Acute diarrhea has a high incidence in children. Pediatric tuina has been widely used in children with acute diarrhea in China. However, there is no guideline on the treatment of tuina for children with acute diarrhea. This guideline was developed following evidence-based principles and the World Health Organization handbook for guideline development. The linked systematic review was conducted following the Cochrane handbook. The quality of evidence and the strength of recommendations were evaluated using the GRADE approach. The reporting followed the RIGHT statement. Seven clinical questions (2 foreground questions and 5 background questions) were identified by literature review and expert consensus. Based on the linked systematic review and through comprehensive consideration of the balance of benefit and harm, quality of evidence, patient preferences, and other resources, we formulated the recommendations using Delphi expert consensus. We suggested combination of a weak recommendation for tuina with Western medicine usual care to treat children with acute diarrhea. This guideline can be used by clinicians and nurses in the department of traditional Chinese medicine pediatrics, and department of pediatric tuina, and can also be used as a reference for relevant clinicians of Western medicine and is also applicable to all institutions that practice tuina treatment.
ObjectiveTo systematically review the efficacy and safety of pediatric tuina in the treatment of children with acute diarrhea.MethodsCNKI, VIP, WanFang Data, CBM, PubMed and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on the treatment of children acute diarrhea with tuina from inception to November 20th, 2020. Two researchers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 15 RCTs involving 1 464 children were included. The results of meta-analysis showed that compared with Western medicine, tuina for children with acute diarrhea could increase the cure rate (RR=1.43, 95%CI 1.26 to 1.63, P<0.001), shorten the time for the frequency of diarrhea to return to normal (MD=?0.86, 95%CI ?1.05 to ?0.66, P<0.001) and the time for stool traits to return to normal (MD=?1.07, 95%CI ?1.15 to ?0.99, P<0.001). There was no statistically significant difference in the incidence of adverse reactions between tuina and Western medicine (RR=0.25, 95%CI 0.03 to 2.23, P=0.22).ConclusionsCurrent evidence shows that tuina has a superior effect on treating children with acute diarrhea, the incidence of adverse reactions is not increased. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
ObjectivesTo evaluate the methodology quality and report quality of the published systematic reviews/meta-analyses (SRs/MAs) of pediatric tuina domestically and abroad.MethodsCBM, VIP, CNKI, WanFang Data, PubMed, EMbase, and The Cochrane Library were electronically searched to collect published pediatric tuina SRs/MAs from inception to December 10th, 2018. The SRs/MAs which includes scale evaluation used AMSTAR2 and the PRISMA report quality evaluation tool to systematically review methodology, adopts Excel to carry out data collation and statistical analysis. ResultsA total of 18 studies (14 in Chinese and 4 in English) on the SRs/MAs of pediatric tuina were finally included. In terms of methodological quality, 6 studies were of low quality and 12 studies were of very low quality. All studies did not explain the reasons for adopting a particular research design type, and few of them explained the pre-plan, exclusion list, reasons and funding. In terms of report quality, 7 studies were relatively complete, 10 studies had certain defects and one study had serious defects. The existing problems were program and registration, comprehensive retrieval, information sources, financial support and so on. ConclusionsSRs/MAs of pediatric tuina have different degrees of issues in terms of methodological quality and report quality which still require further improvement and continuous strengthening.
ObjectivesTo conduct an overview of systematic reviews (SRs) on Tuina from 2013 to 2017, and to explore recent research improvements on Tuina.MethodsPubMed, Web of Science, The Cochrane Library, SpringerLink e-book database, CNKI, VIP, WanFang Data and CBM databases were searched to collect SRs including randomized controlled clinical trials on Tuina from January 1st, 2013 to December 31st, 2017. Two reviewers independently screened literature, extracted data, and used AMSTAR 2 tool and PRISMA statement to assess methodology quality and reporting quality of included studies, respectively. The R 3.4.3 software was used to analyze data.ResultsA total of 8 SRs studies were included in the overview. The studied diseases involved radiculopathy cervical spondylotic, myelopathy cervical spondylotic, constipation, child anorexia, child diarrhea and external humeral epicondylitis. The results of above SRs showed that massage might be superior to other interventions in clinical efficacy, curative effects or total effective rate. However, due to the low quality of included studies of SRs, further evidence from high-quality clinical studies is required to verify above conclusions. For the results of AMSTAR 2 assessment, all 8 SRs were rated as very low quality. The quantity of items accomplished for each SR ranged from 7 to 13, 2 SRs had low methodological quality (percentage of accomplishment or partial accomplishment <50.0%) and 6 SRs with high methodological quality (percentage of accomplishment or partial accomplishment ≥50.0%). All 8 SRs did not report item 2 "Whether to declare research methods", item 10 "Whether reports have included funding sources for each study" and item 11 "Whether reports used the correct statistical method". The results of PRISMA assessment showed that all SR had good quality of reporting. The accomplished items number of each SR ranged from 22 to 26. However, there were defects in item 5(0), item 16(25.0%) and item 23(25.0%). All SRs did not report item 5 "Whether to declare research program".ConclusionsThis study finds that Tuina has supportive evidence-based medical evidence for treating anorexia, cervical spondylosis and other diseases, however, the SRs of Tuina are yet needed to be improved in terms of standardized degree. Therefore, establishing a reporting consolidated standard for evidence-based medicine on Tuina in order to improve the quality of clinical studies so as to provide clinicians with high-quality evidence is the focus of our further research.
