Systematic Evaluation And Meta - Analysis Of The Treatment Of Spastic Paralysis After Stroke By

Purpose:Based on 1978~2015 in domestic about Jingjin needling method for treatment of cerebral apoplexy spastic paralysis after randomized controlled trial(RCT) were: a systematic review and meta analysis to explore the musculature acupuncture method of clinical efficacy and safety, for future clinical treatment provide evidence of evidence-based medicine.Method:Through the research methods of Cochrane system, the content feature extraction, risk bias evaluation, Meta analysis and qualitative analysis, result discussion and conclusion report were carried out for the inclusion of the documents and materials of the randomized controlled trials. The method is as follows.Search methods: to "aponeurotic channel", "stroke", "spastic" three word Related words as key words, retrieval of CNKI(1979- 2015), VIP(1989 to 2015), Wanfang(1989- 2015, China CBM database(1978- 2015), Pub Med(1980- 2015), the Cochrane Library(Issue4,2015) database. Retrieval date from each database since the deadline to November 30, 2015.Inclusion criteria:?Stroke diagnostic criteria: Western medicine diagnosis of the Chinese medicine will be the fourth national cerebrovascular disease conference to develop “the various types of cerebrovascular disease diagnosis points”; Traditional Chinese medicine diagnosis is the diagnosis and therapeutic effect evaluation standard of stroke, which is made by TCM diagnosis and emergency cooperation group, is in line with any one.?Diagnostic criteria for spasm: Brunnstrom staging of stage II to IV stage; modified Ashworth table assessment of risk of spastic limb muscle tension state grade 1 to 5 level; a clear description of spasm of clinical symptoms and signs(suffering from limb girdle muscular hypertonia, tendinous reflex showed strong, joint activities detrimental, positive pathologic reflex, clonus), in line with the either can be.? Intervention measures: the treatment group was treated by the method of reinforcing the meridian(acupuncture points, not limited to the needle). The control group using the traditional body acupuncture therapy(drugs, traditional Chinese medicine or western medicine treatment) and rehabilitationtherapy. The conventional basic treatment of stroke(such as the treatment of blood pressure,blood sugar, blood lipid) is not included in the evaluation.Of all documents into the diagnostic criteria, inclusion and exclusion criteria, efficacy criteria, outcome, adverse events, course of treatment and follow-up situation were summarized, and the Cochrane library system made the Review Manager 5.3 software bias risk assessment tools for inclusion in the literature of quality evaluation. Data analysis: count data using ratio Ratio(or) and continuous variable data using mean deviation(MD) as effect evaluation, the 95% confidence interval. When the results of no heterogeneity, meta analysis was performed, using the fixed effect model; if there is a clinical heterogeneity, but in the acceptable range I2<50%, can still be meta analysis, considering the complexity of acupuncture and moxibustion treatment, choose a random effects model. If the results of the study were large(I2>50%), the results were qualitatively analyzed.Results:In accordance with the requirements of the literature there are 33 articles, a total of 2219 patients with spastic paralysis after stroke.Literature for assessing risk of bias: 45.45%(15 / 33) of the literature in specific description of the random sequence generating method, using the random number table method, computer software to generate, stratified randomization, randomly assigned card method, flip a coin; only 3.03%(1 / 33) of the literature used random assignment of the occult; 12.12% of the literature use the blind method; ending index of literature: 93.93%(31 / 33) have reported a complete, non selective reporting bias. 60.60%(20/33) reported baseline consistency, data comparability, without potential bias. In summary, 33 pieces of literature and the overall risk of bias evaluation only the risk of bias of the article as low risk, the remaining 32 papers were risk is not clear. Therefore, the quality of the 33 articles included is generally not high.The results of Meta analysis:(1) according to the "China Rehabilitation Medicine Treatment norms"(1998 edition) modified Ashworth volume table(MAS) four level evaluation method of observation of limb spasticity muscle tension, Jingjin needling method is more effective than traditional acupuncture acupuncture, the difference was statistically significant.(2) in improving the ability of daily life of patients with bathel index evaluation, Jingjin needling method has obvious advantages in improving the patients’ daily life self-care ability, compared with traditional body acupuncture acupuncture, the difference is statistically significant.(3) in the score of neural function defect, compared to Jingjin needling method with traditional Body Acupuncture Acupuncture and in improving cerebral stroke neurological function recovery effect better.(4) in the Fugl-Meyer motor function score to observe the functional aspect of the limb motor function, the effect of the method is better than that of rehabilitation training in improving the motor function of patients after stroke.Qualitative analysis of the results: the vast majority of the literature study that the treatment of spastic paralysis after stroke has clinical efficacy. Part of the literature shows that Jingjin needling method is superior in reducing CSI and Fugl-Meyer value of traditional acupuncture and rehabilitation training. To improve the curative effect of limb spasm after stroke and improve limb motor function in patients with stroke. The literature also showed that in the MAS four assessment method to evaluate the muscle tension of spastic muscle in patients with stroke after stroke, the effect is better than that of traditional Chinese medicine.Safety: only 1 Literature(3.03%) appeared adverse reaction(subcutaneous ecchymosis and 2 literatures(6%) clear no adverse reaction, 91% of the literature did not mention adverse events.Conclusion:Compared with rehabilitation training and traditional Chinese medicine, treatment of spastic paralysis after cerebral apoplexy by the method of muscle and acupuncture has the advantage of curative effect.It can reduce spastic limb muscle tension, reduce CSI value, promote the recovery of neural function, improve the patient’s motor function and so on.In the security aspect, the method is a relatively safe method of treatment. But by the method of the quality of the literature, it has some limitations, the need for future clinical researchers to improve the quality of RCT, to obtain the high level of clinical evidence to make efforts.