Methodological and reporting quality evaluation of systematic reviews on acupuncture in women with polycystic ovarian syndrome: A systematic review
Introduction
Polycystic ovary syndrome (PCOS), a complex endocrine disorder, is characterized by the clinical signs of ovulatory dysfunction, oligo-amenorrhoea, hyperandrogenism, infertility and hirsutism [1]. The prevalence rate of PCOS was 4%–12% in the reproductive period and 37%–90% with menstrual disorders [2], which has become a major health-care issue attracting great attentions. Currently, the first-line pharmacological therapy for PCOS is oral selective oestrogen receptor modulator such as clomiphene [3]. Other agents, such as metformin are also used [4]. However, its overall limited efficacy and side effects (mood changes, hot flushes or gastrointestinal adverse reactions) are common among in aforementioned treatments [3]. Therefore, find a new or adjuvant treatment with less side effects is of great importance. As a complementary and alternative treatment, acupuncture has gained increasing popularity worldwide in treating reproductive endocrinology and infertility [5]. Previous studies reported that acupuncture was effective for women with PCOS [[6], [7], [8]], but contradictory findings yielded at the same time [9,10].
Systematic reviews (SRs) have integrated relevant original RCT, but the result whether acupuncture is effective in treating PCOS or not is still inconclusive [[11], [12], [13], [14]]. Systematic limitations or flaws in the design, conduction or reporting of a review could bias the results [15]. Thus, it is necessary for SRs to implement a critical appraisal to provide more effective evidence. Revised Assessment of Multiple Systematic Reviews (AMSTAR 2) is a assessment tool explicitly focuses on the assessment of the risk of bias (RoB) and internal validity in methodological quality of SRs relating to interventions [16]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is a reporting guideline used to address several conceptual and methodological advances in the conducting and reporting of SRs of randomized trial [17]. At present, no studies have assessed the methodological and reporting quality of SRs concerning the effectiveness of acupuncture for PCOS.
Thus, our study aimed to assess the methodological and reporting quality of SRs concerning the effectiveness of acupuncture for PCOS with AMSTAR 2 and PRISMA tool respectively, to provide useful suggestions for the implementation of SRs in the field of acupuncture treatment for PCOS.
Section snippets
Searching
A systematic literature search was conducted in PubMed, Ovid-EMbase, the Cochrane Library, International Prospective Register of Systematic Reviews (PROSPERO), China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature (CBM), Wan Fang and VIP database on March 4, 2018, to identify relevant reviews. In addition, grey literature and reference lists of relevant trials were also checked. The following MeSH items or free words included “polycystic ovary”, “polycystic ovary
SRs selection
The search strategies provided 1910 records in total. After adjusting for duplicates by EndNote database, 1216 remained. Among these, 1197 studies were discarded because they failed to meet the inclusion criteria after reviewing the titles and abstracts. The full texts of the remaining 19 records were examined. And three publications were discarded because of irrelevant to PCOS [20], duplicated publication [21], insufficicent data [22], respectively, and the reminding six were not SRs [[23],
Discussion
SRs, the highest quality in the hierarchy of evidence, are increasingly used for evidence-based decision making [35]. With an increasing numbers of acupuncture studies appearing in the literature, SRs of acupuncture effect are becoming more and more important for decision-making. However, methodological flaws and poor reporting of SRs can reduce the validity of conclusions. Hence, this study was the first study to assess the methodological and reporting quality of SRs concerning acupuncture
Conclusion
Our study demonstrated poor methodological and reporting quality of SRs assessing acupuncture in women with PCOS. For future practice, researchers need to address these deficiencies and strengthen training to meet relevant requirements on methodologies and reporting of SRs. It will be better if the editor or reviewer request the author to provide registration information or pre-designed protocol in the submission.
Conflicts of interest
The authors declare that they have no conflict of interest.
Acknowledgements
We thank all authors in this article. The first two authors (YNL and ZBL) contributed equally to this study. They wrote the first draft. YNL, ZBL and QHZ selected, extracted and appraised the data. QHZ, FRZ and YL commented on, and edited all drafts. We appreciated the support from YC who provided language help. All authors read and approved the final manuscript. This study was supported by the National Key Technology R&D Program during the Twelfth Five-year Plan Period of the People’s Republic
References (45)
- et al.
Poly-cystic ovary syndrome
Lancet
(2007) - et al.
The androgen excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report
Fertil. Steril.
(2009) - et al.
The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States
Fertil. Steril.
(2010) - et al.
The use of acupuncture for managing gynaecologic conditions: an overview of systematic reviews
Maturitas
(2011) - et al.
Acupuncture to treat common reproductive health complaints: an overview of the evidence
Auton. Neurosci.
(2010) - et al.
What is in a name? Nonfinancial influences on the outcomes of systematic reviews and guidelines
J. Clin. Epidemiol.
(2014) - et al.
An assessment of methodological quality of systematic reviews of acupuncture and related therapies for cancer-related pain
Compl. Ther. Clin. Pract.
(2018) - et al.
ROBIS: a new tool to assess risk of bias in systematic reviews was developed
J. Clin. Epidemiol.
(2016) - et al.
Letrozole versus clomiphene for infertility in the polycystic ovary syndrome
N. Engl. J. Med.
(2014) - et al.
Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome
Cochrane Database Syst. Rev.
(2014)
Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial
Am. J. Physiol. Endocrinol. Metab.
Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction
Evid Based Complement Alternat Med
Acupuncture: is it effective for treatment of insulin resistance?
Diabetes Obes. Metabol.
Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial
JAMA
True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome
J. Clin. Endocrinol. Metabol.
Acupuncture for polycystic ovarian syndrome: a systematic review and meta-analysis
Medicine (Baltim.)
Acupuncture for polycystic ovarian syndrome
Cochrane Database Syst. Rev.
A systematic review and meta-analysis: the efficacy of integrated acupuncture with medicine for the treatment of polycystic ovary syndrome
J. Practical Tradit. Chin. Intern. Med.
Methodological quality evaluation of systematic reviews or meta-analyses on ERCC1 in non-small cell lung cancer: a systematic review
J. Canc. Res. Clin. Oncol.
AMSTAR 2: a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both
BMJ
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration
Ann. Intern. Med.
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