College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China.
College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China.
Complement Ther Med. 2024 Mar;80:103024. doi: 10.1016/j.ctim.2024.103024. Epub 2024 Jan 15.
BACKGROUND: Post-stroke spasticity (PSS) is the most common complication of stroke. Acupuncture is widely used in clinical practice for the treatment of PSS, and is therefore considered a common complementary treatment. Several systematic reviews (SRs) and meta-analyses (MAs) have demonstrated the efficacy and safety of acupuncture in the treatment of PSS; however, the quality of evidence of these studies has not been adequately assessed. OBJECTIVE: To evaluate and summarize the SRs/MAs and inform future research and clinical practice on the efficacy and safety of acupuncture for PSS. DATA SOURCES AND EXTRACION: The following databases were searched from their dates of inception to March 26, 2023: PubMed, Embase, The Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, SinoMed, and Chinese Science and Technology Periodical Database (VIP), and grey literature were manually searched. Two reviewers independently completed literature retrieval, screening, and data extraction. REVIEW APPRAISAL: Systematic evaluation tools to Assess Systematic Reviews (AMSTAR) 2, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020 Checklist), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system were used to systematically evaluate the methodological, reporting, and evidence quality of the SRs/MAs. RESULTS: Overall, 226 papers were examined, and after careful consideration, 10 SRs/MAs were deemed eligible for inclusion. The AMSTAR 2 assessment revealed that one SR/MA had medium, one study had low, and the remaining eight studies had critically low methodological qualities. Additionally, four SRs/MAs completed more than 60 % of the PRISMA 2020 checklist. The GRADE system indicated that six outcomes were medium, 26 outcomes were low, and 24 outcomes were critically low. CONCLUSION: Based on the evidence, acupuncture may be a promising complementary treatment to improve post-stroke spasticity and quality of life. Further high-quality RCTs are needed in future studies to support the broader application of acupuncture for the treatment of PSS.
背景：脑卒中后痉挛（PSS）是脑卒中最常见的并发症。针灸在临床上广泛用于治疗 PSS，因此被认为是一种常见的补充治疗方法。几项系统评价（SRs）和荟萃分析（MAs）已经证明了针灸治疗 PSS 的疗效和安全性；然而，这些研究的证据质量尚未得到充分评估。
目的：评估和总结针灸治疗 PSS 的 SRs/MAs，为未来的研究和临床实践提供信息。
数据来源和提取：从各数据库的建库日期至 2023 年 3 月 26 日，检索了以下数据库：PubMed、Embase、The Cochrane Library、中国知网（CNKI）、万方数据库、中国生物医学文献服务系统（SinoMed）和中文科技期刊数据库（VIP），并手动检索灰色文献。两位评审员独立完成文献检索、筛选和数据提取。
评价方法：采用系统评价工具评估系统评价（AMSTAR 2）、系统评价和荟萃分析报告规范（PRISMA 2020 清单）和推荐评估、制定和评估（GRADE）系统，对 SRs/MAs 的方法学、报告和证据质量进行系统评价。
结果：共检索到 226 篇文献，经过仔细考虑，有 10 项 SRs/MAs 被认为符合纳入标准。AMSTAR 2 评估显示，1 项 SR/MA 为中度，1 项研究为低度，其余 8 项研究为高度低质量。此外，有 4 项 SRs/MAs 完成了超过 60%的 PRISMA 2020 清单。GRADE 系统显示，6 个结局为中度，26 个结局为低度，24 个结局为高度低。
结论：根据证据，针灸可能是一种有前途的补充治疗方法，可以改善脑卒中后痉挛和生活质量。未来的研究需要更多高质量的 RCT 来支持针灸在治疗 PSS 中的更广泛应用。
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