Narrow Results

This systematic review aims to investigate the efficacy of mirror therapy on the motor and sensory functions of the upper extremities in stroke patients. Literature from PubMed, Embase, CINAHL, and Web of Science databases was searched since their inception until March 8, 2023. Taking CINAHL as an example, the search strategy was formulated, and similar strategies were used for other databases. Four reviewers screened the literature according to the PICO principle, excluding literature related to patients with other neurological disorders, non-English literature, literature without full-text availability, study protocols, dissertations, conference abstracts, and reviews. Finally, 10 papers were selected from 1289 papers. Four researchers independently extracted data, determined the level of evidence using PEDro, and assessed the risk of bias in the literature based on the Cochrane Collaboration’s recommendations. The data synthesis indicates that mirror therapy significantly improves upper-extremity motor function, especially gross motor function, and enhances touch and temperature sensory functions by promoting the ability to distinguish different tactile stimuli. However, some studies have shown that mirror therapy does not significantly improve upper-extremity function in stroke patients. The operations of mirror therapy vary from motor-based to task-based, which may contribute to the variation in outcomes among studies. In conclusion, mirror therapy improves the upper-extremity motor function and has the potential to enhance the sensory function in stroke patients, yet more high-quality studies are still needed to provide evidence support.

The interdisciplinary nature of digital transformation requires a shift from theorizing within disciplinary silos to leveraging theory in a way that helps bridge disciplinary boundaries. This study seeks to contribute to this objective by demonstrating that service-dominant logic (S-D logic) as a meta-theory has strong potential to connect IS, service, innovation, and marketing scholars as well as practitioners in understanding and shaping digital transformation. For this purpose, we conduct a computational literature review and create a map of the S-D logic research landscape. Based on this map, we assess how the S-D logic can help address some of the key gaps in our understanding of digital transformation leading to a cross-disciplinary agenda for future research. We argue that an S-D logic perspective on digital transformation can also be informative for practitioners involved in digital transformation activities, whom we equip with an actionable roadmap for implementation.

Deep learning has emerged as a transformative approach in medicinal plant identification, addressing the critical need for accurate and scalable solutions to support biodiversity conservation, traditional medicine, and sustainable healthcare practices. This systematic literature review examines 30 papers on deep learning for medicinal plant identification, revealing diverse approaches across global contexts. Convolutional neural networks emerge as the primary technique, achieving high accuracy, particularly with leaf-based identification. Data collection methods vary, with manual fieldwork predominating. The review highlights challenges in scaling to larger species sets and using crowdsourced data, though strategies like data augmentation show promise. Plant state and maturity impact model performance, warranting further investigation. The geographical distribution of studies emphasizes the global relevance of this research, with India and China contributing the most. Mobile applications offer potential for deployment and data collection but lack robust user feedback mechanisms for model refinement. The review identifies gaps in continuous model updating and suggests exploring incremental and zero-shot learning. Overall, the field shows promise but requires more balanced datasets and context-aware approaches to maximize real-world impact in medicinal plant identification.

Background: The off-label use of gabapentinoids for carpal tunnel syndrome (CTS) is increasing despite limited evidence of efficacy and known risks of adverse effects. This systematic review and meta-analysis aimed to synthesise the evidence of the benefits and harms of oral gabapentinoids in treating CTS.

Methods: We searched Medline and Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT). Based on the search results, we formed three comparisons assessing the effect of oral gabapentinoid interventions against (1) placebo (primary comparison), (2) open label no-treatment (with co-interventions in both arms) or (3) splinting. The primary outcome was symptom severity. The secondary outcomes were pain, function, clinical improvement, health-related quality of life, adverse effects and need for surgery. We adhered to the Cochrane and GRADE methodology throughout conducting this systematic review and meta-analysis.

