Abstract
OBJECTIVE:
To search for an effective method for treatment of
ankylosing spondylitis (AS).
METHODS:
The treatment group (n = 32) were treated by acupuncture
combined with cupping therapy and the control group (n = 30) by simple
acupuncture for 40 days.
RESULTS:
The clinical remission rate was 62.5% in the treatment group
and 33.3% in the control group with a significant difference between the two
groups (P<0.01); the total effective rate in the treatment group was 93.8%
which was better than 83.3% in the control group (P<0.01); the recurrence
rate after one year was 3.3% in the treatment group and 24.0% in the control
group with significant difference between the two groups (P<0.01).
CONCLUSION:
Acupuncture combined with cupping therapy in the therapeutic
effect on ankylosing spondylitis is better than simple acupuncture, with
shorter therapeutic course and lower recurrence rate.
PMID:
16309054
[PubMed
- in process]
Abstract
We investigated the effectiveness of cupping, a traditional
method of treating musculoskeletal pain, in patients with carpal tunnel
syndrome (CTS) in an open randomized trial. n = 52 outpatients (58.5 +/- 8.0
years) with neurologically confirmed CTS were randomly assigned to either a
verum (n = 26) or a control group (n = 26). Verum patients were treated with a
single application of wet cupping, and control patients with a single local
application of heat within the region overlying the trapezius muscle. Patients
were followed up on day 7 after treatment. The primary outcome, severity of CTS
symptoms (VAS), was reduced from 61.5 +/- 20.5 to 24.6 +/- 22.7 mm at day 7 in
the cupping group and from 67.1 +/- 20.2 to 51.7 +/- 23.9 mm in the control
group [group difference -24.5mm (95%CI -36.1; -2.9, P < .001)]. Significant
treatment effects were also found for the Levine CTS-score (-.6 pts: 95%CI -.9;
-.2, P = .002), neck pain (-12.6mm; 95%CI -18.8; -6.4, P < .001), functional
disability (DASH-Score) (-11.1 pts; 95%CI -17.1; -5.1, P < .001), and
physical quality of life (.3; 95%CI .0; .3, P = .048). The treatment was safe
and well tolerated. We conclude that cupping therapy may be effective in
relieving the pain and other symptoms related to CTS. The efficacy of cupping
in the long-term management of CTS and related mechanisms remains to be
clarified. PERSPECTIVE: The results of a randomized trial on the clinical
effects of traditional cupping therapy in patients with carpal tunnel syndrome
are presented. Cupping of segmentally related shoulder zones appears to
alleviate the symptoms of carpal tunnel syndrome.
Comment in
PMID:
19380259
[PubMed - indexed for
MEDLINE]
Latar belakang
Cupping therapy belongs to
traditional Chinese medicine, the heritage from several thousand years. Terapi Bekam milik
pengobatan Cina tradisional, warisan dari beberapa ribu tahun. It is used with one of several kinds of cups, such as
bamboo cups, glasses or earthen cups, placing them on the desired acupoints on
patients' skin, to make the local place hyperemia or haemostasis, which can
obtain the purpose of curing the diseases Hal ini digunakan dengan salah
satu dari beberapa jenis cangkir, seperti cangkir bambu, gelas atau cangkir
tanah, menempatkan mereka pada acupoints diinginkan pada kulit pasien, untuk
membuat hiperemi tempat lokal atau hemostasis, yang dapat memperoleh tujuan
penyembuhan penyakit [ 1
]. [ 1
]. The earliest records of cupping is in Bo Shu (an
ancient book written on silk), which was discovered in an ancient tomb of the Han Dynasty
in 1973 Catatan awal cupping adalah Bo
Shu (sebuah buku kuno yang ditulis pada sutra), yang ditemukan di
sebuah makam kuno dari Dinasti Han
pada tahun 1973 [ 2
]. [ 2
]. Some therapeutic cupping methods and case
records of treatment were also described in early Chinese books.
Beberapa metode bekam terapi dan catatan hal perawatan juga dijelaskan dalam
buku-buku Cina awal. Zhao Xueming, a Chinese doctor
practicing more than 200 years ago, completed a book named " Ben Cao Gang Mu Shi Yi ", in which he described in detail the history and
origin of different kinds of cupping and cup shapes, functions and applications
Zhao Xueming, seorang dokter Cina berlatih lebih dari 200 tahun yang lalu,
menyelesaikan sebuah buku bernama "Ben
Cao Gang Mu Yi Shi", di mana ia dijelaskan secara rinci
sejarah dan asal usul berbagai jenis cangkir kop dan fungsi bentuk, dan
aplikasi [ 3
]. [ 3
].
There are seven major types of
cupping practice in China Ada
Because cupping is widely used in
Chinese folklore culture, the technique has been inherited by the modern
Chinese practitioners. Karena cupping banyak digunakan dalam budaya cerita
rakyat Cina, teknik ini telah diwarisi oleh para praktisi Cina modern. In the 1950s the clinical efficacy of cupping was
confirmed by Co-Research of China and acupuncturists from the former Soviet
Union, and was established as an official therapeutic practice in hospitals all
over China Pada 1950-an kemanjuran klinis dari cupping dikonfirmasi oleh
Co-Penelitian akupunktur dari Cina dan Uni Soviet, dan didirikan sebagai
praktek terapi resmi di rumah sakit di seluruh China [ 4
]. [ 4
]. This issue substantially stimulated the
development of further cupping research. Masalah ini secara substansial
mendorong pengembangan penelitian cupping lebih lanjut.
