Faculty Bibliography

The assessment of blinding in RCTs is rarely performed. Currently most studies that do report data on evaluation of blinding merely report percentages of correct guessing, not taking into account correct guessing by chance. Blinding assessment using the blinding index (BI) has never been performed in a systematic review on studies of major psychiatric disorders. This study is a systematic review of psychiatric randomized control trials using the BI as a chance-corrected measurement of blinding, a tool to analyze and understand the patterns of blinding across studies of major psychiatric disorders with available data. Of 2467 psychiatric RCTs from 2000 to 2010, 66 reported on blinding and 40 studies were found to have enough information on evaluation of blinding to be analyzed using the BI. The experimental treatment groups had an average BI value of 0.14 and the control groups had an average BI value of 0.00. The most common BI scenario was random-random, indicating ideal blinding. A positive correlation between effect size and more correct guesses was also found. Overall, based on BI values and the most common blinding scenario, the published articles on major psychiatric disorders from 2000 to 2010, which reported on blinding assessment for patients, were effectively blinded.

Background. There is no agreement among researchers on viable controls for acupuncture treatment, and the assessment of the effectiveness of blinding and its interpretation is rare. Purpose. To systematically assess the effectiveness of blinding (EOB) in reported acupuncture trials; to explore results of RCTs using a quantitative measure of EOB. Data Sources. A systematic review of published sham RCTs that assessed blinding. Study Selection. Five hundred and ninety studies were reviewed, and 54 studies (4783 subjects) were included. Data Extraction. The number of patients who guessed their treatment identity was extracted from each study. Variables with possible influence on blinding were identified. Data Synthesis. The blinding index was calculated for each study. Based on blinding indexes, studies were congregated into one of the nine blinding scenarios. Individual study characteristics were explored for potential association with EOB. Limitations. There is a possibility of publication or reporting bias. Conclusions. The most common scenario was that the subjects believed they received verum acupuncture regardless of the actual treatment received, and overall the subject blinding in the acupuncture studies was satisfactory, with 61% of study participants maintaining ideal blinding. Objectively calculated blinding data may offer meaningful and systematic ways to further interpret the findings of RCTs.

Background: Chronic pain caused by lumbar stenosis remains a challenging clinical issue. There is a lack of consensus about the use of acupuncture as a potential treatment for lumbar stenosis.
Objective(s): The aim of this study was to review experience with using acupuncture treatment for decreasing pain symptoms and improving functional mobility and activities of daily living (ADL) in patients with lumbar stenosis. Design, Setting, and Patients: Retrospective telephone interviews were completed with 7 adult patients with lumbar stenosis who received acupuncture treatment.
Intervention(s): Patients received various amounts of acupuncture treatments, and some patients underwent adjunctive physical therapy. The subjects were presented with a scale of 0-5 to assess improvement. Five indicated an improvement (pain symptoms eliminated, functional mobility returned to baseline) and zero indicated no improvement.
Main Outcome Measure(s): The main outcomes sought were reduction of pain and improvements in functional mobility and ADLs.
Result(s): Of the 7 subjects, 2 showed reduction of pain and improvement of function. The remaining 5 patients had no improvement. In the patients with symptom improvement, there was a lack of radicular pain prior to acupuncture treatment, an increase in the number of acupuncture sessions, and adjunctive physical therapy.
Conclusion(s): Acupuncture may be a useful adjunctive therapy in patients with lumbar spinal stenosis without radicular pain. More treatment sessions and concomitant physical therapy may improve results with acupuncture in this setting.