Therapeutic effect of traditional Chinese exercise in stroke patients: An umbrella review of systematic reviews and meta-analyses of clinical trials

IF 1.9 4区医学 Q3 INTEGRATIVE & COMPLEMENTARY MEDICINE

European Journal of Integrative Medicine Pub Date : 2025-02-01 DOI:10.1016/j.eujim.2025.102438

Bingru Luo , Lianlian Zhang , Yan Bai , Fan Zhang , Yiwen Liu

{"title":"Therapeutic effect of traditional Chinese exercise in stroke patients: An umbrella review of systematic reviews and meta-analyses of clinical trials","authors":"Bingru Luo , Lianlian Zhang , Yan Bai , Fan Zhang , Yiwen Liu","doi":"10.1016/j.eujim.2025.102438","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Numerous published systematic reviews have examined the effects of traditional Chinese exercise (TCE) on post-stroke rehabilitation. The results of these studies are often contradictory, so there is an urgent need for a hierarchical synthesis of the evidence and a review of the credibility of previous meta-analyses. To determine the robustness of these findings, we conducted an umbrella review to summarize the effects of TCE on stroke patients.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, Web of Science, and Scopus for meta-analyses published between inception and June 2023, and subsequently updated the search to February 2024. We included meta-analyses involving the effects of TCE, including Tai Chi, Baduanjin, Liuzijue, and Yijinjing, on at least one outcome of interest in stroke patients. Primary outcomes included balance function and activities of daily living (ADL), and secondary outcomes included depression, anxiety, sleep quality, and walking ability. Meta-analyses were assessed using \"A Measure Tool to Assess Systematic Reviews.\" We recalculated standardized mean difference (SMD), 95 % confidence intervals (95 % CI), 95 % prediction intervals, assessment of inconsistency/heterogeneity (<em>I</em>²) based on the \"<em>metaumbrella</em>\" package of <em>R</em> software. Finally, we rated the evidence according to Grading of Recommendations Assessment Development and Evaluation (GRADE).</div></div><div><h3>Results</h3><div>There were 17 systematic reviews and meta-analyses, containing 93 randomized controlled trials, included in the umbrella review. TCE had a significant effect on improving balance function (Tai Chi: SMD=1.661; 95 % CI 1.074 to 2.247; Baduanjin: SMD=1.697; 95 % CI 1.223 to 2.172) and ADL (Tai Chi: SMD=1.216; 95 % CI 0.811 to 1.620), and reducing depression (Tai Chi: SMD=-0.327; 95 % CI -0.618 to -0.035) and anxiety (Tai Chi: SMD=-0.592; 95 % CI -0.862 to -0.321) in stroke patients, with a very low certainty of evidence. However, the impact of TCE on walking ability and sleep quality was insignificant.</div></div><div><h3>Conclusion</h3><div>Among 93 study estimates covering six different outcomes in stroke patients, while some findings suggest potential benefits of TCE (especially Tai Chi) on depression, anxiety, and balance function, all evidence was rated as very low certainty according to GRADE assessment.</div></div>","PeriodicalId":11932,"journal":{"name":"European Journal of Integrative Medicine","volume":"74 ","pages":"Article 102438"},"PeriodicalIF":1.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Integrative Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1876382025000101","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INTEGRATIVE & COMPLEMENTARY MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Numerous published systematic reviews have examined the effects of traditional Chinese exercise (TCE) on post-stroke rehabilitation. The results of these studies are often contradictory, so there is an urgent need for a hierarchical synthesis of the evidence and a review of the credibility of previous meta-analyses. To determine the robustness of these findings, we conducted an umbrella review to summarize the effects of TCE on stroke patients.

Methods

We searched PubMed, Embase, Web of Science, and Scopus for meta-analyses published between inception and June 2023, and subsequently updated the search to February 2024. We included meta-analyses involving the effects of TCE, including Tai Chi, Baduanjin, Liuzijue, and Yijinjing, on at least one outcome of interest in stroke patients. Primary outcomes included balance function and activities of daily living (ADL), and secondary outcomes included depression, anxiety, sleep quality, and walking ability. Meta-analyses were assessed using "A Measure Tool to Assess Systematic Reviews." We recalculated standardized mean difference (SMD), 95 % confidence intervals (95 % CI), 95 % prediction intervals, assessment of inconsistency/heterogeneity (I²) based on the "metaumbrella" package of R software. Finally, we rated the evidence according to Grading of Recommendations Assessment Development and Evaluation (GRADE).

