An Overview of Systematic Reviews and Meta-Analyses on Acupuncture for Post-Acute Stroke Dysphagia

Abstract

Background: Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Conflicting results from different SRs necessitated an overview to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this condition. The aim was to evaluate methodological quality and summarizing the evidence for important outcomes. Methods: Seven databases were searched for SRs and/or meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). Results: Searches yielded 382 SRs, 31 were included. The quality of 22 SRs was critically low, five SRs were low, and four Cochrane SRs were moderate when evaluated by AMSTAR2. A total of 17 SRs reported 85.2–96.3% of PRISMA items. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. Conclusion: Currently, evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is of a low quality. The type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research.

Clinical Effects and Safety of Electroacupuncture for the Treatment of Poststroke Dysphagia: A Comprehensive Systematic Review and Meta‐Analysis

“…The methodological quality of the extracted trials was independently assessed by the two reviewers using the Cochrane risk of bias tool [ 6 ]. The methodological quality was assessed based on the following aspects: (1) random sequence generation; (2) allocation concealment; (3) blinding of participants and personnel; (4) blinding of outcome assessment; (5) incomplete outcome data; (6) selective reporting; and (7) other bias.…”

“…SRs/MAs are considered the gold standard for assessing the effects of health care interventions. The efficacy of acupuncture alone for PSD has been established using SRs/MAs [ 6 ]; however, the evidence of EA for PSD has not been assessed. Thus, we aimed to perform an SR/MA to investigate the efficacy and safety of EA for treating dysphagia in patients with stroke.…”

Quotation Accuracy of Systematic Review and Meta-Analysis Protocols on Acupuncture

“…Finally, it also has been observed that in some cases, the protocol [ 37 ] is quoted inappropriately: “A recent 2019 overview of systematic reviews and meta-analyses of acupuncture for dysphagia24 suggests that evidence may still be insufficient to produce conclusive evidence, although some symptoms associated with dysphagia may improve” [ 38 ]. In this case, the systematic review associated with it was published earlier [ 39 ].…”