2013～2017年发表的推拿系统评价的再评价
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摘要
目的对2013～2017年发表的推拿系统评价进行再评价,以了解目前国内外推拿研究的近况。方法计算机检索PubMed、Web of Science、The Cochrane Library、SpringerLink、CNKI、VIP、WanFang Data和CBM数据库,搜索纳入随机对照试验的推拿相关系统评价,检索时限均从2013年1月1日至2017年12月31日。由2位评价员独立筛选文献、提取资料,采用AMSTAR 2、PRISMA声明评价所纳入系统评价的方法学质量和报告质量,并采用R 3.4.3软件对汇总后数据进行分析。结果最终纳入8篇系统评价,所研究疾病涉及神经根性颈椎病、脊髓性颈椎病、便秘、小儿厌食症、小儿腹泻、肱骨外上髁炎,所纳入系统评价结果显示推拿在治疗上述疾病的临床有效率、疗效或总有效率方面可能优于其他干预,但限于纳入试验质量较低,结论尚待高质量临床试验结果验证。AMSTAR 2评价结果显示,8篇系统评价的质量等级均为极低,单篇系统评价满足条目数范围为7～13条,2篇系统评价方法学质量较低(满足百分比或部分满足<50.0%),6篇系统评价方法学质量较高(满足百分比或部分满足≥50.0%),其中8篇系统评价均未报告条目2"是否声明提前确定研究方法"、条目10"是否报告纳入各个研究的资助来源"及条目11"是否使用正确的统计方法"。PRISMA评价结果显示,8篇SR的报告质量较好,单篇系统评价满足条目数范围为22～26条。但在条目5(0.0%)、条目16(25.0%)条目23(25.0%)方面报告存在较多缺陷,其中所有研究均未报告条目5"是否声明研究方案"。结论本研究发现推拿在厌食症、颈椎病病等多个病种治疗方面有低质量循证医学证据支持。但推拿的系统评价在方法学质量和报告质量规范性方面仍有待提高。未来需构建中医特色的推拿研究的报告规范,为临床工作者更好地实施和报告推拿临床试验提供依据。
Objectives To conduct an overview of systematic reviews(SRs) on Tuina from 2013 to 2017, and to explore recent research improvements on Tuina. Methods PubMed, Web of Science, The Cochrane Library,SpringerLink e-book database, CNKI, VIP, WanFang Data and CBM databases were searched to collect SRs including randomized controlled clinical trials on Tuina from January 1~(st), 2013 to December 31~(st), 2017. Two reviewers independently screened literature, extracted data, and used AMSTAR 2 tool and PRISMA statement to assess methodology quality and reporting quality of included studies, respectively. The R 3.4.3 software was used to analyze data.Results A total of 8 SRs studies were included in the overview. The studied diseases involved radiculopathy cervical spondylotic, myelopathy cervical spondylotic, constipation, child anorexia, child diarrhea and external humeral epicondylitis. The results of above SRs showed that massage might be superior to other interventions in clinical efficacy,curative effects or total effective rate. However, due to the low quality of included studies of SRs, further evidence from high-quality clinical studies is required to verify above conclusions. For the results of AMSTAR 2 assessment, all 8 SRs were rated as very low quality. The quantity of items accomplished for each SR ranged from 7 to 13, 2 SRs had low methodological quality(percentage of accomplishment or partial accomplishment <50.0%) and 6 SRs with high methodological quality(percentage of accomplishment or partial accomplishment ≥50.0%). All 8 SRs did not report item2 "Whether to declare research methods", item 10 "Whether reports have included funding sources for each study" and item 11 "Whether reports used the correct statistical method". The results of PRISMA assessment showed that all SR had good quality of reporting. The accomplished items number of each SR ranged from 22 to 26. However, there were defects in item 5(0), item 16(25.0%) and item 23(25.0%). All SRs did not report item 5 "Whether to declare research program".Conclusions This study finds that Tuina has supportive evidence-based medical evidence for treating anorexia, cervical spondylosis and other diseases, however, the SRs of Tuina are yet needed to be improved in terms of standardized degree.Therefore, establishing a reporting consolidated standard for evidence-based medicine on Tuina in order to improve the quality of clinical studies so as to provide clinicians with high-quality evidence is the focus of our further research.
