Abstract
Systematic reviews (SRs) of randomized controlled trials (RCTs) have demonstrated acupuncture’s effectiveness in stroke rehabilitation. The current study reviews the quality of evidence in SRs of acupuncture in stroke rehabilitation, and rates the strength of recommendation for its use based on this evidence using the GRADE (grading of recommendations, assessment, development and evaluations) approach. A comprehensive literature search was performed using multiple databases (e.g., Medline, Embase) with advanced search strategies. Two authors independently selected articles, collected data, and assessed the methodological quality of each identified SR according to AMSTAR (a measurement tool to assess systematic reviews) and OQAQ (Oxman and Guyatt’s overview quality assessment questionnaire). Outcomes related to stroke rehabilitation were evaluated. SRs of high methodological quality (AMSTAR score ≥9 and OQAQ score ≥7) were graded using GRADE. Ultimately, acupuncture yields benefits in stroke rehabilitation (neurological function improvement: RR = 1.34; swallowing improvement: RR = 1.61, 1.49, 1.07; disability: SMD = 0.49 or 0.07). Poor evidentiary quality and insufficient information about harm led to weak recommendations. In conclusion, acupuncture may improve stroke rehabilitation, as the GRADE approach indicated a weak recommendation for acupuncture’s usage in this context.
Highlights
The weak strength of the recommendation to use acupuncture in stroke rehabilitation implies that the decision to prescribe acupuncture for a patient suffering from stroke symptoms and sequelae should be approached with caution
Recommendation evaluation occurs during the second step of the decision-making process, during which evidence quality is considered in light of other factors to enable both a correct and transparent judgment of recommendation strength
An innovative approach was utilized to assess the quality of the SR evidence and the strength of recommendations pertaining to specific clinical procedures
Summary
The methodological quality of each SR was independently assessed by two reviewers using “A measurement tool to assess the methodological quality of systematic reviews” (AMSTAR32) and the Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ)[33], which contain 11 and 9 assessment criteria, respectively Quality scores for both AMSTAR and OQAQ were calculated in accordance with the principles used in previous studies[34,35,36] as follows: one point was awarded for each answer of “Yes”, and 0 points were awarded for all other cases. All relevant articles were assessed by two authors (Zhang X and Liu XT) using the above two scales, and the SRs of high methodological quality (based on either AMSTAR or OQAQ) were used for data collection. Using a standardized form, two authors (Zhang X and Liu XT) independently extracted data from the SRs, including participant characteristics (age, sex), intervention details, measured outcomes, number of included trials, sample sizes of each group, diagnostic criteria, TCM syndrome classification, study methodology, original RCT quality, and disease duration and state. Two-tailed P values of 0.05 or lower were considered statistically significant
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