Dataset Information

Acupotomy therapy for lumbar disc herniation: Protocol for a systematic review and meta-analysis.

ABSTRACT:

Background

Lumbar disc herniation (LDH) is a clinically common degenerative spinal disease that adversely affects patients' quality of life and work ability. Although several articles have reported that acupotomy can improve the clinical symptoms of LDH, the efficiency of acupotomy has not been scientifically or methodically evaluated. The primary objective of this study is to evaluate and synthesize evidence on the effectiveness and safety of acupotomy therapy in patients with LDH.

Method

We plan to search eight English and Chinese electronic databases, including the Web of Science, Cochrane Library, PubMed, EMBASE, SinoMed, Wanfang, China Science and Technology Journal (VIP), and China National Knowledge Infrastructure (CNKI) databases, for potentially eligible studies. Randomized controlled trials (RCTs) on acupotomy treatment in LDH patients will be searched for independently by 2 reviewers in the databases from their inception to August 2018. We will combine data from clinically homogenous studies in a fixed effect meta-analysis using RevManV.5.3.5, and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results

This systematic review and meta-analysis will use high-quality evidence-based medicine to assess the efficacy and safety of acupotomy therapy in LDH.

Conclusion

This study protocol will provide strong evidence to determine whether acupotomy therapy is an effective and safe intervention for patients with LDH.

SUBMITTER: Jiang C

PROVIDER: S-EPMC6200472 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Publications

Acupotomy therapy for lumbar disc herniation: Protocol for a systematic review and meta-analysis.

Jiang Cai C Li Yinyan Y Guo Miaomiao M Li Xiaomei X Guo Jinhua J Yu Shengxian S Lin Zhonghua Z

Medicine 20181001 40

<h4>Background</h4>Lumbar disc herniation (LDH) is a clinically common degenerative spinal disease that adversely affects patients' quality of life and work ability. Although several articles have reported that acupotomy can improve the clinical symptoms of LDH, the efficiency of acupotomy has not been scientifically or methodically evaluated. The primary objective of this study is to evaluate and synthesize evidence on the effectiveness and safety of acupotomy therapy in patients with LDH.<h4>M ...[more]

PMID: 30290635

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Project description:BackgroundLumbar spinal stenosis (LSS) is caused by neural compression due to narrowing of the lumbar spinal canal or neural foramen. Surgical intervention is a standard treatment for LSS; however, the steep increase in the surgical rate, post-operative complications, and comparatively low long-term satisfaction are considered to be limitations of this surgical approach. Conversely, acupotomy is a minimally invasive technique that combines the effects of conventional acupuncture with micro-incision, which may offer an alternative to surgery for the treatment of LSS. This review was conducted to investigate and critically review the current evidence on the efficacy and safety of acupotomy for LSS.MethodsEleven databases were searched from their respective inception dates to December 28, 2018. Randomized controlled trials (RCTs) comparing acupotomy and wait-list, sham treatment, or active controls were included. The quality of the included studies was assessed using risk-of-bias tool.ResultsSeven RCTs were included in this review and meta-analysis. The methodological quality of the included studies was generally poor. The acupotomy treatment group was associated with significantly lower visual analogue scale scores (range 0∼10) (5 RCTs; mean difference [MD] -1.55, 95% confidence interval [CIs] -2.60 to -0.50; I = 94%) and higher Japanese Orthopedic Association Score (3 RCTs; MD 4.70, 95% CI 3.73 to 5.68; I = 0%) compared to the active control group. In subgroup analysis based on the type of active controls, acupotomy retained significant benefits over lumbar traction and acupuncture, as well as over lumbar traction, spinal decompression, and acupuncture. Safety data were reported in only 1 study, and no adverse events occurred in either the acupotomy or the acupuncture control group.ConclusionAccording to current evidence, acupotomy might be beneficial for treating LSS. Acupotomy showed consistent superiority over lumbar traction, but the results were mixed in comparisons with other interventions, such as spinal decompression and acupuncture. However, the findings should be interpreted cautiously, given the poor methodological quality of the included studies, and potential small-study effects. Further larger, high-quality, rigorous RCTs should be conducted on this topic and rigorous reporting of acupotomy procedures and safety data should be encouraged.

