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and hematoma. TBI can be classified into 3 categories on the Literature Search. Two members of the research team
3
basis of patients’ initial scores on the Glasgow Coma Score independently searched the following databases: Medline
(GCS) : mild, moderate, and severe. (Ovid), Embase, the Cochrane Central Register of Controlled
4
5
TBI is a public health challenge of vast, but insufficiently Trials (CENTRAL), China National Knowledge Infrastructure
recognized, proportions. Patients who survive the initial trauma (CNKI), Wanfang Data, Chongqing VIP, and the Chinese
6
are usually left with debilitating neurologic deficits, behavioral Biomedical Literature (CBM), from their inception to March
7
impairments, long-term coma and even death in extreme 1, 2018, without language restrictions. The following terms
8
situations, all of which may seriously affect patients’ health and were used: acupuncture; acupuncture, ear; electro acupuncture;
quality of life and bring heavy burdens to families and society. meridians; acupuncture points; craniocerebral trauma; brain
Acupuncture, as a Chinese traditional therapy, is a type edema; Glasgow Coma Scale; Glasgow Outcome Scale;
of health care that can be traced back for almost 3000 years. unconsciousness; and cerebrovascular trauma.
9
It has been gaining popularity in the United States, Europe, Data Abstraction. The same 2 members of the research
and other Western countries and also has been extensively team independently extracted trial details pertaining to
9
used in clinical settings. eligible studies. Any disagreements were settled by mutual
10
Concurrently, a number of Chinese clinical trials have consent. The information extracted from each article
found positive therapeutic effects for waking patients in a included: the first author, year, sample size, study design,
coma after TBI using acupuncture. Studies using functional participants’ ages and genders, inclusion and exclusion
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magnetic resonance imaging have shown that acupuncture criteria, types of traumatic brain injury, symptom duration,
can directly stimulating motor cortex excitability and plastic duration of intervention, and needle retention time.
brain reorganization. 12 The research team chose the results that the selected
This stimulation can prompt the functional reorganization studies reported at 1 month of treatment as the measuring
and compensation of those tissues, expand the corresponding time point. The research team chose the measurement point
cortical area, and restore the lost function caused by lesions so closest to 1 month if the study was without a measurement at
that function is restored. The effects of acupuncture in 1 month.
13
neurological conditions has been demonstrated in a number of Quality Assessment. The same 2 members of the
Cochrane systematic reviews, such as strokes rehabilitation, research team assessed the quality of the included studies as
14
schizophrenia, insomnia, and idiopathic headaches. 17 per the Cochrane Handbook for Systematic Reviews of
15
16
One published systematic review focused on the acute Interventions, focusing on sequence generation; allocation
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43
management and rehabilitation of patients after TBI. The concealment; blinding; attrition bias; completeness of
researchers indicated that further evidence on the beneficial outcome data; and other sources of bias. The 2 researchers
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effects of acupuncture in treatment of patients after TBIs is judged these domains as having an unclear, high, or low risk
required due to the poor methodological quality of the of bias for each trial. The original authors of the included
included studies. Several studies, however, have described studies were asked for help about missing information where
the efficacy of acupuncture in helping patients in a coma after necessary.
TBIs to awaken, 19-42 but no information has been synthesized
and disseminated that addresses the potential role of Interventions
acupuncture in awakening patients in a coma. In the selected studies, an intervention group must have
Therefore, the literature needs a systematic review to received acupuncture for TBI, either as a sole therapy or
rigorously explore the available evidence on the efficacy and combined with other treatments and with the control group
safety of acupuncture in awakening coma patients. The current must have received placebo acupuncture, sham acupuncture,
study intended to assess the effectiveness and safety of conventional treatments, or other treatments. The
acupuncture for arousing a patient in a coma following TBI. interventions in those studies included traditional
acupuncture, electroacupuncture, ear acupuncture, and scalp
METHODS acupuncture.
Participants
Participants in the selected studies were people of any Outcome Measures
age and either gender who were in a coma caused by TBI. The following outcome measures were used:
This study was conducted at Tianjin University of Traditional ⦁ Glasgow Outcome Score.
Chinese Medicine (Tianjin City, China). ⦁ Wake-promoting rates.
⦁ Glasgow Coma Score.
Procedures
Study Selection. Studies were included in the Statistical Analysis
meta-analyses if they (1) were randomized controlled trials Data Synthesis. The research team listed features and
(RCTs); (2) incorporated at least 2 groups, an intervention results for all eligible studies; the analysis was quantitative.
group treated with acupuncture and a control group; and The team used RevMan 5.3 (Copenhagen, Denmark: The
(3) contained patients in comas caused by TBI. Nordic Cochrane Centre, The Cochrane Collaboration, 2014)

Zhang—Acupuncture for Patients in Coma After TBI ALTERNATIVE THERAPIES, JUL/AUG 2020 VOL. 26 NO. 4 51