



CD001027 DOI 10100214651858CD001027pub2]

Reid 2000


320292ndash6

Sabin 2003



Schulz 1995




Sharpe 1991




Steele 1998




Streitberger 1998



Wessely 1997







WHO 1992



WSDLI 2002





Zhang 2004





H I S T O R Y








Not known


Internal sources




External sources




O B J E C T I V E S








M E T H O D S


Types of studies













included

















fatigue)


















c) MEDLINE (1966-2004)

d) EMBASE (1998-2004)



egy


and







trials




32 or30-31

33 acupuncture




37 acupuncture$tw

38 acupointstw

39 meridians

40 or 33-39

41 29 and 32 and 40

2 Reference Lists


further information




Eligibility




eligibility

Data extraction




study


imum and mean age



outcomes







arbitrator (Liu)

Quality assesment




















equate
















record numbers

3) Blinding




4) Follow-ups




le 10


ups le 20


ups gt20



analysis

Data synthesis

































Subgroup Analyses




Publication Bias




R E F E R E N C E S


Buscemi 2005






June 2005

CFS workshop 2002



S55

Chalder 1993



Edmonds 2004



CD003200 DOI 10100214651858CD003200pub2]

Fukuda 1994




Garratt 2002




Hamilton 1960



Jadad 1996




1ndash12

Juni 2001



Kjaergard 2001




Liu 2004



Ni 2002



Price 2003



CD001027 DOI 10100214651858CD001027pub2]

Reid 2000


320292ndash6

Sabin 2003



Schulz 1995




Sharpe 1991




Steele 1998




Streitberger 1998



Wessely 1997







WHO 1992



WSDLI 2002





Zhang 2004





H I S T O R Y








Not known


Internal sources




External sources





eligibility

Data extraction




study


imum and mean age



outcomes







arbitrator (Liu)

Quality assesment




















equate
















record numbers

3) Blinding




4) Follow-ups




le 10


ups le 20


ups gt20



analysis

Data synthesis

































Subgroup Analyses




Publication Bias




R E F E R E N C E S


Buscemi 2005






June 2005

CFS workshop 2002



S55

Chalder 1993



Edmonds 2004



CD003200 DOI 10100214651858CD003200pub2]

Fukuda 1994




Garratt 2002




Hamilton 1960



Jadad 1996




1ndash12

Juni 2001



Kjaergard 2001




Liu 2004



Ni 2002



Price 2003



CD001027 DOI 10100214651858CD001027pub2]

Reid 2000


320292ndash6

Sabin 2003



Schulz 1995




Sharpe 1991




Steele 1998




Streitberger 1998



Wessely 1997







WHO 1992



WSDLI 2002





Zhang 2004





H I S T O R Y








Not known


Internal sources




External sources




Subgroup Analyses




Publication Bias




R E F E R E N C E S


Buscemi 2005






June 2005

CFS workshop 2002



S55

Chalder 1993



Edmonds 2004



CD003200 DOI 10100214651858CD003200pub2]

Fukuda 1994




Garratt 2002




Hamilton 1960



Jadad 1996




1ndash12

Juni 2001



Kjaergard 2001




Liu 2004



Ni 2002



Price 2003



CD001027 DOI 10100214651858CD001027pub2]

Reid 2000


320292ndash6

Sabin 2003



Schulz 1995




Sharpe 1991




Steele 1998




Streitberger 1998



Wessely 1997







WHO 1992



WSDLI 2002





Zhang 2004





H I S T O R Y








Not known


Internal sources




External sources




WHO 1992



WSDLI 2002





Zhang 2004





H I S T O R Y








Not known


Internal sources




External sources




External sources




acupuncture for chronic fatigue syndrome

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