Objectives To conduct an overview of systematic reviews(SRs) on Tuina from 2013 to 2017, and to explore recent research improvements on Tuina. Methods PubMed, Web of Science, The Cochrane Library,SpringerLink e-book database, CNKI, VIP, WanFang Data and CBM databases were searched to collect SRs including randomized controlled clinical trials on Tuina from January 1~(st), 2013 to December 31~(st), 2017. Two reviewers independently screened literature, extracted data, and used AMSTAR 2 tool and PRISMA statement to assess methodology quality and reporting quality of included studies, respectively. The R 3.4.3 software was used to analyze data.Results A total of 8 SRs studies were included in the overview. The studied diseases involved radiculopathy cervical spondylotic, myelopathy cervical spondylotic, constipation, child anorexia, child diarrhea and external humeral epicondylitis. The results of above SRs showed that massage might be superior to other interventions in clinical efficacy,curative effects or total effective rate. However, due to the low quality of included studies of SRs, further evidence from high-quality clinical studies is required to verify above conclusions. For the results of AMSTAR 2 assessment, all 8 SRs were rated as very low quality. The quantity of items accomplished for each SR ranged from 7 to 13, 2 SRs had low methodological quality(percentage of accomplishment or partial accomplishment <50.0%) and 6 SRs with high methodological quality(percentage of accomplishment or partial accomplishment ≥50.0%). All 8 SRs did not report item2 "Whether to declare research methods", item 10 "Whether reports have included funding sources for each study" and item 11 "Whether reports used the correct statistical method". The results of PRISMA assessment showed that all SR had good quality of reporting. The accomplished items number of each SR ranged from 22 to 26. However, there were defects in item 5(0), item 16(25.0%) and item 23(25.0%). All SRs did not report item 5 "Whether to declare research program".Conclusions This study finds that Tuina has supportive evidence-based medical evidence for treating anorexia, cervical spondylosis and other diseases, however, the SRs of Tuina are yet needed to be improved in terms of standardized degree.Therefore, establishing a reporting consolidated standard for evidence-based medicine on Tuina in order to improve the quality of clinical studies so as to provide clinicians with high-quality evidence is the focus of our further research.
引文
1李幼平,李静,孙鑫,等.循证医学在中国的发展:回顾与展望.兰州大学学报(医学版),2016, 42(1):25-28.
2张明妍,杨丰文,李越,等.《中国中西医结合杂志》刊载中医药随机对照试验报告质量的研究.中国循证医学杂志,2017, 17(3):357-363.
3毛兵,王刚,陈小东,等.《中国中西医结合杂志》发表随机对照试验报告的质量评价.中国循证医学杂志,2006, 6(4):297-304.
4王家莹,王俊峰,承诗琪,等.中医药系统评价/Meta分析19年发展及现状分析.中医杂志,2017, 58(11):919-925.
5朱国苗,房敏,孙武权,等.循证医学在提高推拿临床研究质量中的应用.按摩与康复医学,2007, 23(5):2-3.
6王军,刘艳,谭曾德,等.中国现代推拿病谱的文献研究概述.中医药信息,2011,28(4):151-153.
7 Wood L, Egger M, Gluud LL, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes:meta-epidemiological study. BMJ,2008, 336(7644):601.
8吴泰相,刘关键.隐蔽分组(分配隐藏)和盲法的概念、实施与报告.中国循证医学杂志,2007, 7(3):222-225.
