| Objective:By understanding the latest clinical research status of acupuncture treatment for cerebral palsy at home and abroad,this study evaluated the efficacy and safety of acupuncture treatment for cerebral palsy by means of systematic evaluation and Meta analysis,explored the impact and value of acupuncture on patients with cerebral palsy,and guided clinical practice and research.Method:First,strict inclusion and exclusion criteria were formulated,and comprehensively searching China National Knowledge Infrastructure(CNKI),Wanfang Journal Database,PubMed,Embase Database and Chorane Library from the first searching time of databases to 31st May 2018.Two researchers independently evaluated the quality of randomized controlled trials that met the inclusion criteria and extracted data.If there were differences,they could be resolved through discussion or with the assistance of a third researcher.Second,assessing the bias risk of the included randomized controlled trials quality was according to the bias risk assessment tools provided in Cochrane Collaborative Network Systematic Evaluation Manual Version 5.1.0.The total effective rate,GMFM score,Ashworth score,WeeFIM score were used as the main index to evaluate the therapeutic effect of'acupuncture on infantile cerebral palsy.Finally,RevMan 5.3 software was used for statistical analysis.The odds ratio(OR)and its 95%confidence interval(Cl)were calculated for the counting data,and the standard mean difference(SMD)and its 95%confidence interval were calculated for the continuous variable data.And the funnel plot was used to analyze the publication bias.Results:After strict screening,14 randomized controlled trials were included,with a total number of 1397 cases.Acupuncture treatment of cerebral palsy acupoints:the top five points are:Baihui,Sanyinjiao,Shenting,Sishencong,Zusanli.Acupoints are mainly distributed in governor meridian,gall bladder meridian of foot-shaoyang,stomach meridian of foot-yangming,spleen meridian of foot-taiyin and kidney meridian of foot shaoyin.Quality assessment:(1)Random Sequence Generation:Four studies were rated as "risk unknown",three as "high risk",and seven as " low risk".(2)Allocation Concealment:Fourteen study were rated as " risk unknown".(3)Blindness among researchers and subjects:Fourteen study were rated as " risk unknown ".(4)Blind method for measuring results:Twelve were rated as " risk unknown " and two as " low risk ".(5)Integrity of Outcome Data:All were rated as "low risk ".(6)Selective reporting:All were rated as "low risk ".(7)Other bias:One was rated as " low risk " and 13 as " unknown risk ".All in all,the overall quality level of the included literature is generally high,and a small number of low-quality literature may lead to a certain degree of bias in the results·Meta-analysis results:(1)In terms of total effective rate,combined effect OR was 3.49,95%CI being(2.60,4.69).The difference was statistically significant(P<0.05).This suggested that treatment group better than control group.According to the subgroup analysis of average age,the combined effect OR of subgroups with average age of 1 to 2 years,2 to 3 years and over 3 years were 2.63[95%Cl(1.18,5.85)],3.08[95%CI(1.85,5.15)],and 3.00[95%CI(1.47,6.12)],among which the clinical effect of 2 to 3 years group was the best.According to the subgroup analysis of the treatment course,the combined effect OR of the treatment course of 1 month,2 months,3 months and 6 months were 2.47[95%Cl(1.16,5.24)],3.27[95%Cl(1.37,7.77)],4.10[95%Cl(2.70,6.23)],2.80[95%Cl(1.40,5.61)],among which the treatment course of 3 months was the best.The difference was statistically significant(P<0.05).(2)In the improvement of GMFM score,the standardized mean difference(SMD)was 0.81 and 95%Cl was(0.61,1.02).After excluding a low-quality study,the standardized mean difference(SMD)was 0.68 and 95%Cl was(0.52,0.84),showed that the curative effect of acupuncture combined with rehabilitation training group was better,the difference was statistically significant(P<0.05).According to the subgroup analysis of intervention measures,SMD was 0.82,95%Cl being(0.62,1.05)in the combination of acupuncture and rehabilitation training control group was signifieantly different(P<0.05);SMD was 0.68,95%CI being(0.16,1.19)in the combination of acupuncture and rehabilitation training control group was not significantly different.(3)In the improved Ashworth score,the standard mean difference(SMD)was 0.65,95%CI being(-1.07,-0.23),the difference is statistically significant(P<0.05),indicating that the effect of acupuncture combined with rehabilitation training is significantly better than that of rehabilitation training.(4)In WeeFIM score,the standard mean difference(SMD)was 0.58,95%Cl being(0.24,0.91),the difference was stati stically significant(P<0.05),and the acupuncture combined with rehabilitation training group was better than the rehabilitation training group.(6)Sensitivity analysis and funnel plot analysis showed that the included studies were homogeneous and had no publication bias.Conclusion:Acupuncture was safe and effective in the treatment of cerebral palsy.It had good advantages in total effective rate,GMFM score,improved Ashworth score and WeeFIM score,especially in improving gross motor function.Acupuncture treatment or three-month treatment for children aged 2 to 3 had better clinical efficacy.This study showed that acupuncture is effective and safe in the treatment of cerebral palsy.In order to improve and consolidate the curative effect,clinicians could choose Baihui,Shenting,Sishencong,Sanyinjiao,Zusanli and other acupoints. |
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