Results: Gabapentinoids probably do not improve CTS symptoms (moderate certainty) compared with placebo. The benefit was 0.08 points better (95% confidence interval [CI] 0.33 better to 0.17 worse; two studies, 286 randomised participants) expressed on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (1–5 points, lower is better; minimal clinically important difference [MCID] 1.14 points) with gabapentinoids at 8 weeks. Secondary comparison to no treatment aligned with this finding. Gabapentinoids probably cause more fatigue (risk ratio [RR] 1.67 [95% CI 1.06–2.63]) and may cause more dizziness (RR 1.96 [95% CI 0.93–4.13]) compared to placebo. When compared to no-treatment at short term, gabapentinoids may provide minor benefits for pain but not for hand function.

Conclusions: Current evidence does not support the use of oral gabapentinoids for CTS. There were no clinically important benefits in symptom relief when compared to placebo or no-treatment, and gabapentinoids caused adverse effects, particularly fatigue and maybe also dizziness.

Level of Evidence: Level II (Therapeutic)

Traditional Chinese Medicine (TCM) has been modified to some extent in other Far Eastern countries such as Korea and Japan. Researchers of each of the three countries seem to use different English names for the same Chinese medicinal formulae. Lack of knowledge of the Chinese characters is destined to increase this confusion. In order to investigate this matter systematically, all investigations of Chinese medicine formulae published in the American Journal of Chinese Medicine (AJCM, 1997-March 2001) were evaluated. Moreover, PubMed (1966-June 2001) was searched using keywords differentiated by language, location and number of hyphens, and upper-or lower-case of the first letter of the English equivalent of each Chinese character. Fifty-four formulae of TCM were identified in 45 reports published in AJCM. Thirty-two were named in Chinese only (23 reports); six in Japanese (six reports); and five in Korean (five reports). Ten formulae were named in Japanese with the Chinese name in brackets (ten reports); and one in Chinese with the Japanese name in brackets (one report). By computerized literature search, different numbers of research papers were retrieved by using keywords differentiated by language, location and number of hyphens. Such confusion may prevent progress in the evaluation of TCM. To increase the efficiency of studies on Chinese medical formulae, standardization of terminology is required.

To evaluate the effects of radix Sophorae flavescentis for chronic hepatitis B, a systematic review of randomized clinical trials was conducted. Randomized trials comparing extract of radix Sophorae flavescentis versus placebo, no intervention, non-specific treatment, other active medicines, or interferon for chronic hepatitis B were identified by electronic and manual searches. Trials of Sophorae herb plus other drugs versus other drugs alone were also included. No blinding and language limitations were applied. The methodological quality of trials was assessed by the Jadad scale plus allocation concealment. Meta-analysis was performed where data was available. Twenty-two randomized trials (n = 2409) were included. Methodological quality of the trials was generally low. The combined results showed that matrine (aqueous extract of Sophorae flavescentis) had antiviral activity, positive liver biochemical effects, and improved symptoms and signs compared with non-specific treatment and other herbal medicines. The combination of matrine and interferon-α (IFN-α), thymosin, or basic treatment showed better effects on viral and liver biochemical responses. The antiviral and biochemical responses were not significantly different between matrine and IFN-α. No serious adverse event was reported. Based on the review, Sophorae flavescentis extract (matrine) may have antiviral activity and positive effects on liver biochemistry in chronic hepatitis B. However, the evidence is not sufficient to recommend matrine for routine clinical use due to the generally low methodological quality of the studies. Further rigorous trials are needed.

Studies on the treatment of chronic fatigue syndrome (CFS) with acupuncture and moxibustion in China were reviewed. All studies concluded the treatments were effective, with response rates ranging from 78.95% to 100%. However, the qualities of the studies were generally poor, and none of them used a RCT design. The common acupoints/sites used in the treatment of CFS, which may reflect the collective experience of acupuncturists in China based on Traditional Chinese Medicine theories can be used to evaluate the effectiveness of acupuncture for the treatment of CFS in future studies using more scientifically rigorous study designs.

