| To evaluate the efficacy and safety of acupuncture-moxibustion therapy for primary hemifacial spasm by using systematic review method. Provide evidence for clinical use of acupuncture-moxibustion therapy for primary hemifacial spasm, and the ideas for further reseach.Method:Searching articals from CBM Database (1978-2013.2), CNKI Datab ase (1979-2013.2), VIP Database (1989-2013.2), Wanfang Database (1989-2013.2),Cochrane Library (2013, ISSue2), Pubmed(1980-2013.2), Embase D atabase(1978-2013.2), along with manual searching and through http://www.google.hk/, http://www.who.int/trialsearch, http://www.hkclinicalt rials.com for supplement search under strict inclusion and exclusion criteria formulated in advance. Two reviewers selected articles and e xtracted data independently firstly, and consulted another one or disc ussing with each other to make a dicision if a disagreement was met.F our aspects were included to evaluate the efficacy of acupuncture-mox ibustion therapy for primary hemifacial spasm, respectively were the total effective rate, the improvement of amplitude and frequency of sp asm wave, the safety. Evaluate the quality of included articles by "b ias rwask assessment tool" based on the Cochrane Handbook5.0, and ana lyswas datas by Review Managers.1softwwere, including qualitative and quantitative analyswas. The option of effect size for quantitative analysed:choosing OR(odds ratio)and its95%CI(confidence intervals) for dichotomous variables, MD (mean difference) for continuous variab les, and SMD(standwered mean differrence) for continuous variables if there was large difference between means of two groups. And evaluat ed the evidence quality grade by GRADE profiler3.6softwwere.Result:Seventeen RCTs concerning acupuncture-moxibustion for hemifacial spasm were included in this systematic review. Eight of them were simple acupuncture vs medicine, six researches were acupuncture with other treatment vs medicine,two were acupuncture and tranditional Chinese medicine vs tranditional Chinese medicine, one was moxibustion vs medicine. ALL of them reported the total effect rate,three reported the improvement of amplitude and frequency of spasm wave, and three researches reported the adverse event of the controlled group. Methodological quality evaluation:two researches was C, other fifteen was B. GRADE quality of evidence rating of "very low" to "morderate"。Meta analysis:①tatal effective rate:simple acupuncture was superior to medicine (MH OR4.89,95%CI [3.31,7.23], P<0.00001); acupuncture wi th other therapy was superior to medicine (MH OR6.75,95%CI [3.55,12.83], P<0.00001); acupuncture with traditional Chinese medicine was superior to traditional Chinese medicine (MH OR14.17,95%CI [4.45,45.10], P<0.00001); can not prove that moxibustion was superior to medicine (MH OR1.99,95%CI [0.81,4.90], P=0.13>0.05).②the improvement of amplitude of spasm wave:simple acupuncture may be superior to medicine (SMD0.76,95%CI [0.34,1.19], P<0.05).③the improvement of frequency of spasm wave:can not prove that simple acupuncture was better than western medicine yet (MD0.68,95%CI [-0.12,1.47], P>0.05).④safety:no adverse event was reported in experience group.Conclusion:The systematic review found that acupuncture was superior to medcine,while moxibustion can not be proved to be superior to medicine in total effect rate, simpple acupuncture may be superior to medcine in improving the amplitude of spasm wave, simpple acupuncture can not be proved to be superior to medcine in improving the frequency of spasm wave yet. It can not be concluded that acupuncture-moxibustion was safety for HFS, although there were not aderse events reported in experienced groups. But further researches may change this conclusion for the methodological defects and the very low to moderate evidence quality grade in included RCTs in this SR.More strictly designed RCTs needed to be carried out to provide high quality evidence for further demonstrating the clinical effect of acupuncture-moxibustion therapy. |
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