Pediatric tuina for the treatment of anorexia in children under 14 years: a systematic review and meta-analysis of randomized controlled trials.

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Publisher: Elsevier B.V.
Document Type: Report
Length: 674 words

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Keywords Pediatric tuina; Anorexia; Traditional Chinese medicine; Randomized controlled trial; Systematic review; Meta-Analysis Highlights * The effects of pediatric tuina was better than western medicine for anorexia in children under 14 years. * The effects of pediatric tuina was better than Chinese herbs for anorexia in children under 14 years. * The longer the course of pediatric tuina, the greater possible advantages for anorexia in children under 14 years. * Pediatric tuina was safe for anorexia in children under 14 years. Abstract Background Pediatric tuina is used to prevent and treat disease by employing various manipulative techniques on specific parts of the body, appropriate to the child's specific physiological and pathological characteristics. Objective To evaluate the effects and safety of pediatric tuina as a non-pharmaceutical therapy for anorexia in children under 14 years. Methods Randomized controlled trials (RCTs) comparing pediatric tuina with medicine for anorexia were included in this review. Six electronic databases were searched from inception to June 2019. Two authors independently extracted data and assessed the risk of bias. Significant effective rate (defined as appetite improved and food intake returning to 3/4 or more of normal intake) was used as primary outcome. Secondary outcomes included food intake, compliance and adverse events. Trial sequential analysis (TSA) was used to calculate the required information size in a meta-analysis and to detect the robustness of the results. Certainty of the evidence was assessed using the online GRADEpro tool. Results Of the included 28 RCTs involving 2650 children, the majority had a high or unclear risk of bias in terms of allocation concealment, blinding, and selective reporting. All trials compared tuina with western medicine or Chinese herbs. For significant effective rate, meta-analysis showed that tuina was superior to western medicine (risk ratio (RR) 1.68, 95 % confidence interval (CI) [1.35, 2.08]) and Chinese herbs (RR 1.36, 95 % CI [1.19, 1.55]). For food intake, 9 trials evaluated it in the form of score (1 points, 2 points, 4 points and 6 points) calculated according to the reduction degree of food intake. Six points represented the most serious. Meta-analysis showed tuina was superior to western medicine (mean difference (MD) -0.88, 95 % CI [-1.27, -0.50]) and Chinese herbs (MD -0.69, 95 % CI [-1.00, -0.38]) on lightening the reduction degree of food intake. Two trials reported compliance and six trials reported no adverse events occurred in pediatric tuina group. TSA for significant effective rate demonstrated that the pooled data had insufficient power regarding both numbers of trials and participants. Conclusions Low certainty of evidence suggested pediatric tuina was beneficial and safe for the treatment of anorexia in children under 14 years. Furthermore well-designed RCTs with adequate sample sizes are needed. Abbreviations RCT, Randomized controlled trial; RR, risk ratio; CI, confidence interval; TSA, Trial sequential analysis; TCM, Traditional Chinese medicine; MD, mean difference; GRADE, Grading of Recommendations Assessment Development and Evaluation criteria Author Affiliation: (a) Centre for Evidence-Based Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China (b) School of Basic Medicine, Shanxi University of Chinese Medicine, Taiyuan, 030000, China (c) The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, China (d) Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China (e) School of Health and Social Care, London South Bank University, London, SE1 0AA, UK (f) Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, China (g) National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9037 Tromsø, Norway * Corresponding author at: Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China. Article History: Received 20 November 2019; Revised 18 March 2020; Accepted 13 April 2020 Byline: Shi-Bing Liang [zyi20126185@163.com] (a,b), Bao-Yong Lai [baoyonglai@bucm.edu.cn] (c), Hui-Juan Cao [huijuancao327@hotmail.com] (a), Qiu-Han Cai [happyqiuhan@126.com] (d), Xue Bai [20170931127@bucm.edu.cn] (a), Jing Li [lj@bucm.edu.cn] (a), Ya-Peng Zhang [zhangyapeng@bucm.edu.cn] (a), Yuan Chi [chiyuan0717@163.com] (a), Nicola Robinson [nicky.robinson@lsbu.ac.uk] (e,a), Jian-Ping Liu [Liujp@bucm.edu.cn] (a,f,g)

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Gale Document Number: GALE|A625712818