1 2 3 4 5 9 10 11 12 13 6 7 8 Question (#) (a) 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Question (#) (b) Figure 1: Distribution of scores of individual OCSI questions: (a) items 1–13; (b) items 14–27. 6 2 1.8 1.6 1.4 re 1.2 o scn 1 a eM0.8 0.6 0.4 0.2 0 Acupunct Med (n = 11). Of these ﬁve journals, The Journal of Traditional Chinese Medicine, which accounted for the largest percentage of publications (11.7%), demonstrated the lowest mean OCSI score for its acupuncture RCTs (39.6%). Figure 3 shows mean OSCI and modeled scores over time for trials from all countries, from China alone, and from countries other than China. The mean OCSI scores from all countries demonstrate a signiﬁcant improvement of 30.9% over the ten-year period (P < .001). Signiﬁcant improve- ments are found in RCTs from China 37.3% (P < .005) and countries other than China 32.2% (P < .005) over time. The modeled mean 1998 OCSI score of RCTs from China (36.1%) is signiﬁcantly lower (P < .01) than the corresponding score from countries other than China (59.6%). The improvement on OCSI scores from China (1.4% per year, P < .005) as compared to the improvement in all other countries (1.7% per year, P < .001) is not signiﬁcantly diﬀerent (P < .42). 4. Discussion Creation of OCSI required two main steps: conversion of the combined guidelines into questions, including breakout of each multicomponent item into a nested set of sub- questions, and development of a manual that outlines criteria for scoring each question as yes, partial, no, or N/A. The former step resulted in a lengthier scoring instrument than we had initially envisioned (63 sub-questions grouped into 27 main questions). The latter, based in large part on the detailed rationales presented with CONSORT [17] and STRICTA, proved essential for applying OCSI and achieving interrater agreement. The acupuncture RCTs identiﬁed for scoring by OCSI revealed a strikingly broad diversity in both geographical origin and publication site, a ﬁnding supported by the recent review by Prady et al. [34]. These demographics, viewed in light of the considerable room for improvement in mean percentage OCSI scores of acupuncture trials appearing in both CAM (51.3, ±15.1) and biomedical (69.9, ±13.1) Evidence-Based Complementary and Alternative Medicine 2 1.8 1.6 1.4 re 1.2 o scn 1 a eM0.8 0.6 0.4 0.2 0 80 70 60 ) 50 n s(T40 RC30 20 10 0 80 75 70 )(%65 reo 60 c IsS 55 CO50 n ea 45 M 40 35 30 9 - 0 9 1 - 0 1 9 2 - 0 2 9 3 - 0 3 -0944 -0559 OCSI Score (%) 9 6 - 0 6 9 7 - 0 7 9 8 - 0 8 0 0 1 - 0 9 Figure 2: Distribution of OCSI scores across articles: scores binned by decile. 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 (year) Other than China All Countries China only Figure 3: OCSI scores over time grouped by RCTs from all countries, China only, and all countries other than China.