未经证实:认知损害是中风后常见的后遗症之一,这不仅阻碍了患者的康复,而且增加了家庭的经济负担。在缺乏有效治疗措施的情况下,针灸治疗在中国已被广泛用于治疗中风后认知障碍(PSCI),但具体疗效尚不清楚。因此,本综述旨在评估针灸治疗PSCI患者的真实疗效。
未经评估:我们搜索了八个数据库[PubMed,Embase,WebofScience,Cochrane中央控制试验登记册,中国生物医学文献数据库(CBM),中国科技期刊(VIP)数据库,中国国家知识基础设施(CNKI)数据库,和万方数据库]从开始到2022年5月,用于与PSCI的针灸治疗联合认知康复(CR)相关的随机对照试验(RCT)。两名研究者独立使用预先设计的表格从符合条件的随机对照试验中提取有效数据。通过Cochrane协作组提供的工具评估偏倚风险。荟萃分析通过RevMan软件(5.4版)进行。使用GRADEprofiler软件评估获得的证据的强度。通过阅读全文收集不良事件(AE),用于评价针灸治疗的安全性。
UNASSIGNED:这项荟萃分析纳入了38项研究,共涉及2,971名参与者。总的来说,纳入本荟萃分析的RCT方法学质量较差.综合结果显示,在改善认知功能方面,针灸治疗联合CR与单独CR相比具有显着优势[平均差(MD)=3.94,95%置信区间(CI):3.16-4.72,P<0.00001(MMSE);MD=3.30,95CI:2.53-4.07,P<0.00001(MoCA);MD=9.53,95CI:5.61-13.45,TCP<0.00001)。此外,与单独使用CR相比,针灸治疗和CR的组合显着改善了患者的自我护理能力[MD=8.66,95CI:5.85-11.47,P<0.00001(MBI);MD=5.24,95CI:3.90-6.57,P<0.00001(FIM)]。同时,亚组分析显示,电针联合CR与单独CR相比,MMSE评分没有得到充分改善(MD=4.07,95CI:-0.45~8.60,P=0.08).然而,我们还观察到,在改善PSCI患者的MoCA和MBI评分方面,电针联合CR优于单独使用CR[MD=2.17,95CI:0.65~3.70,P=0.005(MoCA);MD=1.74,95CI:0.13~3.35,P=0.03(MBI)].针刺联合CR治疗与单纯CR治疗的不良事件(AE)发生率差异无统计学意义(P>0.05)。由于研究设计中的缺陷和纳入研究之间的相当大的异质性,证据的确定性被评为低水平。
UNASSIGNED:这篇综述发现,针灸治疗联合CR可能对改善PSCI患者的认知功能和自我护理能力具有积极作用。然而,由于存在方法学质量问题,我们的研究结果应谨慎对待。未来迫切需要高质量的研究来验证我们的结果。
UNASSIGNED:https://www。crd.约克。AC.uk/prospro/display_record.php?ID=CRD42022338905,标识符:CRD42022338905。
UNASSIGNED: Cognitive impairment is one of the common sequelae after stroke, which not only hinders the recovery of patients but also increases the financial burden on families. In the absence of effective therapeutic measures, acupuncture treatment has been widely used in China to treat post-stroke cognitive impairment (PSCI), but the specific efficacy is unclear. Therefore, this
review aimed to evaluate the true efficacy of acupuncture treatment in patients with PSCI.
UNASSIGNED: We searched eight databases [PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, the China National Knowledge Infrastructure (CNKI) database, and Wan fang database] from the inception to May 2022 for randomized controlled trials (RCTs) related to acupuncture treatment combined with cognitive rehabilitation (CR) for PSCI. Two investigators independently used a pre-designed form to extract valid data from eligible RCTs. The risk of bias was assessed through tools provided by the Cochrane Collaboration. The meta-analysis was implemented through Rev Man software (version 5.4). The strength of the evidence obtained was evaluated using GRADE profiler software. Adverse events (AEs) were collected by reading the full text and used to evaluate the safety of acupuncture treatment.
UNASSIGNED: Thirty-eight studies involving a total of 2,971 participants were included in this meta-analysis. Overall, the RCTs included in this meta-analysis were poor in methodological quality. The combined results showed that acupuncture treatment combined with CR showed significant superiority compared to CR alone in terms of improving cognitive function [Mean Difference (MD) = 3.94, 95% confidence intervals (CI): 3.16-4.72, P < 0.00001 (MMSE); MD = 3.30, 95%CI: 2.53-4.07, P < 0.00001 (MoCA); MD = 9.53, 95%CI: 5.61-13.45, P < 0.00001 (LOTCA)]. Furthermore, the combination of acupuncture treatment and CR significantly improved patients\' self-care ability compared to CR alone [MD = 8.66, 95%CI: 5.85-11.47, P < 0.00001 (MBI); MD = 5.24, 95%CI: 3.90-6.57, P < 0.00001 (FIM)]. Meanwhile, subgroup analysis showed that MMSE scores were not sufficiently improved in the comparison of electro-acupuncture combined with CR versus CR alone (MD = 4.07, 95%CI: -0.45-8.60, P = 0.08). However, we also observed that electro-acupuncture combined with CR was superior to the use of CR alone in improving MoCA and MBI scores in patients with PSCI [MD = 2.17, 95%CI: 0.65-3.70, P = 0.005 (MoCA); MD = 1.74, 95%CI: 0.13-3.35, P = 0.03 (MBI)]. There was no significant difference in the occurrence of adverse events (AE) between acupuncture treatment combined with CR and CR alone (P > 0.05). The certainty of the evidence was rated low level because of flaws in the study design and considerable heterogeneity among the included studies.
UNASSIGNED: This
review found that acupuncture treatment combined with CR may have a positive effect on improving cognitive function and self-care ability in PSCI patients. However, our findings should be treated with caution owing to the existence of methodological quality issues. High-quality studies are urgently required to validate our results in the future.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338905, identifier: CRD42022338905.