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|(Different acupuncture therapies for treating periarthritis of the shoulder: overview of systematic reviews and network meta-analysis) [Chinese - simplified characters]|
|Jinhuan Z, Weiqu Y, Chen C, Xingxian H, Haibo Y|
|Chinese Journal of Tissue Engineering Research 2020 Dec 18;24(35):5723-5732|
BACKGROUND: Increasing systematic reviews of acupuncture treatment for periarthritis of shoulder indicate that acupuncture treatment has better efficacy than western medicine. However, the methodological quality of these systematic reviews and the differences in efficacy between different acupuncture therapies are unclear. OBJECTIVE(S): To evaluate the methodological quality of systematic reviews regarding acupuncture therapy for periarthritis of shoulder and to compare the efficacy of different acupuncture therapies in treating periarthritis of the shoulder. METHOD(S): A total of seven electronic databases were searched for systematic reviews regarding different acupuncture therapies for periarthritis of the shoulder, from inception to December 28, 2019. The AMSTAR2 instrument was used to evaluate the methodological quality of included systematic reviews. The eligible randomized controlled trial (RCTs) were selected from the included systematic reviews and updated RCTs from the above systematic reviews to December 28, 2019. Cochrane risk of bias tool was used for the risk of bias of the included RCTs. Pairwise meta-analyses were performed using the random-effects model, and network meta-analysis of the included RCTs were performed the frequentist framework. All data analyses were completed in Stata 14.0. RESULTS AND CONCLUSION(S): Thirty-four qualified RCTs (n = 3,098) were included from five critically low-quality systematic reviews and updated RCTs. Five interventions were ranked based on the ranking probability in the network meta-analysis. Compared with western medicine, warm acupuncture (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.15 to 1.39) has the highest possibility to improve the symptoms of periarthritis of the shoulder, followed by thermo-sensitive moxibustion (OR 1.26, 95%CI 1.15 to 1.39), electroacupuncture (OR 1.21, 95%CI 1.10 to 1.33), filiform needle (OR 1.21, 95%CI 1.01 to 1.24). In terms of visual analogue scale score, compared with western medicine, thermo-sensitive moxibustion (OR 0.12, 95%CI 0.03 to 0.46) had the highest possibility of reducing visual analogue scale score followed by warm acupuncture (OR 0.28, 95%CI 0.11 to 0.75) and electroacupuncture (OR 0.34, 95%CI 0.12 to 0.96). Considering the pairwise meta-analyses and network meta-analysis of this study, among the four acupuncture therapies included, thermo-sensitive moxibustion and warm acupuncture can be considered as a complementary alternative to the treatment of periarthritis of the shoulder. However, given the critically low methodological quality of the included systematic reviews and poor reporting risk bias of RCTs, more rigorous design and standardized reporting are needed to further demonstrate the reliability of this study.