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      Acupuncture for constipation in patients with stroke: protocol of a systematic review and meta-analysis

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          Abstract

          Introduction

          Constipation is one of the most common complications in patients with stroke. Acupuncture has gained increased popularity for the management of constipation. However, there is a lack of supportive evidence on the efficacy of acupuncture for poststroke constipation. This systematic review aims to collect and critically appraise all the available evidence about the efficacy and safety of the acupuncture for constipation in poststroke patients.

          Methods and analysis

          A comprehensive search of Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, four Chinese databases (National Knowledge Infrastructure (CNKI), Chinese Biomedical Literatures database (CBM), Wanfang Digital Periodicals (WANFANG) and Chinese Science and Technology Periodicals (VIP) database), one Japanese medical database (National Institute of Informatics, CiNii) and one Korean medical database (Oriental Medicine Advanced Searching Integrated System, OASIS) will be conducted to identify randomised controlled trials of acupuncture for constipation in poststroke patients. There is no restriction on language or publication status. The primary outcome measure will be frequency of bowel movement. The risk of bias will be assessed using the approach recommended by Cochrane Handbook for Systematic Reviews of Interventions. We will conduct the meta-analysis to synthesise the evidence for each outcome, if possible. The heterogeneity will be statistically assessed using a χ 2 test and I 2 statistic. This protocol is developed following the guideline of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols 2015.

          Ethics and dissemination

          The ethical approval is not required because no primary data are collected. The findings will be presented at scientific conferences or a peer-reviewed scientific journal.

          PROSPERO registration number

          CRD42017076880.

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          Most cited references28

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          Acupuncture for chronic severe functional constipation: a randomized trial

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            Efficacy of acupuncture for chronic constipation: a systematic review.

            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.
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              Incidence of constipation in stroke patients

              Abstract There is growing awareness of a link between the gut and cardiovascular disease. Constipation is common among individuals who have had a stroke, and it negatively affects social functioning and quality of life. However, no systematic study on the incidence of constipation in stroke patients has been reported. We selected studies included in Medline, Embase, Cochrane database, and Web of Science. Studies were included if they reported the incidence in stroke patients. Two authors selected the studies, extracted the data independently, and assessed these. Subgroup analyses were conducted according to the stroke subtype and stage of stroke. After detailed evaluations, 8 studies (n  =  1385 participants) were found that contained data that were suitable for meta-analytic synthesis. A forest plot showed that the incidence of constipation was 48% (95% confidence interval [CI]  =  33%–63%). In the analysis of the type of stroke subgroup, the incidence of constipation in patients who had had a hemorrhagic stroke (66% [95% CI  =  40–91%]) was higher than that in patients who had experienced an ischemic stroke (51% [95% CI  =  27%–75%]). The incidence in the acute stage (45% [95% CI  =  36%–54%]) was lower than that in the rehabilitation stage (48% [95% CI  =  23%–73%]). Constipation after a stroke event occurs frequently. This finding may raise awareness about bowel complications to allow correct evaluation and proper management.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2018
                30 March 2018
                : 8
                : 3
                : e020400
                Affiliations
                [1 ]departmentResearch institute of Traditional Chinese Medicine , Tianjin University of Traditional Chinese Medicine , Tianjin, China
                [2 ]departmentDepartment of Clinical Pharmacology , The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine , Tianjin, China
                [3 ]departmentLibrary , Tianjin University of Traditional Chinese Medicine , Tianjin, China
                [4 ]departmentSchool of Nursing , Tianjin University of Traditional Chinese Medicine , Tianjin, China
                [5 ]departmentHong Kong Chinese Medicine Clinical Study Centre , Hong Kong Baptist University , Hong Kong, China
                [6 ]departmentKey Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing , Dongzhimen Hospital, Beijing University of Chinese Medicine , Beijing, China
                [7 ]First Teaching Hospital of Tianjin University of Traditional Chinese Medicine , Tianjin, China
                [8 ]departmentLaboratory for Biological Effects of Tuina , State Administration of Traditional Chinese Medicine , Tianjin, China
                Author notes
                [Correspondence to ] Dr Huanan Li; lihuanan1984@ 123456126.com and Prof. Guihua Tian; Rosetgh@ 123456163.com
                Article
                bmjopen-2017-020400
                10.1136/bmjopen-2017-020400
                5884333
                29602854
                5d1c0138-56a5-42f8-8625-a5231ae3cb58
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 02 November 2017
                : 23 January 2018
                : 12 March 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Funded by: FundRef http://dx.doi.org/10.13039/501100005090, Beijing Nova Program;
                Categories
                Cardiovascular Medicine
                Protocol
                1506
                1683
                Custom metadata
                unlocked

                Medicine
                stroke medicine,constipation,acupuncture,systematic review,meta-analysis
                Medicine
                stroke medicine, constipation, acupuncture, systematic review, meta-analysis

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