In the context of evidence-based
medicine (EBM), we need to evaluate therapeutic effect of cupping therapy to
inform the practice heritage from ancient time. Dalam konteks kedokteran berbasis
bukti (MBE), kita perlu mengevaluasi efek terapeutik cupping terapi untuk menginformasikan
warisan praktek dari waktu kuno.
Methods Metode
Inclusion Criteria Kriteria Inklusi
Any type of clinical studies
including randomized controlled trials (RCTs), clinical controlled trials
(CCTs), case series (CSs), and case reports (CRs) indentifying the therapeutic
effect of cupping therapy, including one or more than two types of cupping
methods, compared with no treatment, placebo or conventional medication were
included. Setiap jenis studi klinis termasuk uji coba terkontrol acak (RCT), uji
klinis terkontrol (TTB), seri kasus (CSS), dan laporan kasus (CR)
mengidentifikasi pengaruh terapi bekam terapi, termasuk satu atau lebih dari
dua jenis metode cupping , dibandingkan dengan tanpa plasebo, perawatan atau
pengobatan konvensional dimasukkan. Combined
therapy with cupping and other interventions compared with other interventions
alone were also included. Kombinasi terapi dengan intervensi kop dan
lainnya dibandingkan dengan intervensi lainnya saja juga disertakan. Cupping therapy combined with other TCM therapies
(including acupuncture) compared with non-TCM therapies were excluded.
Bekam terapi kombinasi dengan terapi TCM lainnya (termasuk akupunktur)
dibandingkan dengan terapi non-TCM telah dikecualikan. There was no limitation on language and publication type.
Tidak ada batasan pada bahasa dan jenis publikasi. Multiple
publications reporting the same data of patients were excluded. Beberapa
publikasi melaporkan data yang sama dari pasien dikeluarkan.
Identification and selection of
studies
Identifikasi dan pemilihan studi
We searched China Network
Knowledge Infrastructure (CNKI) (1911-1978, 1979-2008), Chinese Scientific
Journal Database VIP (1989-2008), Wan Fang Database (1985-2008), Chinese
Biomedicine (CBM) (1978-2008), PubMed (1966-2008) and the Cochrane Library
(Issue 4, 2008), all the searches ended at December 2008. Kami mencari Cina
Pengetahuan Jaringan Infrastruktur (CNKI) (1911-1978, 1979-2008), Cina Database
Jurnal Ilmiah VIP (1989-2008), Wan Fang Database (1985-2008), Cina Biomedik
(CBM) (1978-2008), PubMed (1966-2008) dan Cochrane Library (Issue 4, 2008),
semua pencarian berakhir pada Desember 2008. The
search terms included "cupping therapy", "bleeding
cupping", "wet cupping", "dry cupping", "flash
cupping", "herbal cupping", "moving cupping" or
"retained cupping". Istilah pencarian termasuk "terapi
bekam", "berdarah cupping", "cupping basah",
"cupping kering", "flash cupping", "cupping
herbal", "bergerak cupping" atau "ditahan cupping". Four authors (SJ Dong, YM Shang, Q Wang, and S Xu ) were involved in study identifying and each of them
selected one fourth of the studies for eligibility and checked against the
inclusion criteria independently, they all cross checked the results with other
authors. Empat penulis (SJ Dong, YM Shang, Q Wang, dan S Xu) terlibat
dalam penelitian mengidentifikasi dan masing-masing dipilih seperempat dari
studi untuk kelayakan dan diperiksa terhadap kriteria inklusi independen,
mereka semua cross cek hasilnya dengan penulis lain .
Data extraction and quality
assessment Ekstraksi data dan penilaian kualitas
Four authors (SJ Dong, YM Shang, Q
Wang, and S Xu ) extracted the data from the
included trials independently, and each of them was in charge with one fourth
of the included trials. Empat penulis (SJ Dong, YM Shang, Q Wang, dan S Xu)
diekstraksi data dari percobaan termasuk independen, dan masing-masing
bertanggung jawab dengan seperempat dari pengadilan disertakan. Another author (HJ Cao) checked the data and did the
summary of their results. Penulis lain (HJ Cao) memeriksa data dan
melakukan ringkasan hasil mereka. The extracted
data included authors and title of study, year of publication, study design
(detail of randomization if the study was RCT), type of disease, study size,
age and sex of the participants, type of cupping therapy, treatment process,
detail of the control interventions, outcome (for example, total effective
rate), and adverse effect for each study. Data diekstrak termasuk
penulis dan judul penelitian, tahun publikasi, studi desain (detil pengacakan
jika penelitian ini adalah RCT), jenis penyakit, ukuran studi, umur dan jenis
kelamin peserta, jenis terapi cupping, proses pengobatan, detail intervensi
kontrol, hasil (misalnya, tingkat efektif total), dan efek samping untuk studi
masing-masing. All data were extracted from the
published studies. Semua data yang diambil dari studi yang
dipublikasikan.
