Evidence-Based Complementary and Alternative Medicine
Volume 2021 (2021), Article ID 3469122, 14 pages
https://doi.org/10.1155/2021/3469122

Research Article

Analysis of the Most-Cited Systematic Review or Meta-Analysis in Acupuncture Research

Ying He,¹ Yuxi Li,² Juan Li,³ Ning Li,¹ Yonggang Zhang,4,5 and Nian Li⁶

¹Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
²School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
³School of Health Preservation and Rehabilitation, Traditional Chinese Medicine of Chengdu University, Chengdu, Sichuan, China
⁴Department of Periodical Press, West China Hospital, Sichuan University, Chengdu, China
⁵Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
⁶Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, China

Correspondence should be addressed to Ning Li; zhenjiuhuaxi@163.com, Yonggang Zhang; jebm_zhang@yahoo.com, and Nian Li; linian@wchscu.cn

Received 9 June 2021; Revised 1 August 2021; Accepted 18 August 2021; Published 16 September 2021

Academic Editor: Hongcai Shang

Copyright © 2021 Ying He et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Objectives. The aim of the current study was to analyze the 100 most-cited systematic reviews or meta-analyses in the field of acupuncture research. Methods. The Web of Science Core Collection was used to retrieve lists of 100 most-cited systematic reviews or meta-analyses in the field of acupuncture research. Two authors screened literature, extracted data, and analyzed the results. Results. The citation number of the 100 most-cited systematic reviews or meta-analyses varied from 65 to 577; they were published between 1989 and 2018. Fourteen authors published more than 1 study as the corresponding author and 10 authors published more than 1 study as the first author. In terms of the corresponding authors, Edzard Ernst and Linde Klaus published the most systematic reviews/meta-analyses (n = 7). The USA published most of the systematic reviews or meta-analyses (n = 24), followed by England (n = 23) and China (n = 14). Most institutions with more than 1 study were from England (4/13). The institutions with the largest numbers of most-cited systematic reviews or meta-analyses were the Technical University of Munich in Germany, the University of Maryland School of Medicine in the USA (n = 8), the Universities of Exeter and Plymouth in England (n = 6), and the University of Exeter in England (n = 6). The journal with the largest number of most-cited systematic reviews or meta-analyses was the Cochrane Database of Systematic Reviews (n = 20), followed by Pain (n = 6). Conclusion. Our study reveals that the 100 most-cited systematic reviews or meta-analyses in the acupuncture research field are mostly from high impact factor journals and developed countries. It will help researchers follow research hot spots, broaden their research scope, expand their academic horizons, and explore new research ideas, thereby improving the quality of acupuncture research.

1. Introduction

Acupuncture is an important therapy in the traditional medicine of China and has been practiced for thousands of years [1]. It is defined as the insertion of one or several needles into the skin at particular sites for therapeutic purposes [1, 2]. The acupuncture research has shown impressive development during the past decade, and published articles have reflected its evolution [3, 4].

The Science Citation Index was initiated at the Institute for Scientific Information by Eugene Garfield, which is now owned by Clarivate Analytics [5]. It maintains a systematic ongoing measurement of citation counts for scientific journals and articles. The citation number of an article by other articles is widely considered as an important parameter to measure its relevance in the field of knowledge [6, 7]. Citation analysis can be used to identify studies that have influenced a given field, and a highly cited paper is usually seen as a landmark in any medical discipline, and it may influence further research and clinical practice [8]. In addition, the top-cited articles are often written by leading experts who can offer insight into future directions of the discipline and indicate the growth of particular fields [9].

Several recent studies have identified and analyzed citation classics and most-cited articles in various medical fields including gastric diseases [8], antibiotics [10], obstetrics and gynecology [7], and attention-deficit/hyperactivity disorder [11]. However, to the best of our knowledge, no comprehensive studies reported the most-cited systematic reviews or meta-analyses in acupuncture research, especially using the Web of Science database. Thus, we performed the current study to identify the 100 most-cited systematic reviews or meta-analyses published in journals in the field of acupuncture research.

2. Materials and Methods

2.1. Search Strategy

The Web of Science Core Collection was searched for the 100 most-cited systematic reviews/meta-analyses using the following search terms: (Acupuncture [Topic] OR Acupuncture [Title]) AND (systematic review [Topic] OR meta-analysis [Topic] OR systematic review [Title] OR meta-analysis [Title]). The last search was performed on May 5, 2021. The results were screened and ordered by the total number of citations, and the 100 most-cited systematic reviews or meta-analyses were included for data analysis.

2.2. Data Collection and Analysis

The 100 most-cited systematic reviews or meta-analyses were exported into one electronic datasheet and analyzed. Data were inserted into an Excel database (Excel 2010, Microsoft), and a descriptive statistical analysis was performed by Excel software. Structural visualization and analysis of the 100 most-cited studies were performed using VOSviewer 1.6.66 (https://www.vosviewer.com/, Leiden University Centre for Science and Technology Studies). For each study, the characteristics of the study such as the number of citations, ranking, authorship, title, year of publication, published journal, publication type, and topic categories were assessed by two authors. If the authors of an article had more than one affiliation, the department, institution, and country of origin were defined by the first affiliation of the first author.

