Comparative Effectiveness of Western and Eastern Manual Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategy
2.2. Eligibility Criteria
2.3. Study Selection
2.4. Data Extraction
2.5. Risk of Bias Assessment
2.6. Data Analysis and Synthesis
2.6.1. Conventional Pair-Wise Meta-Analysis
2.6.2. Network Meta-Analysis
2.7. Dealing with Missing Data
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Risk of Bias Assessment
3.4. Effectiveness and Safety of Manual Therapies Using Pair-Wise Meta-Analysis
3.5. Comparative Effectiveness of Manual Therapies Using NMA
3.5.1. Lung Function
3.5.2. Exercise Capacity
4. Discussion
4.1. Summary of Evidence
4.2. Clinical Implications
4.3. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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First Author (Year), Country | Sample Size (Included →Analyzed) | Mean Age (Year) | Diagnosis | (A) Treatment Intervention | (B) Control Intervention | Duration of Treatment/Follow-Up | Outcome of Interest |
---|---|---|---|---|---|---|---|
Stable COPD | |||||||
Noll (2008), USA | 35(18:17)→35(18:17) | (A) 69.6 ± 6.6 (B) 72.2 ± 7.1 | Known COPD history, FEV1/FVC < 70% | Osteopathic manipulative treatment | Sham (light touch) | 20 min one session/none | 1. FEV1 (L); 2. FVC (L); 3. FEV1/FVC (%); 4. Adverse events |
Zanotti (2012), Italy | 20(10:10)→20(10:10) | (A) 63.5 ± 4.7 (B) 64.2 ± 5.5 | GOLD | Osteopathic manipulative treatment | Sham (light touch) | 45 min once a week for 4 weeks/none | 1. VC (L); 2. FEV1 (L); 3. FVC (L); 4. 6MWD (m); 5. Adverse events |
Maskey-Warzechowska (2019), Poland | 38(19:19)→38(19:19) | 68 | Severe-very severe (FEV1 < 50%), GOLD 2016 | Osteopathic manipulative treatment | Sham | 25 min one session/none | Note. Only median (IQR) value was reported. 1. FEV1 (L, %pv); 2. FVC (L, %pv); 3. FEV1/FVC (%); 4. VAS (dyspnea); 5. Adverse events |
Buscemi (2020), Italy | 32→32 | 71 | Moderate-severe COPD | Osteopathic manipulative treatment + (B) | Conventional pharmacotherapy | once a week for 8 weeks/15 days | Note. Raw data were not reported except adverse events. 1. FVC (L); 2. FEV1 (L); 3. CAT; 4. 6MWD (m); 5. Adverse events |
Rocha (2015), Brazil | 20(11:9)→19(10:9) | (A) 71 ± 5 (B) 71 ± 6 | GOLD 2011 | Manual diaphragm release technique | Sham (light touch) | 6 times on non-consecutive days within 2 weeks/none | Note. Only change value was reported. 1. 6MWD (m) |
AECOPD | |||||||
Kurzaj (2013), Poland | 30(20:10)→30(20:10) | (A) 57 (B) 55 | NR | Massage + (B) | Basic physiotherapy (Respirometric training) | 30 min daily for 6 days/none | 1. FEV1 (L, %pv); 2. 6MWD (m); 3. MRC; 4. BODE index |
Cross (2012), UK | 522(258:264)→372(186:186) | (A) 69.08 ± 9.85 (B) 69.58 ± 9.51 | NR | Manual chest technique + (B) | Breathing technique | 1–41 min, total 1–21 sessions/6 mon | Note. Raw data of sputum volume and SpO2 were not reported. 1. SGRQ; 2. Breathlessness Cough and Sputum Scale; 3. EQ-5D; 4. EQ-VAS; 5. Sputum volume (mL); 6. SpO2; 7. Hospitalization period; 8. Adverse events |
Wang (2009), China | 120(60:60)→120(60:60) | NR | NR | Manual percussion | Mechanical percussion | twice a day for 7 days/none | 1. Sputum excretion (mL); 2. SpO2; 3. Hospitalization period; 4. Time to improvement/disappearance of cough, dyspnea, and sputum sound in lungs; 5. FVC (L); 6. FEV1 (L) |
Unclear COPD | |||||||
Engel (2016), Australia | 33(9:9:15)→31(8:8:15) | (A1) 67.6 ± 3.5 (A2) 65.0 ± 4.1 (B) 64.5 ± 4.1 | NR | (A1) Massage + (B) (A2) Massage + Spinal manipulation + (B) | Pulmonary rehabilitation | twice a week for 8 weeks/none | Note. Only change value was reported. 1. FEV1 (L); 2. FVC (L); 3. SGRQ; 4. 6MWD (m); 5. Adverse events |