Evidence from RCT is considered as
gold standard for therapeutic evaluation, we specifically evaluate the
methodological quality of RCT in this review. Bukti dari RCT dianggap sebagai
standar emas untuk evaluasi terapi, kami secara khusus mengevaluasi kualitas
metodologis RCT dalam tinjauan ini. Two authors (HJ
Cao and M Han) evaluated the quality of included RCTs. Dua penulis (HJ
Cao dan M Han) mengevaluasi kualitas RCT disertakan. Assessment of methodological quality of RCTs was carried
out using criteria from the Cochrane Reviewers' Handbook Penilaian
kualitas metodologis RCT dilakukan dengan menggunakan kriteria dari Penelaah
Cochrane 'Handbook [ 5
]. [ 5
]. We assessed studies according to the risk of
bias for each important outcome within included trials, including adequacy of
generation of the allocation sequence, allocation concealment, blinding and
outcome reporting. Kami menilai studi sesuai dengan risiko bias untuk
setiap hasil yang penting dalam percobaan disertakan, termasuk kecukupan
generasi urutan alokasi, alokasi penyembunyian, membutakan dan pelaporan hasil.
The quality of all the included trials was
categorized to low/unclear/high risk of bias. Kualitas dari semua
percobaan termasuk dalam kategori ke rendah / risiko jelas / bias tinggi. Trials which met all criteria were categorized to low
risk of bias, trials which met none of the criteria were categorized to high
risk of bias, and other trials were categorized to unclear risk of bias if
insufficient information acquired to make judgment. Ujian yang memenuhi
semua kriteria kategori risiko rendah bias, tidak ada percobaan yang memenuhi
kriteria yang dikategorikan risiko tinggi bias, dan persidangan lainnya
dikategorikan risiko jelas bias jika diperoleh informasi yang cukup untuk
membuat penilaian.
Data analysis and statistical
methods
Analisis data dan metode statistik
Data were extracted using
Microsoft Access, and all the information and data were transferred into forms
of Excel to be calculated for frequency. Data yang diambil menggunakan
Microsoft Access, dan semua informasi dan data ditransfer ke bentuk Excel untuk
dihitung untuk frekuensi. Data were summarized
using risk ratio (RR) with 95% confidence intervals (CI) for binary outcomes or
mean difference (MD) with 95% CI for continuous outcomes. Data diringkas
menggunakan rasio risiko (RR) dengan 95% interval kepercayaan (CI) untuk hasil
biner atau berarti perbedaan (MD) dengan 95% CI untuk hasil berkelanjutan. Revman5.0.20 software was used for data analyses.
Revman5.0.20 perangkat lunak yang digunakan untuk analisis data. Meta-analysis was used if the trials had a good
homogeneity on study design, participants, interventions, control, and outcome
measures. Meta-analisis digunakan jika percobaan memiliki homogenitas
yang baik pada desain studi, peserta, intervensi, kontrol, dan ukuran hasil. Publication bias was explored by funnel plot analysis.
Publikasi bias yang dieksplorasi oleh saluran analisis plot.
Results Hasil
Basic information of studies Informasi dasar studi
After primary searches from six
databases, 4696 citations were identified, and the majority was excluded due to
obvious ineligibility from reading title/abstract, and full text papers of 550
studies were retrieved. Setelah pencarian utama dari enam database, 4696 kutipan
diidentifikasi, dan mayoritas itu dikeluarkan karena tidak memenuhi syarat
jelas dari judul membaca / kertas teks abstrak, dan penuh 550 studi yang
diambil. At last, all of the 550 studies were
included in this review, which included 525 studies published in Chinese, 1
study published in English, 20 unpublished conference papers and 4 unpublished
dissertation papers Akhirnya, semua dari 550 penelitian termasuk dalam
review ini, yang meliputi 525 penelitian yang diterbitkan dalam bahasa Cina, 1
penelitian yang diterbitkan dalam bahasa Inggris, 20 makalah konferensi yang
tidak dipublikasikan dan 4 kertas disertasi tidak dipublikasikan [ 7
, 15
, 30
, 39
] ( Figure [ 7
, 15
, 30
, 39
] (Gambar 1
). 1
).
Semua meliputi
studi yang diterbitkan antara tahun 1959 dan 2008, termasuk 73 RCT [ 6
- 78
], 22 CCTs, 373 CSs, and 82 CRs. [ 6
- 78
], 22 TTB, 373 CSS, dan 82 CR. 214 studies (38.9%)
were published between 1999 and 2008, and the number of studies has increased
over the course of five decades obviously ( Figure 214 studi (38,9%) diterbitkan antara tahun 1999 dan
2008, dan sejumlah studi telah meningkat selama lima dekade jelas (Gambar 2
). 2
). The first RCT published in 1993 and over half of
the involved RCTs were reported between 2006 and 2008. Yang RCT pertama
kali diterbitkan pada tahun 1993 dan lebih dari setengah dari RCT yang terlibat
dilaporkan antara tahun 2006 dan 2008.
Deskripsi intervensi
Among all the included studies,
319 (58.0%) used bleeding cupping as the main intervention, 100 (18.2%) used
retained cupping, 48 (8.7%) used moving cupping, 30 studies (5. 5%) used
medicinal cupping, 7 (1.3%) used flash cupping, 5 (0.9%) used water cupping,
and 3 (0.6%) used needle cupping, combined cupping which used at least two
types of cupping methods was used in 38 studies (6.9%) ( Figure Di antara semua studi
disertakan, 319 (58,0%) digunakan perdarahan cupping sebagai intervensi utama,
100 (18,2%) yang digunakan ditahan cupping, 48 (8,7%) yang digunakan bergerak
cupping, 30 studi (5 5%.) Digunakan cupping obat, 7 (1,3%) digunakan flash cupping,
5 (0,9%) cupping air yang digunakan, dan 3 (0.6%) menggunakan jarum bekam,
cupping gabungan yang digunakan setidaknya dua jenis metode cupping digunakan
dalam 38 studi (6,9%) (Gambar
3
). 3
).