To systematically evaluate the effectiveness of Chinese herbal medicine for treating depression in China, the electronic medical database from China National Knowledge Infrastructure (CNKI) was searched using Chinese and the date is set, from 1st January 1994 to 1st August 2008. The 18 studies that met the entry criteria along with 1,260 randomized patients were included in this review. All studies with words like "randomization" or "quasi-randomization" in their abstracts were included, whether they used blinding or not. The results showed that the Chinese medicine treated group did not decrease the scores of the self-rating depression scale (-1.02, 95% CI -2.16 ~ 0.12, p = 0.08) and the scores of the Hamilton depression scale (-0.45, 95% CI -0.98 ~ 0.08, p = 0.10). The results showed there is no evidence to support that traditional Chinese medicine for depression has improved, which may be due to the low quality in all the trials. Therefore, more qualified, randomized controlled clinical trials are warranted to assure its efficacy.

The objective of this study was to assess the evidence for or against the effectiveness of moxibustion as a treatment option for pain. Fourteen electronic databases were searched. Randomized clinical trials (RCTs) testing moxibustion in human patients with pain of any type were considered. Trials using direct or indirect moxibustion were included. Studies comparing moxibustion with other treatments of unproven effectiveness, studies testing moxibustion together with other treatments of unproven efficacy and trials where pain was not a central symptom of the condition were all excluded. The selection of studies, data extraction, and validation were performed independently by two reviewers. Four RCTs met all the inclusion criteria. Others were of poor methodological quality. Two RCTs suggested significant pain reductions for indirect moxibustion in osteoarthritis as compared with drug therapy (n = 200, RR, 1.11; 95% CI of 1.02 to 1.21, p = 0.02, heterogeneity: χ² = 1.03, p = 0.31, I² = 3%). The other two RCTs suggested positive effects of indirect or direct moxibustion on pain in scleroma or herpes zoster compared to drug therapy, respectively. We conclude that few RCTs are available that test the effectiveness of moxibustion in the management of pain, and most of the existing trials have a high risk of bias. Therefore, more rigorous studies are required before the effectiveness of moxibustion for the treatment of pain can be determined.

Acupuncture is often recommended for obstetrical and gynecological conditions but the evidence is confusing. We aim to summarize all recent systematic reviews in this area. Western and Asian electronic databases were searched for systematic reviews of any type of acupuncture for any type of gynecological conditions. Our own files were hand-searched. Systematic reviews of any type of acupuncture for any type of gynecological conditions were included. Non-systematic reviews and systematic reviews published before 2004 were excluded. No language restrictions were applied. Data were extracted according to predefined criteria and analysed narratively. Twenty-four systematic reviews were included. They relate to a wide range of gynecological conditions: hot flashes, conception, dysmenorrhea, premenstrual syndrome, nausea/vomiting, breech presentation, back pain during pregnancy, and procedural pain. Nine systematic reviews arrived with clearly positive conclusions; however, there were many contradictions and caveats. The evidence for acupuncture as a treatment of obstetrical and gynecological conditions remains limited.

Many patients with chronic hepatitis B (CHB) seek help from traditional Chinese medicine (TCM). TCM treatment is based on syndrome differentiation. This study aimed to investigate the syndrome distribution in populations of CHB patients. The pre-specific search strategy was set, and 93 studies (20,106 participants) were identified by electronic and hand searches. The methodological quality of included studies was assessed. Data on syndrome distribution and correlations between syndromes and severity of CHB, were extracted and analyzed. Forty-seven syndromes were identified under 24 different syndrome diagnosis systems for CHB. The majority of included studies reported Liver Depression and Spleen Deficiency (LDSD) (52.54% of studies) or Liver-Gallbladder Dampness Heat (LGDH)/Dampness-Heat Obstructing Middle Energizer (DHME) (32.20%) as the major syndromes in CHB patients without cirrhosis. Pooled analysis revealed that LDSD and LGDH/DHME accounted for 61.19% of participants without cirrhosis. In addition, Liver-Kidney Yin Deficiency (LKYinD) (40.99%) and Spleen-Kidney Yang Deficiency (SKYangD) (40.43%) syndromes were common in patients with severe CHB. The percentage of patients with Blood Stasis syndrome increased as the disease progressed to cirrhosis (32.09%). To conclude, LDSD and LGDH/DHME syndromes are found in a significant majority of CHB patients, particularly in the early stages. LKYinD, SKYangD and Blood Stasis dominate in patients at more advanced stages. More epidemiological studies of high methodological quality on syndrome distribution in CHB and standardization of syndrome differentiation for CHB are required to confirm the trends indicated by the studies reviewed here; confirming these trends can increase the efficacy of treatment and give guidance to doctors.

