Evidence-Based Complementary and Alternative Medicine journals, emphasize the importance of making CONSORT and STRICTA more widely known and applied. This point is highlighted by a recent survey of high impact journals (n = 165), of which only 62 (38%) mentioned the CONSORT statement in their online “Instructions to Authors” while 23 (14%) stated that a completed CONSORT statement was a condition of submission [39]. Lack of adequate reporting is not unique to English language publications. A recent review of adherence to CONSORT in 142 RCTs from ﬁve leading Chinese medical journals indicated an overall low quality of reporting [40–42]. The translations of both CONSORT and STRICTA into several Asian languages should help the dissemination eﬀort [43–46]. In regard to the seven lowest-scoring OCSI questions (those with mean score <1.0), several recommendations can be made to the acupuncture research community. The sole question from STRICTA within this group (question no. 8) is important since practitioner training and experience may signiﬁcantly aﬀect the outcome of a trial. The low reporting of this item is consistent with the recent assessment of STRICTA items [34] and is also reﬂected in the low ranking of the utility of this question by authors of acupuncture trials [47]. The importance of reporting practitioner training and experience is clearly emphasized in the revised STRICTA Recommendations [48]. Five items from this group (ques- tions nos. 12–16) pertain to aspects of the randomization and blinding procedures. As recommended in CONSORT, trans- parent reporting of these items is necessary to ascertain that selection and performance biases have been reduced [17]. A further low-scoring question (no. 23) is that calling for reporting of adverse events. Data on this topic is of general importance and is a particularly relevant comparator in RCTs of acupuncture versus biomedical standard of care [49]. The mean OCSI score (63.0%; median 64%) of the 333 acupuncture RCTs included in the present review indicates a moderate level of adherence to the CONSORT and STRICTA guidelines. This score is somewhat higher than those from a study that assessed observance of STRICTA as well as a selected set of CONSORT recommendations in samplings of acupuncture RCTs appearing both before and after publication of each set of guidelines [34]. It is also of interest that our subset of 209 acupuncture RCTs that appeared in biomedical (in contrast to CAM) journals received a mean score of 69.9%, similar to the adherence levels to CONSORT in assessments of RCTs of psychotropic pharmaceuticals [28], general medicine interventions [50, 51], endocrinology [23], and surgical procedures [27, 52]. Although a signiﬁcant trend toward an annual increase in reporting quality is apparent in our ﬁndings, the 68.7% mean OCSI score for the ﬁrst three-quarters of 2007 (the most recent period evaluated) indicates a continuing need to improve reporting in acupuncture RCTs. As a secondary analysis, composite scores were examined of both the CONSORT- and STRICTA-based questions. Analysis of CONSORT-based questions reveal an improvement of 18% over the 10-year period (P < .001, 95% CI = 0.011– 0.025), with STRICTA-based questions improving by 17% (P < .001; 95% CI = 0.006–0.017). While a similar increase in CONSORT-related reporting in acupuncture RCTs was 7 observed by Prady et al. [34], the STRICTA-related increase was not previously observed, a diﬀerence likely related to the inclusive (present study) rather than sampling (Prady et al.) approaches utilized. Although the increased trends are apparent, the overall mean OCSI score (63%) implies that reporting of the acupuncture intervention (STRICTA) needs improvement as much as reporting of general aspects of research design (CONSORT). Interpretation of our results is impacted by the included RCTs from China, which comprise, when ranked by country, both the largest number of trials and the lowest mean OCSI score (Table 2). When RCTs from China are excluded, the mean OCSI score increases from 63.0 (16.5) to 68.4 (13.5). A matter of concern is that many RCTs from China either did not actually randomize participants or utilized inadequate procedures [53]. It is likely that this ﬁnding adversely impacted, the OCSI score of RCTs from China. Although, over the decade examined the OCSI scores from China are consistently lower than those form all other countries, the translations of both CONSORT and STRICTA into Chinese should help to close the gap in quality of reporting [44]. A recent national eﬀort in China to improve trial design of acupuncture RCTs should also contribute to enhanced reporting quality [54]. Two further cautionary notes apply when considering interpretations of OCSI scores. First is the somewhat sur- prising ﬁnding that 54% of authors responding to a survey on their use of STRICTA reported that some checklist items were removed in the journal review process in response to editorial concern regarding space constraints [47]. If this is indeed a widespread occurrence, journals should be encouraged to request alternate means for authors to provide STRICTA and CONSORT details, for example, electronic links to an expanded methods section. Second, in calling for acupuncture RCTs to meet reporting standards set by CONSORT and STRICTA, it should be considered that many acupuncture trials have been and continue to be designed as “early phase” research [55]. This does not mean that such trials should be allowed a lower standard of reporting quality but it does indicate that the standards should be applied in a manner appropriate to the early stage of the research, when issues concerning patient recruitment, compliance, and retention are as critical to assess as are “hint of eﬃcacy” and maintenance of beneﬁt. For example, an early phase study should not “lose credit” for lack of reporting a sample size calculation if, in fact, no preliminary data existed on which to base such a calculation. Accordingly, in this case, the OCSI group decided that full credit should be awarded if a rationale was provided for the omission of a sample size calculation. In addition to the limitations of our ﬁndings discussed above, there are several areas to consider for improving the OCSI instrument itself. For example, our decision to keep the numbering, wording, and grouping of the questions similar to those of the parent guidelines should be reconsidered since it may be of advantage to split out some of the sub-questions into stand-alone questions. One example would be to track, as a separate full question, whether the success of blinding study participants was evaluated. In the current OCSI format, evaluation of blinding is scored as a sub-question