3. Results

The search results included more than 1,500 systematic reviews or meta-analyses. After screening the titles and abstracts, the 100 most-cited systematic reviews or meta-analyses were selected for data analysis. Table 1 shows the 100 most-cited systematic reviews or meta-analyses; they are ranked according to the number of citations. The total citation numbers of all 100 most-cited systematic reviews or meta-analyses were 13,459, varying from 65 to 577. Fifteen systematic reviews or meta-analyses had been cited more than 200 times. The most-cited systematic review/meta-analysis was Acupuncture, which was written by Vickers et al. in Arch. Intern. Med. published in 2012 with the citation number of 577 [12]. The second systematic review/meta-analysis was “Do certain countries produce only positive results? A systematic review of controlled trials” written by Vickers et al. published in Control Clin Trials in 1998 with the citation number of 425 [13]. The third systematic review/meta-analysis was “Is acupuncture effective for the treatment of chronic pain? A systematic review” written by Ezzo et al. published in Pain in 2000 with the citation number of 293 [14].

Table 1: The 100 most-cited acupuncture research works.

Ranking
Article
Disease
Citation

1
Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012; 172(19):1444–1453.
Chronic pain
577

2
Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials. 1998; 19(2):159–166.
Controlled trials
425

3
Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000; 86(3):217–225.
Chronic pain
293

4
Huang W, Pach D, Napadow V, et al. Characterizing acupuncture stimuli using brain imaging with FMRI--a systematic review and meta-analysis of the literature. PLoS One. 2012; 7(4):e32960.
Brain imaging with fMRI
272

5
Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analysis: acupuncture for low back pain [published correction appears in Ann Intern Med. 2005 Jun 7; 142(11):950–1]. Ann Intern Med. 2005; 142(8):651–663.
Low back pain
261

6
Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003; 138(11):898–906.
Back pain
252

7
Furlan AD, van Tulder MW, Cherkin DC, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev. 2005; (1):CD001351. Published 2005 Jan 25.
Low back pain
246

8
Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001; 82(7):986–992.
Myofascial trigger point pain
238

9
Hróbjartsson A, Gøtzsche PC. Is the placebo powerless? Update of a systematic review with 52 new randomized trials comparing placebo with no treatment. J Intern Med. 2004; 256(2):91–100.
Randomized trials
237

10
Green S, Buchbinder R, Hetrick S. Acupuncture for shoulder pain. Cochrane Database Syst Rev. 2005; (2):CD005319. Published 2005 Apr 18.
Shoulder pain
230

11
Chen W, Yang GY, Liu B, Manheimer E, Liu JP. Manual acupuncture for treatment of diabetic peripheral neuropathy: a systematic review of randomized controlled trials [published correction appears in PLoS One. 2014; 9(3):e91110]. PLoS One. 2013; 8(9):e73764. Published 2013 Sep 12.
Diabetic peripheral neuropathy
220

12
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009; (1):CD001218. Published 2009 Jan 21.
Migraine
213

13
Furlan AD, van Tulder M, Cherkin D, et al. Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration. Spine (Phila Pa 1976). 2005; 30(8):944–963.
Low back pain
206

14
Bjordal JM, Johnson MI, Ljunggreen AE. Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain. Eur J Pain. 2003; 7(2):181–188.
Postoperative pain
203

15
Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med. 1996; 89(6):303–311.
Antiemesis
202

16
Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005; 39(7):411–422.
Lateral epicondylalgia
198

17
Madsen MV, Gøtzsche PC, Hróbjartsson A. Acupuncture treatment for pain: systematic review of randomized clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009; 338:a3115. Published 2009 Jan 27.
Pain
195

18
Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg. 1999; 88(6):1362–1369.
Postoperative nausea and vomiting
187

19
Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomized placebo-controlled trials. BMC Musculoskelet Disord. 2007; 8:51. Published 2007 Jun 22.
Osteoarthritic knee pain
186

20
Ezzo J, Hadhazy V, Birch S, et al. Acupuncture for osteoarthritis of the knee: a systematic review. Arthritis Rheum. 2001; 44(4):819–825.
Osteoarthritis of the knee
171

21
Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. J Altern Complement Med. 2009; 15(3):213–216.
Clinical trials
168

22
Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomized controlled trials. Eur J Pain. 2009; 13(1):3–10.
Myofascial trigger point pain
167

23
White A, Foster NE, Cummings M, Barlas P. Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology (Oxford). 2007; 46(3):384–390.
Chronic knee pain
165

24
Garcia MK, McQuade J, Haddad R, et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol. 2013; 31(7):952–960.
Cancer care
163

25
Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001; 110(6):481–485.
Safety of acupuncture
161

26
Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anesth. 2008; 101(2):151–160.
Postoperative pain
160

27
Ernst E. Acupuncture - a critical analysis. J Intern Med. 2006; 259(2):125–137.
A critical analysis
160

28
van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). 1999; 24(11):1113–1123.
Acute and chronic low back pain
160

29
Ernst E, White AR. Acupuncture for back pain: a meta-analysis of randomized controlled trials. Arch Intern Med. 1998; 158(20):2235–2241.
Back pain
159

30
Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010; (1):CD001977. Published 2010 Jan 20.
Peripheral joint osteoarthritis
151

31
Eric M, Klaus L, Lixing L, M BL, M BB. Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med. 2007; 146(12).
Osteoarthritis of the knee
148

