| Objective:Systematic evaluation of the efficacy of external Chinese medical treatment for breast cancer-related lymphedema(BCRL)using direct Meta-analysis.Mesh meta-analysis was used to obtain the ranking of the efficacy of different external treatments of traditional Chinese medicine in the treatment of breast cancer-related lymphedema(BCRL),providing objective and effective evidence-based medical evidence of the efficacy of external treatment of traditional Chinese medicine on BCRL,and broadening the thinking and methods for the selection of external treatment of BCRL by clinicians.Methods:The literature on RCTs of BCRL treated externally with Chinese medicine was obtained by systematic searches of the China Knowledge Network(CKNI),Vipshop,Wanfang,Pub Med and The Cochrane Library databases.The final included literature was obtained by screening and careful reading of the full text.Stata software was used to perform mesh Meta-analysis of the data,while Review Manager was responsible for direct Meta-analysis analysis of the data.1.A total of 24 randomized controlled trials with a total of 1794 patients and10 TCM external treatments were included.The values of angular change in upper limb circumferential difference improvement efficiency,visual analogue scale of pain(VAS),upper limb dysfunction scale(DASH),KPSscore,and shoulder mobility(ROM)in internal retraction were used as outcome indicators.Odds Ratio(OR)was used to represent effect indicators for dichotomous variables,and Mean Difference(MD)was used to represent effect indicators for continuous variables,both of which were interval estimated with 95% confidence intervals.2.Results of direct Meta-analysis:(1)TCM external treatment was superior to conventional treatment in improving the upper limb circumference difference,VAS,DASH and KPS,and the differences were statistically significant.(2)TCM external treatment had no significant effect on improving the adduction Angle of shoulder joint range of motion,and the difference was not statistically significant.3.The results of the reticulated Meta-statistical analysis showed that:(i)in terms of the improvement efficiency of upper limb circumference difference,the order of efficacy: acupuncture cupping > moxibustion >Chinese medicine ironing + tui na > Chinese medicine external washing >Chinese medicine external application > abdominal acupuncture >conventional treatment;(ii)in terms of VAS,the order of efficacy: Chinese medicine external application > abdominal acupuncture > Chinese medicine external application + Chinese medicine spray > moxibustion > acupuncture cupping > conventional treatment;(iii)in terms of DASH,the order of efficacy: Chinese medicine(iii)in terms of DASH,the order of efficacy:external Chinese medicine + acupuncture point dressing > external Chinese medicine > acupuncture cupping > conventional treatment;(iv)in terms of KPS score,the order of efficacy: acupuncture point dressing > acupuncture point dressing + Chinese medicine spray > moxibustion > conventional treatment;(v)in terms of ROM internal angle values,the order of efficacy:external Chinese medicine + acupuncture point dressing > external Chinese medicine > acupuncture cupping > conventional treatment.Conclusion : 1.Compared with conventional treatment alone,external treatment of traditional Chinese medicine may be more effective in the treatment of breast cancer-related lymphedema(BCRL).2.In terms of improvement in the degree of swelling of the affected limbs,acupuncture cupping was most effective;in terms of improvement in the visual analogue score of pain,external Chinese medicine was most effective;in terms of improvement in the Dysfunctional Scale of the Upper Extremity(DASH),external Chinese medicine + acupressure was most effective;in terms of improvement in the KPS score,acupressure was most effective;in terms of the change in the angle of internal retraction in shoulder mobility(ROM),external Chinese medicine was most effective.In terms of improvement of KPS scores,acupressure was the most effective. |
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