Abstract
Post-stroke depression (PSD) is common in stroke survivors, with significantly negative effects and serious impairments in terms of personal and social functioning. While both pharmacological and traditional Chinese medicine (TCM) interventions have been administered for PSD, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank, describing the protocol of a systematic review and network meta-analysis (NMA), the commonly used TCM interventions for PSD. We will search CENTRAL (the Cochrane Central Register of Controlled Trials), CINAHL, Embase, PubMed, CBM and PsycINFO, the US National Institutes of Health and the World Health Organisation International Trials Registry Platform search portal from inception to November 2018. There will be no restrictions on language, publication year or publication type. Only randomized clinical trials (RCTs) accessing any TCM treatments against active comparator or other controls for PSD will be included. The primary outcomes will be efficacy (the total number of participants, declining more than 50% on the total score between baseline) and acceptability of treatment (dropout rate due to any cause). A Bayesian NMA will be performed to compare all relative outcome of different TCM interventions. we will conduct the network meta-regression meta-analyses of data on the sex ratio, the types of stroke and the treatment duration of TCM interventions. Potential explanations in extra subgroup analyses according to the results of heterogeneity and inconsistency will be explored, and sensitivity analyses will be conducted to assess the robustness of the findings. PROSPERO CRD42018082400. Our study will generate evidence for TCM in the treatment of PSD and help to reduce the uncertainty about the effectiveness of PSD management, which will encourage further suggestions for TCM clinical practice or guideline.
Highlights
Depression is one of the most common mood disturbance after stroke, with up to 39% prevalence rate reported in previous local studies.[1,2] Pooled data from 61 studies including more than 25,000 subjects with a clinical diagnosis of stroke suggest that approximately 31% of stroke survivors experience depression within the 5 years following stroke.[3]
Ethics and dissemination: No ethical issues are required. These results are very important in terms of evidence-based medicine, which will be published in a peer-reviewed scientific journal, and where appropriate, it will be disseminated electronically in print and on social media
Leading contributors to total years lost to disability based on the global burden of diseases report, such comorbidity of stroke with depression has been described as the ‘double burden’ of stroke.[4]
Summary
Depression is one of the most common mood disturbance after stroke, with up to 39% prevalence rate reported in previous local studies.[1,2] Pooled data from 61 studies including more than 25,000 subjects with a clinical diagnosis of stroke suggest that approximately 31% of stroke survivors experience depression within the 5 years following stroke.[3]. Post-stroke depression (PSD) is common in stroke survivors, with significantly negative effects and serious impairments in terms of personal and social functioning. While both pharmacological and traditional Chinese medicine (TCM) interventions have been administered for PSD, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. We aim to compare and rank, describing the protocol of a systematic review and network meta-analysis (NMA), the commonly used TCM interventions for PSD
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