Efficacy Of Acupuncture And Mox I Bust Ion Randomized Control Led Trial In The Treatment Of Dysphagia After Stroke:a Meta-analysis

ObjectiveTo investigate the reliability of clinical efficacy of acupuncture and moxibustion in the treatment of dysphagia after stroke.Comparing the differences between acupuncture and non-acupuncture therapy and providing evidence for acupuncture and moxibustion in the treatment of dysphagia after stroke.MethodsEvaluate the quality of exist randomized controlled literatures of acupuncture in the treatment of swallowing disorders after stroke,adopting the international recognized randomized controlled trials report standard CONSORT 2010 statement as the scoring criteria.Using the acupuncture clinical trials of interventions STRICTA5 standards to evaluate interventions of treatment in acupuncture randomized controlled trial report.According to the retrieval strategy,a total of 929 articles were retrieved,including 916 articles from the Chinese database(623 articles from wanfang academic journal full-text database,116 articles from Weipu journal full-text database,177 articles from Chinese journal full-text database),13 articles from the English database(7 articles from PubMed database and 7 articles from Embase database).By eliminating duplicate literatures and excluding studies on different acupuncture methods,non-acupuncture effectiveness studies,non-stroke dysphagia studies,non-randomized controlled trials,case reports,etc.,206 literatures were included in the final quality evaluation.According to CONSORT and STRICTA standard scores,literatures with the highest quality were selected for Meta-analysis to understand the efficacy between acupuncture therapy alone,acupuncture combined with drug therapy,acupuncture combined with rehabilitation therapy,acupuncture combined with physical therapy and non-acupuncture therapy.ResultsThe literature quality assessment suggested that the overall quality of the literature was poor and fail to meet the standard of clinical randomized controlled trials.Items such as the application of blind method,interpretation of random concealment mechanism,description of adverse events,drawing of follow-up flow chart,evaluation of sample size and application of intent-to-treat analysis need to be improved.According to the CONSORT statement,the proportion of each item is as follow:Interventions(99.0%),Background(98.5%),“Randomized”in the title or abstract(98.5%),Efficacy standard(85.0%),Participants(84.5%),Statistical methods(82.5%),recruitment(77.2%),Outcomes(72.3%),Inclusion and exclusion criteria(58.7%),Randomization(39.3%),Baseline data(27.2%),Outcomes and estimation(24.2%),Harms(9.2%),Flow chart(5.8%),discussion(5.3%),Trial design(3.9%),description of aalocation concealment(3.3%),Blinding(3.3%),Sample size(2.4%),Intent-to-treat analysis(1.0%)and Ancillary analyses(0%).Reporting of acupuncture intervention are relatively integrity and can be basically duplicated to clinic in terms of acupuncture details.However,there are still a few literatures completely describing all the needling details required in STRICTA standard.The explanations of setting and context of treatment and the description of participating acupuncturists are insufficient.Rationale for the control or comparator is also rarely explained.The STRICTA standards of acupuncture intervention are as follows:Names of points used(97.6%),Number of treatment sessions(92.2%),Frequency and duration of treatment sessions(90.8%),Needle retention time(83.0%),Needle stimulation(78.2%),Depth of insertion(78.2%),Reasoning for treatment(66.0%),Responses sought(68.0%),Precise description of the control or comparator(64.1%),Style of acupuncture(42.2%),Number of needle insertions(32.0%),Extent to which treatment was varied(22.3%),Needle type(20.9%),Rationale for the control or comparator(13.1%),Setting and context of treatment(3.9%)and Description of participating acupuncturists(1.0%).The results of meta-analysis suggested that acupuncture therapy was superior to non-acupuncture therapy,and the analysis of each subgroup showed that acupuncture therapy alone was superior to only use rehabilitation,western medicine and physical therapy.The curative effect of acupuncture combined rehabilitation therapy is better than that of rehabilitation therapy alone.Acupuncture combined with western medicine or traditional Chinese medicine is better than simple drug treatment.Acupuncture combined with electrical stimulation or swallowing therapeutic apparatus is better than only use physical therapy.Sensitivity analysis show that the above conclusions are reliable.The quantitative Meta-analysis of the water swallow test score indicated that the improvement of water swallow test by acupuncture treatment was better than that of non-acupuncture treatment.ConclusionThis study confirmed that the efficacy of acupuncture treating dysphagia after stroke and the score of water swallow test were both better than that of non-acupuncture therapy,but the overall quality of the RCT report was not high,making the Meta-analysis results worthy of further consideration.The RCT literature on acupuncture and moxibustion for post-stroke dysphagia should be designed and reported according to the CONSORT and STRICTA guidelines,especially the items mentioned deficient above,so as to enhance the credibility of meta-analysis.