This study was to evaluate the efficacy and safety of acupuncture for chronic functional constipation. Randomized controlled trials were searched in several databases. The primary outcome was a change in the number of weekly spontaneous bowel movements. The secondary outcomes included colonic transit activity, effective rate, Cleveland Clinic Score, and health-related quality of life score. Meta-analysis was done by using RevMan 5.1. After strict screening, 15 RCTs were included, containing 1256 participants. All of them were conducted in China and published in Chinese journals. Meta-analysis indicated that acupuncture for chronic functional constipation was probably as effective as conventional medical therapy in the change of bowel movements. For the colonic transit activity, acupuncture might be the same as conventional medical therapy and could be better than sham acupuncture. For the Cleveland Clinic Score, acupuncture was unlikely inferior to conventional medical therapy and the deep acupuncture was better than normal depth acupuncture in abdominal region. No obvious adverse event was associated with acupuncture for constipation. In conclusion, acupuncture for chronic functional constipation is safe and may improve weekly spontaneous bowel movements, quality of life, and relevant symptoms. However, the evidence was limited by the small sample size and the methodological quality.

We performed a systematic review to evaluate the efficacy of natural medicines for the treatment of Alzheimer's disease (AD) in randomized controlled trials (RCTs). Disease-specific and intervention terms were searched in MEDLINE, EMBASE, the Cochrane Library and PsycINFO to identify RCTs for the AD intervention of natural medicines, and searched for literatures in English language. The RCTs compared natural medicines and either placebo or orthodox medication in AD patients. The quality of literature was evaluated by Jadad's score and the Cochrane assessing tool to reduce the risk of bias. Meta-analysis and the heterogeneity of results across the trials were performed. Out of the literatures, 21 clinical reports were included in this review that satisfied the particular selection criteria. Apart from Ginkgo, other treatments we came across had minimal benefits and/or the methodological quality of the available trials was poor. The meta-analyses showed that Ginkgo had better outcomes than the placebo, with the standardized mean difference (SMD) between Ginkgo and the placebo on cognition being -1.62 (95% CI: -2.69 to -0.56) and on activities of daily living being -1.55 (95% CI: -2.55 to -0.55), with the existence of significant heterogeneity across studies. The meta-analysis for assessing the prevention effect of Ginkgo against AD suggested that risk ratio (RR) is 1.06 (95% CI: 0.92 to 1.22) between Gingko and the placebo, with no significant heterogeneity across studies (test for heterogeneity, p = 0.49). Our results suggest that Ginkgo may help established AD patients with cognitive symptoms but cannot prevent the neurodegenerative progression of the disease.

Gingko biloba extract (EGB) has been used in traditional medicines for centuries, and although its application to cerebral ischemia has been of great interest in recent years, high quality evidence-based clinical trials have not been carried out. This systematic review and meta-analysis aimed to examine the neuroprotective effect of EGB on focal cerebral ischemia in animal models. A systematic literature search was performed using five databases spanning January 1980–July 2013. The outcome was assessed using the effect size, which was based on infarct size and/or neurological score. A total of 42 studies with 1,232 experimental animals matched our inclusion criteria. The results revealed that EGB improved the effect size by 34% compared to the control group. The animal species, the method and time to measure outcome, and the route and dosage of EGB administration affected the variability of the effect size. Mechanisms of EGB neuroprotection were reported as anti-apoptotic, anti-oxidative, and anti-inflammatory. In conclusion, EGB exerts a significant protective effect on experimental focal cerebral ischemia. However, possible experimental bias should be taken into account in future clinical studies.

