Complementary therapies in medicine最新文献

Background: Herbal medicines (HM) use among type 2 diabetes mellitus (T2DM) patients has grown tremendously despite the existence of conventional treatments. However, evidence on their safety, potential side effects, and interactions remains scarce. This systematic review and meta-analysis aim to determine the global prevalence of HM use among T2DM patients and assess the safety and potential interactions.

Methods: A systematic search of five electronic databases was conducted until March 2024. Data were extracted and then assessed through an adapted quality appraisal tool. A meta-analysis estimated the pooled prevalence of HM use among T2DM patients and examined predictors of use. Identified herbs were classified based on safety and potential interactions with pharmacological treatments. The study followed PRISMA guidelines.

Results: Twenty-two cross-sectional studies from 19 countries were included. The global prevalence of HM use among T2DM patients was 53% with significant regional variations. The highest prevalence of HM use among T2DM patients is in the African region, accounting for 39.8% of global HM use. Among 49 identified herbs, Opuntia ficus-indica L., Trigonella Foenum Graecum L., Allium sativum L., and Cinnamomum verum J. were the most commonly used. The safety classification reported 7 contraindicated herbs and 19 required caution, and 23 considered safe for use. Additionally, 12 herbs reported potential pharmacological interactions.

Conclusions: Although the use of HM is widespread globally, multiple herbs pose safety concerns. Therefore, to preserve patients' safety, it is essential to avoid using contraindicated herbs and to seek healthcare practitioner supervision.

Objective: This study aimed to evaluate the clinical efficacy of acupuncture in the treatment of limb motor dysfunction following ischemic stroke, and to assess the influence of acupuncture intervention type and treatment dosage on therapeutic outcomes.

Methods: We conducted comprehensive searches multiple databases (e.g., PubMed, Embase, Cochrane, CNKI) and clinical trial registries for studies published up to 10 December 2024. Limb motor function, assessed using the Fugl-Meyer Assessment, was evaluated as the primary outcome. Data analysis was performed using RevMan, ADDIS, and STATA, with reviewer consistency evaluated by the intra-class correlation coefficient.

Results: A total of 71 trials were included. The risk of bias assessment indicated 91.5% of studies had some concerns. The pairwise meta-analyses indicated that the combination of acupuncture and conventional treatment was more effective than conventional treatment alone in improving limb motor dysfunction. The network meta-analyses further indicated that manual acupuncture combined with conventional treatment was the most effective acupuncture-based intervention for improving limb motor dysfunction. Meanwhile, among all acupuncture dose regimens, high-dose acupuncture plus conventional treatment was associated with the greatest therapeutic benefit. However, the GRADE evaluation showed that the certainty of the evidence ranged from low to critically low.

Conclusion: Acupuncture combined with conventional therapy enhances limb motor function recovery in patients after ischemic stroke. Manual acupuncture combined with conventional treatment, especially when employing higher-dose acupuncture protocols, may represent one of the most effective therapeutic approaches. Although the low certainty of evidence warrants cautious interpretation, these findings indicate a promising treatment strategy and identify key areas that require verification through subsequent rigorous studies.

Objectives: To synthesize the available evidence on the effects of animal-assisted therapy on core symptom dimensions (including positive, negative, and general symptoms), specific symptom domains (including depression, anhedonia, anxiety, stress) and cognitive functioning in patients with psychotic spectrum disorders.

Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA and Cochrane Handbook for Systematic Reviews of Interventions guidelines. The PubMed, Cochrane Library, Web of Science and PsycINFO databases were searched from inception to June 2025 with no language restrictions. Experimental follow-up studies implementing animal-assisted therapy in patients with psychotic disorders were included. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated using a random effects model. Heterogeneity was assessed with the I² statistic.

Results: A total of 12 studies (10 randomized controlled trials, a nonrandomized controlled trial and a pre-post study) involving 408 patients (mean age range: 37.0-55.3 years; 32.6% women) were included. Compared with control conditions, patients receiving animal-assisted therapy (predominantly dog-assisted) showed significantly greater pre-post improvements in negative symptoms (SMD = -0.51, 95% CI: -0.95, -0.07; I² = 45.1%; n = 6). No significant effects were found for positive symptoms (SMD = -0.68, 95% CI: -1.68, 0.32; I² = 83.8%; n = 6) or general symptoms (SMD = -0.08, 95% CI: -0.86, 0.69; I² = 72.5%; n = 4). Sensitivity analyses restricted to dog-assisted interventions yielded similar effect estimates. Anxiety symptoms showed reductions but could not be synthesized quantitatively.

Conclusion: Animal-assisted therapy may help alleviate symptoms in patients with psychotic disorders, particularly by reducing negative symptoms. Further randomized controlled trials are needed to confirm these findings and clarify their clinical significance.

Background: Chronic nonspecific low back pain (NSLBP) imposes a substantial burden on individuals and healthcare systems globally. Although exercise therapy is a recommended first-line intervention, its implementation faces significant challenges. This study employed the Consolidated Framework for Implementation Research (CFIR) to systematically identify multi-level factors influencing the implementation of exercise interventions for NSLBP patients within the Chinese healthcare context.

Methods: A qualitative study design was utilized. Participants (n=25) included spine surgeons, rehabilitation physicians, and patients with chronic NSLBP recruited from multiple hospitals in Jining, Shandong Province. A semi-structured interview guide, developed based on the CFIR framework, was used for data collection via face-to-face or telephone interviews. The CFIR comprises five overarching domains; however, the 'Process' domain was excluded from this study as it focused on pre-implementation factors. Data were analyzed using directed content analysis.

Results: The study identified 37 factors influencing implementation, mapped onto four CFIR domains. From the physician perspective (n=18), 14 facilitators and 15 barriers were identified. Patient perspectives (n=7) revealed 4 facilitators and 4 barriers across the same domains. Physicians acknowledged the cost-effectiveness and benefits of exercise therapy but highlighted challenges including the need for professional patient evaluation, lack of standardized protocols, insufficient insurance coverage, and limited surgeon engagement. Primary healthcare institutions expressed willingness to promote exercise therapy. Rehabilitation departments possessed advantages in facilities and expertise, while spine surgery departments faced shortages in resources, personnel, and training. At the individual level, perceptions, habits, and knowledge gaps among both physicians and patients significantly impacted implementation.

Conclusions: This CFIR-guided qualitative study elucidated salient barriers and facilitators influencing exercise therapy implementation for NSLBP in China. Consequently, healthcare policymakers and managers should prioritize revising relevant policies to mitigate identified barriers and amplify facilitators. Enhanced implementation is expected to improve quality of life for chronic back pain patients and lessen the societal burden.