| OBJECTIVE To evaluate the clinical curative effect and safety of tuina therapy for infantile enuresis via method of systematic review, as well as relevant literature quality, and to keep abreast of current status of literature about tuina therapy for infantile, so as to provide basis from evidence-based medicine to clinical practice of tuina for infantile enuresis.METHOD With enuresis, tuina, spinal manipulation and synonyms of these words as retrieval word, use computer retrieval and manual retrieval to search CBM, CNKI, VIP, WanFang DATA, Pubmed and the Cochrane Library, as well as some other important medical journals. All literatures are searched before time of December 31th, 2015. Then we extract relevant information from the literatures and assess quality of literatures. In the end, we evaluate curative effect of tuina therapy for infantile by clinical total effective rate and recurrence rate. The software Revman 5.3 was used for Meta-analysis.RESULT 11 RCTs and 1006 patients were included in the end, among which there were 519 patients in the treatment group and 487 patients in the controlled group. Among all the treatment group, intervention were applied as only tuina therapy in 4 researches, tuina combined with acupuncture in 4 researches, tuina combined with herbal medicine in 2 researches, and tuina combined with moxibustion in 1 research. In the controlled groups, western medicine, Chinese herbal medicine, acupuncture and moxibustion were applied in relevant researches. For final outcome, all researches used total effective rate.3 researches used symptom score.2 researches used recurrence rate.1 research used syndrome score. Only 1 research reported adverse reaction during treatment. The methodological quality of the trials were generally low, mainly reflected as follows:incorrect random allocation, no allocation concealment, no mention of blinding, incomplete follow-up. The meta-analysis shows that:in total effective rate, tuina therapy is not better than western medicines (DDAVP:RR=0.99,95C%CI=[0.82,1.19], Z=0.14,P=0.89) (Meclofenoxate: RR=1.12,95%CI=[0.89,1.41], Z=1.00,P=0.32) and Chinese patent drug (RR=1.05,95%CI=[0.74,1.48], Z=0.28,P=0.78) Tuina therapy shows better effect than Chinese herbal medicine. Combination of tuina and acupuncture has better effect than acupuncture (RR=1.34, 95%CI=[1.11,1.63], Z=2.98,P=0.003). Combination of tuina and patent drug shows better effect than patent drug (RR=1.06,95%CI=[1.00,1.11], Z=2.01,P=0.04) Combination of tuina and herbal medicine is not better than herbal medicine (RR=1.09,95%CI=[0.91,1.30], Z=0.97,P=0.33).Combination of tuina andmoxibustion is not better than moxibustion (RR=1.06,95%CI=[0.96,1.17], Z=1.10,P=0.27). In recurrence rate, tuina is not better than patent drug (RR=0.25, 95%CI=[0.04,1.40], Z=1.58,P=0.11).Combination of tuina and acupuncture shows better effect than acupuncture (RR=0.11,95%CI=[0.02,0.58], Z=2.59,P=0.009).In symptom score, combination of tuina and acupuncture is better than acupuncture (MD=-2.14,95%CI=[-2.66,-1.62], Z=8.12, P<0.00001). In syndrome score, tuina is better than patent drug (MD=-2.37,95%CI=[-4.19,-0.55], Z=2.56, P=0.01)CONCLUSION Amount of literatures about tuina for infantile enuresis is limited and they are of low quality. The outcome of analysis shows that tuina therapy has effect for infantile enuresis. However, due to the low quality of the included literatures, further RCTs and researches with high quality and large samples are needed to testify that tuina has better effect than other treatments. |
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