Universidade Federal do Ceará
Grupo de Atenção Integral e Pesquisa em Acupuntura e Medicina Tradicional Chinesa – GAIPA UFC

Revisões Cochrane estratificadas pela certeza nas evidências

Classificamos as revisões Cochrane de acordo com a confiança no efeito estimado do tratamento para cada resultado considerando o(s) melhor(es) resultado(s) dentre os desfechos avaliados no estudo. A GRADE é usada para classificar o corpo de evidências no nível do resultado em vez do nível de estudo. Para entender mais sobre os critérios para classificação da qualidade das evidências segundo a GRADE “clique aqui“.

• Ji Z et al. The quality of Cochrane systematic reviews of acupuncture: an overview. BMC Complement Med Ther. 2020 Oct 14;20(1):307. <https://pubmed.ncbi.nlm.nih.gov/33054785/>.

High-certainty evidence

Os autores têm muita confiança de que o verdadeiro efeito é próximo do efeito estimado para:

• Tai Chi reduziu em 20% o número de idosos comunitários que sofreram experiência de queda (Sherrington C et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019 Jan 31;1:CD012424). <https://www.ncbi.nlm.nih.gov/pubmed/30703272>.

Moderate-certainty evidence

Os autores acreditam que o verdadeiro efeito provavelmente é próximo do efeito estimado para:

• Acupressão comparada ao sham ou cuidados habituais provavelmente reduz a taxa de cesariana e levemente a intensidade da dor durante o trabalho de parto. Acupuntura comparada a acupuntura sham pode aumentar a satisfação com o alívio da dor e provavelmente reduzir o uso de medicamentos analgésicos em gestantes durante o trabalho de parto (Smith CA et al. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev. 2020 Feb 7; 2:CD009232). <https://pubmed.ncbi.nlm.nih.gov/32032444/>.
• Acupressão provavelmente melhora levemente a latência do sono e a duração (tempo) do sono e reduz levemente a fadiga em pessoas com doença renal crônica (Natale P et al. Interventions for improving sleep quality in people with chronic kidney disease. Cochrane Database Syst Rev. 2019 May 26;5:CD012625). <https://www.ncbi.nlm.nih.gov/pubmed/31129916>.
• Acupuntura comparada ao sham provavelmente reduz de modo clinicamente relevante a curto prazo os sintomas de prostatite em homens diagnosticados com prostatite crônica/síndrome da dor pélvica crônica (Franco JV et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2018 May 12;5:CD012551). <https://www.ncbi.nlm.nih.gov/pubmed/29757454>.
• Acupuntura comparada a acupuntura sham, tratamento inativo e lista de espera promove a melhora da dor ao final do tratamento e a curto prazo em indivíduos com dor cervical. Comparada a lista de espera, o pacientes tratados com acupuntura também relataram menor incapacidade (Trinh K et al. Acupuncture for neck disorders. Cochrane Database Syst Rev. 2016 May 4;(5):CD004870). <https://www.ncbi.nlm.nih.gov/pubmed/27145001>.
• Acupuntura promove redução moderada da frequência da dor de cabeça, caindo pela metade em 41% dos indivíduos com episódios de enxaqueca, onde 1 a cada 4 indivíduos se beneficia com o tratamento. Quando comparada a acupuntura sham, a acupuntura também se mostra eficaz porém com menor efeito para redução da frequência da dor de cabeça. Comparada com tratamento medicamentos profilático, acupuntura reduziu de modo significativo a frequência de enxaqueca após o tratamento, além de resultar em menores efeitos adversos (Linde K et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016 Jun 28;(6):CD001218). <https://www.ncbi.nlm.nih.gov/pubmed/27351677>.
• Acupuntura promoveu redução de pelo menos 50% da frequência da dor de cabeça quando comparada aos cuidados usuais, tratamentos de rotina ou acupuntura sham nos indivíduos com cefaleia tensional crônica (Linde K et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016 Apr 19;4:CD007587). <https://www.ncbi.nlm.nih.gov/pubmed/27092807>.
• Tai Chi comparado ao cuidado usual promove melhores resultados para capacidade física e função pulmonar em indivíduos com doença pulmonar obstrutiva crônica (Ngai SP et al. Tai Chi for chronic obstructive pulmonary disease COPD). Cochrane Database Syst Rev. 2016 Jun 7;(6):CD009953). <https://www.ncbi.nlm.nih.gov/pubmed/27272131>.
• Acupuntura reduz significativamente a dor noturna melhor do que o exercício em gestantes com dor lombar e pélvica, sendo ambos os tratamentos melhores do que o cuidado usual (Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2013 Aug 1;(8):CD001139). <https://www.ncbi.nlm.nih.gov/pubmed/23904227>.
• Moxabustão no acuponto B67, associada ao tratamento padrão, antes da 37 semana de gestação provavelmente reduz a chance de apresentação pélvica dos bebes durante o parto e o uso de ocitocina durante o parto, mas não o número de cesarianas. (Coyle ME, Smith C, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev. 2023 May 9;5(5):CD003928.) <https://pubmed.ncbi.nlm.nih.gov/37158339/>.

