| Research BackgroundSingapore’s population is ageing rapidly and chronic diseases such as stroke,diabetes,hypertension and coronary heart disease are on the rise.According to epidemiological statistics,one out of four people over the age of 40 has at least one chronic disease.Many chronic diseases can only be controlled but cannot be cured.The Singapore government is actively looking for cost-effective treatments to relieve the pressure on the health care system.The development of Traditional Chinese Medicine(TCM)will help to meet the needs of an aging society for the treatment of chronic diseases.The Government’s health policy emphasizes that"prevention is better than cure" in order to control the rising demand for health care.TCM emphasizes the idea of "preventive treatment" which includes changes in lifestyle habits,healthy diet and regular exercise.In Singapore,where the pace of life is fast with a changing diet pattern,TCM focuses on health maintenance program,whieh complements the Government’s policy of promoting preventive health care.As TCM in Singapore gradually enters the medical system of Western society,more and more Western medicine practitioners have an open mind on TCM,which will help promote the development of TCM in Singapore.More and more non-Chinese nationals(Malays,Indians,Europeans and Americans,etc.)also receive low-cost TCM treatment or voluntary consultation,making TCM an important part of the local medical system.Stroke is a common disease in Singapore,and its recurrence rate,fatality rate and disability rate are very high.Stroke has become the fourth leading cause of death in Singapore,and accounts for about 10-12 per cent of all deaths.According to the Stroke Epidemiology Report,there are nearly 70,000 stroke patients in Singapore,with 7,500 new cases of stroke each year.In Singapore,high blood pressure,diabetes,dyslipidemia,obesity are important risk factors for stroke in all races.With the development of new treatment technology,the death rate of stroke decreases,but the disability rate increases significantly,and more than 75%of survivors will have different degrees of sequelae,such as physical impairment,dysphagia,sensory impairment,cognitive impairment,speech impairment,visual impairment,dyslexia,anxiety and depression,among whieh paraplegia is the most common.Many sequelae,such as falls caused by mobility problems,inhalation pneumonia caused by irritability,can affect the quality of life and prognosis of stroke patients.Stroke is a heavy burden on patients,family members and society.The survey finds that only 27%of stroke patients had continuous rehabilitation within one year of discharge,and only about 33%of patients discharged after one month had received recuperation care.The study shows that the recurrence rate of stroke in Singapore is 30%of the total incidence,of which 16.5%were relapsed within one year,56.3%in 2 years,and 15.6%after five years.Therefore,how to improve the efficacy and reduce the disability rate of stroke has become a hot issue in Singapore.Ischemic stroke is the most common stroke in Singapore,while limb dysfunction has the greatest impact on the quality of life of stroke patients.A large number of studies have advocated that the earlier intervention in post-stroke treatment and rehabilitation care,the better the recovery of body function.Rehabilitation treatment within three months after a stroke is the golden period for recovery.However,many stroke patients,due to lack of basie rehabilitation knowledge or financial constraints,often miss the most favorable opportunity for rehabilitation.Traditional Chinese medicine has its distinctive characteristics and advantages in the prevention and treatment of stroke disease,rehabilitation and improving the quality of life of stroke patients.Because of the many symptoms of stroke sequelae and its complicated mechanism,the clinical treatment method has to be very extensive.The targeted and directional treatment method takes lesion site as the main consideration factor.As lesion site is closely related to clinical symptoms,the treatment method must be based on the main symptoms of motor system disorders and the position of the site as well as the body constitutions of patients to formulate the individualized treatment.In addition,the patient’s non-motor symptoms associated with the lesions must be considered and given treatment accordingly.Non-motor symptoms include muscle spasms,shoulder syndrome,pendant pneumonia,hemorrhoids,sweating abnormalities,depression or anxiety disorders.Improvements in motor disorders do not improve the patient’s non-motor symptoms,and the severity of non-motor symptoms often directly affects the quality of life of the patient.The approaches of this study include:improving the neurological function and rectifying neurological defects,applying an integrated method to strengthen active and passive exercise training,improving the function of body movement and the quality of life.As stroke is common in the elderly,the course of the disease is generally longer,the lesions and the organs affected are more extensive,and holistic treatment is needed.The focus of this study is to carry out research on patients with limb paraplegia of ischemic stroke.ObjectiveThis study undertakes investigation in Singapore to obtain the research data to determine the clinical efficacy of TCM health and maintenance treatment in stroke.MethodsThe clinical study selects 60 cases of stroke from the outpatient department of the Zhong Hwa Hospital based in Singapore.The subjects were randomly divided into the acupuncture group and the TCM health and maintenance group.The acupuncture group serves as the control group and has 30 cases.The TCM health and maintenance group is the study group and also has 30 cases.Both groups receive conventional western medicine and acupuncture treatment.Acupuncture treatment include:"Jia Jian Xing Nao Ka Qiao" method and "Jin San