Problems lowering the study quality in traditional medicine, introspection from an example of meta-analysis of acupuncture
Problems lowering the study quality in traditional medicine, introspection from an example of meta-analysis of acupuncture
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DOI：
10.1186/s12906-019-2806-z
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发表时间：
2020-02-11
影响因子：
3.9
通讯作者：
Asakawa, Tetsuya
中科院分区：
文献类型：
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作者：
Chen, Qiliang;Wang, Qiong;Asakawa, Tetsuya
背景：大多数传统医学（如中医、心理治疗或行为治疗、饮食干预等）随机对照试验（RCT）报告称，由于研究质量低，无法提供令人信服的证据支持疗效。在这里，我们旨在利用循证医学（EBM）标准来评估传统医学的疗效，以确定研究质量的根本问题。 方法：我们进行了荟萃分析的一个例子来评估针灸这一传统中医疗法治疗脑出血（ICH）的疗效。采用Jadad评分对纳入研究的质量进行评价。结果：共纳入24项中国RCT，共纳入1815名ICH患者。尽管结果表明针灸对于缓解神经功能缺损和改善日常生活活动具有良好的疗效，尽管纳入的研究异质性很高，但纳入的文献质量较低，降低了证据的价值。在这项说明性荟萃分析中，发现了中医研究的两个系统性问题（缺乏盲法和分配隐藏以及高度异质性）和一个非系统性问题（缺乏不良事件报告和随访）。我们认为传统医学的其他干预措施也存在这些问题。结论：非系统性问题可以通过完善实验设计、教育研究者、完善报告制度来改善。但传统医学的特点衍生出难以纠正的系统性问题。我们认为，采用客观指标可能是改善传统医学系统性问题的更好解决方案。我们总结了存在的问题和潜在的解决方案，这可能有助于严格遵循循证医学的原则，提高传统医学系统评价的研究质量。
Background: Most randomized controlled trials (RCTs) of traditional medicine (such as traditional Chinese medicine (TCM), psychotherapy or behavioral therapy, and dietary interventions, etc.) have reported that they could not provide convincing evidence to support the efficacy because of the low quality of their studies. Here, we aimed to determine the underlying problems of the study quality using standards of evidence-based medicine (EBM) to evaluate the efficacy of traditional medicine.Methods: We conducted an example of meta-analysis to evaluate the efficacy of acupuncture, a classical treatment of TCM, for treatment of intracerebral hemorrhage (ICH). The quality of the included studies was evaluated by using a Jadad score.Results: A total of 24 Chinese RCTs that enrolled 1815 patients with ICH were included. Although the results suggested that acupuncture had good efficacy for relief of neurological deficits and improvement of the activities of daily living despite the high heterogeneity of the included studies, the low quality of the included literature reduced the worthiness of the evidence. Two systematic problems (lack of blinding and allocation concealment and high heterogeneity) and one non-systematic problem (lack of reports on adverse events and follow-up) of the TCM studies were found in this illustrational meta-analysis. We believed that other interventions of traditional medicine also suffer from these problems.Conclusions: Non-systematic problems can be improved by perfecting the experimental design, educating the researcher, and improving the reporting system. However, systematic problems are derived from the characteristics of traditional medicine that are difficult to be corrected. We propose that adoption of objective indexes might be a better solution to improve the systematic problems of traditional medicine. We summarized the problems and the underlying solutions, which may contribute to improve the study quality of systematic review in traditional medicine, strictly complying with the principles of EBM.