Low-certainty evidence

O verdadeiro efeito pode ser muito diferente do efeito estimado para:

• Griffiths JD et al. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Cochrane Database Syst Rev. 2021 May 18;5(5):CD007579. <https://pubmed.ncbi.nlm.nih.gov/34002866/>.
• Zimpel SA et al. Complementary and alternative therapies for post-caesarean pain. Cochrane Database Syst Rev. 2020 Sep 1;9:CD011216. <https://pubmed.ncbi.nlm.nih.gov/32871021/>.
• Lim CED et al. Acupuncture for polycystic ovarian syndrome. Cochrane Database Syst Rev. 2019 Jul 2;7: CD007689. <https://www.ncbi.nlm.nih.gov/pubmed/31264709>.
• Armour M et al. Acupuncture and acupressure for premenstrual syndrome. Cochrane Database Syst Rev. 2018 Aug 14;8:CD005290. <https://www.ncbi.nlm.nih.gov/pubmed/30105749>.
• Zhang HW et al. Moxibustion for alleviating side effects of chemotherapy or radiotherapy in people with cancer. Cochrane Database Syst Rev. 2018 Nov 13;11(11):CD010559. <https://pubmed.ncbi.nlm.nih.gov/30480754/>.
• Chan ES et al. Traditional Chinese herbal medicine for vascular dementia. Cochrane Database Syst Rev. 2018 Dec 6;12(12):CD010284. <https://pubmed.ncbi.nlm.nih.gov/30520514/>.
• Deng H, Xu J. Wendan decoction (Traditional Chinese medicine) for schizophrenia. Cochrane Database Syst Rev. 2017 Jun 28;6(6):CD012217. <https://pubmed.ncbi.nlm.nih.gov/28657646/>.
• Lee A, Chan SK, Fan LT. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2015 Nov 2;2015(11):CD003281. <https://pubmed.ncbi.nlm.nih.gov/26522652/>.
• Shen X et al. Acupuncture for schizophrenia. Cochrane Database Syst Rev. 2014 Oct 20;(10):CD005475.<https://www.ncbi.nlm.nih.gov/pubmed/25330045>.
• Oltean H et al. Herbal medicine for low-back pain. Cochrane Database Syst Rev. 2014 Dec 23;2014(12):CD004504. <https://pubmed.ncbi.nlm.nih.gov/25536022/>.
• Jiang L et al. Chinese medicinal herbs for influenza. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD004559. <https://www.ncbi.nlm.nih.gov/pubmed/23543533>.

Very low-certainty evidence

O verdadeiro efeito provavelmente é muito diferente do efeito estimado para:

• Hartley L et al. Qigong for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2015 Jun 11;2015(6):CD010390. <https://pubmed.ncbi.nlm.nih.gov/26068956/>.
• Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DA, Berman BM, Bouter LM. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001977.  <https://pubmed.ncbi.nlm.nih.gov/20091527/>.

Motivos comuns para redução da confiança

Due to poor methodological quality, high levels of heterogeneity and publication bias, the current evidence is not sufficiently rigorous to support or refute the intervention for treating this condition. Larger high-quality clinical trials are required.

There is no conclusive evidence that the intervention is effective for treatment of this condition.

Current evidence does not support the use of this interventtion for treatment of this condition.

The evidence in this review was assessed as low to very low‐certainty evidence, with downgrading decisions based on limitations in study design, indirectness and imprecision.

The certainty of the evidence was downgraded due to risk of bias and imprecision.

Due to the small sample size in the studies, the confidence intervals include both the possibility of moderate benefits and the possibility of no effect of acupuncture.

Although some interventions may be promising for the treatment of this condition, the certainty of evidence is low and we cannot draw robust conclusions about their true effects.

Although these data were insufficient to support firm conclusions, they do not conflict with clinical guideline recommendations based.

One unblinded trial found that acupuncture as an addition to routine primary physician care was associated with benefits on pain and function. However, these reported benefits are likely due at least partially to RCT participants’ greater expectations of benefit from acupuncture.

What are the limitations of the evidence? Because we did not find any trials comparing yoga to sham yoga, we cannot say how yoga would affect low back pain if people did not know they were doing yoga. Participants in all the trials were aware of whether they were practicing yoga or not, and this may have influenced their interpretation of whether their back pain had changed. Given the lack of trials of sham yoga, there is also a need for additional methodologic research in this field, particularly into the potential influence of people’s preferences and expectations on outcomes within randomized trials of yoga. We found no studies comparing yoga to a sham yoga intervention for chronic low back pain. A sham comparison to yoga would clarify the extent to which the eFects of yoga are related to the belief that participants are practicing yoga. Depending upon the form of the sham, this could serve as a blinded comparison between yoga and another active intervention. For example, if a yoga intervention was compared to an exercise intervention that is not yoga, but that participants believe is yoga, we would have information on a blinded comparison between yoga and the other exercise. PMID: 36398843