| ObjectiveIn recent years,the incidence rate of child language disorder is increasing.It is difficult,time-consuming and laborious to treat the disease,and it is easy to cause psychological pressure and financial burden of parents and caregivers.Acupuncture of traditional Chinese medicine is the characteristic of traditional Chinese medicine.It has the name of simplicity,convenience,cheapness and experience in treatment,without obvious side effects;Since 2014,the literature on acupuncture treatment of children’ s language retardation has increased year by year,and the high-quality literature has also increased year by year.Since 2010,there has been no relevant research to systematically evaluate and statistically analyze the literature on acupuncture treatment of children’ s language retardation.Therefore,the purpose of this study is to:1.Looking for evidence-based medical evidence of acupuncture in the treatment of children’ s language retardation through systematic evaluation of previous literature.2.Summarize how modern Chinese medicine used acupuncture to treat children’s language retardation,and provide therapeutic basis for clinical treatment of the disease in the future.Methods1.Literature system evaluation(1)Research dataThe quality evaluation,meta-analysis and mesh meta-analysis were carried out on the literature of clinical randomized controlled trials at home and abroad on acupuncture treatment of children’s language retardation from the beginning of the database to the publication in official academic journals on November 21,2021,so as to objectively evaluate the clinical efficacy of acupuncture treatment of children’ s language retardation,the existing problems of current research and the prospect of future research.(2)Retrieval methodThe full-text data of Chinese Journals(CNKI),Wanfang Chinese academic journal database,Chinese biomedical literature database(CBM),PubMed,EMBASE and Cochrane were searched systematically.The retrieval time is from the beginning of the literature included in the database to November 21,2021.The search words are "language development","language disorder","mental development","intellectual development","all-round development","acupuncture","acupuncture","acupoints",sca1p acupuncture","electroacupuncture","buried needle","language development delay","language disorder","speech disorder","mental retardation" "intellectual developmental disorder"、“global development delay"、“acupuncture"、"acupoint";The retrieval expression is used for professional retrieval or advanced retrieval,and each database is cross searched to avoid missing inspection.(3)Literature screeningUse the document management software Noteexpress to check and screen theincluded documents;Through reading the title,abstract and full text,the randomized controlled literature meeting the inclusion criteria were selected,and the literature extraction table was designed to extract the literature.(4)Literature quality evaluationThe bias of the included literature was evaluated according to Cochraneevaluator manual 5.1,and the improved Jadad scale was used to determine the quality of the study.(5)Statistical methodRevman5 3 and Addis 1.16.8 for meta and mesh meta analysis.The countingdata adopts odds ratio(or),the measurement data adopts weighted mean difference(WMD),and the interval estimation adopts 95%confidence interval(CI);The sensitivity analysis between random effect model and fixed effect model is carried out according to the specific situation,and the stability and reliability of the results are tested by sensitivity analysis;If the included studies do not have enough similarity,only descriptive analysis is used;Calculate the meta-analysis results including all studies,exclude the meta-analysis results after low-quality studies,and evaluate the reliability of the results according to whether the two results are consistent.If the two results are inconsistent,explain the results of meta-analysis according to the results of high-quality studies.The mesh meta-analysis was used to run the consistency model and inconsistency model to sort the probability of intervention measures,so as to find the best intervention scheme for the treatment of children’s language retardation.2.Acupoint selection and meridian returnAccording to 162 literatures on acupuncture acupoints included in Excel table,this paper summarizes the acupoint selection and meridians of modern Chinese medicine on how to use acupuncture to treat children’s language retardation.Results1.Literature system evaluation(1)Search results4074 relevant literatures were preliminarily retrieved,907 repetitive literatures were eliminated,and 3167 were left.According to the purpose of the study and the criteria of nanodischarge,162 literatures were included,including 156 Chinese literatures and 6 English literatures.The literature was published from 2004 to 2021.After 2014,the number of published literature increased year by year,with a maximum of 26 relevant literatures published in 2021.(2)Research objectDiseases-a total of 10 diseases were included,including simple speech retardation,cerebral palsy,autism spectrum disorder,mental retardation,intellectual development disorder,brain injury syndrome,growth retardation,hearing impairment,global growth retardation and brain white matter injury of premature infants;The largest number of studies and participants were cerebral palsy.Evaluation scale-a total of 17 evaluation scales are used for specific description.Gesell language development quotient,S-S and Wechsler intelligence test speech IQ evaluation scale are used most frequently.Intervention measures-due to the different characteristics of different diseases,there are also great differences in intervention measures.Among them,acupuncture+language training is used in the treatment group and language training is used in the control group.