Supplementary file 1_Efficacy of acupuncture therapy plus related rehabilitation therapy for post-stroke urinary incontinence: a systematic review and meta-analysis.docx

IntroductionResearchers have increasingly focused on the efficacy of acupuncture therapy (AT) combine with rehabilitation therapy (RT) for post-stroke urinary incontinence (PSUI). This study aims to fully assess the efficacy of AT plus related RT in treating PSUI.
MethodsWe systematically searched eight databases from their inception to March 2025 for randomized controlled trials (RCTs) evaluating AT plus related RT for PSUI. Stata 18.0 was utilized for the meta-analyses.
ResultsThirty-six studies involving 2,796 subjects were included, with AT plus related RT performed in the treatment group. The total effective rate of AT plus RT was significantly higher than that of RT or AT alone [RR = 1.23, 95% CI (1.19, 1.28), p < 0.001]. AT plus RT was also superior to related RT or related AT in improving maximum bladder capacity [WMD = 44.93, 95% CI (32.00, 57.87), p < 0.001]; increasing maximum urinary flow rate [WMD = 2.64, 95% CI (1.27, 4.01), p < 0.001], mean urine output per time [WMD = 44.30, 95% CI (20.31, 68.29), p < 0.001], and pelvic floor muscle strength (including fast [WMD = 2.64, 95% CI (1.04, 4.25), p = 0.001], slow [WMD = 6.09, 95% CI (3.44, 8.75), p < 0.001], and complex muscle fibers [WMD = 5.46, 95% CI (3.60, 7.32), p < 0.001]); and reducing the residual urine volume [WMD = −20.84, 95% CI (−27.53, −14.14), p = 0.001], maximal detrusor pressure [WMD = −10.6, 95% CI (−12.72, −8.55), p = 0.001], frequency of 24-h UI [WMD = −1.40, 95% CI (−1.92, −0.88), p < 0.001], and frequency of 24-h urination [WMD = −3.76, 95% CI (−4.87, −2.66), p < 0.001]. Moreover, AT plus RT significantly reduced scores on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) [WMD = −2.40, 95% CI (−2.93, −1.83), p < 0.001]. While reductions were also observed in the quality of life (QOL) score [WMD = −0.72, 95% CI (−1.64, 0.20), p = 0.127] and the National Institutes of Health Stroke Scale (NIHSS) score [WMD = −3.51, 95% CI (−8.20, 1.18), p = 0.143], these did not reach statistical significance. Additionally, AT plus RT significantly increased the Incontinence Quality of Life Scale (I-QOL) score [WMD = 11.71, 95% CI (8.10, 15.33), p < 0.001] and the Barthel index (BI) score [WMD = 6.92, 95% CI (−0.22, 14.05), p = 0.058].
DiscussionAT plus RT outperforms related RT or related AT in improving clinical efficacy and bladder function in PSUI patients. However, the number of included studies on AT plus RT remains limited, highlighting the need for more high-quality RCTs are needed to validate the findings.
Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier [CRD42024588520].

引言 研究者们日益关注针刺疗法（acupuncture therapy, AT）联合康复疗法（rehabilitation therapy, RT）治疗脑卒中后尿失禁（post-stroke urinary incontinence, PSUI）的临床疗效。本研究旨在全面评估针刺联合相关康复疗法治疗脑卒中后尿失禁的疗效。
方法 本研究系统检索8个数据库自建库至2025年3月的文献，筛选评估针刺联合相关康复疗法治疗脑卒中后尿失禁的随机对照试验（randomized controlled trial, RCT），采用Stata 18.0软件开展meta分析。
结果 最终纳入36项研究，共涉及2796名受试者，治疗组采用针刺联合相关康复疗法。结果显示，针刺联合康复疗法的总有效率显著高于单纯康复疗法或单纯针刺疗法[相对危险度RR=1.23，95%置信区间CI(1.19, 1.28)，p<0.001]。在改善膀胱最大容量[加权均数差WMD=44.93，95%CI(32.00, 57.87)，p<0.001]、最大尿流率[WMD=2.64，95%CI(1.27, 4.01)，p<0.001]、单次平均排尿量[WMD=44.30，95%CI(20.31, 68.29)，p<0.001]以及盆底肌力量（包括快肌[WMD=2.64，95%CI(1.04, 4.25)，p=0.001]、慢肌[WMD=6.09，95%CI(3.44, 8.75)，p<0.001]和复合肌纤维[WMD=5.46，95%CI(3.60, 7.32)，p<0.001]）方面，针刺联合康复疗法均优于单纯相关康复疗法或单纯相关针刺疗法；同时可降低残余尿量[WMD=-20.84，95%CI(-27.53, -14.14)，p=0.001]、最大逼尿肌压力[WMD=-10.6，95%CI(-12.72, -8.55)，p=0.001]、24小时尿失禁发作频率[WMD=-1.40，95%CI(-1.92, -0.88)，p<0.001]以及24小时排尿次数[WMD=-3.76，95%CI(-4.87, -2.66)，p<0.001]。此外，针刺联合康复疗法可显著降低国际尿失禁咨询委员会简版问卷（International Consultation on Incontinence Questionnaire-Short Form, ICIQ-SF）评分[WMD=-2.40，95%CI(-2.93, -1.83)，p<0.001]。虽生活质量（quality of life, QOL）评分[WMD=-0.72，95%CI(-1.64, 0.20)，p=0.127]与美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分[WMD=-3.51，95%CI(-8.20, 1.18)，p=0.143]亦有所下降，但差异未达到统计学显著性。另外，针刺联合康复疗法可显著提升失禁患者生活质量量表（Incontinence Quality of Life Scale, I-QOL）评分[WMD=11.71，95%CI(8.10, 15.33)，p<0.001]与巴氏指数（Barthel index, BI）评分[WMD=6.92，95%CI(-0.22, 14.05)，p=0.058]。
讨论 针刺联合康复疗法在改善脑卒中后尿失禁患者的临床疗效与膀胱功能方面，均优于单纯相关康复疗法或单纯相关针刺疗法。但目前针刺联合康复疗法的相关纳入研究数量仍有限，亟需开展更多高质量随机对照试验以验证本研究结论。
系统评价注册 系统评价注册网址：https://www.crd.york.ac.uk/prospero/，注册号：[CRD42024588520]。