Effectiveness and safety of acupuncture for children with cerebral palsy: An overview of systematic reviews

Introduction: Evidence on the effectiveness and safety of acupuncture for cerebral palsy (CP) is inconsistent, and methodological quality has not been comprehensively assessed in systematic reviews (SRs) or meta-analyses (MAs). This overview aims to integrate the evidence from SRs, summarize the safety issues, and comprehensively assess the methodological quality. 

Methods: 11 databases were searched for SRs/MAs. Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) was used to evaluate the methodological quality of the included SRs. The quality of the reporting was determined according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses of acupuncture (PRISMA-A). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was applied to assess the quality of evidence for the primary outcomes. Risk of Bias in Systematic Reviews (ROBIS) evaluated the risk of bias of included SRs. Network meta-analysis(NMA) for comparing the relative effectiveness of different acupuncture treatments for CP. 

Results: 9 SRs/MAs included 107 randomized controlled trials (RCTs) with 9744 patients. Evidence suggests that acupuncture can increase the total effective rate and improve motor function, independence, and activities of daily living without serious adverse events. NMA indicated that conventional acupuncture showed a slight statistical difference in improving the overall symptoms of CP. 

Conclusions: Evidence from SRs and NMA suggests that acupuncture for CP is promising and safe. Conventional acupuncture is expected to be the best treatment for CP; however, the clinical differences may not be significant. The low methodological quality and the slight overlap of SRs limit the conclusions of this overview.¹