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acupuncture:evaluation:neuro-psychiatrie:07. depression post-avc [16 Sep 2023 10:47] Nguyen Johan [2.1. Hung 2019] |
acupuncture:evaluation:neuro-psychiatrie:07. depression post-avc [23 May 2025 16:36] (Version actuelle) Nguyen Johan [2. Overviews of Systematic Reviews] |
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| ====== Dépression post-AVC : évaluation de l'acupuncture ====== | ====== Dépression post-AVC : évaluation de l'acupuncture ====== | ||
| ===== Systematic Reviews and Meta-Analysis ===== | ===== Systematic Reviews and Meta-Analysis ===== | ||
| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | + | |
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | + | |
| - | | ☆ |Limited evidence for effectiveness of acupuncture | | + | |
| - | | Ø |No evidence or insufficient evidence | | + | |
| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
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| + | === Li 2024 === | ||
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| + | Li Y, Wang Y, Gao L, Meng X, Deng Q. Effect of nonpharmacological interventions on poststroke depression: a network meta-analysis. Front Neurol. 2024 Apr 5;15:1376336. https://doi.org/10.3389/fneur.2024.1376336 | ||
| + | ^Purpose| To investigate the effects of nonpharmacological interventions (NPIs) on poststroke depression (PSD) in stroke patients.| | ||
| + | ^Methods| Computer searches were conducted on the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases from their establishment to December 2023. The selection was made using the inclusion and exclusion criteria, and 40 articles were included to compare the effects of the 17 NPIs on patients with PSD.| | ||
| + | ^Results| Forty studies involving seventeen interventions were included. The network findings indicated that compared with conventional therapy (COT), superior PSD improvement was observed for cognitive behavioral therapy (CBT) + **acupoint acupuncture** (CBTA) (mean difference [MD], -4.25; 95% CI, -5.85 to -2.65), team positive psychotherapy (MD, -4.05; 95% CI, -5.53 to -2.58), music therapy (MT) + positive psychological intervention (MD, -2.25; 95% CI, -3.65 to -0.85), CBT (MD, -1.52; 95% CI, -2.05 to -0.99), mindfulness-based stress reduction (MD, -1.14; 95% CI, -2.14 to -0.14), MT (MD, -0.95; 95% CI, -1.39 to -0.52), **acupoint acupuncture** + MT (AAMT) (MD, -0.69; 95% CI, -1.25 to -0.14). Furthermore, CBT (MD, -3.87; 95% CI, -4.57 to -3.17), AAMT (MD, -1.02; 95% CI, -1.41 to -0.62), **acupressure** + MT (MD, -0.91; 95% CI, -1.27 to -0.54), and narrative care + acupressure (MD, -0.74; 95% CI, -1.19 to -0.29) demonstrated superior Pittsburgh Sleep Quality Index (PSQI) improvement compared with COT.| | ||
| + | ^Conclusion| Evidence from systematic reviews and meta-analyses suggests that CBTA improves depression in patients with PSD. Moreover, CBT improves sleep in these patients. Additional randomized controlled trials are required to further investigate the efficacy and mechanisms of these interventions.| | ||
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| + | === Xiao 2024 (combined with repetitive transcranial magnetic stimulation) === | ||
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| + | Xiao K, Li X, Hu W, Li X. Acupuncture combined with repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: a systematic evaluation and meta-analysis based on a randomised controlled trial. Front Neurol. 2024 May 16;15:1360437. https://doi.org/10.3389/fneur.2024.1360437 | ||
| + | ^Objective| This study aimed to systematically assess the efficacy of combining acupuncture with repetitive transcranial magnetic stimulation (rTMS) in treating post-stroke depression (PSD).| | ||
| + | ^Methods| We conducted a comprehensive search of eight major domestic and international databases, including the China Knowledge Network, from inception until December 2023. Included were randomized controlled trials that investigated acupuncture combined with rTMS for PSD. The screening process adhered to predetermined inclusion and exclusion criteria, and study quality was assessed using Cochrane Handbook 5.1 guidelines. Meta-analysis was conducted using RevMan 5.4 software.| | ||
