Combination treatment with acupoint therapy and conventional medication for non-motor symptoms in Parkinson's disease: a systematic review and meta-analysis

Abstract

Background: Managing Parkinson's non-motor symptoms (PD-NMS) is challenging. Traditional methods have limited efficacy for NMS. Acupoint therapy offers a safe and personalized option. There has been a growing number of studies on acupoint therapies for PD-NMS. However, a systematic review of their effectiveness and safety is currently not available. Therefore, this study aims to evaluate the effectiveness and safety of acupoint therapy for PD-NMS.

Methods: PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Chinese Biomedical Literature Database were searched. Data were analyzed using fixed or random effects models. Randomized controlled trials (RCT) in Chinese and English relating to acupoint therapy for NMS in PD (PD-NMS), individuals diagnosed with PD, primary and secondary outcome measures are HAMD, MMSE, MoCA, PDSS, PSQI were included. Cochrane risk-of-bias tool (ROB 2) for RCT was used. Meta-analyses were performed to calculate the RR and WMD. Subgroup analyses, sensitivity analyses, and funnel plot analyses were conducted.

Results: Forty-two studies (3120 PD-NMS patients) from database establishment to May 2023 were included. According to the ROB 2 evaluation, risks of bias in random sequence generation, missing data and selective reporting were low, moderate in allocation concealment, and high in blinding. Acupoint therapy combined with CM or NDT was more effective than single-therapy in most outcome measures like effective rate, HAMD, MoCA, PDSS and PSQI, but the MMSE difference was non-significant.

Conclusion: Due to the large number of research subjects, differences in the severity of the diseases, and possible variations of the intervention details, there is a certain degree of heterogeneity in the research results. However, acupoint therapy or acupoint therapy combined with CM could be an option for the treatment of PD-NMS in the future.

Systematic review registration: This review protocol has been registered in PROSPERO (ID: CRD42023426305). https://www.crd.york.ac.uk/PROSPERO/.

Keywords: Parkinson’s disease; acupoint therapy; meta-analysis; non-motor symptom; randomized controlled trials.

Figure 1

Literature screening process.

Figure 2

(A) Risk of bias summary, (B) Risk of bias domain for each included study.

Figure 3

Forest plot of comparison-acupoint therapy combined with CM or non-drug therapies vs. CM or non-drug therapies alone on response rate.

Figure 4

Forest plot comparing the effects of acupoint therapies plus western drugs versus western drugs alone on effective rates.

Figure 5

(A) L’Abbe plot comparing the effects of acupoint therapies plus western drugs versus western drugs alone on effective rates. (B) Galbraith radial plot comparing the effects of acupoint therapies plus western drugs versus western drugs alone on effective rates.

Figure 6

Forest plot comparing the effects of acupoint therapies plus other therapies versus other therapies alone on effective rates.

Figure 7

Forest plot comparing the effects of acupoint therapies plus CM or NDT versus CM or NDT alone on HAMD.

Figure 8

Forest plot comparing the effects of acupoint therapies with other therapies versus other therapies alone on MMSE.

Figure 9

Forest plot comparing the effects of acupoint therapies with other therapies versus other therapies alone on MoCA.

Figure 10

Forest plot comparing the effects of acupoint therapies with drugs versus drugs alone on PDSS.

Figure 11

Forest plot comparing the effects of acupoint therapies with other therapies versus other therapies alone on PSQI.

Figure 12

Forest plot comparing the effects of acupoint therapies with other therapies versus other therapies alone on PAC-QoL scores.