Zhen" method.In addition to these treatments the TCM health and maintenance group also receive treatment with the use of Chinese herbs,healthy diet,improvement of lifestyle habits,emotional managing,physical training and acupoint stimulation(cupping,moxibustion,massage).Data on the efficacy of the two groups after 20 treatments were analyzed using NDS、Fugl-Meyer and Barthel Index scores.Results.1.Comparison of baseline data between the two groupsThere is no significant difference in age and course of disease,gender,ethnicity,and syndrome type between the study group and the control group,indicating that the baseline data are basically consistent and has good comparability.Both groups of patients completed the whole course of study without drop out,rejection,and adverse reactions.2.Scores and comparisons of the scales before treatment,after 14 days of treatment,and after 28 days of treatmentComparison between groups:There is no significant difference in the NDS score,FMA score and Barthel index score between the two groups before treatment(P>0.05).There is comparability between the two groups.After 14 days and 28 days of treatment,the difference of NDS,FMA and Barthel scores between the two groups is statistically significant(P<0.05).After 14 days and 28 days of treatment,the difference between the two groups is statistically significant(P<0.05),indicating that there are differences between the two treatments,and the efficacy of study group was better than the control group.Comparison within the group:NDS,FMA,Barthel index and the scores before treatment are compared between the two groups after treatment for 14 days and 28 days,the difference is statistically significant(P<0.05);NDS,FMA,Barthel index and treatment after 28 days of treatment After 14 days,the scores of the scales are statistically significant(P<0.05).After 14 days of treatment,the scores of the two groups are better than those before treatment.Treatment after 28 days has better result than treatment after 14 days,indicating that NDS,FMA and Barthel index have a tendency to change with time.3.Comparison of total efficacy after treatment in both groupsThe results of the study show that after 28 days of treatment in study group,4 cases were cured,15 cases were markedly effective,8 cases were effective,and 3 cases were ineffective,the total effective rate is 90%.After 28 days of treatment in the control group,1 case was cured,8 cases were markedly effective,15 cases were effective,and 6 cases were ineffective,the total effective rate is 80%.The total efficacy of the two groups is statistically different(P<0.05),indicating that the efficacy of the study group is significantly better than the control group.4.Safety evaluationThere were no adverse reactions such as severe headache,dizziness,nausea and vomiting during the treatment.After acupuncture there were no adverse reactions such as fainting,palpitation,and broken needles.Therefore,the two methods are safe for stroke sequelae patients.ConclusionThe comprehensive TCM health and maintenance treamtment for the improvement of clinical symptoms and neurological function is significantly better than acupuncture treatment.The comprehensive TCM health and maintenance treatment can play a more effective therapeutic role in treating stroke patients.Characteristics of this research topic1.Makes full use of traditional Chinese medicineThis study makes full use of traditional Chinese medicine in the fields of treatment,prevention,health care relating to comprehensive rehabilitation treatment.2.Combination of western and Chinese medicineSingapore is the center of the convergence of Eastern and Westerncultures,and is in a good position to promote the exchange and integration of Western medicine with traditional Chinese medicine.Although Western medicine differs from the theory of Chinese medicine,it may create more favorable conditions for the combination of the two after understanding the differences between the two.The combination of Chinese and Western medicine will improve the overall standard of medical care and provide more cost-effective medical services.Chinese medicine practitioners have been stationed in local public and private hospitals to work side by side with Western medicine practitioners to provide patients with seamless care.Chinese medicine intervention in the treatment of paraplegia in stroke proves that Western medicine and Chinese medicine can complement each other to play a positive role in rehabilitation medicine and achieve good results.In addition,the use of modern acupuncture therapy("Jia Jian Xing Nao Kai Qiao" and "Jin San Zhen" method)is based on traditional acupuncture,and makes use of the neurophysiology knowledge in Western medicine,so that acupuncture prescriptions tend to be more reasoned and scientific.3.PerspicacityThis study used a perspicacity,randomly controlled research method,using modern acupuncture("Jia Jian Xing Nao Kai Qiao" and "Jin San Zhen" method)and Chinese medicine health care program,to assess and compare different rehabilitation treatments on stroke patients after treatment for 14 days,28 days;clearly indicating the effectiveness of the Chinese medicine and health care program on the improvement of comprehensive function.4.ScientificResearch is based on cases of outpatient in the Chong Hwa Hospital of Singapore,and each argument is supported by scientific data and theory.5.EffectivenessThe treatment of stroke sequelae in this study is a practical,safe and economical comprehensive rehabilitation and prevention method(systematic,normative,repeatable,operable)and is worthy of widespread clinical promotion and application.6.PracticabilityThis study combines prevention and treatment,and embodies the idea of "prevention is better than cure" in health care.It can stimulate the re-understanding of health,pay attention to health care,prevent the occurrence of diseases. |
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