头皮针与计算机辅助认知康复治疗中风：随机对照试验的荟萃分析
Scalp acupuncture and computer assisted cognitive rehabilitation for stroke: A meta-analysis of randomised controlled trials.
作者信息
Xiao Jinliang, Wang Tian, Ye Bingyun, Tang Chunzhi
机构信息
Guangzhou University of Traditional Chinese Medicine Acupuncture Rehabilitation Clinical Medical College, Guangzhou, Guangdong, China.
The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong, China.
出版信息
Heliyon. 2023 Jul 11;9(7):e18157. doi: 10.1016/j.heliyon.2023.e18157. eCollection 2023 Jul.
OBJECTIVE
To assess the clinical effectiveness of scalp acupuncture and computer assisted cognitive rehabilitation in the treatment of cognitive impairment in stroke patients.
METHODS
The literatures published before August 2021 in the following databases were included: PubMed, Chinese Biomedical Database, Wanfang Database, China National Knowledge Infrastructure, Database of Chinese sci-tech periodicals (VIP), EBSCO Information Services, MEDLINE and Web of Science. Only randomised controlled trials (RCTs) were included. Primary outcomes were the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and Montreal Cognitive Assessment (MoCA). Our secondary outcome was Modified Barthel Index Score (MBI). The quality of all included trials was evaluated according to the Cochrane Collaboration. This protocol was registered in PROSPERO (CRD42016048528).
RESULTS
Sixteen articles were selected including 1333 patients. The result of the meta analysis showed that the combination of scalp acupuncture and computer assisted cognitive rehabilitation had a significant improvement in the cognitive impairments. The analysis of LOTCA showed the improvement on the LOTCA (p < 0.0001, n = 410, I2 = 86%, mean difference 8.31). The meta-analysis of the MOCA showed a weighted mean difference of 3.76 and 95% confidence intervals (CI) of 2.90-4.62 (p < 0.0001, n = 301). Besides, it was showed that the combination therapy played an important role in the improvement of the score of MBI with a weighted mean difference of 9.30 and 95% confidence intervals (CI) of 5.87-12.672 (p < 0.0001, n = 278).
CONCLUSIONS
Scalp acupuncture and computer assisted cognitive rehabilitation appears to be effective for stroke patients with respect to certain outcomes. However, the evidence thus far is inconclusive. Further high-quality RCTs following standardized guidelines with a low risk of bias are needed to confirm the effectiveness of acupuncture for postpartum depression.
目的
评估头皮针联合计算机辅助认知康复治疗脑卒中患者认知障碍的临床疗效。
方法
纳入2021年8月前在以下数据库发表的文献：PubMed、中国生物医学数据库、万方数据库、中国知网、维普中文科技期刊数据库、EBSCO信息服务平台、MEDLINE和科学引文索引。仅纳入随机对照试验（RCT）。主要结局指标为洛文斯顿作业疗法认知评定量表（LOTCA）和蒙特利尔认知评估量表（MoCA）。次要结局指标为改良Barthel指数评分（MBI）。根据Cochrane协作网对所有纳入试验的质量进行评估。本方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42016048528）。
结果
共纳入16篇文章，涉及1333例患者。Meta分析结果显示，头皮针联合计算机辅助认知康复对认知障碍有显著改善。LOTCA分析显示LOTCA评分有所提高（p < 0.0001，n = 410，I² = 86%，平均差值8.31）。MoCA的Meta分析显示加权平均差值为3.76，95%置信区间（CI）为2.90 - 4.62（p < 0.0001，n = 301）。此外，结果显示联合治疗在改善MBI评分方面发挥了重要作用，加权平均差值为9.30，95%置信区间（CI）为5.87 - 12.672（p < 0.0001，n = 278）。
结论
头皮针联合计算机辅助认知康复在某些结局方面对脑卒中患者似乎有效。然而，目前的证据尚无定论。需要进一步开展遵循标准化指南且偏倚风险低的高质量随机对照试验，以证实针灸治疗产后抑郁症的有效性。
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