Zhuang (2017), China | 70(35:35)→70(35:35) | (A) 64.98 ± 4.98 (B) 65.23 ± 5.25 | NR | Massage + (B) | Routine care (medication, exercise education, diet education, etc.) | NR/none | 1. FEV1 (L); 2. FEV1/FVC (%); 3. TER (respiratory symptom) |
Kütmeç Yilmaz (2020), Turkey | 91(49:42)→58(28:30) | 70.6 | NR | Back massage + (B) | Routine care | 15 min, daily for 4 days/none | Note. Only median (IQR) value was reported. 1. SpO2 |
First Author (Year), Country | Sample Size (Included→Analyzed) | Mean Age (Year) | Diagnosis | (A) Treatment Intervention | (B) Control Intervention | Duration of Treatment/Follow-Up | Outcome of Interest |
---|---|---|---|---|---|---|---|
Stable COPD | |||||||
Guo (2017), China | 200(100:100)→200(100:100) | NR | Criteria used by associations or guidelines in China | Acupressure + (B) | Basic physiotherapy (Respirometric training) | 2–3 min per acupoint, once a day for 6 mon/none | 1. FEV1 (L); 2. FEV1/FVC (%); 3. SGRQ |
Huang (2018), China | 68(34:34)→68(34:34) | (A) 52.43 ± 3.96 (B) 54.43 ± 1.27 | COPD | Acupressure + (B) | Basic physiotherapy (Respirometric training) | 2 min per acupoint twice a day for 3 mon/none | 1. FEV1 (L, %pv); 2. FEV1/FVC (%); 3. 6MWD (m); 4. CAT |
Zhang (2020), China | 90(45:45)→90(45:45) | (A) 67.46 ± 5.23 (B) 67.85 ± 5.62 | Criteria used by associations or guidelines in China | Acupressure + (B) | Basic physiotherapy (Respirometric training) | 2–3 min per acupoint once a day for 6 mon/none | 1. FVC (L); 2. FEV1 (L); 3. FEV1/FVC (%) |
Wilkinson (2006), UK | 14(7:7)→14(7:7) | (A) 77 (B) 75 | Moderate–severe COPD | Foot reflexology | No intervention | 50 min once a week for 4 weeks/none | Note. Raw data were not reported. 1. Quality of life (questionnaire); 2. SpO2 |
Gong (2011), China | 60(30:30)→60(30:30) | (A) 67.03 ± 9.48 (B) 69.93 ± 8.18 | Criteria used by associations or guidelines in China | Foot reflexology + (B) | Health education | 30 min once a day for 3 mon/none | Note. Only change value was reported. 1. SGRQ; 2. FEV1 (L, %pv); 3. FEV1/FVC (%) |
Gong (2012), China | 60(30:30)→60(30:30) | (A) 67.03 ± 9.48 (B) 69.93 ± 8.18 | Criteria used by associations or guidelines in China | Foot reflexology + (B) | Health education | 30 min once a day for 3 mon/none | Note. On 6MWD and MRC, only change values were reported. 1. 6MWD (m); 2. MRC; 3. TER (respiratory symptom) |
Huang (2017), China | 60(30:30)→59(29:30) | (A) 69.52 ± 4.31 (B) 69.37 ± 4.56 | Criteria used by associations or guidelines in China | Foot reflexology + (B) | Health education | 30 min once a day for 6 mon/none | 1. 6MWD (m) |
Gong (2018), China | 60(30:30)→59(29:30) | (A) 69.52 ± 4.31 (B) 69.37 ± 4.56 | Criteria used by associations or guidelines in China | Foot reflexology + (B) | Health education | 30 min once a day for 6 mon/none | Note. Only change value was reported. 1. BODE index; 2. 6MWD (m); 3. modified MRC; 4. FEV1 (%) |
Zhang (2005), China | 66(33:33)→63(31:32) | (A) 68.3 ± 6.79 (B) 67.7 ± 7.92 | Criteria used by associations or guidelines in China | Tuina | Basic physiotherapy (Respirometric training) | 20 min 3 times a week for 3 mon/none | 1. FVC (%); 2. FEV1 (L); 3. FEV1/FVC (%); 4. 6MWD (m); 5. TER (SGRQ); 6. Quality of life (questionnaire) |
Chen (2006), China | 30(15:15)→30(15:15) | (A) 69.12 ± 6.21 (B) 67.63 ± 7.01 | Criteria used by associations or guidelines in China | Tuina + (B) | Conventional pharmacotherapy | 20 min 5 times a week for 8 weeks/none | 1. TER (dyspnea); 2. FEV1/FVC (%); 3. FEV1 (L); 4. FVC (L); 5. 6MWD (m) |
Mo (2016), China | 60(30:30)→57(29:28) | (A) 56.5 ± 6.2 (B) 58.4 ± 5.6 | Criteria used by associations or guidelines in China | Tuina + (B) | Conventional pharmacotherapy | 6 times a week for 4 weeks/none | 1. CAT; 2. 6MWD (m); 3. Adverse events |
AECOPD | |||||||