Distribusi penyakit / kondisi
More than 50 kinds of diseases or
symptoms were treated by cupping therapy according to included studies. Lebih dari 50 jenis
penyakit atau gejala yang diperlakukan oleh cupping terapi menurut studi
disertakan. The top 20 diseases/conditions in which
cupping is commonly employed were pain (70 studies), herpes zoster (59
studies), cough or asthma (39 studies), acne (29 studies), common cold (24
studies), urticaria (22 studies), lateral femoral cutaneous neuritis (21
studies), cervical spondylosis (19 studies), lumbar sprain (19 studies),
scapulohumeral periarthritis (17 studies), mastitis (14 studies), facial
paralysis (13 studies), Bi syndrome (Wind, cold and dampness invading the body,
which is caused by changeable climate and alternate cold and heat, or dwelling
in damp places, or wading, or being caught in the rain, and linger in channels
and joints resulting in Bi syndrome as the result of stagnation of qi and
blood, 13 studies), headache (13 studies), soft tissue injury (10 studies),
arthritis (10 studies), neurodermatitis (10 studies), wound and sious (8
studies), sciatica (7 studies) and myofascitis (6 studies), 264 studies were
concerned on other diseases treated by cupping therapy ( Figure 20 besar penyakit / kondisi di
mana cupping umumnya digunakan adalah sakit (70 penelitian), herpes zoster (59
penelitian), batuk atau asma (39 penelitian), jerawat (29 penelitian), flu (24
penelitian), urtikaria (22 studi), kulit femoral lateral neuritis (21
penelitian), spondylosis serviks (19 penelitian), keseleo lumbal (19
penelitian), periarthritis scapulohumeral (17 penelitian), mastitis (14
penelitian), kelumpuhan wajah (13 penelitian), Bi sindrom (Angin , dingin dan kelembaban menyerang tubuh,
yang disebabkan oleh iklim berubah dan alternatif dingin dan panas, atau
tinggal di tempat-tempat lembab, atau rendam, atau terperangkap dalam hujan,
dan berlama-lama di saluran dan sendi yang mengakibatkan sindrom Bi sebagai
hasil dari stagnasi qi dan
darah, 13 studi), sakit kepala (13 penelitian), cedera jaringan lunak (10
studi), arthritis (10 studi), neurodermatitis (10 studi), luka dan sious (8
studi), linu panggul (7 studi) dan myofascitis (6 studi), 264 studi khawatir
tentang penyakit lainnya dirawat dengan terapi cupping (Gambar 4
). 4
).
Di antara 20 penyakit tertinggi dalam kajian ini, 12 di
antaranya adalah rasa sakit yang terkait, termasuk nyeri otot kronis (100
studi, seperti nyeri pinggang, skelalgia, fibromyalgia, dll); sakit umum (93
studi, seperti keseleo lumbal, dll) ; infeksi sakit (59 studi, herpes zoster),
dan nyeri neuralgia (20 studi, seperti sakit kepala dan linu panggul). Relieving pain was the main purpose of treating with
cupping therapy of these studies. Menghilangkan rasa sakit adalah tujuan
utama dari perawatan dengan terapi cupping studi ini. Retained cupping, moving cupping, or wet cupping therapy
was usually used in these studies. Saldo cupping, bergerak cupping, atau
terapi cupping basah biasanya digunakan dalam studi ini.
Beside pain, respiratory disease,
such as common cold and symptom of cough and asthma are also treated by cupping
therapy. Selain nyeri, penyakit pernafasan, seperti flu biasa dan gejala batuk
dan asma juga diobati oleh terapi cupping. Common
cold is caused by wind and cold pathogen according to TCM theory, moving
cupping along Du meridian may regulate the qi ,
expelling wind and clearing away cold. Dingchuan (EX-B1) is an
acupoint belonging to Extra Meridian, which is effective on relieving asthma
and cough symptoms. Common dingin disebabkan oleh angin dan patogen
dingin menurut teori TCM, bergerak sepanjang meridian Du cupping dapat mengatur qi, angin mengusir dan kliring pergi
dingin). Dingchuan (EX-B1
adalah milik Acupoint Extra Meridian, yang berlaku efektif menghilangkan gejala
asma dan batuk. Retained cupping or wet cupping
therapy on Dingchuan is usually used on cough and asthma. Saldo basah
cupping terapi atau cupping pada Dingchuan
biasanya digunakan pada batuk dan asma.
Acne belongs to disorders of skin
appendages, neurodermatitis and urticaria belong to disease of skin and
subcutaneous tissue. Jerawat milik gangguan pelengkap kulit, neurodermatitis
dan urtikaria milik penyakit kulit dan jaringan subkutan. All these three diseases may be caused by over heat in
blood system according to TCM theory. Semua ketiga penyakit dapat
disebabkan oleh lebih panas dalam sistem darah menurut teori TCM. Thereby, wet cupping therapy is popularly used for these
diseases. Dengan demikian, terapi cupping basah yang populer digunakan
untuk penyakit ini.
