| Therapeutic effect evaluation is the main of clinical evaluation, the study of methods of Therapeutic effect evaluation is very important, had become a great matter for TCM's existence and development. Complex is a character of TCM's diagnosis and intervention, such as the determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs, therapeutic intervention is variegated, and the goals of treatment is multidimensional. Previous TCM clinical evaluation emphasized on single therapy(regime), single outcome index, single dimension, and lacked of the measurement of multi-dimension in TCM complicated intervention, accordingly lowered TCM'S superiority, and covered TCM actual effect, so, therapeutic effect evaluation should return to clinical actuality, reflect the real world of clinical, emphasize TCM'S integrated effect to the patient and comprehensive evaluation.Data envelopment analysis(DEA) is a new field in the cross study of operational research, Management Science and Mathematical Economics, used to evaluate the relative effectiveness in the department have the same kind of input and output. DEA has absolutely superiority to deal with multi-input and multi-output problem, and corresponding to TCM'S characteristic of complex intervention(multi-input) and multi-index comprehensive evaluation.Under the support of 863 program, we utilized DEA to evaluate the relative effectiveness in the patients of chemic stroke early rehabilitation, and research DEA'S possibility and applicability in TCM's complex intervention.Research contents and results:Study 1 Single index therapeutic effect of TCM'S comprehensive regimenThe hospital patients of chemic stroke early rehabilitation come from Dongzhimen hospital affiliated to Beijing university of traditional Chinese medicine, Beijing Tiantan hospital affiliated to capital medical university, the second affiliated hospital of Tianjin university of traditional Chinese medicine, the first affiliated hospital of Henan university of traditional Chinese medicine, the second affiliated hospital of Shandong university of traditional Chinese medicine, the people's hospital of Xingtai, hospital affiliated to Changchun university of traditional Chinese medicine, the second affiliated hospital of Guangdong university of traditional Chinese medicine, and they are randomly distributed to TCM comprehensive regime group and western medicine group by clinical research central random system according to 2:1 ratio. TCM comprehensive group apply the regime of basic therapy of internal medicine, Chinese herbal medicine, Chinese materia medica injection, acupuncture, massage, rehabilitative treatment based BOBATH Therapy, and the western medicine group apply the regime of basic therapy of internal medicine rehabilitative treatment based BOBATH Therapy. The index including neurologic impairment degree measured by (National Institute of Health Stroke Scale(NIHSS); motor function measured by Fugl-Meyer Assessment(FMA); activities of daily living measured by Barthel Index(BI); disability degree measured by Modified Rankin Scale(MRS); TCM symptom measured by TCM Stroke Sympotom Scale(ZHONGYI) Our object was to evaluate the TCM COMPREHENSIVE REGIMEN'S effect ON neurologic impairment, motor function, activities of daily living, disability degree and TCM symptom.Results:①Improvement of neurologic impairment:at 7 day, all of two group's NIHSS score obviously decrease(P<0.001), and at 14day,21 day, two group's score continued decrease., every evaluation point had statistic difference between two group s(P<0.05).②Improvement of motor function:at 7 day, all of two group's FMA score obviously increase (P<0.001), and 14 days,21 days, two group's score continued increase. There was no statistic difference at every evaluation point between two groups (P>0.05).③Improvement of activities of daily living:at 21 day, all of two group's BI score obviously increased(P<0.001), and There was statistic difference between two groups (P<0.05).④Improvement of disability:at 21 day, all of two group's MRS score obviously increased(P<0.001), but There was no statistic difference between two groups (P>0.05).⑤Improvement of TCM Symptom:at 21 day, all of two group's ZHONGYI score obviously decreased(P<0.001), but there was no statistic difference between two group (P>0.05).Conclusion:Both TCM comprehensive regimen and western medicine regimen have favourable improvement to neurologic impairment, motor function, activities of daily living, disability, TCM Symptom in ischemic stroke early rehabilitation patient. TCM comprehensive regimen group wais better than western medicine regimen group in neurologic impairment and activities of daily living, but there was no statistic difference between two groups in motor function, disability and TCM Symptom.Study2 DEA evaluation on TCM comprehensive regimenThe study object, groups, therapeutic regimen was same to study 1. Each patient as a decision making unit(DMU), the input index is the cost of hospitalization, and the output index is the improvement of neurologic impairment, motor function, activities of daily living, disability degree and TCM symptom. The object was to evaluate the relative effectiveness, the DEA model are C2R and BC2.Results:①TCM comprehensive group's average efficiency value was 0.27 and 0.35, and the western medicine group's average efficiency value was 0.22 and 0.31, the former was superior to the latter. TCM comprehensive group's average scale efficiency value was also superior to the western medicine group.