Results

There were 17 systematic reviews and meta-analyses, containing 93 randomized controlled trials, included in the umbrella review. TCE had a significant effect on improving balance function (Tai Chi: SMD=1.661; 95 % CI 1.074 to 2.247; Baduanjin: SMD=1.697; 95 % CI 1.223 to 2.172) and ADL (Tai Chi: SMD=1.216; 95 % CI 0.811 to 1.620), and reducing depression (Tai Chi: SMD=-0.327; 95 % CI -0.618 to -0.035) and anxiety (Tai Chi: SMD=-0.592; 95 % CI -0.862 to -0.321) in stroke patients, with a very low certainty of evidence. However, the impact of TCE on walking ability and sleep quality was insignificant.

Conclusion

Among 93 study estimates covering six different outcomes in stroke patients, while some findings suggest potential benefits of TCE (especially Tai Chi) on depression, anxiety, and balance function, all evidence was rated as very low certainty according to GRADE assessment.

查看原文本刊更多论文

中医运动对脑卒中患者的治疗效果：临床试验的系统综述和荟萃分析

许多已发表的系统综述研究了中国传统运动（TCE）对脑卒中后康复的影响。这些研究的结果往往是相互矛盾的，因此迫切需要对证据进行分层综合，并对以前的荟萃分析的可信度进行审查。为了确定这些发现的稳健性，我们进行了一项总括性综述，总结了TCE对脑卒中患者的影响。方法：检索PubMed、Embase、Web of Science和Scopus，检索自成立至2023年6月间发表的meta分析，并将检索更新至2024年2月。我们纳入了包括太极、八段筋、六子觉和益筋精在内的TCE对脑卒中患者至少一项结果的影响的meta分析。主要结局包括平衡功能和日常生活活动（ADL），次要结局包括抑郁、焦虑、睡眠质量和行走能力。使用“评估系统评价的测量工具”对meta分析进行评估。我们重新计算标准化平均差（SMD）， 95%置信区间（95% CI）， 95%预测区间，基于R软件的“元伞”包的不一致性/异质性评估（I²）。最后，我们根据建议评估发展和评价分级（GRADE）对证据进行评级。结果总括性综述共纳入17项系统综述和荟萃分析，包含93项随机对照试验。TCE对改善平衡功能有显著作用(太极：SMD=1.661；95% CI 1.074 - 2.247；Baduanjin: SMD = 1.697;95% CI 1.223 - 2.172)和ADL(太极：SMD=1.216；95% CI 0.811 ~ 1.620)，减少抑郁(太极：SMD=-0.327；95% CI -0.618至-0.035)和焦虑(太极：SMD=-0.592；95%可信区间为-0.862 ~ -0.321)，证据的确定性非常低。然而，TCE对行走能力和睡眠质量的影响不显著。结论：在93项研究评估中，涵盖了中风患者的6种不同结局，尽管一些研究结果表明TCE（尤其是太极）对抑郁、焦虑和平衡功能有潜在益处，但根据GRADE评估，所有证据的确定性都被评为非常低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Integrative Medicine INTEGRATIVE & COMPLEMENTARY MEDICINE-

CiteScore

4.70

自引率

4.00%

发文量

102

审稿时长

33 days

期刊介绍： The European Journal of Integrative Medicine (EuJIM) considers manuscripts from a wide range of complementary and integrative health care disciplines, with a particular focus on whole systems approaches, public health, self management and traditional medical systems. The journal strives to connect conventional medicine and evidence based complementary medicine. We encourage submissions reporting research with relevance for integrative clinical practice and interprofessional education. EuJIM aims to be of interest to both conventional and integrative audiences, including healthcare practitioners, researchers, health care organisations, educationalists, and all those who seek objective and critical information on integrative medicine. To achieve this aim EuJIM provides an innovative international and interdisciplinary platform linking researchers and clinicians. The journal focuses primarily on original research articles including systematic reviews, randomized controlled trials, other clinical studies, qualitative, observational and epidemiological studies. In addition we welcome short reviews, opinion articles and contributions relating to health services and policy, health economics and psychology.