| Objective:Bibliometric studies of randomized controlled trials have found that common TCM external treatment techniques for Allergic rhinitis(AR)in children are acupoint application,thumbtack needle,and tuina therapy.Using classical meta-analysis methods,a systematic review of the effectiveness of the above-mentioned TCM external treatment techniques in the treatment of AR in children.At the same time,the cumulative meta-analysis method was used to observe the dynamic changes caused by the inclusion of different studies one by one,taking the publication time and sample size as the cumulative factors,so as to judge the stability of the efficacy of TCM external treatment techniques in the treatment of AR in children.Methods:1 Literature search:Comprehensive search of electronic databases:randomized controlled trials of CNKI,Wanfang,VIP,CBM,Pub Med database,EMbase database and Cochrane Library database.The search is current to:31 December 2022.2 Quality evaluation:The risk of bias assessment tool(Ro B2.0)was used to evaluate the methodological quality of the randomized controlled clinical studies of the included TCM external treatment techniques(acupoint application,thumbtack needle,tuina therapy)in the treatment of AR in children.At the same time,the CONSORT guideline was used to evaluate the above RCT literature for report quality evaluation.3 Document screening and data extraction:Use the Literature Manager(e.g.Note Express 3.2.0 software)to initially screen and eliminate duplicate publications from major databases.In the second step,the screening was based on reading titles and abstracts,and exclusion was made in terms of repeated publications,theoretical studies,experimental studies,interventions,and other types of articles(such as reviews,etc.).In the third step,the full text of the remaining literature was screened again by downloading the full text of the remaining literature,and the full text of RCTs that met the inclusion criteria was screened out,and a baseline table was made.4 Statistical analysis:4.1 Classic meta-analysis:Classical meta-study analysis was mainly performed using Rev Man 5.4.1 software.The evaluation index for dichotomous variable selection was RR and the continuous variable selection SMD,and the effect size of both was based on 95%CI.The size of heterogeneity is judged by the value of I~2.By observing the corresponding forest plots,the results of quantitative combined data were evaluated and analyzed to judge the effectiveness of TCM external treatment techniques(acupoint application,thumbtack needle,tuina therapy)in the treatment of AR in children.4.2 Cumulative meta-analysis:Cumulative meta-analysis using STATA13.0software.The size of the heterogeneity was determined by P value and I~2,and all eligible RCT data were combined and cumulatively sorted in a certain order.The cumulative factor is generally the time of publication of the study and the size of the sample.The inspection standards generally use RR,SMD,95%CI and other indicators.The resulting effect can be judged based on the variation in the 95%CI range and the size of the effect.In this way,whether the efficacy of TCM external treatment techniques(acupoint application,thumbtack needle,tuina therapy)in the treatment of AR in children has a cumulative trend of time and sample size.Results:1 Quality assessment:A total of 40 RCTS were included in the evaluation.There were 26 RCTS describing random allocation methods(65%)and 2 RCTS detailing hidden allocation steps(5%).Three RCTS(7.5%)used the blinding method,and the specific description of how to implement the blinding method.Ten RCTS(25%)differentiated primary and secondary outcome measures.2 Classic meta-analysis:Forty RCTS were included.There were 3534 subjects(trial group VS control group=1803:1731).In terms of total effective rate,the external treatment group(acupoint application,thumbtack needle,tuina therapy)had better efficacy(RR=1.22,95%CI[1.17,1.27]).The results of subgroup analysis showed that:Acupoint application group RR=1.26,95%CI[1.20,1.33];The needle group were:RR=1.27,95%CI[1.18,1.37];Massage group:RR=1.21,95%CI[1.14,1.28].Heterogeneity results yielded:Chi~2=1.62,P<0.05,I~2=0%<50%。