Efficacy of the Oriental herbal medicine, Jie Yu Dan, for alleviating post-stroke aphasia: A Systematic Review and meta-analysis of randomized clinical trials

Abstract

IntroductionJie Yu Dan(JYD), a traditional Chinese medicine, is used to promote circulation and has been used for people experiencing speech and language difficulties with post-stroke aphasia. The objectives of this study were to systematically evaluate randomized clinical trials (RCTs) to assess the efficacy of JYD for improving post-stroke aphasia. MethodsAll RCTs that studied JYD treatment in post-stroke aphasia were selected from English, Korean and Chinese language databases until February 2018. Studies of participants with post-stroke aphasia were divided into 2 groups that had common treatments with JYD and placebo or Western medicine, respectively. Risk ratio and mean differences with 95% confidence intervals (CI) were calculated for the pooled RCTs with a fixed or random model in the meta-analysis. Since the RCTs had some heterogeneity in JYD prescriptions, duration of the therapy and the control group, some subgroup analysis was conducted. Risk of bias and publication bias was assessed for all included RCTs. ResultsThe JYD with conventional therapy (n = 439) additionally improved the overall efficacy of post-stroke aphasia by 1.34 fold in comparison to the conventional therapy (n = 370) in the fixed effect model including 10 RCTs(P < 0.00001). JYD plus conventional therapy (n = 374) was more effective for improving aphasia by 4.88 fold (95% CI = 2.87–6.78) than the conventional therapy (n = 307) as a control group in pooling 8 RCTs(P < 0.00001). There were no differences in JYD efficacy according to treatment duration and original and modified JYD treatments in subgroup analysis. No adverse effects were observed in any of the studies. All 10 studies used an appropriate method for randomization of the subjects but about 25% did not include allocation concealment and blinding of patients and practitioners. The 10 studies included had low to moderate risk of bias. There was no significant publication bias in the meta-analysis. ConclusionsJYD might improve the efficacy of conventional therapy and/or acupuncture for treating post-stroke aphasia considering the quality of RCTs included. However, larger and highly controlled RCTs are needed to confirm the results.