②Slack variance analysis:TCM comprehensive group is relatively approaching to ideal condition in the improvement of neurologic impairment, motor function, disability degree and TCM symptom, but western medicine group was relative approaching to ideal condition in the improvement of activities of daily living.Conclusion:DEA evaluation on TCM comprehensive regimen and western medicine group, TCM comprehensive group is better than western medicine group, and TCM comprehensive group was relatively approaching to ideal condition in the improvement of neurologic impairment, motor function, disability degree and TCM symptom, but western medicine group was relative approaching to ideal condition in the improvement of activities of daily living. Study3 Single index therapeutic effect of different TCM'S comprehensive regimenThe research object is the patients in TCM'S comprehensive group. Based on the clinical actuality, we divided TCM'S comprehensive group into three groups:under the basic treatment of internal medicine, group 1(93 patients) apply the regimen of, Chinese herbal medicine, Chinese materia medica injection, acupuncture, massage, rehabilitative treatment based BOBATH Therapy, group 2 (54 patients) was Chinese materia medica injection, acupuncture, massage, rehabilitative treatment based BOBATH Therapy, and group 3(46 patients) was Chinese herbal medicine, Chinese materia medica injection, acupuncture, massage.Object:To evaluate the therapeutic effect of different TCM'S comprehensive regimen on neurologic impairment, motor function, activities of daily living, disability degree and TCM symptom.Results:①Improvement of neurologic impairment:at 7 day evaluation point, all of group 1's NIHSS score obviously decrease compared to the other two groups(P<0.05), but at 14day,21 day, there is no statistic difference between three group (P>0.05).②Improvement of motor function:There was no statistic difference at every evaluation point between three group (P>0.05).③Improvement of activities of daily living:at 21 day, There was statistic difference between three group (P<0.05), group 1 was the best.④Improvement of disability:at 21 day, There was statistic difference between three group (P<0.05), group 1 was the best.⑤Improvement of TCM Symptom:at 21 day, There was statistic difference between three group (P<0.05), group 1 is the best.Conclusion:Single index therapeutic effect of different TCM'S comprehensive regimen, the group 1 (regimen of, Chinese herbal medicine, Chinese materia medica injection, acupuncture, massage, rehabilitative treatment based BOBATH Therapy) is the best in improvement of activities of daily living, disability, TCM Symptom. And at 7 day evaluation point, group 1's NIHSS score obviously decreased compared to the other two groups but at 14day,21 day, there was no statistic difference between three groups. There was no statistic difference at every evaluation point between three groups in the improvement of motor function.Study 4 DEA evaluation on different TCM comprehensive regimensThe study object, groups, therapeutic regimen is same to study 3.Each patient as a decision making unit(DMU), the input index is the cost of hospitalization, and the output index is the improvement of neurologic impairment, motor function, activities of daily living, disability degree and TCM symptom. The object was to evaluate the relative effectiveness, the DEA model are C2R and BC2.Result:①groupl's average efficiency value was 0.33 and 0.43, group2 is 0.39 and 0.53, group3 was 0.27 and 0.34, group2's relative effectiveness is the highest. But group1's scale efficiency was the highest, the next was group3, the next is group2.②slack variance analysis:group2 was relatively approaching to ideal condition in the improvement of neurologic impairment, motor function, disability degree and TCM symptom, but group 1 was relative approaching to ideal condition in the improvement of activities of daily living.Conclusion:DEA evaluation on different TCM comprehensive regimen, group 1 was the best, the next is group2, group3 was the worst. Slack variance analysis indicated group2 was relatively approaching to ideal condition in the improvement of neurologic impairment, motor function, disability degree and TCM symptom, but group 1 was relative approaching to ideal condition in the improvement of activities of daily living.Innovation1. We applied DEA on TCM complex intervention and multi-index comprehensive evaluation, and compared to mono-index evaluation, we research the index system and adapted mathematic model in TCM Therapeutic effect evaluation firstly.2. The results indicate that DEA has some superiority in TCM Therapeutic effect comprehensive evaluation.①Each patient as a decision making unit(DMU), sufficiently indicated the superiority and characteristic.②DEA can envelope multi-dimension index into analysis, ignore index's nonhomogeneity.③It is not necessary to determine the weight of the index in advance, and overcome the deficiency in index weight's determination.④Slack variable can reflect possibility of different regimens reaching the best therapeutic effectness, it is profit to optimize the therapeutic regimen. So, DEA is a suitable way to evaluate TCM comprehensive effect, and should have a good perspective.3. In order to increase the evidence level, TCM clinical evaluation should return to clinical actuality. Based actual clinical science research, this study classified TCM regimen into three regimen, and evaluated their superiority and characteristic, this method may supply a way for TCM regimen's Optimization.
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