Facial paralysis is a kind of
nerve root and plexus disorders, which belongs to disease of the nerve system. kelumpuhan wajah
adalah sejenis akar saraf dan gangguan pleksus, yang termasuk penyakit sistem
saraf. Flashing cupping and moving cupping are
commonly used on this disease by regulating the circulation of qi and
blood, expelling wind and clearing away cold, and channel meridians.
Berkedip kop dan bergerak menangkupkan biasanya digunakan pada penyakit ini
dengan mengatur sirkulasi qi
dan darah, mengusir angin dan kliring pergi dingin, dan saluran meridian.
Mastitis is a kind of disease of
the genitourinary system, is an inflammatory disorders of breast. Mastitis adalah
sejenis penyakit sistem genitourinari, merupakan gangguan peradangan payudara. Wet cupping therapy is commonly used and acupoints
belonged to liver meridian are always chosen for the blood-letting before cups
retained. Terapi bekam basah biasanya digunakan dan acupoints milik
meridian hati selalu dipilih untuk membiarkan darah-sebelum cangkir ditahan. Some of the studies also used retained cupping therapy on
nipple to utilize the negative pressure to cause milk ejection, which is
applied to patients with galactostasis. Beberapa studi juga digunakan
saldo cupping terapi pada puting susu untuk menggunakan tekanan negatif
menyebabkan ejeksi susu, yang diterapkan untuk pasien dengan galactostasis. The same theory is used for patients with wound and sious
that retained cupping therapy may help discharge of pus. Teori yang sama
digunakan untuk pasien dengan luka dan sious yang ditahan cupping terapi dapat
membantu pembuangan nanah.
We also counted the number of
studies of the top 20 diseases by study type between 1994 and 2008 ( Figure Kami juga menghitung
jumlah studi tentang penyakit tertinggi 20 oleh jenis studi antara tahun 1994
dan 2008 (Gambar 5
). 5
).
Metodologis kualitas RCT
According to our pre-defined
methodological quality criteria, no trial could be evaluated as low risk of
bias, the majority of the 73 included trials were evaluated as high risk of
bias (Table Menurut kriteria yang telah ditetapkan kami kualitas metodologi,
sidang tidak dapat dievaluasi sebagai risiko rendah bias, mayoritas dari 73
percobaan termasuk dievaluasi sebagai risiko tinggi bias (Tabel 1
: Reporting of five quality components in randomized clinical trials on cupping
therapy). 1
: Pelaporan lima komponen kualitas dalam uji klinis secara acak pada terapi
cupping). None of the trials reported sample size
calculation, 15 trials described randomization procedures (such as random
number table or computer generated random numbers), but none of them reported
allocation concealment. Tak satu pun dari percobaan melaporkan
perhitungan ukuran sampel, 15 percobaan yang dijelaskan prosedur pengacakan
(seperti tabel nomor acak atau komputer dihasilkan angka acak), tetapi tidak
satupun dari mereka melaporkan penyembunyian alokasi. Three trials mentioned blinding, but only one trial
reported that they blinded outcome assessors, the other two trials did not
report who were blinded. Tiga uji coba disebutkan menyilaukan, tetapi
hanya satu percobaan melaporkan bahwa mereka buta penilai hasil, dua lainnya
tidak melaporkan percobaan yang telah menjadi buta. Two trials reported the number of dropouts, but none of
them used intention-to-treat analysis. Dua uji coba melaporkan jumlah
putus sekolah, namun tidak satupun dari mereka digunakan niat-to-treat.
Table 1 Tabel 1
|
||||||
|
Reporting
of five quality components in randomized clinical trials on cupping therapy Pelaporan |
||||||
|
Published year Diterbitkan
tahun
|
No. of Randomized
controlled trials Jumlah percobaan terkontrol Acak
(N) (N) |
Adequate sequence
generation Urutan generasi yang memadai
(n/N %) (N /% N) |
Adequate allocation
concealment Alokasi yang memadai penyembunyian
(n/N %) (N /% N) |
Blinding method
reported Metode membutakan dilaporkan
(n/N %) (N /% N) |
Incomplete outcome
data (yes) Lengkap hasil data (ya)
(n/N %) (N /% N) |
Other sources of bias
(yes) Sumber lain bias (ya)
(n/N %) (N /% N) |
|
|
||||||
|
1993-2002 1993-2002
|
6 6
|
0 0
|
0 0
|
0 0
|
0 0
|
6(100%) 6 (100%)
|
|
|
||||||
|
2003 2003
|
5 5
|
1(20%) 1 (20%)
|
0 0
|
0 0
|
0 0
|
3(60%) 3 (60%)
|
|
|
||||||
|
2004 2004
|
9 9
|
0 0
|
0 0
|
0 0
|
0 0
|
3(33.33%) 3 (33.33%)
|
|
|
||||||
|
2005 2005
|
8 8
|
2(25%) 2 (25%)
|
0 0
|
