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Published in: BMC Complementary Medicine and Therapies 1/2020

01-12-2020 | Acupuncture | Research article

Problems lowering the study quality in traditional medicine, introspection from an example of meta-analysis of acupuncture

Authors: Qiliang Chen, Qiong Wang, Shanshan Ding, Shunan Li, Yuanyuan Zhang, Shujiao Chen, Xuejuan Lin, Candong Li, Tetsuya Asakawa

Published in: BMC Complementary Medicine and Therapies | Issue 1/2020

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Abstract

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.
Literature
1.
go back to reference Asakawa T, Xia Y. Acupuncture treatment for Parkinson’s disease. In: Current Research in Acupuncture. New york, USA: Springer; 2013. p. 215–53. Asakawa T, Xia Y. Acupuncture treatment for Parkinson’s disease. In: Current Research in Acupuncture. New york, USA: Springer; 2013. p. 215–53.
2.
go back to reference Asakawa T, Xia Y. Can Acupuncture Treat Alzheimer’s Disease and Other Neurodegenerative Disorders? In: Current Research in Acupuncture. New york, USA: Springer; 2013. p. 255–301. Asakawa T, Xia Y. Can Acupuncture Treat Alzheimer’s Disease and Other Neurodegenerative Disorders? In: Current Research in Acupuncture. New york, USA: Springer; 2013. p. 255–301.
3.
go back to reference Jiang F, Yang T, Yin H, Guo Y, Namba H, Sun Z, Asakawa T. Evidence for the use of acupuncture in treating Parkinson's disease: update of information from the past 5 years, a mini review of the literature. Front Neurol. 2018;9:596.PubMedPubMedCentralCrossRef Jiang F, Yang T, Yin H, Guo Y, Namba H, Sun Z, Asakawa T. Evidence for the use of acupuncture in treating Parkinson's disease: update of information from the past 5 years, a mini review of the literature. Front Neurol. 2018;9:596.PubMedPubMedCentralCrossRef
4.
go back to reference Gan T, Chen J, Jin SJ, Wang Y. Chinese medicinal herbs for cholelithiasis. Cochrane Database Syst Rev. 2013;(6):CD004547. Gan T, Chen J, Jin SJ, Wang Y. Chinese medicinal herbs for cholelithiasis. Cochrane Database Syst Rev. 2013;(6):CD004547.
5.
go back to reference Wang Y, Li S, Lin X, Wang C, Li C. Preliminary study on the evaluation model of efficacy based on integral, dynamic and personalized. China J Tradit Chin Med Pharm. 2017;32(8):3371–3. Wang Y, Li S, Lin X, Wang C, Li C. Preliminary study on the evaluation model of efficacy based on integral, dynamic and personalized. China J Tradit Chin Med Pharm. 2017;32(8):3371–3.
6.
go back to reference Li JH, Su YS, Jing XH, Shi H, Chen SL, Zhang L, Jin ZG. Analysis and strategy report on overseas large-scale systematic evaluation on clinical effectiveness of acupuncture. Zhongguo Zhen Jiu. 2011;31(7):665–9.PubMed Li JH, Su YS, Jing XH, Shi H, Chen SL, Zhang L, Jin ZG. Analysis and strategy report on overseas large-scale systematic evaluation on clinical effectiveness of acupuncture. Zhongguo Zhen Jiu. 2011;31(7):665–9.PubMed
7.
go back to reference Wang Y, Tu Y. The analysis and consideration of methodology on evidence -based Chinese medicine and acupuncture. Med Philos. 2010;31(6):15–6. Wang Y, Tu Y. The analysis and consideration of methodology on evidence -based Chinese medicine and acupuncture. Med Philos. 2010;31(6):15–6.
8.
go back to reference Du H, Chen X, Li C. Thoughts on the therapeutic evaluation of traditional Chinese medicine in the context of bid data era. China J Tradit Chin Med Pharm. 2016;31(7):2459–62. Du H, Chen X, Li C. Thoughts on the therapeutic evaluation of traditional Chinese medicine in the context of bid data era. China J Tradit Chin Med Pharm. 2016;31(7):2459–62.
