Efficacy of acupuncture in ameliorating anxiety in Parkinson's disease: a systematic review and meta-analysis with trial sequential analysis.

IF 4.1 2区医学 Q2 GERIATRICS & GERONTOLOGY

Frontiers in Aging Neuroscience Pub Date : 2024-11-11 eCollection Date: 2024-01-01 DOI:10.3389/fnagi.2024.1462851

Zhennan Wu, Chang Liu, Vickie Chan, Xiaofeng Wu, Fan Huang, Zining Guo, Wenhao Liu, Liming Lu, Nenggui Xu

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引用次数: 0

Abstract

Background: Although numerous studies have explored acupuncture for alleviating Parkinson's disease (PD) symptoms, specific methods focusing on reducing anxiety in these patients are lacking. Preliminary research indicates that acupuncture may improve anxiety in patients with Parkinson's; however, high-quality evidence is lacking. Therefore, we conducted a meta-analysis and trial sequential analysis (TSA) to assess the efficacy of acupuncture in managing anxiety symptoms in PD.

Methods: We systematically searched eight databases for randomized controlled trials (RCTs) evaluating the efficacy of acupuncture for the treatment of anxiety in patients with PD. Primary outcomes were measured using the Hamilton Anxiety Scale (HAMA) and the Self-Rating Anxiety Scale (SAS). Secondary outcomes included the Parkinson's Disease Questionnaire-39 (PDQ-39) and the Unified Parkinson's Disease Rating Scale (UPDRS). Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was assessed using the GRADE system. The Trial Sequential Analysis (TSA) was used to assess the sufficiency of the evidence.

Results: Our meta-analysis included 14 studies. The Manual acupuncture (MA) + routine drug treatment (RDT) group improved more than the RDT alone group. MA was more effective than sham acupuncture. MA+ traditional Chinese medicine (TCM) was also more effective than TCM. Auricular therapy (AT) was not as effective as control therapy (CT). The Electroacupuncture (EA) + routine drug treatment (RDT) group was not as effective as RDT. PDQ-39 and UPDRS subgroup analysis showed that the acupuncture group had better clinical efficacy than CT. The GRADE assessment rated the overall certainty of evidence for anxiety outcomes as low, PDQ-39 as very low and UPDRS as low. TSA results indicate insufficient evidence; further high-quality RCTs are needed to substantiate these findings.

Conclusion: Our analysis suggests that MA combined with RDT may help ameliorate anxiety in PD patients, although the evidence is weak due to low quality RCTs. EA and AT showed no significant effects, highlighting the need for more rigorous studies with better controls and longer follow-up. The potential of acupuncture for PD-related anxiety should be considered with caution until stronger evidence becomes available.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/.

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针灸在改善帕金森病患者焦虑症方面的疗效：系统综述和荟萃分析以及试验序列分析。

背景：尽管已有许多研究探讨了针灸缓解帕金森病 (PD) 症状的方法，但仍缺乏针对减轻帕金森病患者焦虑的具体方法。初步研究表明，针灸可改善帕金森病患者的焦虑；但目前还缺乏高质量的证据。因此，我们进行了一项荟萃分析和试验序列分析（TSA），以评估针灸在控制帕金森病患者焦虑症状方面的疗效：我们在八个数据库中系统地检索了评估针灸治疗帕金森病患者焦虑症疗效的随机对照试验（RCT）。主要结果采用汉密尔顿焦虑量表（HAMA）和焦虑自评量表（SAS）进行测量。次要结果包括帕金森病问卷-39（PDQ-39）和帕金森病统一评定量表（UPDRS）。使用 Cochrane RoB 2.0 工具评估了偏倚风险，并使用 GRADE 系统评估了证据的确定性。采用试验序列分析法（TSA）评估证据的充分性：我们的荟萃分析包括 14 项研究。手法针灸（MA）+常规药物治疗（RDT）组比单纯RDT组的改善程度更大。手法针灸比假针灸更有效。MA+传统中药（TCM）也比传统中药更有效。耳针疗法（AT）不如对照疗法（CT）有效。电针（EA）+常规药物治疗（RDT）组的疗效不及RDT组。PDQ-39和UPDRS亚组分析显示，针灸组的临床疗效优于CT组。GRADE 评估将焦虑结果的总体证据确定性评为低，PDQ-39 为极低，UPDRS 为低。TSA结果显示证据不足；需要进一步的高质量RCT来证实这些结果：我们的分析表明，MA与RDT相结合可能有助于缓解PD患者的焦虑，但由于RCT质量较低，因此证据不足。EA和AT没有显示出明显的效果，这突出表明需要进行更严格的研究、更好的对照和更长时间的随访。在获得更有力的证据之前，应谨慎考虑针灸治疗帕金森病相关焦虑症的潜力。系统综述注册：https://www.crd.york.ac.uk/PROSPERO/。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Aging Neuroscience GERIATRICS & GERONTOLOGY-NEUROSCIENCES

CiteScore

6.30

自引率

8.30%

发文量

1426

期刊介绍： Frontiers in Aging Neuroscience is a leading journal in its field, publishing rigorously peer-reviewed research that advances our understanding of the mechanisms of Central Nervous System aging and age-related neural diseases. Specialty Chief Editor Thomas Wisniewski at the New York University School of Medicine is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.