Methodological quality of clinical practice guidelines and technical operation norms in acupuncture and moxibustion:...

The methodological quality of current acupuncture and moxibustion clinical practice guidelines and technical operation norms remain unclear. Given their potential impact on clinical decision-making and health policy, this study aimed to evaluate their quality using the AGREE II and STAR tools, and to explore the need for a tailored appraisal tool for Traditional Chinese Medicine (TCM) technical operation norms.

A methodological evaluation was conducted using standardized appraisal instruments. A systematic search across 14 databases identified guidelines and norms related to acupuncture and moxibustion published up to December 31, 2025. Two independent reviewers assessed the included documents using Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Scientific, Transparent, Applicable Rating (STAR) tools.

Seventy-six publications were included: 31 clinical practice guidelines and 45 technical operation norms. AGREE II results showed that 29 guidelines scored >50% in 4 out of 6 domains, while 7 norms met the criterion. STAR evaluation showed an overall score of 64.4% for guidelines versus 15.3% for norms.

This study found that acupuncture and moxibustion clinical practice guidelines generally demonstrate moderate methodological quality, whereas technical operation norms consistently show low scores across multiple domains, indicating substantial room for improvement. These findings also suggest that commonly used appraisal tools, such as AGREE II and STAR, may not fully capture the unique characteristics of TCM technical documents. Future work should develop TCM-specific appraisal tools and improve implementation.