Project description:MethodsWe performed a comprehensive search on PubMed, the Cochrane Library, EMBASE, and four Chinese databases for articles published prior to June 2020. We included only randomized controlled trials (RCTs) that used acupotomy therapy as the major intervention in adults with knee OA, were published in either Chinese and English, included more than 20 subjects in each group, and included pain and function in the outcome measures. Knee OA was defined by the American College of Rheumatology or Chinese Orthopedic Association criteria in all studies. We extracted the visual analogue scale (VAS) pain score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total effectiveness rate, the modified Japanese Orthopedic Association (JOA) activities of daily living score, and Lysholm's score. We calculated the mean difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were conducted using random-effects models when appropriate.ResultsWe identified 1317 potentially relevant studies, thirty-two of which met the eligibility criteria and were conducted in China between 2007 and 2020. A total of 3021 knee OA patients (62.96% female, median age: 57 years, and median disease duration: 33 months) were included. The treatment duration ranged from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment involved releasing soft tissue adhesions and was performed once a week for 1-5 weeks until the pain was relieved. The control group treatments included acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 studies), radiofrequency electrotherapy (1 study), and nonsteroidal anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis showed that acupotomy led to superior improvements in the VAS pain score (MD = -1.11; 95% confidence interval (CI), -1.51 to -0.71; p < 0.00001) and WOMAC pain score (MD = -2.32; 95% CI, -2.94 to -1.69; p < 0.00001), a higher total effectiveness rate (RR = 1.15; 95% CI, 1.09-1.21; p < 0.00001), and superior improvements in the JOA score (MD = 6.39; 95% CI, 4.11-9.76; p < 0.00001) and Lysholm's score (MD = 12.75; 95% CI, 2.61-22.89; p = 0.01) for overall pain and function. No serious adverse events were reported.ConclusionChinese acupotomy therapy may relieve pain and improve function in patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs are warranted.

Project description:Objective:Lumbar disc herniation (LDH) is based on the degenerative changes of the intervertebral disc. Many drugs are used to treat and prevent LDH, including Western medicine and Chinese medicine. Duhuo Jisheng Decoction (DHJSD) is one of the most classic Chinese medicine prescriptions. The purpose of our meta-analysis is to evaluate the efficacy and safety of modified DHJSD in the treatment of LDH. Methods:We searched multiple databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) databases, Wanfang Database, and Chinese Scientific Journal Database (VIP) to identify studies that met the inclusion criteria. This meta-analysis was registered at INPLASY with reference number ID: INPLASY202060053. Results:Fourteen randomized controlled trials (RCTs) were identified, including 1560 patients. This meta-analysis showed that the total effective rate and cure rate of modified DHJSD are higher than those of diclofenac sodium enteric-coated tablets (total effective rate: RR?=?1.18, 95% CI: 1.12 to 1.25, P < 0.0001, I 2?=?0%; cure rate: RR?=?1.60, 95% CI: 1.30 to 1.97, P < 0.00001, I 2?=?2%), diclofenac sodium enteric-coated tablets plus ibuprofen and indomethacin (total effective rate: RR?=?1.23, 95% CI: 1.11 to 1.37, P=0.0001, I 2?=?0%; cure rate: RR?=?1.58, 95% CI: 1.22 to 2.04, P=0.0005, I 2?=?0%), and diclofenac sodium sustained-release capsule (total effective rate: RR?=?1.49, 95% CI: 1.27 to 1.74, P < 0.00001, I 2?=?0%; cure rate: RR?=?10.07, 95% CI: 3.29 to 30.88, P < 0.00001, I 2?=?5%). Modified DHJSD was also better than Western medicine (MD?=?-1.56, 95% CI: -2.42 to -0.70, P=0.0004, I 2?=?74%) in terms of visual analogue scale (VAS) scores. Three RCTs showed no adverse events in the modified DHJSD group, but adverse events existed in the Western medicine group. Conclusion:This meta-analysis showed that modified DHJSD had a more favorable effect on the treatment of LDH than Western medicine, and there were no obvious adverse events. More high-quality RCTs are needed to complement existing conclusions.

Dataset Information

Acupotomy therapy for lumbar disc herniation: Protocol for a systematic review and meta-analysis.

Background

Method

Results

Conclusion

Publications

Acupotomy therapy for lumbar disc herniation: Protocol for a systematic review and meta-analysis.

Similar Datasets

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