Network meta-analysis of Tuina-based combination therapies versus oral medication for insomnia

BackgroundInsomnia has a high incidence rate among adults, severely affecting physical and mental health and increasing the risk of multiple diseases. Tuina represents an effective non-pharmacological intervention for insomnia management. Nevertheless, the majority of existing clinical evidence on Tuina for insomnia pertains to its use in conjunction with other modalities, and the relative effectiveness among different combined approaches remains unknown. Accordingly, this network meta-analysis compared the impacts of various Tuina-based combination therapies on patients with confirmed insomnia.MethodsA systematic search was performed across PubMed, Cochrane, Embase, Web of Science, CNKI, VIP, WanFang, and SinoMed electronic databases to identify randomized controlled trials (RCTs) meeting the prespecified criteria. Network meta-analysis was performed using Stata version 16.0.ResultsThirty-four RCTs comprising 2,663 subjects were enrolled, assessing 12 distinct Tuina-based combined interventions. The network meta-analysis revealed that for the outcome of total effective rate, the following combinations were showed a statistically significant difference compared to oral medication (P < 0.05): Tuina+breath guiding+acupoint application, Tuina+music, Tuina+foot bath, Tuina+breath guiding, Tuina+foot bath+acupoint application, Tuina+acupuncture, Tuina+acupoint application, and Tuina+scraping. The top-ranked regimens were Tuina+breath guiding+acupoint application, Tuina+music, and Tuina+foot bath. For the outcome of Pittsburgh Sleep Quality Index (PSQI) score improvement, Tuina+breath guiding+acupoint application, Tuina+music, Tuina+foot bath, and Tuina+acupuncture were significantly better than oral medication (P < 0.05). The three highest-ranking interventions were again Tuina+breath guiding+acupoint application, Tuina+music, and Tuina+foot bath. Regarding safety, Tuina+acupoint application exhibited the lowest rate of adverse events; however, this finding was derived from only 5 RCTs assessing 3 interventions, and the sparse evidence network precludes definitive comparative safety conclusions.ConclusionTuina-based combination therapies showed a potential advantage over drug monotherapy in enhancing both the Total effective rate and PSQI score for insomnia. Among them, the integrated protocol of Tuina together with Breath guiding and acupoint application ranked highest in the network meta-analysis;however, given that the majority of evidence quality was assessed as low or very low, these findings are exploratory and further verification through high-quality RCTs is needed.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261344347.