Comparison of the efficacy of acupuncture with tuina with acupuncture-only in the treatment of peripheral facial paralysis: a network meta-analysis

Abstract

At present, traditional Chinese medicine treatment is considered safe for treating peripheral facial paralysis (PFP). Acupuncture-only and acupuncture combined with tuina are widely used for this purpose. However, it is not clear whether acupuncture combined with tuina is better for treating PFP than acupuncture-only. Conventional meta-analysis and network meta-analysis were used to compare the clinical efficacies of acupuncture combined with tuina and acupuncture-only in the treatment of PFP. Randomized controlled trials (RCTs), with the subjects being patients with PFP and treatment interventions including acupuncture combined with tuina, acupuncture-only, tuina-only, placebo, single Western medicine, and steroids combined with other Western medicine were searched from both Chinese and English databases. The primary outcomes included Modified House-Brackmann (MHBN) scores and Sunnybrook Facial Grading System, whereas the secondary outcomes included cure time, Portmann scores, and physical function scale of Facial Disability Index, using conventional meta-analysis and network meta-analysis. The study included 22 RCTs with a sample size of 1814 patients. The results of conventional meta-analysis (MD = 16.12, 95%CI 13.13,19.10) and network meta-analysis (MD = 14.53, 95%CI 7.57,21.49) indicate that acupuncture combined with tuina was better than acupuncture-only in improving MHBN and shortening the cure time (MD = - 6.09, 95%CI - 7.70, - 4.49). Acupuncture combined with tuina was the optimal therapy for improving MHBN (SUCRA was 100%) and shortening the cure time (SUCRA was 100%). The results of this meta-analysis indicate that acupuncture combined with tuina can significantly improve MHBN and shorten the cure time, compared with acupuncture-only. However, the current evidence is insufficient, and more high-quality clinical studies are needed.Registration: This study had been registered with PROSPERO (CRD42022379395).

Keywords: Acupuncture; Acupuncture in combination with tuina; Conventional meta-analysis; Network meta-analysis; Peripheral facial paralysis.

Fig. 1

Flowchart of the study process

Fig. 2

(I) Assessment result of the risk of bias. There are three ratings, green for low risk of bias, yellow for uncertain risk of bias, and red for high risk of bias. Figure 2 (II) is the same. (II) Details of assessment result of risk of bias

Fig. 3

Forest plot of outcomes. A: acupuncture-only; B: tuina-only; C: acupuncture + tuina; D: placebo; E: single Western medicine; and F: steroids + other Western medicine. The same as Fig. 4

Fig. 3

Forest plot of outcomes. A: acupuncture-only; B: tuina-only; C: acupuncture + tuina; D: placebo; E: single Western medicine; and F: steroids + other Western medicine. The same as Fig. 4

Fig. 4

Network plot (left) and SUCRA (right) of outcomes. Node represents the intervention, and node size is positively correlated with the total sample size of the intervention. The line represents a direct comparison between the two interventions linked, and the line thickness is positively correlated with the number of studies on the two interventions

Fig. 4

Network plot (left) and SUCRA (right) of outcomes. Node represents the intervention, and node size is positively correlated with the total sample size of the intervention. The line represents a direct comparison between the two interventions linked, and the line thickness is positively correlated with the number of studies on the two interventions

Fig. 5

Results of sensitivity analysis

Fig. 6

Risk of a bias bar chart for network meta-analysis. Each bar represents a relative treatment effect estimated from the network meta-analysis. Each bar shows the percentage contribution from studies judged to be at low (green), moderate (yellow), and high (red) risk of bias