9安光辉,赵毅,姚斐,等.脊柱推拿治疗腰背及颈部疼痛的疗效和安全,性的系统评价再评价.中国循证医学杂志,2015, 15(9):1010-1017.
10 Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or nonrandomised studies of healthcare interventions, or both. BMJ,2017,358:j4008.
11 Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement.PLoS Med, 2009, 6(7):e1000097.
12杨佳,张瑞春,王新军.推拿与牵引治疗神经根型颈椎病的Meta分析.环球中医药,2013, 6(9):641-648.
13张军,吴宗蔚,马笃军,等.推拿治疗便秘临床研究文献的Meta分析.湖南中医杂志,2013, 29(3):127-130.
14 Qiao CX, Zhang XF, Cai XP. Evaluating the efficacy of tui na in treatment of childhood anorexia:a meta-analysis. Altern Ther Health Med,2014, 20(5):45-52.
15李娜.小儿推拿治疗小儿厌食症的系统评价.成都:成都中医药大学,2016.
16司梦冉,蔡君豪,王文奕,等.推拿与蒙脱石散治疗小儿腹泻效果比较的Meta分析.中国医药导报,2016,13(19):76-79.
17朱成林,徐波,李艳,等.推拿治疗脊髓型颈椎病的系统评价.陕西中医学院学报,2016, 39(2):71-74.
18林强,严隽陶.手法治疗肱骨外上髁炎文献质量评价及Meta分析.中医药导报,2017,(21):116-122.
19杨超,鲁梦倩,于天源,等.推拿治疗小儿厌食症随机对照试验的系统评价和Meta分析.中华中医药学刊,2017, 35(5):1161-1166.
20张方圆,沈傲梅,曾宪涛,等.系统评价方法学质量评价工具AMSTAR 2解读,中国循证心血管医学杂志,2018, 18(1):14-18.
21 David Moher,Alessandro Liberati,Jennifer Tetzlaff, et al·系统综述和荟萃分析优先报告的条目:PRISMA声明.中西医结合学报,2009, 7(9):889-896.
22 Bj S, Ga HC, Lm B, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol, 2009,62(10):1013-1020.
23罗智博,张哲,张会永,等.以系统论为指导构建中医临床疗效评价指标体系.中华中医药学刊,2008, 26(2):257-259.
24王传池,胡镜清,江丽杰,等.中医学与现代医学整体论的差别.中医杂志,2017, 58(5):361-365.
25王永炎,刘保延,谢雁鸣.应用循证医学方法构建中医临床评价体系.中国中医基础医学杂志,2003, 9(3):17-23.
26陈捷,梁伟雄.中医循证教学的现状与思考.中医药导报,2015,21(8):105-107.
27陈书,魏高文,邓思思,等.中医专业本科生循证医学教学体会及思考.科教导刊(上旬刊),2017,(10):45-46.
28朱音,周态,陆颖,等.中医研究生循证医学教学探索.上海中医药大学学报,2010, 24(5):18-19.
29 Cheng CW, Wu TX, Shang HC, et al. CONSORT extension for Chinese herbal medicine formulas 2017:recommendations,explanation, and elaboration. Ann Intern Med, 2017, 167(2):112-121.
30 Schulz KF, Altman DG, Moher D, et al. CONSORT 2010Statement:updated guidelines for reporting parallel group randomised trials. BMJ, 2010, 340(7748):698-702.
2张明妍,杨丰文,李越,等.《中国中西医结合杂志》刊载中医药随机对照试验报告质量的研究.中国循证医学杂志,2017, 17(3):357-363.
3毛兵,王刚,陈小东,等.《中国中西医结合杂志》发表随机对照试验报告的质量评价.中国循证医学杂志,2006, 6(4):297-304.
4王家莹,王俊峰,承诗琪,等.中医药系统评价/Meta分析19年发展及现状分析.中医杂志,2017, 58(11):919-925.