9.
go back to reference Petzinger GM, Walsh JP, Akopian G, Hogg E, Abernathy A, Arevalo P, Turnquist P, Vučković M, Fisher BE, Togasaki DM. Effects of treadmill exercise on dopaminergic transmission in the 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine-lesioned mouse model of basal ganglia injury. J Neurosci. 2007;27(20):5291–300.PubMedPubMedCentralCrossRef Petzinger GM, Walsh JP, Akopian G, Hogg E, Abernathy A, Arevalo P, Turnquist P, Vučković M, Fisher BE, Togasaki DM. Effects of treadmill exercise on dopaminergic transmission in the 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine-lesioned mouse model of basal ganglia injury. J Neurosci. 2007;27(20):5291–300.PubMedPubMedCentralCrossRef
10.
go back to reference Liang F, Ren Y, Tang Y. Current situations about studies on the evaluation of clinical efficacy of acupuncture. Acupunct Res. 2008;33(1):62–4. Liang F, Ren Y, Tang Y. Current situations about studies on the evaluation of clinical efficacy of acupuncture. Acupunct Res. 2008;33(1):62–4.
11.
go back to reference Asakawa T, Zong L, Wang L, Xia Y, Namba H. Unmet challenges for rehabilitation after stroke in China. Lancet. 2017;390(10090):121–2.PubMedCrossRef Asakawa T, Zong L, Wang L, Xia Y, Namba H. Unmet challenges for rehabilitation after stroke in China. Lancet. 2017;390(10090):121–2.PubMedCrossRef
12.
go back to reference Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.PubMedPubMedCentralCrossRef Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.PubMedPubMedCentralCrossRef
13.
go back to reference Asakawa T, Xia Y. Future Research in Acupuncture: Better Design and Analysis for Novel and Valid Findings. In: Current Research in Acupuncture. New york, USA: Springer; 2013. p. 687–725. Asakawa T, Xia Y. Future Research in Acupuncture: Better Design and Analysis for Novel and Valid Findings. In: Current Research in Acupuncture. New york, USA: Springer; 2013. p. 687–725.
14.
go back to reference Wang X. Diagnosis of cerebrovascular disease academic standards. Chin J Neurol. 1996;29(6):376–81. Wang X. Diagnosis of cerebrovascular disease academic standards. Chin J Neurol. 1996;29(6):376–81.
15.
go back to reference Bao CL, Dong HS, Dong GR, Luo EL. Effects of scalp penetration acupuncture on plasma endothelin (ET) and calcitonin related peptide (CGRP) contents in the patient of acute intracerebral hemorrhage. Zhongguo Zhen Jiu. 2005;25(10):717–9.PubMed Bao CL, Dong HS, Dong GR, Luo EL. Effects of scalp penetration acupuncture on plasma endothelin (ET) and calcitonin related peptide (CGRP) contents in the patient of acute intracerebral hemorrhage. Zhongguo Zhen Jiu. 2005;25(10):717–9.PubMed
16.
go back to reference Cao Y. Acupuncture treatment for hypertensive intracerebral hemorrhage. J Clin Acupunct Moxibustion. 2013;29(4):11–3. Cao Y. Acupuncture treatment for hypertensive intracerebral hemorrhage. J Clin Acupunct Moxibustion. 2013;29(4):11–3.
17.
go back to reference Chen Z, Xu X, Wei X, Fu X, Pan H, Xie Q, Wen L. Observation of the efficacy of acupuncture combined with Tongxinluo capsule in treating cerebral hemorrhage. Zhejiang J Tradit Chin Med. 2013;48(10):747–8. Chen Z, Xu X, Wei X, Fu X, Pan H, Xie Q, Wen L. Observation of the efficacy of acupuncture combined with Tongxinluo capsule in treating cerebral hemorrhage. Zhejiang J Tradit Chin Med. 2013;48(10):747–8.
18.
go back to reference Chen H. Effects of acupuncture on early rehabilitation in patients with cerebral hemorrhage undergone minimally invasive surgery. Xiandaiyangsheng. 2016;6:192. Chen H. Effects of acupuncture on early rehabilitation in patients with cerebral hemorrhage undergone minimally invasive surgery. Xiandaiyangsheng. 2016;6:192.
