■本研究旨在探讨针刺治疗急性中风时肢体功能障碍的剂量与疗效之间的关系。
■从七个数据库中搜索了研究,包括PubMed,Embase,科克伦图书馆,中国国家知识基础设施(CNKI),万方数据(WF),VIP信息数据库(VIP),和中国生物医学数据库(CBM)。从开始到2023年8月1日搜索所有数据库。使用CochraneCollaboration的偏倚风险工具(RoB2)评估偏倚风险。采用RevManV.5.4和Stata12.0统计软件进行Meta分析。我们使用Fugl-Meyer评估(FMA)来测量肢体功能障碍的恢复,NIH卒中量表(NIHSS)测量神经功能缺损,和Barthel指数,修改后的Barthel指数(MBI),和日常生活活动(ADL)来衡量日常生活活动。主要结果指标是FMA。在检查和整合原始数据后,我们采用3步流程进行了荟萃分析.首先,我们研究了不同剂量针刺的剂量相关效应,并确定了最大治疗效果的最佳剂量.第二,我们确定了相关结局的干预后评分和基线评分之间的差异,以确定最小临床重要差异(MCID),从而为临床治疗提供证据.第三,通过结合步骤1和步骤2的结果,我们提出了采用建议等级的建议,评估,开发和评估(等级)工具。
■纳入了26项包含1947名参与者的研究,其中61.5%的RCT偏倚风险较低.通过三步分析,不同针刺剂量对改善急性中风肢体功能障碍的作用不同。关于针灸的频率,结果表明,低(每隔一天)和中等频率(每天一次)组(低频率:MD:9.02,95CI:5.40-12.64,p<0.00001;中等频率:MD:10.11,95CI:5.05-15.18,p<0.00001,异质性(p=0.87),I2=0%)。对于针刺保留时间,结果显示短保留组与中保留组之间没有显着差异(短保留时间:MD:0.05,95%CI:-0.21-0.31,p=0.71;中保留时间:MD:-1.16,95%CI:-2.80-0.48,p=0.17,异质性(p<0.00001),I2=99%)。对于针灸的过程,结果显示短期治疗(少于2周)组(MD:14.87,95%CI:12.18-17.56,p<0.00001,异质性(p=0.45),I2=0%)。
■我们的研究证明了不同针刺剂量在改善肢体功能障碍方面的有效性。汇总的数据表明,针灸间隔时间的最佳干预剂量是低(每隔一天)和中等频率(每天一次),针疗程时间的最佳干预剂量为短疗程治疗(少于2周).但是我们没有找到最佳的干预剂量为针头保留时间。未来需要更高质量的研究来证实这一点。系统审查注册:https://www。crd.约克。AC.英国/PROSPERO/,CRD42023447202。
UNASSIGNED: This study aimed to investigate the relationship between the dose and efficacy of acupuncture in treating limb dysfunction during acute stroke.
UNASSIGNED: Studies were searched from seven databases, including PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), VIP information database (VIP), and China Biology Medicine Database (CBM). All databases were searched until August 1, 2023 from inception. The risk of bias was assessed using Cochrane Collaboration\'s risk of bias tool (RoB2). Meta-analyses were performed using RevMan V.5.4 and Stata 12.0 statistical software. We used Fugl-Meyer Assessment (FMA) to measure recovery of limb dysfunction, NIH Stroke Scale (NIHSS) to measure neurological deficits, and Barthel index, Modified Barthel Index (MBI), and Activities of Daily Living (ADL) to measure activities of daily living. The primary outcome measure is FMA. After examining and integrating the raw data, we performed a meta-analysis using a 3-step process. First, we investigated the dose-related effects of acupuncture at varying doses and determined the optimal dosage for maximum therapeutic benefits. Second, we determined the difference between post-intervention and baseline scores on the outcomes of interest to determine minimal clinically important differences (MCID) to provide evidence for clinical treatment. Third, by combining the results of step 1 and step 2, we made the recommendations employing the Grades of Recommendations, Assessment, Development and Evaluations (GRADE) tool.
UNASSIGNED: Twenty-six studies containing 1947 participants were included, among which 61.5% of RCTs had a low risk of bias. Through the three-step analysis, the effect in improving limb dysfunction of acute stroke varied across different acupuncture dosages. Regarding the frequency of acupuncture, the results demonstrated a significant improvement in the low (every other day) and moderate-frequency (once a day) groups (low frequency: MD: 9.02, 95%CI: 5.40-12.64, p < 0.00001; moderate frequency: MD: 10.11, 95%CI: 5.05-15.18, p < 0.00001, heterogeneity (p = 0.87), I2 = 0%). For the acupuncture retention time, the results showed no significant difference between the short and medium retention groups (short retention time: MD: 0.05, 95% CI: -0.21-0.31, p = 0.71; medium retention time: MD: -1.16, 95% CI: -2.80-0.48, p = 0.17, heterogeneity (p < 0.00001), I2 = 99%). For the course of acupuncture, the results showed a significant improvement in the short course treatment (less than 2 weeks) group (MD: 14.87, 95% CI: 12.18-17.56, p < 0.00001, heterogeneity (p = 0.45), I2 = 0%).
UNASSIGNED: Our study demonstrated the effectiveness of different acupuncture dose in improving limb dysfunction. The pooled data suggested that the optimal intervention dose for acupuncture interval time was low (every other day) and moderate frequency (once a day), the optimal intervention dose for needle course time was short course treatment (less than 2 weeks). But we did not find the optimal intervention dose for needle retention time. Future studies of higher quality are needed to confirm this.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, CRD42023447202.