5朱国苗,房敏,孙武权,等.循证医学在提高推拿临床研究质量中的应用.按摩与康复医学,2007, 23(5):2-3.
6王军,刘艳,谭曾德,等.中国现代推拿病谱的文献研究概述.中医药信息,2011,28(4):151-153.
7 Wood L, Egger M, Gluud LL, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes:meta-epidemiological study. BMJ,2008, 336(7644):601.
8吴泰相,刘关键.隐蔽分组(分配隐藏)和盲法的概念、实施与报告.中国循证医学杂志,2007, 7(3):222-225.
9安光辉,赵毅,姚斐,等.脊柱推拿治疗腰背及颈部疼痛的疗效和安全,性的系统评价再评价.中国循证医学杂志,2015, 15(9):1010-1017.
10 Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or nonrandomised studies of healthcare interventions, or both. BMJ,2017,358:j4008.
11 Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement.PLoS Med, 2009, 6(7):e1000097.
12杨佳,张瑞春,王新军.推拿与牵引治疗神经根型颈椎病的Meta分析.环球中医药,2013, 6(9):641-648.
13张军,吴宗蔚,马笃军,等.推拿治疗便秘临床研究文献的Meta分析.湖南中医杂志,2013, 29(3):127-130.
14 Qiao CX, Zhang XF, Cai XP. Evaluating the efficacy of tui na in treatment of childhood anorexia:a meta-analysis. Altern Ther Health Med,2014, 20(5):45-52.
15李娜.小儿推拿治疗小儿厌食症的系统评价.成都:成都中医药大学,2016.
16司梦冉,蔡君豪,王文奕,等.推拿与蒙脱石散治疗小儿腹泻效果比较的Meta分析.中国医药导报,2016,13(19):76-79.
17朱成林,徐波,李艳,等.推拿治疗脊髓型颈椎病的系统评价.陕西中医学院学报,2016, 39(2):71-74.
18林强,严隽陶.手法治疗肱骨外上髁炎文献质量评价及Meta分析.中医药导报,2017,(21):116-122.
19杨超,鲁梦倩,于天源,等.推拿治疗小儿厌食症随机对照试验的系统评价和Meta分析.中华中医药学刊,2017, 35(5):1161-1166.
20张方圆,沈傲梅,曾宪涛,等.系统评价方法学质量评价工具AMSTAR 2解读,中国循证心血管医学杂志,2018, 18(1):14-18.
21 David Moher,Alessandro Liberati,Jennifer Tetzlaff, et al·系统综述和荟萃分析优先报告的条目:PRISMA声明.中西医结合学报,2009, 7(9):889-896.
22 Bj S, Ga HC, Lm B, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol, 2009,62(10):1013-1020.
23罗智博,张哲,张会永,等.以系统论为指导构建中医临床疗效评价指标体系.中华中医药学刊,2008, 26(2):257-259.
24王传池,胡镜清,江丽杰,等.中医学与现代医学整体论的差别.中医杂志,2017, 58(5):361-365.
25王永炎,刘保延,谢雁鸣.应用循证医学方法构建中医临床评价体系.中国中医基础医学杂志,2003, 9(3):17-23.
26陈捷,梁伟雄.中医循证教学的现状与思考.中医药导报,2015,21(8):105-107.
27陈书,魏高文,邓思思,等.中医专业本科生循证医学教学体会及思考.科教导刊(上旬刊),2017,(10):45-46.
28朱音,周态,陆颖,等.中医研究生循证医学教学探索.上海中医药大学学报,2010, 24(5):18-19.
29 Cheng CW, Wu TX, Shang HC, et al. CONSORT extension for Chinese herbal medicine formulas 2017:recommendations,explanation, and elaboration. Ann Intern Med, 2017, 167(2):112-121.
30 Schulz KF, Altman DG, Moher D, et al. CONSORT 2010Statement:updated guidelines for reporting parallel group randomised trials. BMJ, 2010, 340(7748):698-702.
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