Research On Integrated Evaluation Of Acupuncture Clinical Evidence And Development Of Evidence Mapping

ObjectiveBased on the wide application of acupuncture in medical practice and the development and dissemination of evidence-based medicine,more and more clinical randomized controlled trials(RCTs),systematic reviews(SRs)and meta-analysis have been published to explore the efficacy of acupuncture.Therapies with demonstrated substantial benefits that may require more assertive evidence dissemination and promising acupuncture therapies that require further investigation.Therefore,it is necessary to apply scientific concepts and methods to integrate and evaluate the massive evidence in acupuncture.The purpose of this study is:1.To improve the acupuncture systematic reviews inthe Epistemonikos database to expand the influence of acupuncture therapy in the world and prepare the database for this study.2.Through the integration and evaluation of the acupuncture evidence,on the one hand,in order to clarify the dominant diseases of acupuncture supported by high-certainty evidence so as to increase the spread of acupuncture therapy in this field,on the other hand,to summarize the potential diseases of acupuncture that lack high-certainty evidence to further strengthen research in this field.3.Defining the clinical indications of acupuncture lacking systematicreviews evidence,and understanding the gap between clinical evidence andclinical practice of acupuncture,so as to provide a preliminary researchbasis for further improving the evidence system of acupuncture in the future.Methods1.We established a subject research team,cooperated with the Epistemonikos database development team,completed the types of acupuncture therapies in the database,initially classified and screened acupuncture system evaluations in different diseases,"linked" the original research included in the system evaluation,and prepared for the database work.2.Following the evidence integration method of evidence mapping,we clarified research issues,established inclusion and exclusion criteria,comprehensively searched the literature,standardized data extraction,displayed results via visualization methods,and scientifically summarized and evaluated the abundant evidence groups from acupuncture clinical practice.Clarify the current status of evidence in acupuncture,including the PICO characteristics of the included reviews,the latest therapeutic effects,the quality of evidence in various diseases of acupuncture,etc.The GRADE evidence evaluation system was used to evaluate the quality of the body of evidence,and the AMSTAR 2 was used to evaluate the methodological quality of the included systematic reviews.The current research evidence is of low/very low quality,but promising treatment areas include primary insomnia,neuropathic pain,childhood autism,carpal tunnel syndrome,and functional dyspepsia,etc.3.We conducted an expert questionnaire survey for acupuncturists working on clinical and academic acupuncture for many years.,to clarify thecurrent clinical indications of acupuncture that lack systematic reviews support,and to understand the gap between the clinical indications and evidence of acupuncture.Results1.We comprehensively improved the categories of acupuncture in the Epistemonikos database,screened and completed acupuncture SRs in 20 disease fields.The number of SRs increased by 545 compared with manual screening.We completed the work of "linking" the original studies on 332 SRs of acupuncture.The results are free for users worldwide.2.A total of 80 SRs of acupuncture were included in this study,covering 12 disease fields and 80 diseases.The study data included 223 outcomes from 1,427 RCTs.A large majority of SRs were from nervous system diseases(n=26,32.5%),connective tissue diseases(n=9,11.3%),mental diseases(n=8,10%),gynecological diseases(n=8,10%).Ear,nose and throat diseases(n=2,2.5%),eye diseases(n=1,1.3%),nutritional and metabolic diseases(n=1,1.3%)were containing fewer SRs.The diseases supported by high-quality evidence and with a large effect are defined as the dominant diseases of acupuncture,involving 20 diseases,which are summarized as