确定失眠治疗和护理的补充和替代医学建议：系统评价和综合临床实践指南的批判性评估。

Identifying complementary and alternative medicine recommendations for insomnia treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines.

机构信息

School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.

Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China.

出版信息

Front Public Health. 2023 Jun 15;11:1157419. doi: 10.3389/fpubh.2023.1157419. eCollection 2023.

DOI:10.3389/fpubh.2023.1157419

PMID:37397764

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10308125/

Abstract

BACKGROUND

There is a need for evidence-informed guidance on the use of complementary and alternative medicine (CAM) for insomnia because of its widespread utilization and a lack of guidance on the balance of benefits and harms. This systematic review aimed to identify and summarize the CAM recommendations associated with insomnia treatment and care from existing comprehensive clinical practice guidelines (CPGs). The quality of the eligible guidelines was appraised to assess the credibility of these recommendations.

METHODS

Formally published CPGs incorporating CAM recommendations for insomnia management were searched for in seven databases from their inception to January 2023. The NCCIH website and six websites of international guideline developing institutions were also retrieved. The methodological and reporting quality of each included guideline was appraised using the AGREE II instrument and RIGHT statement, respectively.

RESULTS

Seventeen eligible GCPs were included, and 14 were judged to be of moderate to high methodological and reporting quality. The reporting rate of eligible CPGs ranged from 42.9 to 97.1%. Twenty-two CAM modalities were implicated, involving nutritional or natural products, physical CAM, psychological CAM, homeopathy, aromatherapy, and mindful movements. Recommendations for these modalities were mostly unclear, unambiguous, uncertain, or conflicting. Logically explained graded recommendations supporting the CAM use in the treatment and/or care of insomnia were scarce, with bibliotherapy, Tai Chi, Yoga, and auriculotherapy positively recommended based on little and weak evidence. The only consensus was that four phytotherapeutics including valerian, chamomile, kava, and aromatherapy were not recommended for insomnia management because of risk profile and/or limited benefits.

CONCLUSIONS

Existing guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development. More well-designed studies to provide reliable clinical evidence are therefore urgently needed. Allowing the engagement of a range of interdisciplinary stakeholders in future updates of CPGs is also warranted.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369155, identifier: CRD42022369155.

摘要

背景

由于互补和替代医学（CAM）在失眠治疗中的广泛应用，以及缺乏关于其益处和危害平衡的指导，因此需要有循证医学指导来使用 CAM。本系统评价旨在从现有的综合临床实践指南（CPG）中确定和总结与失眠治疗和护理相关的 CAM 建议。评估合格指南的质量，以评估这些建议的可信度。

方法

从七个数据库中检索了从成立到 2023 年 1 月纳入 CAM 失眠管理建议的正式发表的 CPG，并检索了 NCCIH 网站和六个国际指南制定机构的网站。使用 AGREE II 工具和 RIGHT 声明分别评估每个纳入指南的方法学和报告质量。

结果

纳入了 17 项合格的 GCP，其中 14 项被评为方法学和报告质量中等至较高。合格 CPG 的报告率范围为 42.9%至 97.1%。涉及营养或天然产品、物理 CAM、心理 CAM、顺势疗法、芳香疗法和正念运动的 22 种 CAM 方式。对这些方式的建议大多不明确、不明确、不确定或相互矛盾。逻辑上解释的分级推荐支持在失眠的治疗和/或护理中使用 CAM，但很少有基于少量和薄弱证据的推荐，如图书疗法、太极拳、瑜伽和耳针疗法。唯一的共识是，由于风险状况和/或有限的益处，四种植物疗法（缬草、洋甘菊、卡瓦和芳香疗法）不推荐用于失眠管理。