(3)Risk bias assessment93.83%reported the balance of baseline characteristics between groups;The random distribution method is low risk,accounting for 51.85%,and most of them use the random number table method;Only 0.62%of the descriptions adopt the allocation concealment method;2.47%of patients or researchers were blinded,and 3.09%of outcome evaluators were blinded;95.68%had a complete outcome;There was no selective reporting of test results in all studies;33.95%were rated as high risk due to different needle retention time,treatment duration,treatment frequency and other factors.The improved Jadad scale was used to determine the research quality,and high-quality studies accounted for 55.09%,suggesting that the proportion of high-quality studies included was low.The reason is that many studies did not describe the reasons for randomization concealment,blinding,withdrawal and loss of follow-up in detail.If the discussion of this item can be strengthened in the future research design,it can improve the number of high-quality studies published in the future and increase the credibility of the research.(4)Statistics of curative effect resultsIn 12 of the 162 studies,there was no significant difference in language ability between the observation group and the control group after the course of treatment(P>0.05).After treatment,the curative effect of language ability between the observation group and the control group was better than that of the control group,and the difference was statistically significant(P<0.05).A total of 150 studies accounted for 92.60%of the included studies.(5)Meta analysis resultsAnalysis of overall curative effect-S-S evaluation scale,Gesell language development quotient evaluation scale and Wechsler intelligence test speech IQ evaluation scale were used to compare the curative effects of acupuncture group and non acupuncture group.The results showed that the curative effect of acupuncture group was better than that of non acupuncture group,and the difference was statistically significant(P<0.05).Analysis of curative effect of diseases-S-S and Gesell language development quotient evaluation scale were used to evaluate the curative effect of acupuncture group and non acupuncture group in cerebral palsy with language delay.The results showed that the curative effect of acupuncture group was better than that of non acupuncture group,and the difference was statistically significant(P<0.05);S-S evaluation scale was used to evaluate the curative effect of simple speech delay acupuncture group and non acupuncture group.The results showed that the curative effect of acupuncture group was better than that of non acupuncture group,and the difference was statistically significant(P<0.05).Curative effect analysis of treatment methods-children with cerebral palsy and language delay were evaluated with S-S evaluation scale.The treatment group was treated with acupuncture+language training and the control group was treated with language training.The results showed that the curative effect of the treatment group was better than that of the control group,and the difference was statistically significant(P<0.05).Analysis of therapeutic effect of treatment course-the treatment course of acupuncture for children with language retardation was ≥3 months.S-S evaluation scale,Gesell language development quotient evaluation scale and Wechsler intelligence test speech IQ evaluation scale were used to evaluate the curative effect and outcome.The acupuncture group was better than the non acupuncture group,and the difference was statistically significant(P<0.05);However,due to the small number of included studies and the low quality of many studies,the credibility of the results is affected.If more high-quality studies are published in the future,it can provide dose-effective suggestions for the course of acupuncture treatment of children’s language retardation.Heterogeneity test-the S-S evaluation scale was used to evaluate the overall efficacy of acupuncture group and non acupuncture group,the efficacy of cerebral palsy with language delay and simple language delay,and the efficacy of acupuncture+language training in the treatment group and language training in the control group.The heterogeneity test showed that there was a small heterogeneity I2=0%,representing a small difference in the study design compared with the same group;Gesell language development quotient evaluation scale was used to evaluate the overall efficacy of acupuncture group and non acupuncture group,cerebral palsy with language delay and simple language delay,and Wechsler intelligence test speech IQ evaluation scale was used to evaluate the overall efficacy of acupuncture group and non acupuncture group.The heterogeneity test showed that there was a large heterogeneity I2>50%,which represented that there were great differences in the research designs compared with the same group,It is suggested that if we can select a special evaluation scale for children’ s language retardation and include more studies with similar design,the incidence of heterogeneity in this group can be reduced.Sensitivity analysis-for the study of acupuncture in the treatment of children’s language retardation,in terms of the overall curative effect,this paper evaluated the overall curative effect by S-S,Gesell language development quotient and Wechsler intelligence test speech IQ evaluation scale;In the analysis of curative effect of diseases,the total effective rate of cerebral palsy with language delay and simple language delay assessed by S-S and the total effective rate of cerebral palsy with language delay assessed by Gesell language development quotient;In terms of treatment methods,S-S was used to evaluate the total effective rate of cerebral palsy with language delay in the treatment group(acupuncture+language training)and the control group(language training).The meta-analysis of fixed effect model and random effect model was used.For the groups with large outliers(I2>50%),the efficacy outcomes of acupuncture group and non acupuncture group were compared after excluding low-quality studies.Although the stability of the results was high due to the influence of multiple factors,It is suggested that the curative effect of acupuncture on children with language retardation is better than that of non acupuncture group,and the difference between the two groups is statistically significant(P<0.05).