32
Smith LA, Oldman AD, McQuay HJ, Moore RA. Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain. Pain. 2000; 86(1–2):119–132.
Chronic neck and back pain
147

33
Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018; 19(5):455–474.
Chronic Pain
146

34
Furlan AD, Yazdi F, Tsertsvadze A, et al. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain. Evid Based Complement Alternat Med. 2012; 2012:953139.
Neck and low back pain
145

35
White AR, Ernst E. A systematic review of randomized controlled trials of acupuncture for neck pain. Rheumatology (Oxford). 1999; 38(2):143–147.
Neck pain
144

36
Meissner K, Fässler M, Rücker G, et al. Differential effectiveness of placebo treatments: a systematic review of migraine prophylaxis. JAMA Intern Med. 2013; 173(21):1941–1951.
Migraine
140

37
Geeganage C, Beavan J, Ellender S, Bath PM. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst Rev. 2012; 10:CD000323. Published 2012 Oct 17.
Acute and subacute stroke
139

38
Ahn AC, Colbert AP, Anderson BJ, et al. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics. 2008; 29(4):245–256.
Acupuncture points and meridians
139

39
Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain. 2007; 130(1–2):157–165.
Chronic musculoskeletal pain
137

40
Kietrys DM, Palombaro KM, Azzaretto E, et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013; 43(9):620–634.
Myofascial Pain
136

41
Melchart D, Linde K, Fischer P, et al. Acupuncture for recurrent headaches: a systematic review of randomized controlled trials [published correction appears in Cephalalgia 2000 Oct; 20(8):762–3]. Cephalalgia. 1999; 19(9):779–765.
Recurrent headaches
133

42
Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev. 2008; 2008(4):CD003008. Published 2008 Oct 8.
Chronic low back pain
132

43
Wu P, Mills E, Moher D, Seely D. Acupuncture in poststroke rehabilitation: a systematic review and meta-analysis of randomized trials. Stroke. 2010; 41(4):e171-e179.
Poststroke rehabilitation
129

44
Lao L, Hamilton GR, Fu J, Berman BM. Is acupuncture safe? A systematic review of case reports. Altern Ther Health Med. 2003; 9(1):72–83.
Safe
122

45
Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2009; (2):CD003281. Published 2009 Apr 15.
Postoperative nausea and vomiting
120

46
Ernst E, White A. Life-threatening adverse reactions after acupuncture? A systematic review. Pain. 1997; 71(2):123–126.
Adverse reactions
120

47
Dincer F, Linde K. Sham interventions in randomized clinical trials of acupuncture--a review. Complement Ther Med. 2003; 11(4):235–242.
Sham interventions
117

48
Linde K, Niemann K, Schneider A, Meissner K. How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials. BMC Med. 2010; 8:75. Published 2010 Nov 23.
The nonspecific effects of acupuncture
115

49
Manheimer E, Zhang G, Udoff L, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008; 336(7643):545–549.
Pregnancy and live birth among women undergoing in vitro fertilisation
115

50
Zhang ZJ, Chen HY, Yip KC, Ng R, Wong VT. The effectiveness and safety of acupuncture therapy in depressive disorders: systematic review and meta-analysis. J Affect Disord. 2010; 124(1–2):9–21.
Depressive disorders
114

51
Prady SL, Richmond SJ, Morton VM, Macpherson H. A systematic evaluation of the impact of STRICTA and CONSORT recommendations on quality of reporting for acupuncture trials. PLoS One. 2008; 3(2):e1577. Published 2008 Feb 13.
Acupuncture trials
113

52
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009; (1):CD007587. Published 2009 Jan 21.
Tension-type headache
110

53
Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 2010; 23(5):640–646.
Musculoskeletal pain
109

54
Smith CA, Hay PP, Macpherson H. Acupuncture for depression. Cochrane Database Syst Rev. 2010; (1):CD004046. Published 2010 Jan 20.
Depression
106

55
Ezzo JM, Richardson MA, Vickers A, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev. 2006; (2):CD002285. Published 2006 Apr 19.
Nausea or vomiting
106

56
Trinh KV, Graham N, Gross AR, et al. Acupuncture for neck disorders. Cochrane Database Syst Rev. 2006; (3):CD004870. Published 2006 Jul 19.
Neck disorders
106

57
Patel M, Gutzwiller F, Paccaud F, Marazzi A. A meta-analysis of acupuncture for chronic pain. Int J Epidemiol. 1989; 18(4):900–906.
Chronic pain
106

58
Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine (Phila Pa 1976). 2008; 33(23):E887-E900.
Low back pain
104

59
Jindal V, Ge A, Mansky PJ. Safety and efficacy of acupuncture in children: a review of the evidence. J Pediatr Hematol Oncol. 2008; 30(6):431–442.
Children
104

60
Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011; 152(4):755–764.
Alleviate pain
102

61
Trinh KV, Phillips SD, Ho E, Damsma K. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Rheumatology (Oxford). 2004; 43(9):1085–1090.
Lateral epicondyle pain
102

62
Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in the treatment of fibromyalgia?. J Fam Pract. 1999; 48(3):213–218.
Fibromyalgia
100

63
Sze FK, Wong E, Or KK, Lau J, Woo J. Does acupuncture improve motor recovery after stroke? A meta-analysis of randomized controlled trials. Stroke. 2002; 33(11):2604–2619.
Recovery after stroke
96