19.
go back to reference Duan X: [Clinical research on the effect of acupuncture on intracerebral hemorrhage stroke patients operated with micro-invasive surgical therapy]. http://xuewen.cnki.net/: Fujian University of Traditional Chinese Medicine; 2010. Duan X: [Clinical research on the effect of acupuncture on intracerebral hemorrhage stroke patients operated with micro-invasive surgical therapy]. http://​xuewen.​cnki.​net/​:​ Fujian University of Traditional Chinese Medicine; 2010.
20.
go back to reference Guo X, Luo G, Zhou J. A summary on 30 cases of hypertensive cerebral hemorrhage treated with combination of Chinese traditional and western medicine. Hunan J Tradit Chin Med. 2005;21(5):22–3. Guo X, Luo G, Zhou J. A summary on 30 cases of hypertensive cerebral hemorrhage treated with combination of Chinese traditional and western medicine. Hunan J Tradit Chin Med. 2005;21(5):22–3.
21.
go back to reference Hou X, Chen G, Pan J. Efficacy of acupuncture combined rehabilitation in treating cerebral hemorrhage. Guangming J Chin Med. 2018;33(6):221–3. Hou X, Chen G, Pan J. Efficacy of acupuncture combined rehabilitation in treating cerebral hemorrhage. Guangming J Chin Med. 2018;33(6):221–3.
22.
go back to reference Jiang Y, Zhu J. Xiong J: [clinical report of using acupuncture to treat subacute cerebral hemorrhage]. Chin J Ethnomedicine Ethnopharmacy. 2010;19(18):89–90. Jiang Y, Zhu J. Xiong J: [clinical report of using acupuncture to treat subacute cerebral hemorrhage]. Chin J Ethnomedicine Ethnopharmacy. 2010;19(18):89–90.
23.
go back to reference Li T, Zhao JG, Tian GJ, Zhang L, Liu SJ. Clinical observation on effect of acupuncture on nervous functions of the patient after operation of. Hypertensive cerebral hemorrhage. Zhongguo Zhen Jiu. 2006;26(4):247–9.PubMed Li T, Zhao JG, Tian GJ, Zhang L, Liu SJ. Clinical observation on effect of acupuncture on nervous functions of the patient after operation of. Hypertensive cerebral hemorrhage. Zhongguo Zhen Jiu. 2006;26(4):247–9.PubMed
24.
go back to reference Li J, Dong GR. Scalp acupuncture in treating acute cerebral hemorrhage. J Sichuan Tradit Chin Med. 2008;26(4):119–21. Li J, Dong GR. Scalp acupuncture in treating acute cerebral hemorrhage. J Sichuan Tradit Chin Med. 2008;26(4):119–21.
25.
go back to reference Li L. Treatment of hemorrhagic stroke by acupuncture combined medicine. Hebei Med J. 2009;31(11):1378–9. Li L. Treatment of hemorrhagic stroke by acupuncture combined medicine. Hebei Med J. 2009;31(11):1378–9.
26.
go back to reference Tao WQ, Fang HY, Zou ZQ, Luo Y, Li YF. Impacts of acupuncture on blood pressure and hematoma in patients of cerebral hemorrhage at the early stage. Zhongguo Zhen Jiu. 2014;34(5):426–30.PubMed Tao WQ, Fang HY, Zou ZQ, Luo Y, Li YF. Impacts of acupuncture on blood pressure and hematoma in patients of cerebral hemorrhage at the early stage. Zhongguo Zhen Jiu. 2014;34(5):426–30.PubMed
27.
go back to reference Wang LC, Liu HY. Clinical observation on acupuncture combined with Xingnaojing injection for treatment of cerebral hemorrhage at acute stage. Zhongguo Zhen Jiu. 2006;26(4):253–5.PubMed Wang LC, Liu HY. Clinical observation on acupuncture combined with Xingnaojing injection for treatment of cerebral hemorrhage at acute stage. Zhongguo Zhen Jiu. 2006;26(4):253–5.PubMed
28.
go back to reference Wang G. Clinical research of acupuncture in the treatment acute stage of apoplexy. China J Chin Med. 2012;27(7):919–20. Wang G. Clinical research of acupuncture in the treatment acute stage of apoplexy. China J Chin Med. 2012;27(7):919–20.
29.
go back to reference Wu Q. Treatment of acute cerebral hemorrhage by acupuncture combined with western medicine, a 22-case report. J Tradit Chin Med. 2001;42(5):279. Wu Q. Treatment of acute cerebral hemorrhage by acupuncture combined with western medicine, a 22-case report. J Tradit Chin Med. 2001;42(5):279.