(6)Network Meta-analysisUsing ADDIS software to draw a network meta-analysis of the relationship between interventions.Overall intervention efficiency ranking probability-intervention measures from good to bad-SS evaluation scale,T023(acupuncture+transcranial magnetic)>t003(electroacupuncture+language training)>T001(acupuncture+language training)>T005(acupuncture)>t016(transcranial magnetic)>T002(language training);Gesell language development quotient evaluation scale,T004(acupuncture,acupoint injection+language training)>T001(acupuncture+language training)>t003(electroacupuncture+language training)>T023(acupuncture+transcranial magnetic)>T002(language training);There are differences in the ranking probability of overall intervention efficiency between the two evaluation scales by mesh meta-analysis,which can not explain which treatment method is the best intervention for the treatment of children’ s language retardation.The efficiency ranking probability of intervention measures for cerebral palsy with language delay-the order of intervention measures from good to badSS evaluation scale,T023(acupuncture + transcranial magnetic)>t003(electroacupuncture+language training)>T001(acupuncture+language training)>T002(language training);Gesell language development quotient evaluation scale,T004(acupuncture,acupoint injection+language training)>T001(acupuncture+language training)>t003(electroacupuncture+language training)>T002(language training)>t113(language training,acupoint injection);There are differences in the effective ranking probability of the intervention measures of cerebral palsy with language delay between the two evaluation scales by mesh meta-analysis,which can not explain which treatment method is the best intervention measure for the treatment of cerebral palsy with language delay.The analysis reason is related to the small number of included studies and more therapies.Therefore,it is expected that more scholars will publish high-quality literature,include more studies with similar designs,compare the efficacy and outcomes,and find the best intervention measures for the treatment of children’s language retardation in the future.2.Acupoint selection and meridian returnStatistics of 162 included studies showed that acupuncture of Du Meridian and foot Shaoyang gallbladder meridian commonly used in children with language retardation.The commonly used acupoints-single acupoints are shenting,Benshen and Baihui,compound acupoints are Zhisanzhen and sishengcong,and the stimulation areas are language Ⅰ area,language Ⅱ area and language Ⅲarea.Conclusion1.This paper studies the clinical application of acupuncture in children’s language retardation.It is found that the published research on acupuncture treatment of children’s language retardation has increased year by year in recent years,which represents that acupuncture treatment of the disease has been recognized by medical personnel and children’s parents year by year.2.Disease type cerebral palsy is the mainstream of acupuncture in the treatment of children’ s language retardation.Evaluation scale-Gesell language development quotient,S-S and Wechsler intelligence test speech IQ are commonly used to evaluate the efficacy and outcome of acupuncture in the treatment of children’ s language retardation.Intervention measuresacupuncture+language training was used in the treatment group,and language training was used in the control group.3.This paper collects the clinical research literature collected from the database until November 21,2021,which has been published in official academic journals.There is no degree thesis and unpublished literature,so there is publication bias;In this paper,Gesell language development quotient evaluation scale was used to evaluate the overall curative effect of acupuncture group and non acupuncture group,the curative effect of children with cerebral palsy with language delay and simple language delay,and Wechsler intelligence test speech IQ evaluation scale was used to evaluate the overall curative effect of acupuncture group and non acupuncture group.The funnel diagram of meta-analysis also suggested that there was publication bias;In addition,only 6 of the 162 studies were foreign literature,which was caused by different cultural systems of traditional Chinese and Western medicine,so there was language bias;At present,the research on acupuncture in the treatment of children’ s language retardation is not perfect,the research itself has defects and the number of research is relatively small,resulting in complex etiology and diverse intervention measures.Therefore,a large number of studies can not be analyzed hierarchically or systematically evaluated according to the degree of disease,nor can network meta-analysis be used to find out the best intervention measures for the treatment of children’s language retardation.4.A total of 160 studies were included in the meta-analysis of this literature,all of which support that the curative effect of acupuncture on children’ s language retardation is better than that of non acupuncture group,the difference is statistically significant(P<0.05),and has good application prospect and popularization value;However,because there are many included studies,the random allocation method,allocation concealment and blind bias are unclear or high-risk,which affect the credibility of the included studies.It is expected that more clinical workers will publish high-quality studies in the future,provide evidence-based medical basis for acupuncture treatment of children’ s language retardation,guide the clinic,solve problems for more children with language retardation and families,and make greater contributions to the society. |
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