| + | ^Results| **Twelve studies involving 800 patients** were included in the analysis. The meta-analysis showed that acupuncture combined with rTMS significantly improved the clinical effectiveness rate (RR = 1.19, 95% CI: 1.12 to 1.27, p < 0.00001) and reduced scores on several scales: Hamilton Depression Scale (HAMD) (MD = -3.35, 95% CI: -3.79 to -2.90, p < 0.00001), Self-Depression Scale (SDS) (MD = -9.57, 95% CI: -12.26 to -6.89, p < 0.00001), Chinese Medicine Symptom Score (MD = -3.34, 95% CI: -3.76 to -2.91, p < 0.00001), Pittsburgh Sleep Quality Scale (MD = -3.91, 95% CI: -4.58 to -3.25, p < 0.00001), and National Institutes of Health Stroke Scale (NIHSS) (MD = -2.77, 95% CI: -3.21 to -2.32, p < 0.00001). Furthermore, acupuncture combined with rTMS treatment improved cognitive functioning (MMSE, MoCA scores) (p < 0.00001) and ability to perform activities of daily living scores (MD = 10.40, 95% CI: 9.53 to 11.28, p < 0.00001). Additionally, it was found to reduce interleukin 6, tumor necrosis factor alpha, interleukin 1β, and increase 5-hydroxytryptamine and brain-derived neurotrophic factor levels (p < 0.001).| | ||
| + | ^Conclusion| Acupuncture combined with rTMS therapy is recommended for treating PSD, as it effectively improves clinical outcomes, alleviates depressive symptoms, enhances cognitive function, and daily living capabilities, and modulates inflammatory responses and neurotransmitter levels. However, it is important to note that the limitations of the sample size and quality of the included studies warrant the need for more high-quality research to validate these conclusions. | | ||
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| + | === Yi 2024 === | ||
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| + | Yi Y, Zhao W, Lv S, Zhang G, Rong Y, Wang X, Yang J, Li M. Effectiveness of non-pharmacological therapies for treating post-stroke depression: A systematic review and network meta-analysis. Gen Hosp Psychiatry. 2024 Sep-Oct;90:99-107. https://doi.org/10.1016/j.genhosppsych.2024.07.011 | ||
| + | ^Objective| Post-stroke depression (PSD) is a common neurological and psychiatric sequelae following a stroke, often surpassing the primary effects of the stroke due to its strong correlation with high mortality rates. In recent years, non-pharmacological therapy has garnered significant attention as a supplementary treatment for PSD, becoming widely adopted in clinical practice. However, the efficacy of specific intervention strategies remains unclear. This study aimed to conduct a network meta-analysis (NMA) of published studies to compare the efficacy of different non-pharmacological therapies for treating PSD.| | ||
| + | ^Method| We systematically searched five databases from inception through March 2024 to identify randomized controlled trials (RCTs) evaluating non-pharmacological therapies for the treatment of PSD. We considered individual intervention and intervention class. Intervention classes included traditional Chinese medicine (TCM), non-invasive electrotherapy stimulation (NIES), psychotherapy (PT), exercise therapy, hyperbaric oxygen, and combined interventions. The NMA was conducted using R and Stata software, following a frequency-based methodology. Assessment of methodological quality and risk of bias was conducted using the Risk of Bias assessment tool 2.0. Therapies were ranked using the P-score, and box-plots visualization, meta-regression, and sensitivity analysis, were performed to assess transitivity, heterogeneity, and consistency, respectively.| | ||
| + | ^Results| The NMA included 43 studies with a total of 3138 participants. Random-effects models revealed significant efficacy for **acupuncture (ACUP)** (P-score = 0.92; pooled standardized mean difference (95% CI): -3.12 (-4.63 to -1.60)) and transcranial direct current stimulation (P-score = 0.85; -2.78 (-5.06 to -0.49)) compared to the treatment as usual (TAU) group. In categorical comparisons, TCM_PT (P-score = 0.82; -1.91 (-3.54 to -0.28)), TCM (P-score = 0.79; -1.65 (-2.33 to -0.97)), and NIES (P-score = 0.74; -1.54 (-2.62 to -0.46)) showed significant differences compared to TAU group. Furthermore, our results indicated no significant difference between PT and the control groups. However, Confidence in Network Meta-Analysis results indicated very low overall evidence grade.| | ||
| + | ^Conclusion| Limited evidence suggests that ACUP may be the most effective non-pharmacological therapy for improving PSD, and TCM_PT is the best intervention class. However, the evidence quality is very low, underscoring the need for additional high-quality RCTs to validate these findings, particularly given the limited number of RCTs available for each therapy. | | ||
