RESUMO
BACKGROUND: Low back pain (LBP) is a prevalent and debilitating condition that poses a significant burden on healthcare systems. Acupuncture has been proposed as a promising intervention for LBP, but the evidence supporting its specific effect is insufficient, and the use of sham acupuncture as a control in clinical trials presents challenges due to variations in sham acupuncture techniques and the magnitude of the placebo effect. OBJECTIVE: To investigate the magnitude of the placebo response of sham acupuncture in trials of acupuncture for nonspecific LBP, and to assess whether different types of sham acupuncture are associated with different responses. METHODS: Four databases including PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched through April 15, 2023, and randomized controlled trials (RCTs) were included if they randomized patients with LBP to receive acupuncture or sham acupuncture intervention. The main outcomes included the placebo response in pain intensity, back-specific function and quality of life. Placebo response was defined as the change in these outcome measures from baseline to the end of treatment. Random-effects models were used to synthesize the results, standardized mean differences (SMDs, Hedges'g) were applied to estimate the effect size. RESULTS: A total of 18 RCTs with 3,321 patients were included. Sham acupuncture showed a noteworthy pooled placebo response in pain intensity in patients with LBP [SMD -1.43, 95% confidence interval (CI) -1.95 to -0.91, I2=89%]. A significant placebo response was also shown in back-specific functional status (SMD -0.49, 95% CI -0.70 to -0.29, I2=73%), but not in quality of life (SMD 0.34, 95% CI -0.20 to 0.88, I2=84%). Trials in which the sham acupuncture penetrated the skin or performed with regular needles had a significantly higher placebo response in pain intensity reduction, but other factors such as the location of sham acupuncture did not have a significant impact on the placebo response. CONCLUSIONS: Sham acupuncture is associated with a large placebo response in pain intensity among patients with LBP. Researchers should also be aware that the types of sham acupuncture applied may potentially impact the evaluation of the efficacy of acupuncture. Nonetheless, considering the nature of placebo response, the effect of other contextual factors cannot be ruled out in this study. (PROSPERO registration No. CRD42022304416).
RESUMO
In recent years, the prevalence of sensory integration disorders in children in urban areas has increased. Most existing sensory integration treatments are located in hospital-based sensory integration units; however, medical resources are extremely limited, making it difficult to guarantee the appropriate treatment time and intervention results for many children. The concept of sensory integration therapy must be disseminated widely and correctly to meet these children's needs. Although most urban communities have a high number of children's spaces, these spaces require improvement. This study proposes the incorporation of the concept of sensory integration therapy into neighborhood open spaces for children to positively impact children's sensory development. The purpose of this study is to determine the effective facility factors of an occupational therapy room, translate them into a community facility design, clarify the categories and relative importance of each design attribute, and explore the design strategies of the children's facilities in neighborhood open spaces based on the sensory integration theory. This study investigates the importance of the sensory integration treatment level. The facilities in neighborhood open spaces for children can be considered systemic structures consisting of five partitioned units with different levels of importance among the synergistic components within each unit. These structures will enable children to experience sensory stimulation during daily outdoor play and will serve as preventive and therapeutic tools.