64
Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016; 2016(6):CD001218. Published 2016 Jun 28.
Migraine
95

65
Liu L, Huang QM, Liu QG, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015; 96(5):944–955.
Neck and shoulder pain
94

66
White A, Cummings M, Barlas P, et al. Defining an adequate dose of acupuncture using a neurophysiological approach--a narrative review of the literature. Acupunct Med. 2008; 26(2):111–120.
Neurophysiological
93

67
Kwon YD, Pittler MH, Ernst E. Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2006; 45(11):1331–1337.
Peripheral joint osteoarthritis
93

68
Asher GN, Jonas DE, Coeytaux RR, et al. Auriculotherapy for pain management: a systematic review and meta-analysis of randomized controlled trials. J Altern Complement Med. 2010; 16(10):1097–1108.
Pain
90

69
Cho SH, Lee JS, Thabane L, Lee J. Acupuncture for obesity: a systematic review and meta-analysis. Int J Obes (Lond). 2009; 33(2):183–196.
Obesity
89

70
Lim B, Manheimer E, Lao L, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006; (4):CD005111. Published 2006 Oct 18.
Irritable bowel syndrome
89

71
Ernst E, Pittler MH. The effectiveness of acupuncture in treating acute dental pain: a systematic review. Br Dent J. 1998; 184(9):443–447.
Acute dental pain
88

72
Lee A, Chan SK, Fan LT. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2015; 2015(11):CD003281. Published 2015 Nov 2.
Postoperative nausea and vomiting
87

73
Cao H, Pan X, Li H, Liu J. Acupuncture for treatment of insomnia: a systematic review of randomized controlled trials. J Altern Complement Med. 2009; 15(11):1171–1186.
Insomnia
86

74
Casimiro L, Barnsley L, Brosseau L, et al. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev. 2005; (4):CD003788. Published 2005 Oct 19.
Rheumatoid arthritis
84

75
Park J, Hopwood V, White AR, Ernst E. Effectiveness of acupuncture for stroke: a systematic review. J Neurol. 2001; 248(7):558–563.
Stroke
84

76
Corbett MS, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M, Sutton AJ, Macpherson H, Woolacott NF. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage. 2013 Sep; 21(9):1290–8.
Osteoarthritis of the knee
82

77
Zhang J, Shang H, Gao X, Ernst E. Acupuncture-related adverse events: a systematic review of the Chinese literature. Bull World Health Organ. 2010; 88(12):915–921C.
Adverse events
81

78
Adams D, Cheng F, Jou H, Aung S, Yasui Y, Vohra S. The safety of pediatric acupuncture: a systematic review. Pediatrics. 2011; 128(6):e1575-e1587.
Pediatric acupuncture
80

79
Yamashita H, Tsukayama H, White AR, Tanno Y, Sugishita C, Ernst E. Systematic review of adverse events following acupuncture: the Japanese literature. Complement Ther Med. 2001; 9(2):98–104.
Adverse events
75

80
Lee H, Schmidt K, Ernst E. Acupuncture for the relief of cancer-related pain--a systematic review. Eur J Pain. 2005; 9(4):437–444.
Cancer-related pain
74

81
Brosseau L, Milne S, Robinson V, et al. Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a meta-analysis. Spine (Phila Pa 1976). 2002; 27(6):596–603.
Chronic low back pain
74

82
Linde K, Niemann K, Meissner K. Are sham acupuncture interventions more effective than (other) placebos? A re-analysis of data from the Cochrane review on placebo effects. Forsch Komplementmed. 2010; 17(5):259–264.
Placebo effects
73

83
Dowswell T, Bedwell C, Lavender T, Neilson JP. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database Syst Rev. 2009; (2):CD007214. Published 2009 Apr 15.
Pain relief in labour
73

84
Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013; 38(24):2124–2138.
Nonspecific chronic low back pain
72

85
Dodin S, Blanchet C, Marc I, et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst Rev. 2013; 2013(7):CD007410. Published 2013 Jul 30.
Menopausal hot flushes
71

86
Yeung WF, Chung KF, Poon MM, et al. Acupressure, reflexology, and auricular acupressure for insomnia: a systematic review of randomized controlled trials. Sleep Med. 2012; 13(8):971–984.
Insomnia
71

87
Mayhew E, Ernst E. Acupuncture for fibromyalgia--a systematic review of randomized clinical trials. Rheumatology (Oxford). 2007; 46(5):801–804.
Fibromyalgia
70

88
Manyanga T, Froese M, Zarychanski R, et al. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med. 2014; 14:312. Published 2014 Aug 23.
Osteoarthritis
68

89
Cheuk DK, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database Syst Rev. 2012; (9):CD005472. Published 2012 Sep 12.
Insomnia
68

90
Hurlow A, Bennett MI, Robb KA, Johnson MI, Simpson KH, Oxberry SG. Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults. Cochrane Database Syst Rev. 2012; 2012(3):CD006276. Published 2012 Mar 14.
Cancer pain
68

91
Vas J, Perea-Milla E, Méndez C, et al. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: a randomized controlled study. Pain. 2006; 126(1–3):245–255.
Chronic uncomplicated neck pain
67

92
Streitberger K, Ezzo J, Schneider A. Acupuncture for nausea and vomiting: an update of clinical and experimental studies. Auton Neurosci. 2006; 129(1–2):107–117.
Nausea and vomiting
67

