Systematic Review Of Randomized Controlled Trials Of Acupuncture Combined With Moxibustion To Treat Lumbar Muscle Strain

Objectives:To collect randomized controlled trails (RCTs) on acupuncture combined with moxibustion for lumbar muscle strain before the end of January 2015 published in Chinese or English.Via systematic review we aimed to evaluate the efficiency, safety and recurrence rate.Materials and Methods:We set strict inclusion and exclusion criteria,and comprehensively searched Chinese Journal Full-text Database-(CNKI),Chinese Biological Medical Database-(CBM), Chinese Science and Technology Periodical Database (VIP),Wanfang Database,The Cochrane Library, PubMed, and Excerpt Medica Database(EMBASE).Hand searching was performed for Chinese Acupuncture, Journal of Clinical Acupuncture and Moxibustion, Shanghai Journal of Acupuncture and Moxibustion, Journal of New Chinese Medicine and Liaoning Journal of Traditional Chinese Medicine to supplement the search. in http://www.controlled-trials.com;http://scholar.google.com/;http://www.cLinical trials, gov and other network resources to supplement search. Two researchers independently screened the literature, then extracted data and assessed the quality for literature according to the standard. Disagreement was solved through discussion or by a third researcher. Finally, data synthesis used total effective rate as primary indicator of the efficacy of acupuncture combined with moxibustion for lumbar muscle strain. Statistical analysis was provided by Cochrane Collaboration RevMan5.2 software to count data, calculate relative risk (RR) and measure data with 95% confidence interval (CI).Results:A total of 468 documents were found. Ultimately 11 Chinese literatures conformed to the inclusion criteria, which included 806 subjects,and English literatures up to the standard were not found. Methodological quality of these trials was low, mainly due to imperfect random allocation scheme and allocation concealment. No trials used the correct blinding nor reported sample size estimation. All were deficient of follow-up, very small number of subjects explaining the intention of analysis and dropped reasons. Extracting data for Meta analysis showed that:(1)Total effective rate:①Acupuncture combined with moxibustion was better than other physical therapy (including electropuncture, acupuncture, acupuncture plus TDP and computerized intermediate frequency plus thermomagnetic vibration) (RR=1.17,95%CI=[1.11,1.23],Z=6.13(P<0.00001)), but subgroup analysis showed total effective rate of acupuncture combined with moxibustion and acupuncture was the same (RR=1.12,95%CI=[1.00,1.24], Z=1.96(P=0.05)).the sensitivity analysis was deficiency because of none correct blinding and allocation concealment;②Acupuncture combined with moxibustion was better than Western medicine (RR=1.21,95%CI=[1.05,1.40], Z=2.61 (P=0.009),and sensitivity analysis was also not being done. (2)VAS,Oswestry and Greenough-frasher:Change of VAS,Oswestry and Greenough-frasher of experimental group were lower than control group after treatment. (3) Recurrence rate:One test reported follow-up and recurrence(recurrence rate of experimental group was 3.33%,while control group was 26.67%);One test reported efficacy of experimental group was much better than control group one month after treatment.(4)Only one included study reported safety outcome (no adverse event existed).Conclusion:Current evidence suggests that, in terms of total effective rate, acupuncture combined with moxibustion is better than electropuncture, acupuncture plus TDP,computerized intermediate frequency plus thermomagnetic vibration and western medicine, while total effective rate of acupuncture combined with moxibustion and acupuncture is the same.It can not affirm that acupuncture combined with moxibustion is better than others for lumbar muscle strain. In terms of safety, it is uncertain that acupuncture combined with moxibustion treatment of lumbar muscle strain is satisfactory, therefore it needs more evidence to confirm.There is not enough evidence to provide recurrence rate.There is need to track related high quality clinical evidence and update this study,to provide further literature basis for clinic.