The results suggest that:compared with the control group,each group has more advantages in the treatment of children with AR,and there is no heterogeneity among the three interventions,which can be evaluated in combination.In terms of AR symptom scores in children,the scores of the TCM external treatment group(acupoint application,thumbtack needle,and tuina therapy)were lower(SMD=-0.94,95%CI[-1.20,-0.68]).In terms of RQLQ scores for AR in children,the scores of the TCM external treatment group(acupoint application,thumbtack needle,and tuina therapy)were lower(SMD=-1.21,95%CI-1.98,-0.44]).In terms of Ig E scores,the TCM external treatment group(acupoint application,thumbtack needle,tuina therapy)scored even lower(SMD=-1.12,95%CI[-2.70,-0.46]).3 Cumulative meta-analysis:3.1 Total effective rate:Thirty-five RCTs with a sample size of 2847 cases were included.Cumulative meta-analysis was assessed in order of time of publication and sample size.In 2012,it was first demonstrated that TCM external treatment techniques(acupoint application,thumbtack needle,tuina therapy)were superior,and the cumulative effect is now(RR=1.80,95%CI[1.73,1.88]).In terms of sample size,an RCT with a sample size of 40 demonstrated for the first time the advantages of external treatment techniques(acupoint application,thumbtack needle,tuina therapy).The current cumulative effect was(RR=1.80,95%CI[1.70,1.91]).The results suggest that the RR value and the 95%CI gradually developed and changed in order of publication time,and the cumulative value was consistent with the first accuracy,and the confidence interval range was small and the accuracy was high.In order of sample size,the cumulative values are now more accurate than the first time,indicating a relative improvement in accuracy.3.2 Symptom points:Twenty-five RCTs with a sample size of 1808 cases were included.Cumulative meta-analysis was assessed in order of time of publication and sample size.In 2016,it was first proved that TCM external treatment techniques(acupoint application,thumbtack needle,tuina therapy)are more advantageous.The current cumulative effect is(SMD=-0.72,95%CI[-0.85,-0.6]).In terms of sample size,an RCT with a sample size of 40 demonstrated for the first time the advantages of external treatment techniques(acupoint application,thumbtack needle,tuina therapy).The current cumulative effect is(SMD=-0.74,95%CI-0.93,-0.55]).Results suggest:SMD value and 95%CI gradually develop and change,and the cumulative value is more accurate than the first time,and the prompt accuracy is relatively improved.3.3 Quality of life score:Five RCTs with a sample size of 338 cases were included.Cumulative meta-analysis was assessed in order of time of publication and sample size.In 2016,it was first proved that TCM external treatment techniques(acupoint application,thumbtack needle,tuina therapy)are more advantageous.The current cumulative effect was(SMD=-0.5,95%CI[-0.71,-0.28]).In terms of sample size,an RCT with a sample size of 40 demonstrated for the first time the advantages of external treatment techniques(acupoint application,thumbtack needle,tuina therapy).The current cumulative effect is(SMD=-0.54,95%CI[-0.79,-0.28]).The results suggest that the SMD value and the 95%CI gradually develop and change,and the cumulative value is more accurate than the first time,and the prompt accuracy is relatively improved.4 The quality of the evidence was graded:Risk of bias,inconsistency,indirectness,imprecision,and publication bias were assessed.The results showed that the quality of the evidence was low in terms of total effective rate;The certainty of the evidence for symptom scores,quality of life scores,and Ig E was very low.Conclusion:1 At present,the quality of clinical randomized controlled trials of TCM external treatment techniques in the treatment of AR in children needs to be further improved,and it is recommended to strictly follow the reporting standards such as Ro B2.0 and CONSORT guidelines for standardized and complete implementation.For pediatric AR diseases,"large-sample,multi-center"clinical trials can be conducted to explore more accurate and conducive to clinical decision-making results.2 Meta-analysis showed that the efficacy of TCM external treatment techniques(acupoint application,thumbtack needle,tuina therapy)in the treatment of AR in children was better than that of the control group in terms of total effective rate,symptom score,RQLQ,and Ig E.The cumulative meta-analysis combined the results of the results based on the cumulative factors of publication time and sample size,suggesting that the advantages of TCM external treatment techniques(acupoint application,thumbtack needle,tuina therapy)in the treatment of AR in children have a cumulative trend with the change of publication time and sample size,but more studies are needed to further verify. |
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