Table 3_Network meta-analysis of tuina or acupuncture in combination with adjunctive therapy for cervical spondylotic radiculopathy.xlsx

BackgroundTuina and acupuncture therapy have been widely applied in patients with cervical spondylotic radiculopathy (CSR). This network meta-analysis (NMA) was carried out to compare the effects of tuina or acupuncture in combination with adjunctive therapy on the physical signs, symptoms, and clinical outcomes of patients with CSR.
MethodRelevant studies were searched in PubMed, Web of Science, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data, and China Biology Medicine (CBM), up to June 15, 2023. Randomized controlled trials (RCTs) comparing tuina, acupuncture, or their combination with conventional Western medical adjunctive therapies were selected. Literature quality was assessed using the ROB2 tool, and statistical analyses were conducted using Stata SE15 and R 4.3.1.
Results90 studies involving 8,612 participants were included. Compared to acupuncture alone, acupuncture + warm needle acupuncture (RR: 17.97; 95% CrI [1.98, 563.78]), acupuncture + cupping (RR: 15.84; 95% CrI [1.48, 538.41]), tuina + auricular acupuncture and conventional therapy (RR: 12.83; 95%CrI [1.31, 170.78]), acupuncture + moxibustion (RR: 8.55; 95% CrI [2.17, 40.28]), and acupuncture + warm needle acupuncture (RR: 8.62; 95% CrI [1.78, 50.25]) significantly improved the clinical response rate, with acupuncture + warm needle acupuncture exhibiting the best effect (SUCRA: 85.9%). Tuina (SUCRA: 75%) ranked highest in improving the cervical function of patients. Electroacupuncture + moxibustion and conventional therapy (SUCRA: 97%) was most effective in relieving pain. None of these therapies effectively improved patient physical signs.
ConclusionNeedling + warm needle acupuncture, warm needle acupuncture + auricular acupuncture, and warm needle acupuncture + conventional therapy may better alleviate symptoms in patients with CSR. However, more well-designed multicenter, large-sample RCTs are needed to further analyze the findings from this study.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42023443945, CRD42023443945.

背景 推拿与针灸疗法已广泛应用于颈椎神经根型颈椎病（cervical spondylotic radiculopathy, CSR）患者的治疗中。本研究开展此项网络meta分析（network meta-analysis, NMA），旨在对比推拿、针灸单独或联合辅助疗法对CSR患者体征、症状及临床结局的改善效果。
方法 检索截至2023年6月15日的PubMed、Web of Science、Embase、Cochrane图书馆、中国知网（China National Knowledge Infrastructure, CNKI）、中文科技期刊数据库（China Science and Technology Journal Database, VIP）、万方数据及中国生物医学文献数据库（China Biology Medicine, CBM）中相关研究。纳入对比推拿、针灸单独或二者联合常规西医辅助疗法疗效的随机对照试验（randomized controlled trial, RCT）。采用ROB2工具对文献质量进行评估，并使用Stata SE15与R 4.3.1软件开展统计分析。
结果 共纳入90项研究，涉及8612名受试者。与单纯针灸相比，针灸联合温针疗法（相对危险度（relative risk, RR）: 17.97；95%可信区间（credible interval, CrI）[1.98, 563.78]）、针灸联合拔罐疗法（RR: 15.84；95%CrI [1.48, 538.41]）、推拿联合耳针疗法及常规疗法（RR:12.83；95%CrI [1.31, 170.78]）、针灸联合艾灸（RR:8.55；95%CrI [2.17, 40.28]）以及针灸联合温针疗法（RR:8.62；95%CrI [1.78, 50.25]）可显著提升临床应答率，其中针灸联合温针疗法的疗效最优（表面下累积排序概率图下面积（surface under the cumulative ranking curve, SUCRA）: 85.9%）。推拿在改善患者颈椎功能方面排名最高（SUCRA:75%）。电针联合艾灸及常规疗法在缓解疼痛方面效果最佳（SUCRA:97%）。上述疗法均未有效改善患者的体征。
结论 针刺联合温针、温针联合耳针以及温针联合常规疗法或可更好地缓解CSR患者的临床症状。然而，本研究结论仍需更多设计严谨的多中心、大样本随机对照试验进一步验证分析。
系统评价注册 系统评价注册信息：https://www.crd.york.ac.uk/PROSPERO/view/CRD42023443945，注册号为CRD42023443945。