Effectiveness of moxibustion for exercise-induced fatigue--a systematic review for randomized controlled trials.

OBJECTIVE: To review and assess the effect of single moxibustion for exercise-induced fatigue: (EIF). METHODS: Computer-search for 8 medical databases and 5 clinical trail registries were conducted for: randomized controlled trials (RCTs), added with hand-search for 10 Chinese acupuncture-moxibustion journals and additional references. Data from included RCTs were pooled by RevMan5.1. Methodology quality of RCTs was judged by Cochrane Collaboration assessment tool while quality of primary outcomes was evaluated by GRADE3.2. RESULTS: Five RCTs were finally included, all reported in small sample size with high risk of: bias. Comparisons on single moxibustion and rest relief (without treatment) were studied. Six outcomes were reported, all favored moxibustion to rest relief for EIF. Primary outcomes showed as rating of perceived exertion (RPE) with mean difference (MD)=-0.49, 95% confidence interval (CI) [-0.80, -0.19], 800-m race performance with MD=-2.21, 95% CI [-3.57, -0.85], and Harvard Step Index (HSI) with MD=14.75, 95% CI [8.35, 21.15]. Moreover, all primary outcomes as RPE, 800-m race performance and HSI were rated low quality. CONCLUSIONS: Single moxibustion might be considered effective for EIF. However, due to small samples of included RCTs, high risk of bias among studies and poor quality of primary outcomes and subjects restricted to Chinese athletes only, these results present limitation, and should be taken with caution for practice. More large-size studies with rigorous design are warranted to further test effectiveness of moxibustion for EIF.

Status quo, issues, and challenges for acupuncture research evidence: an overview of clinical and fundamental studies.

OBJECTIVE: To systematically review the status quo, issues, and challenges from home and abroad for acupuncture research evidence, in order to identify global acupuncture research datum lines and policy-making evidence for future research direction. METHOD: To carry out computed searching through the Cochrane Library, MEDLINE, CNKI, SCI, WHO-ICTRP, and Chinese Clinical Trials Registry (ChiCTR) (up to January, 2010) for acupuncture-related secondary studies (systematic reviews and meta-analysis), animal randomized controlled trials (RCTs), published human RCTs (fundamental research with the human body or human body specimens as subjects), and registered on-going clinical trials (regardless of subject recruiting), and to analyze yearly publishing trends and research hotspots on subject headings for secondary studies and published and registered RCTs. RESULT: (1) 63.7% of acupuncture clinical RCTs were published in the Cochrane Central Register of Controlled Trials (CENTRAL), while RCTs published in MEDLINE, SCI, and CNKI each accounted for a third of all acupuncture fundamental RCTs. Publishing trends of acupuncture clinical RCTs indicated three periods - a period of slow growth before 1998, a period of gradual growth between 1999 and 2005, and a period of rapid growth after 2005. While few fundamental acupuncture RCTs were published before 2004, the period after 2005 demonstrated an increasing trend, but did not exhibit the same rapid growth as with clinical RCTs. Publication of Cochrane systematic reviews (CSRs) exhibited a time-dependent effect with acupuncture clinical RCTs, a trend that became more pronounced as time passed, while time intervals between CSR and acupuncture clinical RCT publications decreased. (2) Nine SRs were published in China, accounting for 30% of the global total of 29, while China's 68 RCTs accounted for 21% of global RCTs. Among five CSRs affirming the effects of acupuncture, only one contained four RCTs from China, which accounted for 10% of all RCTs included in that CSR. All information provided above demonstrates a deficiency of high-quality evidence from China affirming the efficiency of acupuncture. (3) Nine CSRs published by Chinese researchers included 38 RCTs (44%) from China, as well as 48 foreign RCTs; four of these CSRs included RCTs from China only. (4) Over 70% of acupuncture fundamental RCTs were carried out by China alone while only 11% of acupuncture clinical RCTs included in SCI were from China, both of which suggest the methodology quality of acupuncture clinical RCTs in China should be raised to meet international standards. (5) Clinical research was the primary focus of acupuncture studies in Europe and the US. (6) Acupuncture studies were divided into nine research areas according to the top 50 disease-related high-frequency words in acupuncture RCTs. The first three disease categories, comprehensively ranked using published clinical RCTs, were pain and analgesia, cardio-cerebrovascular diseases, and the neuropsychological system. The top three disease categories of both on-going clinical RCTs and acupuncture fundamental RCTs, respectively, were in accordance with those of published clinical RCTs. CONCLUSION: (1) CL CTRD is the key database in searching for published acupuncture clinical RCTs, and thus should be used first. Databases such as MEDLINE, SCI, and CNKI are all indispensable in retrieving acupuncture fundamental RCTs. (2) China leads the world in terms of both clinical and acupuncture fundamental RCTs, but while publication occurs rapidly, there is a lack of high-quality RCTs, suggesting future acupuncture clinical RCTs in China should place a higher emphasis on quality. Further development of acupuncture fundamental studies with little clinical research is a coming challenge for China. The US provides many of the RCTs published in SCI and on-going RCTs registered in WHO-ICTRP. Its small but high-quality publication will increasingly strengthen its impact on acupuncture research. (3) The fact that the top three disease categories of on-going clinical RCTs and of acupuncture fundamental RCTs, respectively, were in accordance with published clinical RCTs indicate that pain, cardio-cerebrovascular diseases, and neuropsychological diseases are major treatment disease categories for acupuncture and also primary development directions for the future. (4) CSRs will achieve synchronized updates with acupuncture clinical RCTs and its influence in guiding acupuncture clinical RCTs will grow clearer day by day. (5) Though registration of on-going RCTs is still in its initial stage and the number of RCTs registered is still relatively small, that the continued operation of the WHO-ICTRP will boost both the number of acupuncture RCTs registered and their quality. Innovation and time in acupuncture methodology will definitely advance the development of acupuncture research, while national and international cooperative programs in acupuncture research need evidence to support their claims throughout the course of project approval to implementation to inspection and acceptance to transformation to follow-up appraisal, in order to supply scientific and transparent research, thus improving credibility and practicality of the results.