1(12.5%) 1 (12.5%)
|
0 0
|
2(25%) 2 (25%)
|
|
|
||||||
|
2006 2006
|
16 16
|
3(18.75%) 3 (18,75%)
|
0 0
|
1(6.25%) 1 (6,25%)
|
1(6.25%) 1 (6,25%)
|
2(12.5%) 2 (12.5%)
|
|
|
||||||
|
2007 2007
|
13 13
|
4(30.72%) 4 (30,72%)
|
0 0
|
1(7.67%) 1 (7,67%)
|
1(7.69%) 1 (7,69%)
|
4(30.77%) 4 (30,77%)
|
|
|
||||||
|
2008 2008
|
12 12
|
5(41.67%) 5 (41,67%)
|
0 0
|
0 0
|
0 0
|
1(8.33%) 1 (8,33%)
|
|
|
||||||
|
Cao et al. BMC
Complementary and Alternative Medicine 2010 10 :70
doi:10.1186/1472-6882-10-70 Cao et al:
Pelengkap dan Alternatif BMC. Medicine 2010 10 70 DOI:
10.1186/1472-6882-10-70
|
||||||
Ada 48 (65,8%) percobaan dilaporkan komparabilitas data
baseline, 18 (24,7%) percobaan ditentukan kriteria inklusi, 17 (23,3%)
percobaan ditentukan kriteria eksklusi dan 48 (65,8%) percobaan menggambarkan
kriteria diagnostik. 67 (91.8%) trials reported the
efficacy standard, but 51 (69.9%) out of 73 trials used composite outcome
measure which categorized the effect of the treatment into four grades (cured,
markedly effective, effective, ineffective) according to the change of the
symptoms, the remaining 16 trials (21.9%) used single outcome measure for therapeutic
effect. 67 (91,8%) percobaan dilaporkan standar efikasi, tapi 51 (69,9%)
dari 73 percobaan digunakan untuk mengukur hasil komposit yang dikategorikan
pengaruh perlakuan menjadi empat kelas (sembuh, nyata efektif, efektif, tidak
efektif) sesuai dengan perubahan gejala, 16 sisa uji (21,9%) digunakan untuk
mengukur hasil tunggal untuk efek terapeutik. Symptoms
were commonly used as outcome measurements, which were applied in 34 (46.6%)
trials. Gejala yang umum digunakan sebagai hasil pengukuran, yang diterapkan
di 34 (46,6%) percobaan.
Estimate effects of RCTs with
cupping Perkiraan dampak dari RCT dengan menangkupkan
Due to the insufficient RCTs and
the variations in study quality, participants, intervention, control and
outcome measures of the included RCTs, the results of most of the studies could
not be synthesized by quantitative method. Karena tidak cukup RCT dan
variasi dalam kualitas penelitian, peserta, intervensi, kontrol dan ukuran
hasil dari RCT disertakan, hasil sebagian besar studi tidak dapat disintesis
dengan metode kuantitatif. Though most of the
studies showed that cupping therapy was significant effective on certain
diseases, the interpretation of the positive findings from the individual
studies need to be incorporated with the clinical characteristics of the
included studies and evidence strength. Meskipun kebanyakan studi
menunjukkan bahwa terapi cupping signifikan efektif pada penyakit tertentu,
interpretasi temuan positif dari studi individu perlu dimasukkan dengan
karakteristik klinis dari studi disertakan dan kekuatan bukti. Therefore, the conclusion of the beneficial effect of
cupping therapy needs to be confirmed in large and rigorously designed RCTs.
Oleh karena itu, kesimpulan dari efek menguntungkan dari cupping terapi harus
dikonfirmasi di RCT besar dan dirancang ketat.
We conducted a systematic review Kami melakukan kajian
sistematis [ 80
] (in press) of 8 RCTs to evaluate therapeutic effect of wet cupping therapy
for herpes zoster, the meta-analyses showed that wet cupping was superior to
medications for the number of cured patients (RR 2.49, 95%CI 1.91 to 3.24, p <
0.00001), the number of patients with improved symptom (RR 1.15, 95%CI 1.05 to
1.26, p = 0.003), and the incidence rate of post-herpetic
neuralgia (RR 0.06, 95%CI 0.02 to 0.25, p = 0.0001). [ 80
] (di pers) dari 8 RCT untuk mengevaluasi efek terapi terapi cupping basah
untuk herpes zoster, meta-analisis menunjukkan bahwa bekam basah lebih unggul
daripada obat untuk jumlah penderita sembuh (RR 2,49, 95% CI 1,91-3,24 , p <0,00001), jumlah pasien dengan
gejala membaik (RR 1,15, 95% CI 1,05-1,26, p
= 0,003), dan tingkat insiden neuralgia pasca-herpes (RR 0,06, 95% CI
0,02-0,25, p = 0,0001). Combination of wet cupping and medications was
significantly better than medications alone on number of cured patients (RR
1.93, 95%CI 1.23 to 3.04, p = 0.005), but no difference in symptom improvement (RR
1.00, 95%CI 0.92 to 1.08, p = 0.98). Kombinasi bekam basah dan obat-obatan
secara signifikan lebih baik daripada obat sendirian di jumlah pasien sembuh
(RR 1,93, 95% CI 1,23-3,04, p
= 0,005), tetapi ada perbedaan dalam perbaikan gejala (RR 1,00, 95% CI
0,92-1,08, p = 0,98).
