Acupuncture Treatment Of Dysphagia:A Systematic Review

Objective:The objectives of the current analysis are as follows:to review the current clinical research progress on acupuncture treatment of dysphagia,to evaluate its safety and curative effect,to provide credible evidence for the establishment of clinical guidelines and protocols,work towards the recognition of acupuncture as an effective treatment of dysphagia.Method:Literature screening:We searched 6 online databases(CNKI,WANFANG,VIP,PubMed,ScienceDirect,Cochrane Library)for randomized controlled trials(RCTs)published before Dec.3 1,2020.NoteExpress was used to identify duplication,then we manually checked titles and abstracts to exclude unrelated literature,finally the full texts were manually checked to apply the inclusion/exclusion criteria.Data extraction:the basic characteristics,methodology and outcomes were extracted.Outcomes included 3 primary outcomes:Fuj ishima Ichiro rating scale(FIRS),standardized swallowing assessment(SSA),effective rate;4 secondary outcomes:Kubota’s water swallowing test(KWST),video fluoroscopic swallowing study(VFSS),modified Barthel index(MBI),swallowing quality of life(SWAL-QOL)and adverse events.Quality assessment:according to Cochrane risk-of-bias assessment protocol,we performed risk-of-bias assessment and drawn the risk-of-bias summary plot(Review Manager 5.4).We also investigated the possible publication bias by Begg’s and Egger’s tests and drawn the funnel plot(Stata 15.1).Data analyses and quality of evidence assessment:I2 test was performed for heterogeneity(Review Manager 5.4).In case of I2>50%,sensitivity and subgroup analyses were performed to find out the origin of heterogeneity.Effect size was chosen for meta-analysis,pooling model was random effect model.Measurement data was represented by mean difference(MD),categorical data was represented by odds ratio(OR)or relative risk(RR).95%confidence intervals were calculated for all data,p<0.05 was considered as statistically significant.For outcomes that described by less than 2 reports,descriptive analysis was performed.Quality of evidence(QoE)was assessed by GRADE.Results:A total of 4084 reports entered screening.32 reports(2 in English)involving 2665 patients were included in the current analysis.The risk-of-bias of the included studies was high.There was possible publication bias.Acupuncture effects on outcomes regarding swallowing function:acupuncture was more effective than rehabilitation(S S A:p=0.003,QoE:low),acupuncture was similarly effective as rehabilitation(KWST:p=0.29,QoE:very low),the combination of acupuncture and rehabilitation was more effective than rehabil it at ion-only(FIRS:p<0.0000 1,QoE:low;S S A:p<0.00001,QoE:moderate;KW ST:p<0.00001,QoE:moderate;VFSS:p<0.00001,QoE:moderate),the combination of acupuncture and drug was more effective than drug-only(FIRS:p=0.001,QoE:low;KWST:p<0.0001,QoE:low),acupuncture improved effects of rehabilitation-drug combination(FIRS:p<0.00001,QoE:moderate;SSA:p<0.00001,QoE:low;KWST:p<0.00001,QoE:low;VFSS:p<0.0000 1,QoE:low).Acupuncture effects on outcomes regarding the quality of life:acupuncture improved the effects of rehabilitation(SWAL-QOL:p<0.00001,QoE:moderate),acupuncture improved effects of rehabilitation-drug combination(MBI:p=0.02,QoE:moderate;SWAL-QOL:p<0.0001,QoE:moderate).Acupuncture effects on effective rates:acupuncture was similarly effective as rehabilitation(KWST:p=0.22,QoE:low),the combination of acupuncture and drug was more effective than drug-only(KWST:p=0.008,QoE:low),acupuncture improved effects of rehabilitation-drug combination(KWST:p<0.00001,QoE:low;VFSS:p=0.03,QoE:low).The safety of acupuncture was similar to rehabilitation and drug(p=0.10,QoE:very low).Conclusion:Acupuncture was similarly effective in improving KW ST score as the rehabilitation.Rehabilitation-and drug-only therapies,and the combination of two,were all effective in treating dysphagia,a better result could be achieved when acupuncture joined into the therapy.The safety of acupuncture might be similar to other therapies based on the current evidence,while it needed to be further confirmed.