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| + | === Zhang 2024 (plus music therapy) === | ||
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| + | Zhang J, Zhao Y, Li H, Yang Y, Tang Q. Effectiveness of acupuncture plus music therapy for post-stroke depression: Systematic review and meta-analysis. Medicine (Baltimore). 2024 Sep 13;103(37):e39681. https://doi.org/10.1097/MD.0000000000039681 | ||
| + | ^Backgound| Post-stroke depression (PSD) is a prevalent complication of stroke that adversely affects patient outcomes. The etiology of PSD is complex, and no universally effective treatment exists. Acupuncture, with its historical use, combined with music therapy, presents a novel approach for PSD treatment. This study aims to systematically evaluate the clinical efficacy of combining acupuncture with music therapy for PSD through a meta-analysis.| | ||
| + | ^Methods| We systematically searched both Chinese and English literature in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and the Chinese Science and Technology Periodical Database (VIP Database) for randomized controlled trials evaluating acupuncture combined with music therapy for PSD. Two independent evaluators conducted quality assessments and data extraction. Statistical analyses were performed using RevMan 5.4 and Stata 18.0 software.| | ||
| + | ^Results| This article contains **11 studies, involving a total of 698 patients**. The results of the meta-analysis showed that, compared with the control group, the test group showed significant improvement on multiple outcome measures: HAMD score [mean difference (MD) = -3.18, 95% confidence interval (CI) (-3.61, -2.76), P < .00001], Self-Rating Depression Scale score [MD = -5.12, 95% CI (-6.61, -3.63), P < .00001], Pittsburgh sleep quality index score [MD = -2.40, 95% CI (-2.96, -1.84), P < .00001], BI score [MD = 14.16, 95% CI (4.37, 23.94), P = .005] were all significantly lower, significantly higher effectiveness [risk ratio = 1.21, 95% CI (1.11, 1.33), P < .0001]. These differences were also statistically significant.| | ||
| + | ^Conclusion| The use of acupuncture combined with music therapy is effective in reducing depression in PSD patients.| | ||
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| ^Questions and prospects| Eye acupuncture combined with medicine or body acupuncture is superior to non-eye acupuncture in the treatment of post-stroke depression. However, the total sample size is relatively small, and the evidence for efficacy is insufficient. The quality of included literature methodological studies is not high, and more high-quality clinical studies are expected to improve the evidence intensity. | | ^Questions and prospects| Eye acupuncture combined with medicine or body acupuncture is superior to non-eye acupuncture in the treatment of post-stroke depression. However, the total sample size is relatively small, and the evidence for efficacy is insufficient. The quality of included literature methodological studies is not high, and more high-quality clinical studies are expected to improve the evidence intensity. | | ||
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| + | === Scalp Acupuncture === | ||
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| + | == Jiang 2023 == | ||
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| + | Jiang W, Jiang X, Yu T, Gao Y, Sun Y. Efficacy and safety of scalp acupuncture for poststroke depression: A meta-analysis and systematic review. Medicine (Baltimore). 2023 Aug 4;102(31):e34561. https://doi.org/10.1097/MD.0000000000034561 | ||
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| + | ^Background| Poststroke depression (PSD) is a common clinical poststroke complication that adversely affects cognitive and physical function rehabilitation. Scalp acupuncture (SA) can significantly improve somatic dysfunction and emotional disorder in stroke patients. This meta-analysis aims to evaluate the effectiveness and safety of SA in the treatment of PSD.| | ||
| + | ^Methods| We conducted a comprehensive search of multiple electronic databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Internet, China Science and Technology Journal Database, Wan Fang Data Knowledge Service Platform, and China Biology Medicine databases until December 20, 2022, to identify randomized controlled trials investigating the efficacy of SA in the treatment of PSD. Two independent researchers screened the literature, extracted data, and assessed the risk of bias in the included studies based on the inclusion and exclusion criteria. We performed a meta-analysis of the eligible literature using RevMan 5.4.1 and Stata 15.0 software.| | ||