We also conducted a systematic
review
Kami juga melakukan kajian sistematis [ 81
] of RCTs to evaluate the therapeutic effect of TCM therapies for fibromyalgia,
only 3 trials [ 81
] dari RCT untuk mengevaluasi efek terapi terapi TCM untuk fibromyalgia, hanya
3 percobaan [ 82
- 84
] on cupping therapy were included in the review according to the inclusion
criteria, and two of them could be conducted in meta-analysis according to VAS
(Visual Analogue Scale) and HAMD (Hamilton Depression Scale) scores after
treatment. [ 82
- 84
] pada terapi cupping yang termasuk dalam kajian sesuai dengan kriteria
inklusi, dan dua dari mereka bisa dilakukan dalam meta-analisis sesuai dengan
VAS (Visual Analog Scale) dan Hamd (Hamilton Depression Skala) skor setelah
perawatan. These sub-analysis of 2 out of 25 trials
showed that compared to medications alone, cupping therapy combined with
acupuncture plus medications was significantly better on pain relieving (MD
-1.66, 95%CI -2.14 to -1.19, p < 0.00001) and depression remission (MD -4.92, 95%CI
-6.49 to -3.34, p < 0.00001). Sub-analisis 2 dari 25 percobaan
menunjukkan bahwa dibandingkan dengan obat saja, cupping terapi kombinasi
dengan akupunktur plus obat secara signifikan lebih baik dalam menghilangkan
rasa sakit (MD -1,66, 95% CI -2,14 sampai -1,19, p <0,00001) dan depresi pengampunan (MD -4,92, 95% CI
-6,49 sampai -3,34, p
<0,00001).
Serious adverse effects were not
reported in any of the trial publications. efek samping yang serius tidak
dilaporkan dalam salah satu publikasi pengadilan.
Diskusi
According to our findings, clinical studies on cupping
therapy were obviously improved either on number or quality during the last 50
years. Menurut temuan kami, studi klinis pada terapi cupping itu jelas
ditingkatkan baik pada jumlah atau kualitas selama 50 tahun terakhir. Though
the methodological quality of the included RCTs were generally poor, some
quality items showed that it was improved during the last 10 years, such as the
number of the RCTs which reported the sequence generation of randomization
(Table Meskipun kualitas metodologi dari RCT disertakan pada umumnya miskin,
beberapa item kualitas menunjukkan bahwa itu membaik selama 10 tahun terakhir,
seperti jumlah RCT yang dilaporkan generasi urutan acak (Tabel 1
: Reporting of five quality components in randomized clinical trials on cupping
therapy). 1
: Pelaporan lima komponen kualitas dalam uji klinis secara acak pada terapi
cupping).
But we should wake up to that these studies leave much scope
for well designed, conducted and reported trials. Tetapi kita harus bangun
dengan studi-studi ini meninggalkan banyak ruang untuk percobaan dirancang
dengan baik, dilakukan dan dilaporkan. We included 550 clinical studies in this
review, only 73 RCTs were published in the last two decades, 78.1% of these
RCTs were with high risk of bias. Kami menyertakan 550 studi klinis dalam
tinjauan ini, hanya 73 RCT diterbitkan dalam dua dekade terakhir, 78,1% dari
RCT adalah dengan risiko tinggi bias. According to the Consolidated Standards
of Reporting Trials (CONSORT) Menurut Standar Pelaporan Konsolidasi Ujian
(permaisuri) [ 85
], randomization methods need to be clearly described and fully reported. [ 85
], metode pengacakan perlu diuraikan secara jelas dan sepenuhnya dilaporkan.
Although blinding of the cupping therapy might be very difficult, blinding of
outcome assessors and statistics should be attempted as much as possible to
minimize performance and assessment biases. Meskipun membutakan dari terapi
cupping mungkin sangat sulit, membutakan asesor hasil dan statistik harus berusaha
sebisa mungkin untuk meminimalkan bias kinerja dan penilaian. Sample size
calculation and analysis of outcomes based on intention-to-treat principle are
important. Ukuran sampel perhitungan dan analisis hasil berdasarkan
tujuan-to-treat prinsip penting. Similar to acupuncture, cupping therapy is a
kind of treatment which relevant to meridian and acupoints, so researchers may
consult to the standard of STRICTA Serupa dengan akupunktur, cupping terapi
adalah jenis perawatan yang relevan dengan meridian dan titik akupuntur,
sehingga peneliti dapat berkonsultasi dengan standar STRICTA [
86
] on trial report, which means details of cupping treatment should be reported,
such as type of cups, experience of the practitioners, period and frequency of
the treatment. [ 86
] pada laporan percobaan, yang berarti rincian cupping pengobatan harus
dilaporkan, seperti jenis cangkir, pengalaman masa, praktisi dan frekuensi
pengobatan.
About one third of the included RCTs did not report the
diagnostic criteria, 63.0% of the RCTs did not report the criteria of inclusion
and exclusion, and the use of composite outcome measures in 51 (69.9%) trials
to evaluate overall improvement of symptoms, all the issues limit the
generalization of the findings. Sekitar sepertiga dari RCT termasuk tidak
melaporkan kriteria diagnostik, 63,0% dari RCT tidak melaporkan kriteria
inklusi dan eksklusi, dan penggunaan ukuran hasil komposit di 51 (69,9%)
percobaan untuk mengevaluasi perbaikan keseluruhan gejala, semua masalah
membatasi generalisasi temuan. The classification of "cure",
"markedly effective", "effective" or "ineffective"
is not internationally recognized, and it is hard to interpret the effect.