follows:improving the quality of life of breast cancer patients(SMD:-1.21,95%CI:-1.72 to-0.71),improving the language communication function of patients with aphasia after stroke(SMD:1.01,95%CI:0.81 to 1.2),alleviating the severity of tics in patients with tic disorder(SMD:-1.29,95%CI:-1.87 to-0.7),relief of myofascial pain(SMD:-1,95%CI:-1.43 to-0.57),decreased urinary tract infection recurrence(RR:0.39,95%CI:0.26 to 0.58;ARR:322 fewer per 1,000;95%CI:from 391 fewer to 222 fewer),lower the body mass index of patients with simple obesity(SMD:1.11,95%CI:0.67 to 1.56),increase the effective lactation rate at 24 hours postpartum(RR:2.24,95%CI:1.58 to 3.17;ARR:380 more per 1000;95%CI:from 178 more to 666 more),improvedthe pregnancy rate of infertile patients(RR:2.63,95%CI:1.6 to 4.32;ARR:464 more per 1,000;95%CI:from 112 more to 1,000 more),relief of neckpain(SMD:-0.42;95%CI:-0.62,-0.22),shoulder pain(SMD:-0.42;95%CI:-0.62,-0.22),non-specific low back pain(SMD:-0.42;95%CI:-0.62,-0.22),improving sleep quality in patients with fibromyalgia(SMD:-0.42;95%CI:-0.62,-0.22),improving mood disorders caused by chronic pain(SMD:-0.42;95%CI:-0.62,-0.22),shorten the hospitalization time of patients with postoperative ileus(SMD:-0.5;95%CI:-0.69,-0.32),relief of hot flashes after breast cancer surgery(SMD:-0.44;95%CI:-0.73,-0.15),relief of pain after total knee arthroplasty(SMD:-0.47;95%CI:-0.87,-0.08),improving the quality of life of patients with hip arthritis(SMD:-0.56;95%CI:-1.07,-0.05),fibromyalgia(SMD:-0.49;95%CI:-0.79,-0.2),functional constipation(SMD:-0.33;95%CI:-0.45,-0.21),reduced symptoms of allergic rhinitis(SMD:-0.47;95%CI:0.67,0.27).For such dominant diseases supported by acupuncture with higher evidence,the spread of acupuncture in this series of diseases should be expanded.A total of 46 diseases were defined as those with potential for acupuncture therapy,with only low quality evidence support,but with large effect on the outcome of acupuncture therapy.For example:improve the sleep quality of patients with primary insomnia(SMD:-1.01,95%CI:-1.38 to-0.65),relieve neuropathic pain(SMD:-0.96,95%CI:-1.27 to-0.64),improve the symptoms of children's autism(SMD:-1.87,95%CI:-3.21 to-0.53),relieve the pain symptoms of carpal tunnel syndrome(SMD:SMD:-1.21 to-0.53).-1.14,95%CI:-1.98 to-0.3),improve the quality of life of patients with functional dyspepsia(SMD:1.19,95%CI:0.88 to 1.5),reduce the urination symptoms of chronic prostatitis(SMD:-0.87,95%CI:--1.10 to-0.64),reduce the desire for opioids(SMD:-1.26,95%CI:-1.73 to-0.78),and relieve dysmenorrhea(SMD:SMD:1.22,95%CI:-1.73 to-0.78).-0.93,95%CI:-1.39 to-0.47).Acupuncture in the treatment of such diseases has the potential to further clarify the efficacy,and high-quality evidence studies should be conducted.3.After distributing the questionnaire to 16 experts,15 experts filled out some valid questionnaires,and the overall positive coefficient of the experts was relatively high.From the results of the questionnaire,we found that some diseases without supportive evidence were selected by experts as clinical indications of acupuncture,among which were usually the musculoskeletal system and the nervous system diseases.Among musculoskeletal diseases,clinical indications for acupuncture lacking systematicreview evidence are as follows:mandibular arthritis,third lumbar transverse process syndrome,intrahumeral epondylitis,infraspinatus muscle syndrome,facet joint disorder,scapular rib syndrome.Among the nervous system diseases,the clinical indications for acupuncture lacking systematic review evidence include peroneal nerve palsy,lateral femoral cutaneous neuritis,median nerve palsy,gluteal epithelial nerve disease,multiple(peripheral)neuritis,brachial plexus nerve injury(paralysis),motor neurone disease,and optic neuromyelitis.ConclusionFor the dominant diseases supported by high-quality evidence,the spread of acupuncture should be further increased around the world.For promising acupuncture therapies,more research is worth investing in in the future.There is a certain gap between acupuncture clinical evidence and clinical practice,and more research is needed to fill the gap in the future.