| + | ^Results| This study comprised a total of **14 randomized controlled trials**, 10 of which used SA and 4 of which used SA in combination with electroacupuncture therapy. The results of the meta-analysis revealed that the effective rate of the SA group was significantly higher than that of the Western medicine group (relative risk = 1.09, 95% confidence interval (CI) [1.02, 1.16], P = .008). Moreover, compared to the Western medicine group, the SA group demonstrated significant improvements in Hamilton depression scale scores (mean difference = -2.29, 95% CI [-3.88, -0.70], P = .005) and neurological function deficit scores (mean difference = -3.06, 95% CI [-5.91, -0.21], P = .04). Additionally, the SA group has a lower incidence of adverse events than the western medicine group (relative risk = 0.12, 95% CI [0.05, 0.29], P < .00001).| | ||
| + | ^Conclusion| SA has superior efficacy and safety compared to Western medicine for PSD. These findings suggest that SA could be a promising alternative treatment for the assessed condition. Due to the limited number and quality of the included literature, the above conclusions must be confirmed by additional high-quality research. | | ||
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| + | == Zhong 2023 == | ||
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| + | Zhong D, Cheng H, Pan Z, Ou X, Liu P, Kong X, Liu D, Chen J, Li J. Efficacy of scalp acupuncture combined with conventional therapy in the intervention of post-stroke depression: A systematic review and meta-analysis. Complement Ther Med. 2023 Oct;77:102975. https://doi.org/10.1016/j.ctim.2023.102975 | ||
| + | ^Background| Post-stroke depression (PSD) is a common complication following a stroke, significantly impacting patients' quality of life and mental well-being. Currently, two primary approaches are employed to treat PSD: drug therapy and non-drug therapy. Among these, acupuncture, specifically scalp acupuncture (SA), has gained attention due to its cost-effectiveness and broad social benefits. SA is a precise and direct form of acupuncture that has been utilized in the treatment of PSD. Although several randomized controlled trials (RCTs) have demonstrated the efficacy of SA in treating PSD, there is a lack of comprehensive systematic reviews. Given the limitations of existing evidence, we conducted a systematic evaluation to assess the effectiveness of SA in combination with conventional therapy (CT) for intervening in PSD.| | ||
| + | ^Methods| We systematically searched five databases for articles published up until May 31, 2023, pertaining to SA treatment of PSD. A team of researchers meticulously screened and assessed these articles to identify the final included studies. After extracting relevant information and outcome indicators from the selected articles, we employed RevMan5.3 software to evaluate their quality and perform statistical analysis. Throughout our research, we strictly adhered to the PRISMA 2020 guidelines.| | ||
| + | ^Results| A total of **11 articles** were included, and a meta-analysis was conducted to evaluate the effectiveness of SA combined with CT for treating PSD. The results revealed that SA combined with CT can effectively improve the treatment's success rate for PSD and reduce the severity of depressive symptoms measured by the Self-Rating Depression Scale. However, SA combined with CT did not show significant reductions in depressive symptoms assessed by the Hamilton Rating Scale for Depression, which may be related to the inclusion of high heterogeneity articles. Importantly, the combination treatment did not lead to an increase in adverse reactions among PSD patients.| | ||
| + | ^Conclusion| While the effectiveness of SA combined with CT in treating PSD still requires further validation through rigorous randomized double-blind trials, this study provides a comprehensive collection of studies that meet the criteria for SA combined with CT in PSD treatment. It objectively and systematically evaluated the impact of SA combined with CT on PSD. Consequently, the findings of this study hold certain clinical significance.| | ||
| === Comparison of acupuncture techniques === | === Comparison of acupuncture techniques === | ||
