Table 3.
Summary of findings and strength of evidence for outcomes.
|
Patient or population: Patients with vascular cognitive impairment (VCI) Setting: Hospitals in mainland China | ||||
|---|---|---|---|---|
| Outcomes | Anticipated absolute effects* (95% CI) | N o̱ of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with Western medicine | Risk with acupuncture | |||
|
Acupuncture compared to Western medicine for VCI Intervention: Acupuncture Comparison: Western medicine | ||||
| Mental state (MMSE) assessed with: MMSE scale (higher score better outcome) Scale from: 0 to 30 follow up: 2–12 weeks | The mean mental state ranged from 16.84 to 23.96 | MD 1.86 higher (1.19 higher to 2.54 higher) |
1,229 (18 RCTs) | ⊕⊕○○ LOWa,b |
| Cognition (HDS) assessed with: HDS Chinese version (higher score better outcome) Scale from: 0 to 30 follow up: 4–10 weeks | The mean cognition ranged from 12.68 to 24.36 | MD 2.2 higher (1.27 higher to 3.13 higher) |
781 (12 RCTs) | ⊕⊕○○ LOWa,b |
|
Acupuncture plus Western medicine compared to Western medicine for VCI Intervention: Acupuncture plus Western medicine Comparison: Western medicine | ||||
| Mental state (MMSE) assessed with: MMSE scale (higher score better outcome) Scale from: 0 to 30 follow up: 4–12 weeks | The mean mental state ranged from 16.6 to 24.48 | MD 2.37 higher (1.6 higher to 3.14 higher) |
1,106 (14 RCTs) | ⊕⊕○○ LOWa,b |
| Cognition (HDS) assessed with: HDS Chinese version (higher score better outcome) Scale from: 0 to 30 follow up: 2–12 weeks | The mean cognition ranged from 17.12 to 26.83 | MD 1.77 higher (0.85 higher to 2.69 higher) |
235 (4 RCTs) | ⊕○○○ VERY LOWa,c,b |
|
Acupuncture plus Usual care compared to Usual care for VCI Intervention: Acupuncture plus Usual care Comparison: Usual care | ||||
| Mental state (MMSE) assessed with: MMSE scale (higher score better outcome) Scale from: 0 to 30 follow up: 4–12 weeks | The mean mental state ranged from 17.2 to 21.35 | MD 4.4 higher (1.61 higher to 7.19 higher) |
530 (7 RCTs) | ⊕○○○ VERY LOWa,b,d |
| Cognition (HDS) assessed with: HDS Chinese version (higher score better outcome) Scale from: 0 to 30 follow up: 4–10 weeks | The mean cognition ranged from 18.6 to 19.8 | MD 6.42 higher (5.04 higher to 7.81 higher) |
177 (2 RCTs) | ⊕○○○ VERY LOWa,c,b |
| GRADE working froup grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||
*
The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI, Confidence interval; HDS, Hasegawa's Dementia Scale; MD, Mean difference; MMSE, Mini Mental State Examination.
a
Most of the RCTs were low quality with an inadequate level of blinding and unclear risk of concealment of allocation.
b
The statistical test for heterogeneity showed that large variation (I2 > 50%) existed in point estimates due to among-study differences.
c
The total sample size was lower than 400.
d
Study protocols were inaccessible and the number of RCTs was insufficient for a publication bias estimation.