| Background.Pressure injury(PI),a common skin condition,which can last for months or years,seriously affecting the physical and mental health of patients.At present,although the efficacy of acupuncture on PI has been supported by several systematic reviews,the effectiveness and advantages of different acupuncture therapies for PI are still controversial.Objectives.To evaluate the efficacy of various acupuncture and related therapies in treating PI;Screening the best acupuncture treatment methods;Systematically elaborating the deficiencies and prospects of the application of acupuncture techniques in the study.Methods.We searched PubMed,Cochrane Library,Embase,Web of Science,four Chinese databases,clinical research registration platform,the reference lists of the previous meta-analyses,and grey literature.Screening of compliant randomized controlled trials(RCTs).Risk of bias and quality were evaluated using the Revman 5.4 and Jadad scale.Pairwise meta-analysis was performed by using Stata 15.1,and Bayesian multiple network meta-analysis was performed by using Stata 15.1 and R 4.0.5.Results.A total of 2882 literatures were retrieved,and 32 RCTs were included after screening.Eight kinds of intervention measures were involved,6 of which were related to acupuncture,including manual acupuncture,electroacupuncture,moxibustion,thermal moxibustion,Zhuang’s medicine line moxibustion,and moxibustion combined with Chinese medicine external application.One study was of high quality and thirty-one were of low quality.The overall risk of bias in included studies was low.(1)Pairwise meta-analysis:①The total effective rate:manual acupuncture+basic care,electroacupuncture+basic care,moxibustion+basic care,thermal moxibustion+basic care,Zhuang’s medicine line moxibustion+basic care,moxibustion+Chinese medicine external application+basic care were better than basic care;thermal moxibustion+basic care,moxibustion+Chinese medicine external application+basic care were better than Chinese medicine external application+basic care.② The pressure ulcer healing scale(PUSH)score:all kinds of acupuncture and moxibustion+basic care was better than basic care and Chinese medicine external application+basic care.(2)Network Meta-analysis:①The total effective rate:6 kinds of acupuncture and moxibustion related therapies were better than basic care and Chinese medicine external application+basic care;thermal moxibustion+basic care,moxibustion+basic care,and moxibustion+Chinese medicine external application+basic care were better than acupuncture+basic care and electroacupuncture+basic care.② PUSH scores:electroacupuncture+basic care,moxibustion+basic care,thermal moxibustion+basic care,and moxibustion+Chinese medicine external application+basic care was better than basic care.Nevertheless,there was no statistical significance between acupuncture+basic care with basic care.Thermal moxibustion+basic care is better than acupuncture+basic care.(3)Probability ranking:① The total effective rate:thermal moxibustion+basic care,moxibustion+basic care,moxibustion combined with Chinese medicine external application+basic care ranked the top three,respectively.②PUSH scores:thermal moxibustion+basic care,moxibustion+basic care,moxibustion combined with Chinese medicine external application+basic care ranked the top three,respectively.Conclusions.Acupuncture and related therapies have certain advantages in treating PI;thermal moxibustion+basic care has the best efficacy;the efficacy of all kinds of acupuncture combined with basic care are generally superior to basic care and Chinese medicine external application+basic care.Nonetheless,due to the limitations of this study,the conclusions of this study need to be confirmed by more high-quality RCTs in the future. |
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