Depression is the most common non-motor symptom of Parkinson's disease (PD). Recent clinical trials have evaluated the effectiveness of traditional Chinese medicine (TCM) in the treatment of depression in PD (dPD). However, the results are conflicting rather than conclusive. To investigate the effectiveness of TCM for the treatment of dPD, a systematic review was conducted. Literature searches and collections were performed to identify studies addressing the treatment of TCM for dPD. The methodological quality and risk of bias in all studies included were evaluated. Weighted mean difference (WMD) with 95% confidence interval (CI) was used as the effect measure. Finally, a total of 10 studies involving 582 patients were identified. The pooled results revealed that TCM combined with conventional drugs significantly improved the total scores of the unified Parkinson's disease rating scale (WMD = -7.35, 95% CI: -11.24 to -3.47) and the score of the Hamilton rating scale for depression (HAM-D) (WMD = -4.19, 95% CI: -5.14 to -3.24) compared with conventional drug, respectively. Conclusively, there is evidence that TCM may be beneficial to the treatment of dPD in spite of the methodological weakness of the included studies.

Compound Danshen dripping pill (CDDP) is commonly used to treat coronary heart disease (CHD) in China. However, clinical practice has not been informed by evidence from relevant systematic reviews (SRs). This overview aims at summarizing evidence from SRs on CDDP for the treatment of CHD. We included SRs of randomized controlled trials (RCTs) on CDDP in treating CHD until March 2014 by searching the Cochrane Library, PubMed, EMBASE and four Chinese databases. Data were extracted according to a pre-designed form. We assessed the quality of SRs according to AMSTAR and graded the quality of evidence in the included SRs using the GRADE approach. All data analyses were descriptive. About 13 SRs involving a total of 34,071 participants with angina or acute myocardial infarction (AMI) were included. Few SRs assessed endpoints (5/13, 38.5%) and quality of life (QOL) (4/13, 30.8%). Most of the SRs suggested that CDDP had potential benefits for patients with CHD, such as improving symptoms and electrocardiogram (ECG) results, with few adverse reactions, while benefits in endpoints were unproved. Moreover, the overall quality of evidence in the SRs was poor, ranging from "very low" to "moderate", and most of the included SRs were of "low" (3/13, 23.1%) or "moderate" (9/13, 69.2%) quality with many serious flaws. Current SRs suggested potential benefits of CDDP for the treatment of CHD. However, high-quality evidence is warranted to support the application of CDDP in treating CHD.

Traditional Chinese medicine (TCM) has been commonly used by Chinese practitioners to treat irritable bowel syndrome (IBS). However, the effectiveness of combining TCM with Western medicine in managing IBS has not been evaluated systematically. In this study, we evaluated the clinical effectiveness of combining TCM and Western medicine in the treatment of IBS via meta-analyses. We reviewed 72 eligible randomized controlled trials from January 2009 to December 2013 investigating the effectiveness of integrated TCM and Western medicine in the management of IBS. In the meta-analyses, the relative risks (RRs) and 95% confidence interval (95%CI) were calculated using raw data from each study, and low heterogeneity was detected. When compared to the Western medicine treatment alone, our result showed TCM combined with Western interventions significantly improved IBS global symptoms (RR, 1.21; 95%CI: 1.18–1.24). Additionally, there was no significant difference in therapeutic effects of the integrated approach in the meta-analyses involving the various IBS subtypes. Likewise, both Chinese proprietary herbal medicine plus conventional treatment and compound herbal preparations plus conventional treatment showed similar and statistically significant effects on global improvement compared with western treatment alone, with RRs of 1.22 (95%CI: 1.14–1.30) and 1.22 (95%CI: 1.18–1.27), respectively. These results demonstrated that treating IBS with integrated traditional Chinese and Western medicines showed better effectiveness than conventional Western medicine alone. Although due to the quality of the included studies, our results might possess a high risk of bias. TCM, particularly Chinese proprietary medicine, with the benefits of low-cost, easy to use, and good palatability, would be an attractive option to be used in conjunction with conventional Western medicine to manage IBS patients.

