title: Defining the quality of acupuncture: the case of acupuncture for cancer-related fatigue.
abstract: BACKGROUND
  The quality and dose of acupuncture used in a clinical trial affects the outcome, as with the quality and dose of any intervention. The dose of acupuncture treatment may be characterized by the frequency of treatment, needle type and depth, length of needle retention, point selection, and combination. The dose in trials of acupuncture has at times been described as low or inappropriate but is seldom assessed in systematic reviews of acupuncture trials. This article examines the research evaluating acupuncture for cancer-related fatigue to determine what characteristics of treatment may contribute to a quality acupuncture intervention.
  
  
  METHODS
  English and Chinese language databases were searched from inception to December 2013 for randomized controlled trials of acupuncture for the treatment of cancer-related fatigue. Assessment of the quality of the acupuncture intervention was undertaken using the domains and items from the NICMAN framework.
  
  
  RESULTS
  Seven studies with a total of 690 patients were included. Four of the studies were designed as feasibility or pilot studies, and the other 3 studies were described as "effectiveness" trials. The treatment paradigm for the active intervention was based on traditional Chinese medicine in all studies, yet few of the studies were explicit as to how the active intervention was justified within a traditional Chinese medicine paradigm. Acupuncture point prescriptions were developed by a small consensus panel or based on typical points and/or "clinical experience." No discussion of traditional Chinese medicine theory or literature review was reported in any studies. Acupuncture point location was adequately described in 4 of the 7 studies. Frequency of treatment was twice per week in 2 studies; all others were once per week. Two studies did not apply needle manipulation or stimulation, and no justification was given.
  
  
  CONCLUSIONS
  The 7 trials reviewed meet some criteria for a quality acupuncture intervention. However, frequently elements of the intervention were not addressed, and it is possible that the dosage trialed was suboptimal. Systematic reviews of acupuncture are likely to continue to be inconclusive while comparisons are conducted of heterogeneous interventions without providing.
authors.affiliation: University of Western Sydney, Penrith, New South Wales, Australia s.grant@uws.edu.au.
authors.forename: Suzanne J
authors.initials: SJ
authors.lastname: Grant
authors.affiliation: University of Western Sydney, Penrith, New South Wales, Australia.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Smith
authors.affiliation: University of Western Sydney, Penrith, New South Wales, Australia.
authors.forename: Nimna
authors.initials: N
authors.lastname: de Silva
authors.affiliation: Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Chunxiang
authors.initials: C
authors.lastname: Su
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000529:Complementary Therapies; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care
keywords: acupuncture; cancer; dosage; fatigue; review