Xin Zhang, Xue-Ting Liu, De-Ying Kang
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, P.R. China.
Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, P.R. China.
Sci Rep. 2015 Nov 12;5:16582. doi: 10.1038/srep16582.
Systematic reviews (SRs) of randomized controlled trials (RCTs) have demonstrated acupuncture's effectiveness in stroke rehabilitation. The current study reviews the quality of evidence in SRs of acupuncture in stroke rehabilitation, and rates the strength of recommendation for its use based on this evidence using the GRADE (grading of recommendations, assessment, development and evaluations) approach. A comprehensive literature search was performed using multiple databases (e.g., Medline, Embase) with advanced search strategies. Two authors independently selected articles, collected data, and assessed the methodological quality of each identified SR according to AMSTAR (a measurement tool to assess systematic reviews) and OQAQ (Oxman and Guyatt's overview quality assessment questionnaire). Outcomes related to stroke rehabilitation were evaluated. SRs of high methodological quality (AMSTAR score ≥9 and OQAQ score ≥7) were graded using GRADE. Ultimately, acupuncture yields benefits in stroke rehabilitation (neurological function improvement: RR = 1.34; swallowing improvement: RR = 1.61, 1.49, 1.07; disability: SMD = 0.49 or 0.07). Poor evidentiary quality and insufficient information about harm led to weak recommendations. In conclusion, acupuncture may improve stroke rehabilitation, as the GRADE approach indicated a weak recommendation for acupuncture's usage in this context.
随机对照试验的系统评价（SRs）已证明针刺在中风康复中的有效性。本研究回顾了针刺治疗中风康复的系统评价中的证据质量，并使用GRADE（推荐分级、评估、制定和评价）方法根据该证据对其使用的推荐强度进行评级。使用多个数据库（如Medline、Embase）并采用高级检索策略进行了全面的文献检索。两位作者独立选择文章、收集数据，并根据AMSTAR（一种评估系统评价的测量工具）和OQAQ（奥克斯曼和盖亚特的综述质量评估问卷）评估每个纳入的系统评价的方法学质量。对与中风康复相关的结局进行了评估。方法学质量高的系统评价（AMSTAR评分≥9且OQAQ评分≥7）使用GRADE进行分级。最终，针刺在中风康复中产生了益处（神经功能改善：RR = 1.34；吞咽改善：RR = 1.61、1.49、1.07；残疾：SMD = 0.49或0.07）。证据质量差和关于危害的信息不足导致推荐力度较弱。总之，针刺可能改善中风康复，因为GRADE方法表明在这种情况下对针刺使用的推荐力度较弱。
