Page 58 - ATHM26_4

analysis to identify sources of heterogeneity that future used among the trials related to the definition of wake
research on the topic can address. promoting, which may have led to heterogeneity. The definitions
According to some perspectives, acupuncture therapy of rehabilitation prognosis rate and GCS variables both had
48
has the function of dredging the meridian, running qi and relatively low heterogeneity in the selected studies and applied
blood, and blending yin and yang. Its mechanism is associated to overall outcomes. In the current meta-analysis, every
with increasing the blood flow and cerebral vessels, promoting attempt was made to select outcome measures that were as
the recovery of nerve cell function and the regeneration of absolute as possible, reducing heterogeneity.
axons, and activating the function of the reticular activating Second, neither the sample size of treatment nor the
system, which makes the inhibited brain cells reawaken. 48 methodological quality was poor, inhibiting an evaluation of
Today, patients and medical workers often list the effects of acupuncture. For example, only
acupuncture as an option for medical treatment; it is easy to 12 studies 20,22,23,25,26,29,32,33,37,39-42 reported the generation of
accept because the probability of an adverse reaction is low random sequences. Due to these methodological flaws in the
with experienced and skilled practitioners, but bleeding and included studies, the current review failed to reach firm
49
hematoma due to lesions in the small vessels can be major ground on which to base conclusions about the efficacy and
side effects of acupuncture therapy. In contrast, some safety of acupuncture for arousing patients from a coma.
50
pharmacotherapy can have negative consequences for Third, as different time points were used to measure the
patients. For example, osmotic agents can improve cerebral effects of acupuncture, and because the current research
blood flow following injury but have side effects on global team chose only the results at the 1-month time point or the
cerebral blood flow. In no case has acupuncture been time point closest to the 1-month point, which may also have
51
associated with side effects in the context of awakening affected overall outcomes.
patients from a coma after TBI. Fourth, only 1 study included patients who suffered
35
Some evidence exists for the effectiveness of acupuncture from diffuse axonal injury (DAI); the current research team
for some conditions, such as stroke, schizophrenia, insomnia, included this trial because DAI is one of the most important
and other conditions 14-16 ; however, more accurate data about types of TBI. Nevertheless, it is a source of heterogeneity to
57
its therapeutic efficacy and the side effects on the promoting include specific disease types in an analysis.
revival from coma are needed. From an economic perspective, The current research team believes that stimulation of
a previously reported meta-analysis had indicated that acupoints with acupuncture is available for unconscious
52
acupuncture, with or without usual care, has acceptable cost patients after TBI. However, several important relevant issues
effectiveness. As the cost of acupuncture is not standardized, still need to be discussed. The existing studies awakened
a clear definition of and more studies on the cost effectiveness unconscious patients using acupuncture therapy on varied
of acupuncture for arousing patients from a coma are acupoints, with many auxiliary acupoints, and researchers
necessary to create a stronger position for acupuncture in need to determine whether all points or only some specific
clinical treatment. 52 points can work. The current research team has also noted
The current research team used wide inclusion criteria the fact that the proficiency of the practitioner, the needling
and performed a sufficient search, without language manipulation, and the time for needle retention may affect
restrictions, to find all trials applicable to clinical practice. the effectiveness of acupuncture.
Also, the team tried to improve the precision of the risk Finally, all trials explored the effects of a set of points
estimates with its strict inclusion criteria. However, all of the rather than a single acupoint. This could be because most
included trials were from China only, and none were from acupuncture therapy needs a combination of different
other countries, which may provide insufficient data to assess acupoints as a group; identification of the effects of acupoint
the overall benefits of acupuncture and may result in a groups might be more clinically applicable than investigating
certain degree of selection bias. the effectiveness of single acupoints with certain populations
Two studies evaluated the reporting quality of RCTs or under certain circumstances. In fact, not enough data are
53
and the quality of reporting in abstracts of RCTs that had available to support such an analysis.
54
been published in the 5 leading Chinese medical journals In consideration of these situations, the current analysis
that MEDLINE indexes. The results of the quality assessment further highlights the need for high-quality randomized
were not ideal. Some authors even think that most trials studies evaluating the best courses of treatment, the
published in China overstate the effects of interventions and comparative effectiveness of different single-acupoint
are not performed based on methodological criteria for interventions, needling manipulation, and the time for
quality. With the opening of the Chinese Cochrane Center, needle retention.
55
the current research team expects that Chinese clinical trials
will pay more attention to quality. 56 CONCLUSION
It is important, however, to address the weaknesses of the Despite the differences among the studies, the results for
current meta-analysis. First, different trials may have had the GOS, wake-promoting rate and GCS after treatment
varied defining criteria for the outcome measures considered. showed considerable convergence with regard to the ability
The current meta-analysis found that different criteria were for acupuncture to awaken patients from a coma. Given the

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