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| ===== Overviews of Systematic Reviews ===== | ===== Overviews of Systematic Reviews ===== | ||
| - | === Xie 2022 === | + | ==== Miao 2025 ==== |
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| + | Miao RQ, Zhu FY, Wang TY, Yin S, Shuai C, Li T, Li Z, Luo L, Yang B. The effectiveness and safety of acupuncture for post-stroke depression: an overview of systematic reviews. Complement Ther Med. 2025 Apr 19:103178. https://doi.org/10.1016/j.ctim.2025.103178. | ||
| + | ^Backgound| In recent years, research on acupuncture for post-stroke depression (PSD) has grown significantly, yet findings remain inconsistent. Few researchers have conducted comprehensive assessments of systematic reviews (SRs) in this area. Consequently, there is a need for a thorough and objective synthesis of clinical evidence regarding acupuncture's effectiveness in treating PSD.| | ||
| + | ^Objective| To evaluate and synthesize evidence on the efficacy and safety of acupuncture for PSD through systematic reviews, offering valuable insights for clinical practice and guiding future research directions.| | ||
| + | ^Methods| We searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, Wanfang, VIP and Google Scholar databases for relevant literature. The search covered publications from database inception to September 10, 2024. Literature selection and data extraction were independently performed by two reviewers. The methodological quality, bias risk, and evidence level of included SRs were assessed using AMSTAR 2, ROBIS, and GRADE tools. The corrected covered area (CCA) was calculated to assess overlap in original studies. Data from included SRs were subjected to quantitative or descriptive analysis.| | ||
| + | ^Results| A total of **38 SRs **on acupuncture for PSD were included. After assessment using AMSTAR 2, one SR was rated as moderate quality, two as low quality, and 35 as very low quality. According to ROBIS, 21 SRs were classified as high risk of overall bias, and 17 as low risk. Acupuncture showed potential to improve depressive symptoms, stroke-related symptoms, and activities of daily living in PSD patients, though the quality of evidence is limited. Some studies suggested possible effects on cognitive function, biomarkers, sleep quality, and Traditional Chinese Medicine syndromes, but these findings require further validation with higher-quality research. While no serious adverse effects were reported in the reviewed studies, more rigorous safety evaluations are needed before definitive conclusions about acupuncture's safety for PSD can be made.| | ||
| + | ^Conclusion| Acupuncture shows potential as a treatment for PSD, though more high-quality research is needed to establish its effectiveness and safety. Currently, the majority of systematic reviews exhibit deficiencies in protocol pre-registration, documentation of excluded studies, and disclosure of funding sources, resulting in systematic reviews of suboptimal quality. Current evidence suggests possible benefits for depressive symptoms, stroke-related symptoms, activities of daily living, cognitive function, biomarkers, sleep quality, and TCM syndromes, but these findings should be interpreted cautiously given the limitations in study quality. Further high-quality studies are needed to confirm the efficacy and safety of acupuncture for PSD.| | ||
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| + | ==== Xie 2022 ==== | ||
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| - | === Hung 2019 === | + | ==== Hung 2019 ==== |
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| + | ==== Department of Veterans Affairs and Department of Defense (VA/DoD, USA) 2024 Ø ==== | ||
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| + | VA/DoD Clinical Practice Guideline for Management of Stroke Rehabilitation. Department of Veterans Affairs and Department of Defense. Washington, DC: U.S. Government Printing Office. 2024. https://www.healthquality.va.gov/guidelines/Rehab/stroke/VADoD-2024-Stroke-Rehab-CPG-Full-CPG_final_508.pdf | ||
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| + | | 43. There is insufficient evidence to recommend for or against acupuncture, either alone or as an adjunct to pharmacotherapy, for depression following stroke. (Neither for nor against / Reviewed, New-added) | | ||
| ==== Stroke Foundation (Australia, New-Zealand) 2022 ⊕ ==== | ==== Stroke Foundation (Australia, New-Zealand) 2022 ⊕ ==== | ||
