Systematic Evaluation And Meta-analysis Of Clinical Efficacy Of Acupuncture Vs Different Western Medicines For The Treatment Of Post-stroke Depression

Objectives:This study adopts a multivariate approach using a systematic literature review and a meta-analysis to conduct a comprehensive evaluation on the use of acupuncture and moxibustion(abbreviated as acupuncture hereafter)treatment for post-stroke depression(PSD).Based upon results reported in literature on the effectiveness of different treatments for PSD,the effective use of acupuncture treatment against the use of different western medicines was evaluated and meta-analysed.The results of this study provide evidence-based information for clinical use of acupuncture treatment for PSD.Research Methods:1.An extensive literatures search on local and overseas publications to identify publications with the following three features:acupuncture for treatment of post-stroke depression;systematic review;and meta-analysis.Upon excluding the standard publications,NoteExpress2.9 was adopted to scan and organize the research outputs based on six major criteria:year of publication,research focus,AMSTAR description,PRISMA statement,similarity,and bias level for a quality analysis.The results were reported as radar charts.2.Upon selection and organization of the publications by NoteExpress2.9,quality analysis of the selected publications was conducted based upon Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0.In the quality analysis of the selected publications,the basic information and the quality levels were statistically analyzed.The bias level of the publications were reported in the form of risk analysis charts.The bias characteristics were classified into two major groups:acupuncture Vs western medicines,and acupuncture plus western medicines Vs western medicines.Findings of the selected publications were statistically analyzed by software Review Manager 5.3(RevMan5.3).Results:1.Quality analysis on publications with the following three features:acupuncture for treatment of post-stroke depression;systematic review;and meta-analysis were analyzed.The analysis was done by systematic review and meta-analysis based on six criteria.The results were reported in the form of radar charts.From the charts,it is noted that 12 publications were selected,and it was suggested that the quality of publications by Zhan Jie 2016 and Zhang Wei 2014 were good,while Zhang Jianbo 2009 was slightly weak.2.Results of the quality analysis on publications with acupuncture Vs western medicines and meta-analysis are summarized as follows:(1)Random approach:correct use of random approach,34 Publications(35%);with key word "random",42 publications(43.3%);no key word "random",10 publications(10.31%);incorrect use of random approach,15 Publications(15.46%).(2)Hide allocation approach:adopting hide allocation approach,3 publications(3.09%);others are uncertain.(3)Blind approach:adopting single blind approach,1 publication(1.03%);adopting blind approach,2 publications(2.06%);correct use of blind approach,5 publications(5.15%);others are uncertain.(4)Data Integrity:all selected publications are acceptable.(5)Results reporting:no selected results reporting,84 publications(86.6%);reporting selected results,3 publications(13.4%).(6)Possible bias:no report.3.Meta-analysis results:A total of 97 publications were included in the meta-analysis.The publications were classified by acupuncture Vs western medicines;and acupuncture plus western medicines Vs western medicines for analysis.The classification on acupuncture Vs western medicines was further divided into 6 groups,namely:acupuncture Vs fluoxetine;acupuncture Vs deanxit;acupuncture Vs amitriptyline;acupuncture Vs citalopram;and acupuncture Vs paroxetine.While the classification on acupuncture plus western medicines Vs western medicines was further divided into 4 groups,namely:acupuncture plus deanxit Vs deanxit;acupuncture plus fluoxetine Vs fluoxetine;acupuncture plus sertraline Vs sertraline;and acupuncture plus venlafaxine Vs venlafaxine.Through the use of Review Manager 5.3 for analysis of the scores of different groups,including MESSS scores,BI index scores,NIHSS scale scores,TESS side effect scores,clinical efficacy,Asberg(SERS scores)scores,CGI scores,SDS(Zung scale)scores,ADL scake scores,HAMD scores and neurological deficit effect.Results of meta-analysis showed that 7 items were not statistically significant.They include:The NIHSS score for acupuncture Vs fluoxetine;the HAMD score for acupuncture Vs citalopram;clinical efficacy for acupuncture Vs deanxit;clinical efficacy for acupuncture plus deanxit Vs deanxit,TESS score for acupuncture plus fluoxetine Vs fluoxetine;Asberg(SERS scores)score for acupuncture plus sertraline Vs sertraline;and HAMD score for acupuncture plus venlafaxine Vs venlafaxine.Others,based on meta-analysis,are statistically significant.Conclusion:1.Previous studies have already identified that literature review and meta-analysis on the use of acupuncture treatment for post-stroke depression(PSD)are inadequate.This study presented a systematic meta-analysis in accordance with AMSTAR description and PRISMA statement,and a quality analysis on the clinical efficacy.Through the objective and vigorous analysis provided by this study,the reliability and practicality of previous studied results could be enhanced.2.The meta-analysis results indicated that acupuncture treatment for PSD was clinically more effective.3.The meta-analysis results indicated that the efficacy for using acupuncture treatment for PSD was comparable to use the of western medicines as unveiled from the followings:the NIHSS score for acupuncture Vs fluoxetine;HAMD score for acupuncture Vs citalopram;clinical efficacy for acupuncture Vs deanxit;clinical efficacy for acupuncture plus deanxit Vs deanxit;TESS score for acupuncture plus fluoxetine Vs fluoxetine;Asberg(SERS scores)score for acupuncture plus sertraline Vs sertraline;and HAMD score for acupuncture plus venlafaxine Vs venlafaxine.