Klasifikasi "menyembuhkan", "nyata efektif",
"efektif" atau "tidak efektif" tidak diakui secara
internasional, dan sulit untuk menafsirkan efek. All of the above uncertain
items may increase the clinical heterogeneity. Semua item yang tidak menentu
atas dapat meningkatkan heterogenitas klinis. We suggest future trials
completely report all the criteria they chose and comply with international
standards in the evaluation of treatment effect. Kami menyarankan masa
percobaan benar-benar melaporkan semua kriteria mereka memilih dan memenuhi
standar internasional dalam evaluasi efek pengobatan.
We searched PubMed database using the above searching
strategy, only 2 RCTs were published by international researchers outside of China China China
This review suggests that there is insufficient high-quality
evidence to support the use of cupping therapy on relevant diseases. Tinjauan
ini menunjukkan bahwa ada bukti berkualitas tinggi tidak cukup untuk mendukung
penggunaan cupping terapi pada penyakit yang relevan. Although quite a number
of clinical studies reported that cupping therapy may have effect on pain
conditions, herpes zoster, symptoms of cough and asthma, acne, common cold, or
other common diseases. Meskipun cukup banyak studi klinis melaporkan bahwa
terapi cupping dapat berpengaruh terhadap kondisi sakit, herpes zoster, gejala
batuk dan asma, jerawat, pilek, atau penyakit umum lainnya. The current
evidence is not sufficient to allow recommendation for clinical use of cupping
therapy for the treatment of above diseases of any etiology in people of any
age group. Bukti saat ini tidak cukup untuk memungkinkan rekomendasi untuk
penggunaan klinis terapi cupping untuk pengobatan penyakit di atas dari setiap
etiologi pada orang dari setiap kelompok usia. The long-term effect of cupping
therapy is not known, but use of cupping is generally safe based on long term
clinical use and reports from the reviewed clinical studies. Efek jangka
panjang dari terapi cupping tidak diketahui, tetapi penggunaan cupping umumnya
aman berdasarkan penggunaan klinis jangka panjang dan laporan dari studi klinis
ditinjau.
The number of RCTs on treatment using cupping therapy is
scarce in terms of a specific disease. Jumlah RCT pada pengobatan dengan
menggunakan terapi cupping langka dalam hal penyakit tertentu. Existing trials
are of small size and low methodological quality. percobaan yang ada adalah
ukuran kecil dan kualitas metodologi rendah. Further high quality studies of
larger sample size are needed to assess the effectiveness of cupping therapy.
Studi lebih lanjut kualitas tinggi ukuran sampel yang lebih besar diperlukan
untuk menilai efektivitas terapi cupping. It might be worthwhile to examine the
effectiveness of cupping therapy or combination of cupping therapy with other
non-pharmacological or pharmacological treatments for pain conditions, herpes
zoster, symptoms of cough and asthma, acne, common cold, or other common
diseases which were most treated by cupping therapy according to this review.
Mungkin berguna untuk mengetahui efektivitas terapi cupping atau kombinasi dari
cupping terapi dengan perawatan non-farmakologis atau farmakologis lainnya
untuk kondisi sakit, herpes zoster, gejala batuk dan asma, jerawat, pilek, atau
penyakit umum lainnya yang paling diperlakukan oleh cupping terapi sesuai
dengan review ini. In addition, the methodological quality should be improved,
and the study design and report should also be standardized. Selain itu,
kualitas metodologi harus ditingkatkan, dan desain studi dan laporan juga harus
standar. The protocol of the study should be registered in authoritative
organizations Protokol penelitian harus didaftarkan dalam organisasi otoritatif
[ 91
], such as WHO International Clinical Trial Registration Platform (WHO ICTRP).
[ 91
], seperti WHO International Clinical Trial Pendaftaran Platform (WHO ICTRP).
The authors declare that they have no competing interests. Para penulis menyatakan bahwa mereka tidak memiliki
kepentingan bersaing.
HC participated in the design of the study, searched
studies, participated in extracted data, assessed study quality, analyzed data,
performed the statistical analysis and drafted the manuscript. HC
berpartisipasi dalam desain penelitian, mencari studi, berpartisipasi dalam
data yang diambil, kualitas studi dinilai, menganalisis data, melakukan
analisis statistik dan menyusun naskah. MH participated in extracted data,
assessed study quality. MH berpartisipasi dalam data yang diambil, dinilai
kualitas pembelajaran. XL co-developed the full text of the review. XL-co
mengembangkan teks lengkap dari pemeriksaan. SD, YS, QW, SX participated in
searched literature, identified clinical studies for inclusion and extracted
data. SD, YS, QW, SX berpartisipasi dalam mencari literatur, diidentifikasi
studi klinis untuk dimasukkan dan data diekstraksi. JL conceived of the study,
and participated in its design and coordination, co-developed the full text of
the review and is the corresponding author. JL dikandung penelitian, dan
berpartisipasi dalam desain dan koordinasi, dikembangkan bersama teks lengkap
tinjauan dan adalah penulis yang sesuai.
Huijuan Cao and Jianping Liu were supported by a grant from
the National Basic Research Program of China ('973' Program, No. 2006CB504602),
the grant of international cooperation project (No. 2009DFA31460) and the 111
Project (B08006) from China National Center
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