93
Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017; 47(3):133–149.
Musculoskeletal conditions
66

94
Li H, He T, Xu Q, et al. Acupuncture and regulation of gastrointestinal function. World J Gastroenterol. 2015; 21(27):8304–8313.
Gastrointestinal function
66

95
Lee JH, Choi TY, Lee MS, Lee H, Shin BC, Lee H. Acupuncture for acute low back pain: a systematic review. Clin J Pain. 2013; 29(2):172–185.
Acute low back pain
66

96
Leo RJ, Ligot JS Jr. A systematic review of randomized controlled trials of acupuncture in the treatment of depression. J Affect Disord. 2007; 97(1–3):13–22.
Depression
66

97
Zhang SH, Liu M, Asplund K, Li L. Acupuncture for acute stroke. Cochrane Database Syst Rev. 2005; (2):CD003317. Published 2005 Apr 18.
Acute stroke
66

98
Wu MS, Chen KH, Chen IF, et al. The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. PLoS One. 2016; 11(3):e0150367. Published 2016 Mar 9.
Postoperative pain
65

99
Zhou J, Peng W, Xu M, Li W, Liu Z. The effectiveness and safety of acupuncture for patients with Alzheimer disease: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2015; 94(22):e933.
Alzheimer’s disease
65

100
MacPherson H, Maschino AC, Lewith G, et al. Characteristics of acupuncture treatment associated with outcome: an individual patient meta-analysis of 17,922 patients with chronic pain in randomized controlled trials [published correction appears in PLoS One. 2013; 8(12).
Chronic pain
65

As to the authors, the results showed that there were 14 corresponding authors who published more than one study and 10 authors who published more than one study as first authors. In terms of the corresponding authors, Edzard Ernst and Linde Klaus published the most studies (n = 7). The author with most studies as the first author was Edzard Ernst who published 6 studies. Table 2 summarised the characteristics of the authors.

Table 2: Authors with more than 1 study as first author or corresponding author included in the 100 most-cited studies.

Author
Name
Number of studies

Corresponding author
Ernst E
7

Linde K
7

Manheimer E
5

Vickers AJ
3

Lee A
3

Hrobjartsson A
2

Lee H
2

Trinh KV
2

White A
2

Liu JP
2

Furlan AD
2

Ezzo J
2

Brosseau, L
2

Bjordal JM
2

First author
Ernst E
6

Linde K
5

Furlan AD
3

Lee A
3

Vickers AJ
3

Manheimer E
3

Trinh KV
2

White A
2

Bjordal JM
2

Ezzo J
2

As shown in Table 3, the 100 most-cited systematic reviews or meta-analyses were from 16 countries, respectively. The USA ranked first with 24 studies, followed by England (n = 23) and China (n = 14). When considering the average citation, the average citations of the Chinese authors were less than authors from other countries.

Table 3: Country of origin of the 100 most-cited studies (based on country of the first author).

Addresses
Number of studies
Total citations
Average citation
Number of studies in each ranking

50–99
100–149
150–199
200–249
250–299
300–349
350–399
400–449
450–499
500–549
550–599

USA
24
3,920
163
4
10
5

3

1

England
23
3,158
137
8
6
5
2

1

China
14
1,299
93
11
2

1

Canada
11
1,237
112
5
5

1

Germany
10
1,335
134
3
5

1
1

Australia
4
721
180

1
2
1

Denmark
2
432
216

1
1

Netherlands
1
206
206

1

Norway
2
389
195

1
1

South Korea
3
229
76
3

Japan
1
75
75
1

Ireland
1
72
72
1

Spain
1
67
67
1

Israel
1
109
109

1

Switzerland
1
106
106

1

North Ireland
1
104
104

1

Table 4 shows institutions that published at least two most-cited studies. There were four institutions from England that published at least two most-cited studies, including the Universities of Exeter and Plymouth, the University of Exeter, the University of York, and Research Council for Complementary Medicine. As for the number of most-cited studies, the Technical University of Munich in Germany and the University of Maryland School of Medicine in the USA all ranked the first with eight studies; the Universities of Exeter and Plymouth in England ranked the second with seven studies.

Table 4: Institutions with at least 2 studies based on the institution of the corresponding authors included in the 100 most-cited studies.

Country
Institution
Number of studies

Canada

8

University of Ottawa
4

McMaster University
2

Institute for Work & Health
2

China

7

Beijing University of Chinese Medicine
2

University of Hong Kong
3

Chinese University of Hong Kong
2

England

17

Universities of Exeter and Plymouth
6

University of Exeter
6

The University of York
3

Research Council for Complementary Medicine
2

Germany

10

Technische Universität München
8

Nordic Cochrane Centre
2

South Korea

2

Kyung Hee University
2

USA

10

University of Maryland School of Medicine
8

Memorial Sloan Kettering Cancer Center
2

Table 5 shows the published year of the 100 most-cited systematic reviews or meta-analyses. Most of these studies were published in 2009 (n = 9) and 2010 (n = 9), and 8 studies were published in 2005, 2008, and 2013.

Table 5: Distribution by year of publication of the 100 most-cited studies.

