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Objective:To summarize the characteristics of the participants (P), interventions (I), control measures (C), outcomes (O) and study design (S) of the clinical study of chronic back pain (CBP) in recent years; To further systematically organize the outcomes of the clinical study of CBP and their corresponding measurement tools.Methods:Clinical studies of CBP were retrieved from various databases including CNKI, Wanfang Database, VIP, SinoMed, Cochrane Library, Pubmed, Embase, Web of Science, etc. The search period was from January 1, 2015 to December 31, 2019. The retrieved literature was extracted and analyzed.The retrieved literatures will be extracted and analyzed. The retrieved literature was subjected to data extraction and analysis, and the quality of outcome indicators was evaluated according to 6 items. The Newcastle-Ottawa Scale ( NOS ) was used to evaluate the quality of cohort studies and case-control studies. Analyze the relationship between outcome indicators and interventions.Results:A total of 3 028 articles were finally included after examination and screening. The top 7 diagnoses of CBP were low back pain, lumbar disc protrusion, lumbar vertebral stenosis, lumbar vertebral slip, lumbar disc degression, non-specific chronic low back pain and post-operative pain syndrome. The top 7 intervention measures in clinical studies of CBP were surgery, acupuncture, physiotherapy, Tuina, exercise therapy, Western medicine painkillers and oral Chinese patent medicines. A total of 47 outcomes and 348 outcome measurement tools were reported in the literature included.Conclusion:In the clinical study of CBP in the recent years, there are problems such as incomplete and low quality of reporting, a wide variety of outcome measurement tools and lack of uniform reporting standards. The characteristics of patients determine the common characteristics of outcomes selection and it is also necessary to consider the specific outcomes related to interventions.
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Objective To preliminarily verify the effectiveness and safety of bloodletting combined with drug bamboo cups in intervention of degenerative lumbar spinal stenosis,and to explore the prognostic factors that affect the efficacy of TCM regimens in the treatment of DLSS.Methods 64 consecutive patients with degenerative lumbar spinal stenosis were enrolled.Bloodletting combined with drug bamboo cup intervention was used.Acupoints were selected and treated with the same length of the governor channel of the lumbar spine,the first and second side lines of the bladder meridian and Ashi point,weekly 2 times,8 times per course,2 consecutive courses of treatment.Before treatment,after treatment,and 1 month follow-up,the changes of the patient's lumbar spinal stenosis specific scale(SSM),modified Oswestry dysfunction index(ODI),and 12 health survey summary scores(SF-12)were observed.Using SSM symptom or function score≥0.5,the criteria for grouping were first single-factor analysis,and then logistic regression was used to analyze the prognostic factors of the treatment.Results After 2 courses of treatment,the patient's SSM symptom score(2.25±0.56),SSM function score(2.06±0.67),ODI index(15.49±8.72),and SF-12 physiological score(36.31±7.35)were more significant than before treatment Improved,the difference was statistically significant(P<0.05),the SF-12 psychological score(49.70±9.47),the difference was not statistically significant compared with before treatment(P>0.05);the patient's SSM symptom score(2.22±0.54)was followed up for one month,SSM function score(2.09±0.66),ODI index(15.53±8.23),SF-12 physiological score(36.55±7.25),SF-12 psychological score(50.62±9.17),which are significantly better than before treatment,and the difference is statistically significant(P<0.05),the difference was not statistically significant(P>0.05)after 2 courses of treatment.The univariate logistic regression analysis of each influencing factor showed that:BMI,baseline symptom dimension,baseline functional dimension,foraminal stenosis,lateral recess stenosis,and two-stage stenosis had statistically significant differences between the effective and ineffective groups(P<0.05).Conclusion Bloodletting combined with drug bamboo cups has a certain clinical effect on degenerative lumbar spinal stenosis.
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Based on the resutls of literature review and interviews of experts, two rounds of Delphi surveys were conducted. The mean, importance ratio, coefficient of variation and coordination coefficient were used for assessment of survey from multiple perspectives, and finally form a framework model of factors affecting the efficacy of Tuina therapy. A total of 37 experts were selected for questionnaire surveys, the positive coefficients of experts' participatation in the first round and second round were 92.5% and 80.0%, respectively. The overall coordination coefficient in the second round is 0.68. The items were included into the consensus meeting if the importance ratio of items were equal to and more than 80%. After the expert consensus meeting, 22 items were included to form a framework model of factors affecting the efficacy of Tuina therapy, and summarized as 5 major influencing factors, including diagnostic factors, treatment factors, prognostic factors, patient factors, and doctor-patient communication. This framework can guide and help young Tuina practitioners to improve clinical efficacy. It is also clearly pointed out that the effect of Tuina for pain is not only related to disease diagnosis or manipulation, but also related to home exercise, health care, and doctor-patient communication.
