Level 2: Mid-level evidence

A randomized trial evaluated the impact of increased practitioner interaction in 262 patients (mean age 39 years) with irritable bowel syndrome (IBS) (BMJ. 2008;336:999-1003; full-text available online free of charge at: www.bmj.com/cgi/content/full/336/7651/999; accessed August 13, 2008). Patients were randomized to one of three groups for three weeks: waiting-list control vs. placebo acupuncture alone vs. placebo acupuncture plus patient-practitioner relationship augmented by warmth, attention, and confidence.Compared with waiting list, both acupuncture alone and acupuncture/practitioner relationship were associated with higher scores on mean global improvement scale, higher proportion of patients reporting adequate relief, and greater mean improvement in symptom severity score and quality of life score (in all instances P < 0.001). The use of sham acupuncture as a co-intervention limits the ability to conclude that increased practitioner interaction is uniquely associated with benefit.