Complex traditional Chinese medicine for poststroke motor dysfunction: a systematic review.
OBJECTIVE
For its current dimensions, stroke represents the world's primary health challenge. In China stroke is the second most common cause of death. Traditional Chinese Medicine (TCM) has for many centuries been used, and it is still widely used today in countries of south and east Asia for the treatment of people with stroke. The objective of this systematic review was to evaluate whether complex Traditional Chinese Medicine (cTCM) improves poststroke motor recovery. In particular, we defined cTCM as intervention that included at least acupuncture and Chinese herbal medicine.


METHODS
An extensive search including PubMed, EMBASE, CBM, and the Cochrane Library was performed up to December 2007. Randomized clinical trials (RCTs) about cTCM for motor dysfunction of poststroke were searched irrespective of any language. The quality of each trial was assessed according to the Cochrane Reviewers' Handbook 4.2.6.


RESULTS
After selection of 11 234 articles, 34 RCTs and quasi-RCTs were included. All these trials were conducted in China and published on Chinese journals. All trials but one reported results in favor of cTCM treatments suggesting a strong publication bias. Because of the significant clinical and methodological heterogeneity, no meta-analysis was performed and thus no cumulative result was obtained pooling data of RCTs.


CONCLUSIONS
What appears from this systematic review is that scant data are available to evaluate efficacy of cTCM for poststroke motor dysfunction. Most of the primary studies available for this review were inadequately designed trials characterized by unknown dropout rates and definitional vagueness in outcomes measures. None of the studies approached important end points like death, survival times, rate of dependency, reduction in length of stay in hospital, etc. The key to lead to evidence-based practices is establishing a consensus on standardized relevant outcome measures and then designing and conducting appropriate RCTs that adopt those standards.
Junhua
Zhang
Z
Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
Menniti-Ippolito
Francesca
F
Xiumei
Gao
G
Firenzuoli
Fabio
F
Boli
Zhang
Z
Massari
Marco
M
Hongcai
Shang
S
Yuhong
Huang
H
Ferrelli
Rita
R
Limin
Hu
H
Fauci
Alice
A
Guerra
Ranieri
R
Raschetti
Roberto
R
D026881:Acupuncture / Q000379:methods; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use; D006801:Humans; D008516:Medicine, Chinese Traditional / Q000379:methods*; D019957:Motor Skills Disorders / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D020521:Stroke / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*
D004365:Drugs, Chinese Herbal