Dear Editor,
We read the recent article ‘Comparative effectiveness of noninvasive therapeutic interventions for myofascial pain syndrome: a network meta-analysis of randomized controlled trials’ by Liu et al.1 with great interest, which evaluates the comparative effectiveness of various noninvasive therapeutic interventions for myofascial pain syndrome (MPS). The study’s findings suggest that manual therapy, laser therapy, and extracorporeal shock wave therapy are effective in reducing pain intensity and disability associated with MPS are significant for clinical practice. However, we have a few considerations and suggestions that we would like to bring to your attention.
Primarily, Tuina as a key manual therapy component, is well-studied in China2. The authors didn’t search Chinese databases, potentially missing valuable data. Future research should include searches in CNKI, Wanfang Medicine, and VIP databases.
Secondly, the authors claimed adherence to PRISMA guidelines, yet the study lacked sensitivity analysis. It’s suggested that reporting standards be further enhanced3.
In addition, variations in intervention duration and outcome measurement times across studies can introduce significant heterogeneity. Subgroup analyses and regression analyses based on treatment durations and observation points are advised.
Finally, although the results of this study are positive, the limited study count, neglect of sparse data, and repeated testing in standard meta-analyses risk false positives. Conducting a trial sequential analysis (TSA) is suggested to mitigate these concerns4.
Ethical approval
Not applicable.
Consent
Not applicable.
Sources of funding
No fundings were received for this research.
Author contribution
W.F.: methodology, formal analysis, and writing – original draft; J.W.: conceptualization, methodology, supervision, and writing – review and editing.
Conflicts of interest disclosure
The author declares no conflict of interest.
Research registration unique identifying number (UIN)
Not applicable.
Guarantor
Jian Wang.
Data availability statement
All data generated or analyzed during this study are included in this article. The data are available from the corresponding author upon reasonable request.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Published online 20 May 2024
Contributor Information
Weijing Fan, Email: fanweijing1993@gmail.com.
Jian Wang, Email: 18811023202@163.com.
References
- 1. Liu C, Wang Y, Yu W, et al. Comparative effectiveness of noninvasive therapeutic interventions for myofascial pain syndrome: a network meta-analysis of randomized controlled trials. Int J Surg 2024;110:1099–1112. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Cheng ZJ, Zhang SP, Gu YJ, et al. Effectiveness of Tuina therapy combined with Yijinjing exercise in the treatment of nonspecific chronic neck pain: a randomized clinical trial. JAMA Netw Open 2022;5:e2246538. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 2021;88:105906. [DOI] [PubMed] [Google Scholar]
- 4. Kang H. Trial sequential analysis: novel approach for meta-analysis. Anesth Pain Med (Seoul) 2021;16:138–150. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All data generated or analyzed during this study are included in this article. The data are available from the corresponding author upon reasonable request.