30.
go back to reference Zhang S, Bao CL, Dong GR. Treatment of neurological deficits in patients with cerebral hemorrhage by scalp acupuncture. J Clin Acupunct Moxibustion. 2005;21(3):12–3. Zhang S, Bao CL, Dong GR. Treatment of neurological deficits in patients with cerebral hemorrhage by scalp acupuncture. J Clin Acupunct Moxibustion. 2005;21(3):12–3.
31.
go back to reference Zhang ZW, Li WX, Xue WH. Clinical observation on shallow needling for treatment of acute intracerebral hemorrhage. Zhongguo Zhen Jiu. 2005;25(4):246–8.PubMed Zhang ZW, Li WX, Xue WH. Clinical observation on shallow needling for treatment of acute intracerebral hemorrhage. Zhongguo Zhen Jiu. 2005;25(4):246–8.PubMed
32.
go back to reference Zhang C. Efficacy of acupuncture in treating cerebral hemorrhage combined with minimally invasive surgery. J China Three Gorges Univ. 2017;39(12):81–3. Zhang C. Efficacy of acupuncture in treating cerebral hemorrhage combined with minimally invasive surgery. J China Three Gorges Univ. 2017;39(12):81–3.
33.
go back to reference Zhao B, Liu R, Wang Z. Effects of electro-acupuncture on the changes of serum neuron-specific enolase and nerve function of hypertensive intracerebral hemorrhage patients. Chin J Clin Rehabil. 2006;10(31):7–9. Zhao B, Liu R, Wang Z. Effects of electro-acupuncture on the changes of serum neuron-specific enolase and nerve function of hypertensive intracerebral hemorrhage patients. Chin J Clin Rehabil. 2006;10(31):7–9.
34.
go back to reference Zhao YZ, Yu CD. Effect of cranial needling combined with medicine on IL-6 in the patient of acute cerebral hemorrhage. Zhongguo Zhen Jiu. 2008;28(8):569–72.PubMed Zhao YZ, Yu CD. Effect of cranial needling combined with medicine on IL-6 in the patient of acute cerebral hemorrhage. Zhongguo Zhen Jiu. 2008;28(8):569–72.PubMed
35.
go back to reference Zhou S, Fang B, Sun G. Effect of acupuncture on neurological defects and daily life ability in patients with acute cerebral hemorrhage. World J Acupunct Moxibustion. 2003;13(4):19–22. Zhou S, Fang B, Sun G. Effect of acupuncture on neurological defects and daily life ability in patients with acute cerebral hemorrhage. World J Acupunct Moxibustion. 2003;13(4):19–22.
36.
go back to reference Zhu W, Ni J, Bao CL, Dong GR, Tang Q. Clinical study on the treatment of 28 acute cerebral hemorrhage patients by scalp point-through-point acupuncture plus rehabilitation therapy. Shanghai J Acupunct Moxibustion. 2006;25(5):5–7. Zhu W, Ni J, Bao CL, Dong GR, Tang Q. Clinical study on the treatment of 28 acute cerebral hemorrhage patients by scalp point-through-point acupuncture plus rehabilitation therapy. Shanghai J Acupunct Moxibustion. 2006;25(5):5–7.
37.
go back to reference Zou W, Li D, Yu X, Dai X, Teng W, Sun X. Clinical study on acupuncture in treating cerebral hemorrhage. Inf Tradit Chin Med. 2009;26(5):104–5. Zou W, Li D, Yu X, Dai X, Teng W, Sun X. Clinical study on acupuncture in treating cerebral hemorrhage. Inf Tradit Chin Med. 2009;26(5):104–5.
38.
go back to reference Li Y. Effection of acupuncture on treating 120 patients of hemorrhage. Liaoning J Tradit Chin Med. 2011;9:1883–4. Li Y. Effection of acupuncture on treating 120 patients of hemorrhage. Liaoning J Tradit Chin Med. 2011;9:1883–4.