Liu (2004), China | 127(64:63) | (A) 65.33 ± 4.44 (B) 64.49 ± 5.63 | Criteria used by associations or guidelines in China | Acupressure + (B) | Routine care | 1hr once a day for 7 days/none | 1. TER (respiratory symptom); 2. Time to improve cough, sputum, and dyspnea; 3. PaO2; 4. PaCO2 |
Gao (2017a), China | 60(30:30)→60(30:30) | (A) 66.65 ± 3.70 (B) 68.77 ± 4.28 | Criteria used by associations or guidelines in China | Acupressure + (B) | Routine care | 1 min per acupoint for 10 min twice a day for 7 days/none | 1. TER (respiratory symptom); 2. Symptom score (cough, sputum, wheezing, shortness of breath); 3. PaO2; 4. PaCO2; 5. SaO2 |
Gao (2017b), China | 60(30:30)→60(30:30) | (A) 70.5 ± 4. (B) 68.5 ± 4.7 | Criteria used by associations or guidelines in China | Acupressure + (B) | Routine care | 20 min twice a day for 7 days/none | 1. Sputum excretion (mL); 2. SpO2; 3. PaO2; 4. PaCO2 |
Gao (2017c), China | 60(30:30)→60(30:30) | (A) 69.36 ± 5.65 (B) 70.84 ± 4.76 | Criteria used by associations or guidelines in China | Acupressure + (B) | Routine care | 15 min twice a day for 7 days/none | 1. Symptom score (cough, sputum, asthma, dyspnea); 2. PaO2; 3. PaCO2; 4. SaO2; 5. TER (respiratory symptom); 6. Hospitalization period |
Zhao (2017), China | 58(29:29)→58(29:29) | (A) 67.5 ± 3.6 (B) 68.5 ± 4.1 | NR | Acupressure + (B) | Routine care | 10 min twice a day for 7 days/none | 1. Sputum excretion (mL); 2. SpO2; 3. PaO2; 4. PaCO2 |
Unclear COPD | |||||||
Wu (2004), Taiwan | 44(22:22)→44(22:22) | 73 ± 9.7 | NR | Acupressure | Sham (unrelated acupoint) | 16 min five times a week for 4 weeks/none | Note. Only change value was reported. 1. 6MWD (m); 2. SpO2 |
Xiong (2020), China | 120(60:60)→120(60:60) | (A) 50.89 ± 4.58 (B) 55.72 ± 4.54 | NR | Acupressure + (B) | Routine care | 30 min twice a day for 1 mon/none | 1. TER (respiratory symptom); 2. Sputum excretion (mL) |
Zhang (2015), China | 80(40:40)→80(40:40) | (A) 45 ± 2.5 (B) 43 ± 3.4 | Criteria used by associations or guidelines in China | Tuina + (B) | Routine care (medication) | ~25 min five times a week for 7 weeks/none | 1. TER (respiratory symptom); 2. FEV1/FVC (%); 3. FEV1 (L); 4. FVC (L) |
ROC | 0.04 (−0.48, 0.55) | 0.74 (0.08, 1.40) | 0.09 (−0.46, 0.65) |
0.33 (0.17, 0.49) | ACU + ROC | 0.70 (−0.13, 1.54) | 0.05 (−0.70, 0.81) |
MAS + ROC | −0.65 (−1.51, 0.21) | ||
0.26 (−0.05, 0.58) | −0.07 (−0.42, 0.28) | TUI + ROC |
ROC | 0.82 (−3.50, 5.14) | 20.00 (12.16, 27.84) | 3.01 (−1.68, 7.69) | |
14.38 (−12.74, 41.50) | ACU + ROC | 19.18 (10.23, 28.13) | 2.19 (−4.18, 8.56) | |
36.08 (−1.14, 73.30) | 21.70 (−24.35, 67.75) | FRF + ROC | ||
56.20 (−12.84, 125.24) | 41.82 (−32.36, 116.00) | 20.12 (−58.31, 98.55) | MAS + ROC | −16.99 (−26.13, −7.86) |
49.49 (25.60, 73.38) | 35.11 (−1.03, 71.26) | 13.41 (−30.81, 57.64) | −6.71 (−79.77, 66.35) | TUI + ROC |
Interventions | FEV1 (L) | FVC (L) | FEV1/FVC (%) | 6MWD (m) |
---|---|---|---|---|
ROC | 27.9 | 2.5 | 15.4 | 6 |
ACU + ROC | 35.1 | 82.4 | 29.9 | 30 |
FRF + ROC | 59.5 | |||
MAS + ROC | 95.6 | 100 | 76.5 | |
TUI + ROC | 41.4 | 65.1 | 54.7 | 78 |
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Kwon, C.-Y.; Lee, B.; Lee, B.-J.; Kim, K.-I.; Jung, H.-J. Comparative Effectiveness of Western and Eastern Manual Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis. Healthcare 2021, 9, 1127. https://doi.org/10.3390/healthcare9091127
Kwon C-Y, Lee B, Lee B-J, Kim K-I, Jung H-J. Comparative Effectiveness of Western and Eastern Manual Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis. Healthcare. 2021; 9(9):1127. https://doi.org/10.3390/healthcare9091127
Chicago/Turabian StyleKwon, Chan-Young, Boram Lee, Beom-Joon Lee, Kwan-Il Kim, and Hee-Jae Jung. 2021. "Comparative Effectiveness of Western and Eastern Manual Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis" Healthcare 9, no. 9: 1127. https://doi.org/10.3390/healthcare9091127