Year
Number of study
Total citation
Average citation

1989
1
106
106

1996
1
202
202

1997
1
120
120

1998
3
672
224

1999
5
724
145

2000
2
440
220

2001
5
729
146

2002
2
170
85

2003
4
694
174

2004
2
339
170

2005
8
1,365
171

2006
7
688
103

2007
6
772
129

2008
8
960
120

2009
9
1,221
136

2010
9
968
108

2011
2
182
91

2012
7
1,340
192

2013
8
795
99

2014
2
288
144

2015
4
312
78

2016
2
160
80

2017
1
66
66

2018
1
146
146

The 100 most-cited systematic reviews or meta-analyses were published in 50 journals (Table 6). Two systematic reviews or meta-analyses were from stroke and were cited with an average of 133 times, which was in the moderate level. Among the 50 journals, impact factors (2020) of 5 journals were higher than 10, including Annals of Internal Medicine, British Journal of Sports Medicine, British Medical Journal, Journal of Clinical Oncology, and JAMA Internal Medicine.

Table 6: Journals in which the 100 most-cited studies were published.

Journal
Abbreviated name
Articles included in top 100 cited
Total citations
Average citation/article
Impact factor (2021)

Archives of Internal Medicine
Arch. Intern. Med.
2
736
368
NA

Annals of Internal Medicine
Ann. Intern. Med.
3
661
220
21.316

Archives of Physical Medicine and Rehabilitation
Arch. Phys. Med. Rehabil.
2
332
166
3.097

Anesthesia and Analgesia
Anesth. Analg.
1
187
187
4.307

Arthritis and Rheumatism
Arthritis Rheum.
1
171
171
NA

American Journal of Medicine
Am. J. Med.
1
161
161
4.528

Alternative Therapies in Health and Medicine
Altern. Ther. Health Med.
1
122
122
0.939

Acupuncture in Medicine
Acupunct. Med.
1
93
93
2.127

Autonomic Neuroscience: Basic & Clinical
Auton. Neurosci-Basic Clin.
1
67
67
2.2

British Journal of Sports Medicine
Br. J. Sports Med.
1
198
198
12.021

British Medical Journal
BMJ
2
310
155
30.22

BMC Musculoskeletal Disorders
BMC Musculoskelet. Disord.
1
186
186
1.878

British Journal of Anaesthesia
Br. J. Anaesth.
1
160
160
6.881

Bioelectromagnetics
Bioelectromagnetics
1
139
139
2.277

BMC Medicine
BMC Med.
1
115
115
6.783

British Dental Journal
Br. Dent. J.
1
88
88
1.306

Bulletin of the World Health Organization
Bull. World Health Organ.
1
81
81
6.962

BMC Complementary and Alternative Medicine
BMC Complement. Altern. Med.
1
68
68
2.831

Controlled Clinical Trials
Control Clin. Trials
1
425
425
NA

Cochrane Database of Systematic Reviews
Cochrane Database Syst. Rev.
20
2,360
118
7.893

Clinical Journal of Pain
Clin. J. Pain
1
66
66
2.891

Cephalalgia
Cephalalgia
1
133
133
4.867

Complementary Therapies in Medicine
Complement. Ther. Med.
2
192
96
2.064

Journal of Internal Medicine
J. Intern. Med.
2
397
199
6.874

Journal of the Royal Society of Medicine
J. R. Soc. Med.
1
202
202
5.239

Journal of Alternative and Complementary Medicine
J. Altern. Complement Med.
3
344
115
2.105

Journal of Clinical Oncology
J. Clin. Oncol.
1
163
163
32.959

Journal of Pain
J. Pain
1
146
146
4.62

JAMA Internal Medicine
JAMA Intern. Med.
1
140
140
18.654

Journal of Orthopaedic and Sports Physical Therapy
J. Orthop. Sports Phys. Ther.
2
202
101
3.839

Journal of Affective Disorders
J. Affect. Disord.
2
180
90
3.891

Journal of the American Board of Family Medicine
J. Am. Board Fam. Med.
1
109
109
2.663

The Journal of Family Practice
J. Fam. Pract.
1
100
100
0.693

journal of Neurology
J. Neurol.
1
84
84
3.958

Journal of Pediatric Hematology Oncology
J. Pediatr. Hematol. Oncol.
1
104
104
1.016

Pain
Pain
6
866
144
5.481

PLoS one
PLoS One
5
735
147
2.742

SPINE
SPINE
5
616
123
2.646

European Journal of Pain
Eur. J. Pain
3
444
148
3.49

Rheumatology
RHEUMATOLOGY
5
574
115
5.605

Evidence-Based Complementary and Alternative Medicine
Evid.-based Complement Altern. Med.
1
145
145
1.812

Stroke
Stroke
2
225
113
7.194

International Journal of Epidemiology
Int. J. Epidemiol.
1
106
106
7.708

International Journal of Obesity
Int. J. Obes.
1
89
89
NA

Osteoarthritis and Cartilage
Osteoarthritis Cartilage
1
82
82
4.79

Pediatrics
Pediatrics
1
80
80
5.359

Forsch Komplementarmed
Forsch. Komplement.med
1
73
73
NA

Sleep Medicine
Sleep Med.
1
71
71
3.035

World Journal of Gastroenterology
World J. Gastroenterol
1
66
66
3.669

Medicine (Baltimore)
Medicine (Baltimore)
1
65
65
1.552

The cocitation of the 100 top-cited studies is shown in Figure 1. The most frequent cocited study was about quantifying heterogeneity in a meta-analysis (n = 31) published by Controlled Clinical Trials in 1996. The most frequent cocitied source was Pain (n = 280). Edzard Ernst from the University of Exeter in England was the most frequent cocitied author (n = 70).

