A protocol for systematic review and network meta-analysis
Abstract
Background:
Poststroke depression (PSD) is an important complication of stroke, resulting in increased disability and mortality, which is a great threat to stroke survivors and public health. Complementary and alternative medicine (CAM) therapies is widely used in the treatment of PSD, However, the selection strategies of different CAM approaches in clinical practice is still not clear, and the purpose of this protocol is to compare the efficacy and acceptability of different CAM therapies using systematic review and network meta-analysis.
Methods:
According to the strategy, the authors will retrieve a total of seven electronic databases by August 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chinese Scientific Journals Database, and Wan-fang databases. The network meta-analysis will be performed using Aggregate Data Drug Information System 1.16.8 and Stata 13.0 software. In addition, the Cochrane Collaboration’s tool is employed for the methodological quality, and the quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation system.
Results:
This study will provide a reliable evidence for the selection strategy of CAM therapies for PSD.
Conclusion:
The results of this study will provide references for evaluating the effects of different CAM therapies on PSD, and provide decision-making references for clinical practitioners, patients, and health policy makers.
1 Introduction
Poststroke depression (PSD) is the most common neuropsychiatric consequences of stroke,[1] occurring in 29% to 33% of stroke survivors.[2,3] It is estimated that nearly 2 million individuals in the United States are dealing with PSD at any given time.[4] The major symptoms of early PSD (within the first 3 months after stroke) are dysphoria, melancholia, and vegetative signs.[5,6] The current evidence indicates that the neurobiological factors may be the main factors associated with PSD, specifically includes change in ascending monoamine pathways, excess of proinflammatory cytokines, dysfunction of the hypothalamic-pituitary adrenal axis and alterations in neuroplasticity.[7] Studies have demonstrated that PSD can significantly compromise quality of life, including affecting cognitive function, social activity, and stroke rehabilitation. Moreover, it is also associated with increase mortality risk.[8,9] Current research suggests that disability, personal and family history of a psychiatric illness, and high overall medical burden may be risk factors for PSD.[10,11] Due to the complexity of diagnosis and the uncertainty of various screening tools, consequently, only a small percentage of PSD patients can be accurately diagnosed and treated.[12] The main therapeutic strategies for PSD include pharmacological and nonpharmacological interventions (eg, psychotherapy, surgical therapy, electroconvulsive therapy). In the pharmacological interventions, it has been suggested that Selective Serotonin Reuptake Inhibitors is the first line treatment,[13] such as fuoxetine, sertraline, and citalopram.[14] There is no doubt that the pharmacological therapy for PSD has a positive effect. However, there was also a significant increase in adverse events,[15] such as gastroenterological symptoms, epilepsy/ seizures and hyponatremia.[7] In addition, intolerance of antidepressants by some stroke survivors, and poor treatment adherence may further reduce the impact of drugs in PSD treatment.[16] Thus, better strategies for effective PSD treatment are needed.
Complementary and alternative medicine (CAM) therapies refers to a diverse range of healing techniques that are not considered established or standard practices in western medicine.[17] Many CAM modalities have been used by stroke survivors all around the world,[18] including acupuncture, meridian acupressure, light therapy, exercise, repetitive transcranial magnetic stimulation (rTMS), music therapy, herbal medicines and so on. One study reports that 46% of stroke survivors engage in some form of complementary medicine.[19] In Korea, 54% of stroke patients used CAM therapies, and 16% who felt that it can effectively achieve psychological relaxation.[20] In recent years, CAM therapies has been increasingly sought by people with PSD.[21] It is reported that acupuncture is more effective than short-term use of antidepressants in patients with PSD.[22] Deng et al[23] found that rTMS is a beneficial therapeutic method for managing PSD and may even be superior in efficacy to selective serotonin reuptake inhibitors. Kim et al[24] reported the positive roles of music therapy on improvement of depressive mood and anxiety in stroke patients. A study from Kang et al[25] has proven Meridian acupressure benefits in improvement of PSD.
Despite the numerous CAM therapies for PSD has been evaluated in previous randomized controlled trials (RCTs), However, majority have not been quantitatively analyzed in head-to-head comparisons. Thus, we performed a network meta-analysis (NMA) of all RCTs involving CAM therapies for PSD, to compare and comprehensively rank all available CAM therapies, and assess efficacy and acceptability of different CAM therapies. […]
TBI Rehabilitation 