Objective To observe the effect of “Luo’s Roujin Technique” on the inflammatory response and joint capsule fibrosis in white rabbits with scapulohumeral periarthritis model. Methods Thirty healthy male New Zealand white rabbits were randomly divided into a control group, a model group, and a treatment group, with 10 rabbits in each group. Scapulohumeral periarthritis models were established in the model group and the treatment group, while the control group received identical restraint procedures at the same timepoints. Six rabbits in the model group and seven in the treatment group were successfully modeled. The subsequent experiment included all six successfully modeled rabbits from the model group, along with six rabbits randomly selected from each of the control and treatment groups. On the second day after successful modeling, blood samples were collected from the auricular marginal vein in all three groups. After blood collection, the treatment group began massage therapy for 21 consecutive days, while the other two groups underwent the same restraint procedure simultaneously. On Day 22, all the three groups were euthanized after blood collection from the auricular marginal vein, and the synovial tissue of the affected shoulder joint was completely collected. Hematoxylin-eosin staining was used to examine the histopathological features of the synovial tissue. Enzyme-linked immunosorbent assay was employed to measure the concentrations of interleukin (IL)-1β, IL-6, IL-17, and tumor necrosis factor-α (TNF-α). Western blot and reverse transcription polymerase chain reaction were used to assess the protein and mRNA expression levels of vascular endothelial growth factor (VEGF), connective tissue growth factor (CTGF), transforming growth factor-β1 (TGF-β1), and Smad3. Results After treatment, the control group showed no significant inflammatory cell infiltration or fibrous tissue proliferation in the synovial tissue. The model group exhibited synovial cell hyperplasia in the lining layer and inflammatory cell infiltration in the sublining layer. The treatment group displayed mild inflammatory cell infiltration in the sublining layer. Compared with the control group, the model group showed significantly increased concentrations of IL-1β, IL-6, IL-17, and TNF-α in both serum and synovial homogenate, as well as elevated protein and mRNA expression of VEGF, CTGF, TGF-β1, and Smad3 in synovial tissue (P<0.05). Compared with the model group, the treatment group exhibited significantly lower serum levels of IL-1β, IL-6, and TNF-α, as well as reduced synovial homogenate levels of IL-1β, IL-6, IL-17, and TNF-α (P<0.05); furthermore, protein expression of VEGF, CTGF, TGF-β1, and Smad3 and mRNA expression of VEGF and CTGF in synovial tissue were significantly decreased in the treatment group (P<0.05). Conclusions “Luo’s Roujin Technique” can significantly alleviate local inflammatory infiltration in the synovial tissue of rabbits with scapulohumeral periarthritis, and reduce the levels of IL-1β, IL-6, IL-17, and TNF-α in both serum and synovial tissue. The underlying mechanism may involve suppression of VEGF, CTGF, TGF-β1, and Smad3 expression, leading to attenuated inflammatory responses and inhibition of fibroblast-to-myofibroblast transition. Thereby, it mitigates fibrotic changes in the shoulder joint capsule, exerting anti-inflammatory and analgesic effects and improving joint mobility.
ObjectivesTo evaluate the clinical efficacy of massage in the treatment of primary dysmenorrhea (PD).MethodsCNKI, VIP, WanFang Data, CBM, The Cochrane Library, PubMed and EMbase databases were searched to collect randomized controlled trials (RCTs) on the treatment of primary dysmenorrhea from inception to January 6th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. RevMan 5.3 software was used for meta-analysis.ResultsA total of 10 RCTs were included, including 758 patients with PD. Meta-analysis results showed that the total effective rate (RR=1.14, 95% CI 1.03 to 1.26, P<0.000 01; RR=1.24, 95% CI 1.15 to 1.34, P<0.000 01) and the dysmenorrhea symptom score (MD=–2.59, 95% CI –3.08 to –2.29, P<0.000 1) in massage group were superior to the control group.ConclusionCurrent evidence suggests that massage for PD has certain advantages. However, due to the limited quality of the included studies, high-quality clinical trials are required to further verify the clinical efficacy of massage in the treatment of primary dysmenorrhea.