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Tuina (Chinese massage) is an important part of Traditional Chinese Medicine. It is a simple and inexpensive technique, and has shown effectiveness for muscle and bone diseases, visceral diseases, gynecological diseases, and common diseases in children. This paper aims to analyze the factors influencing the effects of Tuina. The factors included the aspects of diagnosis, treatment, prognosis, patient factors and doctor-patient communication. During the treatment of Tuina, doctors should carry out good doctor-patient communication, properly evaluate and exam patients, and clarify diagnosis, take appropriate Tuina techniques according to the patients' constitution, health condition, and comorbidity. Only in such way, could Tuina achieve effectiveness and safety.
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Objective:Based on network pharmacology to study the mechanism of Shaoyao-Gancao Decoction in treating tension-type headache. Methods:Searched for the active ingredients and potential targets of Shaoyao-Gancao Decoction from TCMSP database, and adopted the targets of tension-type headache from GeneCards, DisGeNET, Drugbank and OMIM databases. Then obtained all the intersections of Shaoyao-Gancao Decoction and tension-type headache, and uploaded them to the STRING databases to construct a PPI network and conduct topological properties analysis. Finally, established a Chinese medicine regulatory network of Chinese medicine-components-target genes-disease by Cytoscape 3.6.1 software. To perform the GO function enrichment analysis and KEGG analysis on the core targets. Results:There were 51 intersections of Shaoyao-Gancao Decoction and tension-type headache. The topological properties analysis suggested that CASP3, JUN, HSP90AA1, MAPK1, STAT3, CCND1, ESR1, RELA, PTGS2, MAPK14 may be the potential targets for the treatment of tension-type headache in Shaoyao-Gancao Decoction. Gene ontology enrichment analysis showed 876 biological processes, 101 molecular functions and 62 cellular components. KEGG pathway enrichment analysis showed 25 related signaling pathways, including TNF signaling pathway, serotonergic synapse, NOD-like receptor signaling pathway, Dopaminergic synapse and Sphingolipid signaling pathway. Conclusion:The treatment of tension-type headache by Shaoyao-Gancao Decoction verified the characteristics of multi-component, multi-target and multi-pathway, which provided reference for the clinical medication.
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Objective:To evaluate the methodological quality and evidence quality of outcome of the systematic reviews/meta analyses on traditional exercise for the improvement of cardiopulmonary function.Methods:By searching for PubMed, Cochrane Library, Web of Science, CNKI, Wanfang, VIP and CBM databases in Chinese or English, the Systematic Reviews/meta analysis of traditional exercises for improving cardiopulmonary function was conducted. The retrieval time was March 8th, 2020. The AMSTAR 2 scale was used to evaluate the methodological quality of the systematic review/meta-analysis that met the inclusion criteria. Since the included studies cannot reflect the overall effect of traditional exercises on improving cardiopulmonary function, and the methodological quality of systematic reviews was generally low, a secondary analysis of the RCT studies included in the systematic reviews was conducted. The methodological quality evaluation of the original RCT study adopted the Cochrane Reviewers’ Handbook Version 5.0.0 bias risk assessment method (Risk of Bias, ROB), and applied the Revman 5.3 software to merge the original RCT data. The GRADE system was used for evidence evaluation.Results:A total of 32 systematic reviews/meta analysis were included, and the AMSTAR2 scale indicated that only one of the 32 systematic reviews/meta included was of high-quality, 1 was of low-quality, and the others were of extremely low quality. A total of 57 RCTs were included in the 32 systematic reviews for bias risk assessment and data consolidation. GRADE evidence quality evaluation showed that 14 evidences were of medium quality, 26 evidences were of low quality, and 5 evidences were of extremely low quality.Conclusions:Traditional exercises can improve cardiopulmonary function, but with low evidence quality. Thus, clinicians should make clinical decisions based on conditions.