Visualization studies on evidence-based medicine domain knowledge (series 1): mapping of evidence-based medicine research subjects.

OBJECTIVE: To use visualization methods to illustrate and compare major subjects, domains, and developments in evidence-based medicine (EBM) in recent years. METHOD: We analyzed MeSH terms and keywords in EBM articles in the MEDLINE and CNKI databases, and developed subject charts, research field relationship charts, and strategy coordination charts using word co-occurrence, PFNET algorithms, and visualization methods. RESULT: Rapid developments and growth are taking place in EBM in China and around the world. Studies on humans comprised 94.4% of the EBM studies that we identified, while animal studies accounted for 2.6% (three quarters of these animal studies were on primates). The six countries with the largest number of EBM articles and the eight host nations for the 108 journals with the most EBM publications were from high-income countries. In China, 31 provinces, municipalities, and autonomous regions have published EBM articles, although most of these publications come from the more highly-developed areas of the country. The investigation of word co-occurrence showed that EBM articles outside of China involve seven main fields: "Therapy", "Methods", "Standards", "Research", "Education", "Nursing" and "Organization and Administration". Five of these fields ("Therapy", "Nursing", "Research", "Education" and "Management") were common to China but the top seven fields for this country included "Traditional Chinese Medicine (TCM)" and "Information resources"; and did not include "Methods" and "Standards". Furthermore, studies on "Nursing" and "Research" were not as advanced in China as in other countries. CONCLUSION: There are similarities between China and the rest of the world in several areas in the EBM literature but also some important differences. Throughout the world, the most resource-rich regions o organizations tend to have the most well-developed EBM. These regions and organizations are pdocuing more evidence and conducting more methodology research than the less resourced regions and organizations. There is an urgent need for these regions and organizations to strengthen their use of evidence, to learn more about the philosophy that underpins EBM, and to improve accessibility to, and use of, evidence in choices about health care.