Evidence Map And Network Meta-analysis Of Clinical Research On TCM Exercise Health-preserving Methods For Stroke Interventio

Objective:To comprehensively summarize the distribution of clinical research evidence on the treatment of stroke using traditional Chinese medicine exercise and health preservation methods,display the current research status,reveal the gaps and shortcomings in relevant research fields,and further conduct evidence-based medicine analysis based on existing research foundations,in order to obtain the optimal rehabilitation plan for traditional Chinese medicine exercise and health preservation methods that are clinically applicable.Method This study is divided into two parts.Part 1 adopts evidence-based medicine research methods using evidence graphs.The system searches CNKI,WanFang,VIP,China Biomedical Literature Database(CBM),PubMed,EMbase,Cochrane Library,Web of Science,as well as the China Clinical Trials Registry(ChiCTR)and the United States Clinical Trials Registry(Clinical Trials)using subject words combined with free words.The search time is from January 7th,2023.All clinical studies related to Chinese medicine exercise regimen intervention in stroke were included.NoteExpress document management software was used for inclusion screening.Excel was used to establish an information extraction table to extract the literature information included in the study.AMSTAR 2 tool was used to evaluate the methodological quality of the included system evaluation/Meta analysis.Finally,by drawing the document screening flow chart,line chart,histogram,pie chart,radar chart,heat map Bubble charts,tables,other charts and words display the research results.Part 2 adopts a network meta-analysis method under the Bayesian framework.The research plan is registered on the PROSPERO platform(registration number CRD42023407247).Based on the literature included in the first part of the study,a randomized controlled study was further screened to investigate the intervention of traditional Chinese medicine exercise regimen combined with conventional therapy in stroke,.Simplified Fugl-Meyer Aassessment(FMA),Modified Barthel Index(MBI),and Berg Balance Scale(BBS)were selected as outcome indicators to evaluate the recovery of motor function,balance function,and activities of daily life after stroke.Specific values of the above indicators were supplemented and extracted on the basis of the Information Extraction Table in part 1,Use the Cochrane risk bias assessment tool to conduct a bias risk assessment of the included studies and draw a bias risk assessment map using RevMan5.2 software.Stata14 software was used for direct comparative meta-analysis,as well as the drawing of network relationship diagrams and comparison correction funnels.ADDIS1.16.8 software was used for network meta-analysis,and the probability diagram and probability table for rank sorting were drawn.Results A total of 261 articles were included in the study,including randomized controlled trials(208 articles),non randomized controlled trials(15 articles),case series(11 articles),cohort study(2 articles),systematic evaluation/Meta analysis(19 articles),systematic evaluation reevaluation(1 article),guidelines(1 article),other types(4 articles).The number of published literature has been increasing year by year,and the research locations are mainly concentrated in China(240 articles).The specific types of traditional Chinese medicine exercise and health preservation methods include Taijiquan(99 articles),Baduanjin(65 articles),Liuzijue(23 articles),Chaoyuanfang Guiding Method(9 articles),Other Guiding Methods(18 articles),Yijinjing(15 articles),Tai Chi Exercise Imagination(7 articles),Wuqinxi(3 articles),Shibaduanjin(3 articles),Relaxation Qigong(2 articles),and other methods(17 articles),totaling 11 categories.83%of the studied diseases include hemorrhagic stroke and ischemic stroke.The hot research direction focuses on the rehabilitation of motor function(165 articles)and balance function(121 articles)after stroke,as well as the improvement of daily life ability and quality(134 articles).The most common type of intervention comparison between the experimental group and the control group is the study of traditional Chinese medicine exercise regimen combined with conventional treatment compared to conventional treatment(103 articles).The top three outcome indicators in terms of application frequency are motor.function indicators,balance function indicators,daily living ability indicators,and quality of life indicators,lack of safety indicator report.The 19 systematic evaluations/Meta analysis methodology quality evaluations included in this study were all extremely low.A total of 51 articles were included in Study 2.The total sample size is 3243.Including 9 traditional Chinese medicine exercise and health preservation methods,including Taijiquan(21 articles),Baduanj in(12 articles),Chaoyuanfang Guiding Method(6 articles),Yijinjing(3 articles),Shibaduanjin(2 articles),Other Guiding Methods(2 articles),Liuzijue(2 articles),Relaxation Qigong(2 articles),Wuqinxi(1 articles).The three network relationship diagrams of FMA,BBS,and MBI did not form a closed loop,and there was no direct comparative study of two traditional Chinese medicine exercise and health preservation methods.There is an unknown risk of multiple bias items in the included study’s bias risk assessment.The direct comparison of meta-analysis results showed that,except for Other Guiding Methods that had no statistical significance in FMA indicators[WMD=4.35,95%CI(-2.23,10.93)]and the Baduanjin[WMD=10.78,95%CI(-1.25,22.80)]and Liuzijue[WMD=6.44,95%CI(-0.73,13.61)]in MBI indicators,the combination of traditional Chinese medicine exercise and health preservation methods with conventional treatment was superior to conventional treatment alone intervention.The results of the network meta-analysis showed that in improving FMA,the combination of Baduanjin,Chao Yuan Fang Guiding Method,Relaxation Gong,Tai Chi,and conventional treatment was superior to conventional treatment alone,and the combination of Relaxation Gong and conventional treatment was superior to Tai Chi combined with conventional treatment.On the basis of combining conventional treatment,the order of efficacy may be Relaxation Gong>Chaoyuan Fang Guiding Method>Baduanjin>Taij iquan>Liuzijue>Other Guiding Methods>Yijinjing.In terms of improving BBS,the combination of Baduanjin,Shibaduanjin,Tai Chi,and Wuqinxi is superior to conventional treatment alone.The combination of Wuqinxi and conventional treatment is superior to Baduanjin,Chaoyuan Fang Guiding Method,Liuzijue,Shibaduanjin,Tai Chi,and Yijinjing combined with conventional treatment.On the basis of combining conventional treatment,the order of efficacy may be Wuqinxi>Shibaduanj in>Tai Chi>Baduanj in>Chaoy uan Fang Guiding Method>Liuzijue>Yijinjing;In terms of improving MBI,the combination of Baduanjin and Taijiquan with conventional therapy is superior to conventional therapy alone.On the basis of combining conventional treatment,the order of efficacy may be Relaxation Gong>Chaoyuan Fang Guiding Method>Baduanj in>Tai Chi>Shibaduanj in>Other Guidance>Yijinjing>Liuzijue.The funnel plot shows that there is possibility of publication bias in the study.There is no funding support or conflict of interest in this study.Conclusion:In stroke rehabilitation,the combination of traditional Chinese medicine exercise regimen and conventional treatment is often superior to conventional treatment alone.Among them,the combination of relaxation exercise and conventional treatment may be the best plan to improve motor function and enhance daily living activities,while the combination of Wuqinxi and conventional treatment may be the best plan to improve balance function.There are currently issues in this field,such as uneven research directions on the types of traditional Chinese medicine exercise and health preservation methods and post stroke disorders,low methodological quality,lack of direct comparative research,and insufficient reporting on safety indicators.The results of this study are only indicative.In the future,attention should be paid to grasping the quality of research and increasing research on traditional Chinese medicine exercise and health preservation methods,as well as other stroke disorders such as emotional disorders and sleep disorders,in addition to Tai Chi and Baduanjin.In addition,in the clinical practice of treating stroke patients,it is recommended to actively use traditional Chinese medicine exercise regimen methods for rehabilitation and pay attention to taking safety measures to avoid secondary injuries.