A systematic review was conducted to evaluate the effectiveness of qigong as a treatment for chronic pain. Five electronic databases were searched from their date of establishment until July 2014. The review included 10 randomized clinical trials (RCTs) that compared the impacts of qigong on chronic pain with waiting list or placebo or general care. Random effect models and standard mean differences were used to present pain scores. A total of 10 RCTs met inclusion criteria. There was a statistically significant difference on reducing chronic pain between internal qigong and control (SMD: $-$1.23 95% $\mathrm{\text{CI}}=-2.23$, $-0.24p=0.02$), external qigong and general care (SMD: $-$1.53 95% $\mathrm{\text{CI}}=-2.15,-0.91p<0.05$), external qigong and placebo (SMD: $-$0.51 95% $\mathrm{\text{CI}}=-0.95,-0.06p=0.03$), and internal qigong for chronic neck pain at 6 months (SMD: $-$1.00 95% $\mathrm{\text{CI}}=-1.94,-0.06p=0.04$). The differences between external qigong and control, external qigong and waiting list, internal qigong and waiting list, and external for premenstrual syndromes were not significant. This study showed that internal qigong generated benefits on treating some chronic pain with significant differences. External qigong showed nonsignificant differences in treating chronic pain. Higher quality randomized clinical trials with scientific rigor are needed to establish the effectiveness of qigong in reducing chronic pain.

Electroacupuncture (EA) is an extension technique of acupuncture based on traditional acupuncture combined with modern electrotherapy. Here, we conducted a systematic review specifically to assess the effectiveness and safety of EA for acute ischemic stroke. Eight databases were searched for randomized-controlled clinical trials (RCTs) of EA for acute ischemic stroke published from inception to June 2013. Ultimately, 67 studies claimed to be RCTs. Eighteen studies with 1411 individuals were selected for the analyses, which got $\ge 4$ “yes” in the domains of Cochrane risk of bias tool. The meta-analysis showed a significant effect of EA for improving Barthel Index ($p<0.00001$), Fugl–Meyer Assessment ($p<0.00001$), National Institutes of Health Stroke Scale ($p<0.00001$) and Revised Scandinavian Stroke Scale ($p<0.00001$) compared with western conventional treatments (WCTs). In an analysis of the total clinical efficacy rate, there was a significant difference between EA and WCTs ($p=0.0002$). Adverse effects were monitored in 6 studies, and were well tolerated in all stroke patients. According to the GRADE approach, the quality of evidence was mostly high or moderate. In conclusion, this systematic review revealed the evidence in support of the use of EA for acute ischemic stroke, although further larger sample-size and rigorously designed RCTs are required.

Tai Chi has frequently been used as a preventive measure against falling in at-risk populations. However, studies have yielded contradictory results, and literature reviews have considered only a small number of trials and have not addressed some key aspects, such as sources of heterogeneity and publication bias. This study includes 13 controlled trials published before June 2015 that analyzed the effectiveness of Tai Chi in fall prevention in populations of frail and at-risk adults. The effect measure used in this meta-analysis was absolute risk reduction (ARR) with a 95% confidence interval (CI). According to our findings, practice of Tai Chi significantly prevents the risk of falling (ARR, $-0.10$; 95% CI: $-0.06$, $-0.15$). The heterogeneity of results across the trials was low, with a reduced risk of publication bias, and no significant effect differences were observed between studies comparing Tai Chi with other interventions or non-treatment. We therefore conclude that Tai Chi is more effective than other measures, or no intervention, for fall prevention in at-risk populations. Further research is warranted to analyze the consequences of falls and to study the episodes rather than the cases of falls.