ABSTRACT
The Japan-Korea Workshop on Acupuncture and EBM is an academic exchange between the Japan Society of Acupuncture and Moxibustion (JSAM) and the Korean Acupuncture and Moxibustion Medical Society (KAMMS). The theme of the 9th and 10th Workshop was clinical practice guidelines (CPG). Three Korean and two Japanese speakers presented in the 9th Workshop held at Osaka, and two in each country did in the 10th at Jecheon, Korea. Since Korea has already developed some Korean Medicine CPGs, the present state and protocols for improvement process were reported. On the other hand, Japan has not developed such CPGs on acupuncture. The Japanese speakers therefore presented results of a survey on Japanese CPGs that include “acupuncture-moxibustion” as a treatment option and quality assessment of those CPGs. Although there are some differences on circumstances surrounding acupuncture practice between Japan and Korea, it was a good opportunity to obtain useful information for developing CPG on acupuncture in Japan and to discuss on this issue with Korean researchers preceding in this area. We reaffirmed the need for continued academic exchange between JSAM and KAAMS.
ABSTRACT
The "Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Low Back Pain 2019, 2nd Edition" was published in May, 2019. We found multiple issues of serious misinformation on acupuncture; these included, but are not limited to inappropriate conclusions due to errors in literature selection, data extraction and data input. Accordingly we point out each error and provide the correct information. 1. A published paper of meta-analysis of randomized controlled trials (RCTs) on Japanese acupuncture for low back pain in Japanese patients is ignored. 2. Regarding acupuncture for acute low back pain, some RCT data has been incorrectly inputted and analyzed. The wrong numbers have been mistakenly inserted into the analysis software (plus instead of minus) leading to the opposite and incorrect conclusion that acupuncture is not superior to the control group. Furthermore, in a meta-analysis on the effect of acupuncture on functional disorder, data on pain are incorrectly inputted and analyzed. 3. The Guidelines' meta-analysis on acupuncture for chronic low back pain included five RCT papers. The papers included acupuncture (1 article), auricular point acupressure (2 articles), laser acupuncture (1 article) and acupressure backrest (1 article). Only one article in the meta-analysis used needle-inserting acupuncture, therefore, this is not a meta-analysis on acupuncture. There are also many errors in data input. Moreover, there is mislabeling of the forest plot figures: Figure 7 is incorrectly labelled "pain", but actually shows data on "functional disorder" (Figure 8), and vice versa. 4. A published paper of meta-analysis on the cost-effectiveness of acupuncture is ignored. Additionally, although a paper of "meta-analysis on the health economic effects of yoga" is cited, the health economic effects of yoga are not actually addressed or mentioned in that paper. Although the Guidelines state they have fully complied with "Minds Manual for Guideline Development 2014" (Minds: Medical Information Network Distribution Service, Japan Council for Quality Health Care), they did not set up a systematic review team, and do not state whether or not they organized an external review committee. Such circumstances may have contributed to the serious errors in the Guidelines. Because we have also recognized many errors regarding other therapies addressed in the Guidelines, we fear that the present Guidelines may destroy the credibility of the entire clinical practice guidelines published in Japan. We strongly hope that a corrected and revised version is published as soon as possible.