【摘要】 目的 觀察循膀胱經彈撥法干預亞健康狀態方案的療效及優勢，并規范其技術標準，為臨床提供安全有效的治療技術范例。 方法 2009年3月-2010年8月，采用多中心、分層區組隨機、平行對照的臨床研究方法，選擇亞健康狀態受試者360例，隨機分為傳統組、彈撥組、復合組，每組120例。觀察受試者干預前后的臨床癥狀積分、血沉、血漿乳酸、全血黏度（切變率分別為1、5、30、200/s）的變化，及有效性和安全性。 結果 共305例完成試驗，其中傳統組97例，彈撥組102例，復合組106例。彈撥組、復合組的總體療效與傳統組比較差異有統計學意義（Plt;0.05），彈撥組與復合組比較差異無統計學意義（Plt;0.05）。干預后彈撥組、復合組的臨床癥狀積分、血沉、血漿乳酸、全血黏度與傳統組比較差異有統計學意義（Plt;0.05）；彈撥組與復合組臨床癥狀積分、血液乳酸全血黏度（切變率分別為1、200/s）差異無統計學意義（Pgt;0.05），血沉、全血黏度（切變率分別為5、30/s）差異有統計學意義（Plt;0.05）。各組各指標干預后前后自身比較差異均有統計學意義（Plt;0.05）。 結論 推拿能有效地改善亞健康狀態，復合組療效最佳，彈撥組其次，傳統組較差。循膀胱經彈撥法對亞健康狀態的干預有效性較傳統推拿更好。【Abstract】 Objective To observe the efficacy and advantages of flicking and poking along bladder channels in intervening sub-health state and regulate the technical standards for clinical treatment techniques, in order to provide safe and effective treatment criteria. Methods Multi-centered, stratified randomized and parallel controlled clinical research methods were adopted in this study. From March 2009 to August 2010, 360 subjects with sub-health status were randomly divided into traditional group, flicking and poking group, and combining group with 120 cases in each group. The changes of clinical symptoms, erythrocyte sedimentation rate, plasma lactate, and whole blood viscosity (shear rates of 1, 5, 30, 200/s) as well as the efficacy and safety were observed. Results A total of 305 patients completed the trial, including 97 in the traditional group, 102 in the flicking and poking group, and 106 in the combining group. The general efficacy for the flicking and poking group and the combining group was significantly different from that for the traditional group (Plt;0.05), while there was no significant difference between the flicking and poking group and the combining group. After the intervention, the clinical symptom score, erythrocyte sedimentation rate, plasma lactate, and whole blood viscosity of the flicking and poking group and the combining group were significantly different from those of the traditional group (Plt;0.05). The clinical symptom score, plasma lactate and whole blood viscosity (shear rates of 1, 200/s) of the flicking and poking group and the combining group were not significantly different (Pgt;0.05), while erythrocyte sedimentation rate, and whole blood viscosity (shear rates of 5, 30/s) between those two groups were significantly different (Plt;0.05). All the above mentioned indexes before and after intervention in each group were statistically different (Plt;0.05). Conclusion Massage can improve the sub-health state, and the combining method has the best efficacy followed by flicking and poking, while traditional method has a poor efficacy. Intervening sub-health state with flicking and poking along bladder channels has a better efficacy than the traditional method of massage.
ObjectivesTo overview the systematic reviews/meta-analyses (SRs/MAs) of effectiveness and safety of spinal manipulation for low back pain or neck pain.
MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), CBM, CNKI, WanFang Data and VIP to collect SRs/MAs of spinal manipulation for low back pain or neck pain from inception to January 30th, 2015. Two reviewers independently screened literature, extracted data, and then AMSTAR tool was used to assess the methodological quality of included SRs/MAs.
ResultsA total of 21 SRs/MAs were included. Twenty of them assessed the methodological quality of included original randomized controlled trials (RCTs) with different tools:2 used Jadad scale, 5 used PEDro scale, 6 used Cochrane bias risk assessment tool and 7 used other tools. The assessment results of AMSTAR tool suggested that:among 11 items, the item 1 of "Was an ‘a priori’ design provided" (18 SRs/MAs did not provide) and item 4 of "Was a list of studies (included and excluded) provided" (18 SRs/MAs did not provide) appeared to be the most problematic, followed by item 10 of "Was the likelihood of publication bias assessed" (14 SRs/MAs did not assess the publication bias) and item 11 of "Was the conflict of interest stated" (14 SRs/MAs did not provide the conflict of interest and 4 were incomplete).
ConclusionThe methodological quality of included SRs/MAs is poor. The limited evidence showed that spinal manipulation is more effective for acute low back pain than chronic low back pain, and the short term effect is better than the long term one. Different spinal manipulation techniques have various effects but are all safe. Chiropractic manipulation may have the best effect. Due to the limitation of quality and quantity of included SRs/MAs, there may be potential bias in the above conclusion that needs more high quality studies to verify.
