中国循证医学杂志

中国循证医学杂志

2013~2017年发表的推拿系统评价的再评价

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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。

ObjectivesTo conduct an overview of systematic reviews (SRs) on Tuina from 2013 to 2017, and to explore recent research improvements on Tuina.MethodsPubMed, 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 1st, 2013 to December 31st, 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.ResultsA 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 item 2 "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".ConclusionsThis 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.

关键词: 中医推拿; 文献计量学; 系统评价再评价; AMSTAR 2 工具

Key words: Tuina; Bibliometrics; Overview of systematic reviews; AMSTAR 2 tool

引用本文: 张夏天, 胡烨胤, 张晓雨, 陈荷清, 王晓丽, 李心怡, 黄雨丝, 林繄依, 商洪才, 卞兆祥, 田贵华. 2013~2017年发表的推拿系统评价的再评价. 中国循证医学杂志, 2019, 19(3): 361-367. doi: 10.7507/1672-2531.201806062 复制

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