(a)

(b)

(c)

Figure 1: The cocitation between the included studies. (a) The most frequent cocitation reference: Studies by Controlled Clinical Trials, British Medical Journal, and Annals of Internal Medicine were the most frequently cocitation references. (b) The most frequent cocitation source: Studies from Pain, Acupuncture in Medicine, Spine, and British Medical Journal were the most frequently cocitation source. (c) The most frequent cocitation author. Studies by Edzard Ernst, Linde Klaus, MacPherson, and Hugh are the most frequently cocitation author.

4. Discussion

Acupuncture is undoubtedly valuable in Chinese traditional medicine. It is effective, especially in reducing chronic pain, such as cervical spondylosis and the management of low back pain [15–17]. In the field of acupuncture research, citation of studies varied. The most-cited studies ranked the highest position and could show research ability and development in different countries and institutions. Thus, analyzing the most-cited studies would help future studies.

The numbers of citations of the 100 most-cited systematic reviews or meta-analyses were considerable. The data indicated that the researchers in the medical field give huge attention to acupuncture. Our results showed the top researches of acupuncture, investigating the distribution of authors, countries, institutions, year, and journals. The study showed that authors from the USA published most studies among the 100 most-cited studies. Although China is the birth land of acupuncture, the number of Chinese studies was only 14. Traditional Chinese clinicians might always focus on the clinical practice, ignoring the research, especially the study using modern scientific methods [18]. On the contrary, western researchers were proficient in research methods. So when they develop great interests in this field, they could perform studies with high quality.

The institutions revealed that researchers in famous research-based universities or hospitals made huge efforts to investigate the principle and effectiveness of acupuncture, such as Technische Universität München, Harvard University, Massachusetts General Hospital, and the University of Maryland School of Medicine. Acupuncture was the traditional therapeutic method with large varieties of clinical practice, especially in China and other East Asian countries, which suggest that more attention should be paid to China in international journals.

In terms of journals, the number of systematic reviews or meta-analyses from the Cochrane Database of Systematic Reviews was the largest (n = 20) because this journal is dedicated to publishing systematic reviews. Besides, some highly influential journals, such as Annals of Internal Medicine, BMJ, and Journal of Clinical Oncology, also published some studies in this field. It is undoubted that papers published in highly influential journals would be cited more because of the great reputation of these journals; thus, we should publish more studies in highly influential journals.

In terms of the cocitation of the 100 most-cited studies, the results indicated that the most-cited studies were published in Pain; this might be related to the limitation of understanding on acupuncture by foreign researchers. Hence, it suggested that editors and authors should choose other interesting research topics of studies in the future.

It should be noted that Chinese researchers contributed 14 papers, and some Chinese authors were really outstanding. Jian-Ping Liu from Beijing University of Chinese Medicine published 1 study in PLoS One [19] and Journal of Alternative and Complementary Medicine [20]. Lee Anna from the Chinese University of Hong Kong published 2 studies in the Cochrane Database of Systematic Reviews [21, 22]. Sze, FKH from Shatin Hospital in Hong Kong published 1 study in Stroke [23], while Huang Qiang-Min from Shanghai University of Sports in Shanghai published 1 study in Archives of Physical Medicine and Rehabilitation [24]. It should be noted that acupuncture was used most widely in China; due to language constraints, some excellent Chinese studies might not be cited, which might bias the conclusion of this study. The strengthening of exchanges and cooperation with international institutions and institutions had been identified as a priority in the acupuncture field. Hence, the acupuncture researchers should pay attention to the research in high-impact institutions and published high-impact researches in a timely manner, in order to promote interinstitutional cooperation and exchanges.

There were some limitations of our study. Our electronic search was performed in the Web of Science Core Collection. As a result, the bias of searching cannot be avoided [25]. In addition, a number of studies conducted by Chinese researchers were published in Chinese journals and have not been included in the current study, so the results should be explained with caution.

In conclusion, our study revealed that the 100 most-cited systematic reviews or meta-analyses in the acupuncture research field are mostly from high impact factors journals and are mostly from western counties. It will help researchers follow research hot spots, broaden their research scope, expand their academic horizons, and explore new research ideas, thereby improving the quality of acupuncture research.

Data Availability

The original data used to support the findings of this study are included within the article.

Disclosure

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

The corresponding author attests that all listed authors meet authorship criteria. Yonggang Zhang, Ning Li, and Nian Li provided ideas and designed the manuscript. Ying He and Yuxi Li collected and analyzed data. Ying He and Yonggang Zhang wrote the first draft of the manuscript. Juan Li, Ning Li, Yonggang Zhang, and Nian Li revised the manuscript. All authors read and approved the final manuscript.

Acknowledgments

This study was supported by the National Natural Science Foundation of China (grant no. 82004213) and the Project of Sichuan Provincial Department of Science and Technology (no. 2021YFH0191).

References

Y. Zhuang, J.-j. Xing, J. Li, B.-Y. Zeng, and F.-r. Liang, “History of acupuncture research,” International Review of Neurobiology, vol. 111, pp. 1–23, 2013.

