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Would integrated Western and traditional Chinese medicine have more benefits for stroke rehabilitation? A systematic review and meta-analysis
  1. Linda LD Zhong1,
  2. Ya Zheng1,
  3. Alexander Y Lau2,
  4. Norman Wong1,
  5. Liang Yao3,
  6. Xingyao Wu1,
  7. Tengteng Shao4,
  8. Zhenxing Lu5,
  9. Huijuan Li6,
  10. Chun Sum Yuen7,
  11. Jianwen Guo8,
  12. Suzanne Lo9,
  13. Janita Chau9,
  14. Kam Wa Chan10,
  15. Bacon Fung Leung Ng11,
  16. Zhaoxiang Bian1,
  17. Edwin Chau-leung Yu12
  1. 1 Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
  2. 2 Department of Medicine and Therapeutics and Hong Kong Institute of Integrative Medicine, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
  3. 3 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  4. 4 Clinical Laboratory, Shanghai Traditional Chinese Medicine Integrated Institute of Vascular Abnomalies, Shanghai, China
  5. 5 Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shanxi, China
  6. 6 Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
  7. 7 School of Chinese medicine, Hong Kong Baptist University, Hong Kong SAR, China
  8. 8 Brain Center, Guangdong Procincial Hospital of Traditional Chinese Medicine, Guangdong University of Chinese Medicine, Guangzhou, China
  9. 9 The Nethersole School of Nuring, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
  10. 10 Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
  11. 11 Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
  12. 12 Hong Kong Association for Integration of Chinese-Western Medicine Limited, Hong Kong SAR, China
  1. Correspondence to Dr Linda LD Zhong; ldzhong{at}hkbu.edu.hk; Dr. Alexander Y Lau; alexlau{at}cuhk.edu.hk

Abstract

Background Stroke is a major cause of death or long-term disability worldwide. Many patients with stroke receive integrative therapy consisting of Western medicine (WM) and routine rehabilitation in conjunction with Chinese medicine (CM), such as acupuncture and Chinese herbal medicine. However, there is no available evidence on the effectiveness of the combined use of WM and CM interventions in stroke rehabilitation.

Aims The purpose of this meta-analysis is to evaluate the results of all individual studies to assess the combined use of CM and WM in stroke rehabilitation compared with WM only.

Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. MEDLINE, EMBASE, Cochrane and China National Knowledge Infrastructure (CNKI) were searched. The included outcomes were dependency, motor function, depression and swallowing function. Subgroup analysis was performed, and publication bias was assessed using funnel plots.

Summary of review 58 studies and 6339 patients were included in the meta-analysis. Subgroup analysis revealed that combined therapy comprising both acupuncture and WM had a superior effect on improving dependency and swallowing function compared with standard WM therapy alone. Potential superiority of combined therapy comprising CM and WM in improving depression compared with standard WM therapy was also found.

Conclusions Our results indicate that the combined use of CM and WM could be more efficacious in stroke rehabilitation compared with the use of WM therapy alone. However, most studies were short in duration (2 to 4 weeks) and prone to different types of biases, which prevents making any conclusion regarding the long-term effects and raises concerns regarding true efficacy in context of high likelihood of Hawthorn bias. So, more randomised controlled trials with more rigorous design and longer duration of treatment and follow-up need to be conducted to compare WM alone versus WM and CM combined.

PROSPERO registration number CRD42020152050.

  • stroke rehabilitation
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2020-000781

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    Footnotes

    • LLZ and YZ are joint first authors.

    • Contributors LLDZ and YZ screened all articles and drafted the manuscript. They contributed equally and could be considered as co-first authors. NW, XW, TS conducted the literature searching and synthesised the data. ZL, HL extracted the data and manufactured the figures. NW and LY worked independently and assessed potential risks of bias for all included studies using the Cochrane’s tool for assessing risk of bias and they also help to make the tables. CSY and JG contributed to revise the manuscript. AL, ECY designed the research plan and gave supervision. SL, JC, KWC, BFLN, ZB contributed to monitor the research and give critical comments and finalised the manuscript.

    • Funding This study was funded by Innovative Technology Commission of the government of Hong Kong SAR (GSP/008/18).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.