Evidence Project Brisbane, Australia Increasing interest in acupuncture has led to the need for an updated review of its efficacy, effectiveness and cost effectiveness. Rather than starting from scratch, this review draws on two prior comprehensive literature reviews into acupuncture. The first was undertaken for the Australian Department of Veterans’ Affairs (DVA) in 2010, the second for the United States Department of Veterans Affairs (USVA) in 2013 (5, 6). These reviews did not limit themselves to veteran-specific health issues but considered the evidence regarding acupuncture in the broadest health terms. A search was then conducted for studies after the USVA 2013 review and the evidence analysed, graded and tabulated. The advantage of this comparative approach is not only a pragmatic way of avoiding duplication of work; it also demonstrates the increasing quality and quantity of evidence supporting the effectiveness of acupuncture over the eleven-year period (2005 to 2016) from which studies were drawn. Table 3 categorises the research literature by evidence levels. This table clearly demonstrates the increase in the volume and scope of research on acupuncture since the prior reviews. Table 4 summarises the changes in evidence levels among the reviews. Of note is the finding that eight conditions are now rated as ‘evidence of positive effect’. Two of these had been listed as ‘unclear’ evidence and three as ‘evidence of potential positive effect’ prior to this review. Table 5 provides brief notes for each condition and the references justifying the change in evidence levels found by this review. Table 6 organises conditions by clinical areas, allowing the reader to get a snapshot of the state of the evidence for any particular clinical area, and identifies areas where further research needs to be undertaken. Numerous clinical guidelines now recommend acupuncture for a range of conditions. Of the 122 conditions examined in this review, levels of evidence have increased for 24 conditions. There is now ‘evidence of positive effect’ for eight conditions and ‘evidence of potential positive effect’ for a further 38 conditions. Seventy-one conditions are rated as ‘unclear/insufficient evidence’ and only five conditions are currently rated at ‘no evidence of effect’. Further statistics can be found at Table 2. The comparative approach used in this study serves as a reminder that a finding of ‘no evidence of effect’ or ‘unclear’ does not mean ‘ineffective’. Many of the conditions currently rated as ‘unclear’ have consistently positive findings in systematic reviews, but because they represent new clinical areas for acupuncture research, the evidence is not yet sufficient to allow firm conclusions to be drawn on effectiveness or efficacy. Section 1.6 provides further assistance in interpreting the findings of this review. There are methodological challenges in investigating acupuncture such as the problems with placebo controlled trials (outlined in section 1.4) which are slowly being overcome. 1.1 Methods A review of alternative therapies was published by the Australian Government Department of Veterans’ Affairs in 2010 (5). In 2014, the US Department of Veterans Affairs published an Evidence Map of Acupuncture reviewing acupuncture research published in or before March 2013 (6). This review focuses on new evidence between March 2013 and September 2016. Like the two previous reviews, this review concentrates on systematic reviews (SR) and meta-analyses (MA), using Cochrane Systematic Reviews where available. The primary focus of this review is to examine evidence supporting the effectiveness and efficacy of acupuncture (see section 1.3 Efficacy versus effectiveness). Where available, evidence on cost-effectiveness and safety has been included (see Tables 7 and 8). The Acupuncture Evidence Project © AACMA 2 A search was undertaken on PubMed and the Cochrane Library using the search term ‘acupuncture’ with limits set for dates between March 2013 and September 2016, and restricted to reviews. All languages were included. Systematic reviews, meta-analyses, network metaanalyses, overviews of systematic reviews (NHMRC level I evidence) and some narrative reviews were included, but protocols for systematic reviews were excluded. Systematic reviews of noninvasive or nonpharmacological interventions or of complementary and/or alternative medicine (CAM) interventions were included if they included acupuncture studies. One systematic review from the Australian Journal of Acupuncture and Chinese Medicine was included although this journal is not included in PubMed listings. A check in January 2017 identified three more relevant SRs and MAs (one from October 2016, one from December 2016, and one from January 2017) which were included. A total of 136 systematic reviews, including 27 Cochrane systematic reviews were included in this review, along with three network meta-analyses, nine reviews of reviews and 20 other reviews. Meta-analyses were conducted for 62 of the non-Cochrane systematic reviews. This review includes pooled data from more than 1,000 randomised controlled trials. Some of the included systematic reviews included studies which were not randomised controlled trials. 1.2 Assessment of the quality of evidence The Australian DVA review (2010) used the National Health