T. J. Kaptchuk, “Acupuncture: theory, efficacy, and practice,” Annals of Internal Medicine, vol. 136, no. 5, pp. 374–383, 2002.

Y.-Y. Kung, S.-J. Hwang, T.-F. Li, S.-G. Ko, C.-W. Huang, and F.-P. Chen, “Trends in global acupuncture publications: an analysis of the Web of Science database from 1988 to 2015,” Journal of the Chinese Medical Association, vol. 80, no. 8, pp. 521–525, 2017.

I.-S. Lee and Y. Chae, “A bibliometric analysis of acupuncture research trends in Acupuncture in Medicine,” Acupuncture in Medicine, vol. 37, no. 6, pp. 375–377, 2019.

A. S. Mohammad, K. Ali, H. Gholamreza, N. Behdad, M. S. Abolfazl, and M. M. Saber, “An overview and mapping of childhood tuberculosis: prevalence, scientific production and citation analysis,” Indian Journal of Tuberculosis, vol. 60, no. 1, 2013.

S. A. Azer and A. Sarah, “Top-cited articles in medical professionalism: a bibliometric analysis versus altmetric scores,” BMJ Open, vol. 9, no. 7, 2019.

J. S Brandt, H. Ola, S. Meike, R. Todd, M. V. Sauer, and C. V. Ananth, “A bibliometric analysis of top-cited journal articles in obstetrics and gynecology,” JAMA network open, vol. 2, no. 12, 2019.

F. Yuan, J. Cai, B. Liu, X. Tang, and G. Mahady, “Bibliometric analysis of 100 top-cited articles in gastric disease,” BioMed Research International, vol. 2020, Article ID 2672373, 8 pages, 2020.

W. Shuaib, J. N. Acevedo, M. S. Khan, L. J. Santiago, and T. J. Gaeta, “The top 100 cited articles published in emergency medicine journals,” American Journal of Emergency Medicine, vol. 33, no. 8, pp. 1066–1071, 2015.

A. I. Arshad, P. Ahmad, M. I. Karobari et al., “Antibiotics: a bibliometric analysis of top 100 classics,” Antibiotics, vol. 9, no. 5, 2020.

L. C. Ho, C. T. Wei, and Y. Y. Hua, “Predicting the number of article citations in the field of attention-deficit/hyperactivity disorder (ADHD) with the 100 top-cited articles since 2014: a bibliometric analysis,” Annals of General Psychiatry, vol. 20, no. 1, 2021.

A. J. Vickers, A. M. Cronin, A. C. Macshino et al., “Acupuncture for chronic pain: individual patient data meta-analysis,” Archives of Internal Medicine, vol. 172, no. 19, 2012.

A. Vickers, N. Goyal, R. Harland, and R. Rees, “Do certain countries produce only positive results? a systematic review of controlled trials,” Controlled Clinical Trials, vol. 19, no. 2, 1998.

J. Ezzo, B. Berman, V. A. Hadhazy, A. R. Jadad, L. Lao, and B. B. Singh, “Is acupuncture effective for the treatment of chronic pain? a systematic review,” Pain, vol. 86, no. 3, 2000.

M. Cummings, A. Hróbjartsson, and E. Ernst, “Should doctors recommend acupuncture for pain?” British Medical Journal, vol. 360, p. k970, 2018.

U. Ivan, W. J. Kway, Y. Kristina et al., “Acupuncture for the management of low back pain,” Current Pain and Headache Reports, vol. 25, no. 1, 2021.

R. Rubin, “Medicare proposes coverage of acupuncture for lower back pain,” Journal of the American Medical Association, vol. 322, no. 8, p. 716, 2019.

L. Xing and X. Yan-ming, “What can comparative effectiveness research, propensity score and registry study bring to Chinese medicine?” Chinese Journal of Integrative Medicine, vol. 20, no. 10, 2014.

The PLoS One Staff, “Correction: manual acupuncture for treatment of diabetic peripheral neuropathy: a systematic review of randomized controlled trials,” PLoS One, vol. 9, no. 3, Article ID e91110, 2014.

C. Huijuan, P. Xingfang, L. Hua, and L. Jianping, “Acupuncture for treatment of insomnia: a systematic review of randomized controlled trials,” Journal of Alternative and Complementary Medicine (New York, N. Y.), vol. 15, p. 11, 2009.

L. Anna, S. K. C. Chan, and L. T. Y. Fan, “Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting,” Cochrane Database of Systematic Reviews, vol. 11, 2015.

L. Anna and F. L. Ty, “Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting,” Cochrane Database of Systematic Reviews, vol. 2, 2009.

F. K. Sze, E. Wong, K. K. H. Or, J. Lau, and J. Woo, “Does acupuncture improve motor recovery after Stroke?: a meta-analysis of randomized controlled trials,” Stroke: Journal of the American Heart Association, vol. 33, no. 11, 2002.

L. Lin, H. Qiang-Min, L. Qing-Guang et al., “Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis,” Archives of Physical Medicine and Rehabilitation, vol. 96, no. 5, 2015.

S. Zhang, H. Fan, and Y. Zhang, “The 100 top-cited studies on dyslexia research: a bibliometric analysis,” Frontiers in Psychiatry, vol. 12, 2021.