39.
go back to reference Asakawa T, Fang H, Sugiyama K, Nozaki T, Kobayashi S, Hong Z, Suzuki K, Mori N, Yang Y, Hua F, et al. Human behavioral assessments in current research of Parkinson's disease. Neurosci Biobehav Rev. 2016;68:741–72.PubMedCrossRef Asakawa T, Fang H, Sugiyama K, Nozaki T, Kobayashi S, Hong Z, Suzuki K, Mori N, Yang Y, Hua F, et al. Human behavioral assessments in current research of Parkinson's disease. Neurosci Biobehav Rev. 2016;68:741–72.PubMedCrossRef
40.
go back to reference Asakawa T, Fang H, Sugiyama K, Nozaki T, Hong Z, Yang Y, Hua F, Ding G, Chao D, Fenoy AJ, et al. Animal behavioral assessments in current research of Parkinson's disease. Neurosci Biobehav Rev. 2016;65:63–94.PubMedCrossRef Asakawa T, Fang H, Sugiyama K, Nozaki T, Hong Z, Yang Y, Hua F, Ding G, Chao D, Fenoy AJ, et al. Animal behavioral assessments in current research of Parkinson's disease. Neurosci Biobehav Rev. 2016;65:63–94.PubMedCrossRef
41.
go back to reference Li C. TCM inclusion shows WHO's holistic view on health. In: China Daily. Beijing: China Daily; 2018. Li C. TCM inclusion shows WHO's holistic view on health. In: China Daily. Beijing: China Daily; 2018.
42.
go back to reference Ng AWT, Poon SL, Huang MN, Lim JQ, Boot A, Yu W, Suzuki Y, Thangaraju S, Ng CCY, Tan P, et al. Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia. Sci Transl Med. 2017;9(412):eaan6446.PubMedCrossRef Ng AWT, Poon SL, Huang MN, Lim JQ, Boot A, Yu W, Suzuki Y, Thangaraju S, Ng CCY, Tan P, et al. Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia. Sci Transl Med. 2017;9(412):eaan6446.PubMedCrossRef
43.
go back to reference Shen T, Liu Y, Shang J, Xie Q, Li J, Yan M, Xu J, Niu J, Liu J, Watkins PB, et al. Incidence and etiology of drug-induced liver injury in mainland China. Gastroenterology. 2019;156(8):2230–2241.e11.PubMedCrossRef Shen T, Liu Y, Shang J, Xie Q, Li J, Yan M, Xu J, Niu J, Liu J, Watkins PB, et al. Incidence and etiology of drug-induced liver injury in mainland China. Gastroenterology. 2019;156(8):2230–2241.e11.PubMedCrossRef
44.
go back to reference Chen Q, Zhang Y, Li S, Chen S, Lin X, Li C, Asakawa T. Mechanisms underlying the prevention and treatment of Cholelithiasis using traditional Chinese medicine. Evid Based Complement Alternat Med. 2019;2019:2536452. Chen Q, Zhang Y, Li S, Chen S, Lin X, Li C, Asakawa T. Mechanisms underlying the prevention and treatment of Cholelithiasis using traditional Chinese medicine. Evid Based Complement Alternat Med. 2019;2019:2536452.
45.
go back to reference Fang H, Lin X, Zhang J, Hong Z, Sugiyama K, Nozaki T, Sameshima T, Kobayashi S, Namba H, Asakawa T. Multifaceted interventions for improving spontaneous reporting of adverse drug reactions in a general hospital in China. BMC Pharmacol Toxicol. 2017;18(1):49.PubMedPubMedCentralCrossRef Fang H, Lin X, Zhang J, Hong Z, Sugiyama K, Nozaki T, Sameshima T, Kobayashi S, Namba H, Asakawa T. Multifaceted interventions for improving spontaneous reporting of adverse drug reactions in a general hospital in China. BMC Pharmacol Toxicol. 2017;18(1):49.PubMedPubMedCentralCrossRef
Metadata
Title
Problems lowering the study quality in traditional medicine, introspection from an example of meta-analysis of acupuncture
Authors
Qiliang Chen
Qiong Wang
Shanshan Ding
Shunan Li
Yuanyuan Zhang
Shujiao Chen
Xuejuan Lin
Candong Li
Tetsuya Asakawa
Publication date
01-12-2020
Publisher
BioMed Central
Keywords
Acupuncture
EBM
Published in
BMC Complementary Medicine and Therapies / Issue 1/2020
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-019-2806-z

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