People with insomnia often rely on pills to sleep. But what if gentle touch and breathing exercises worked better? A new review looked at Tuina-based combination therapies against oral medication for patients with confirmed insomnia. The group included 2,663 subjects. Researchers compared these therapies to standard oral medication. They measured how well treatments worked and how sleep quality improved. The results showed that Tuina combined with breath guiding, music, foot baths, or acupoint application performed significantly better than taking pills alone. This held true for both the total effective rate and sleep quality scores. Even Tuina with acupuncture or scraping showed improvement over medication. Safety data suggested Tuina with acupoint application had the lowest rate of side events among the options tested. However, the review noted that most evidence quality was low or very low. The network of studies was sparse, which limits definitive safety conclusions. These findings are exploratory and need verification through higher-quality trials. Until then, the potential advantage of these therapies over drug monotherapy remains a promising area for further study.
Network meta-analysis of Tuina-based combination therapies versus oral medication for insomniaTuina combination therapies beat oral medication for insomnia in this exploratory review
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Key Takeaway
Note exploratory evidence for Tuina therapies versus oral medication in insomnia with low-quality data.
This systematic review and network meta-analysis examined Tuina-based combination therapies versus oral medication for patients with confirmed insomnia. The study included 2,663 subjects across a network where the majority of evidence quality was assessed as low or very low. The primary outcomes assessed were total effective rate and Pittsburgh Sleep Quality Index (PSQI) score improvement.
The analysis indicated that 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 showed a statistically significant difference compared to oral medication. Specifically, Tuina+breath guiding+acupoint application, Tuina+music, Tuina+foot bath, and Tuina+acupuncture were significantly better than oral medication for PSQI score improvement. All significant differences had a P value less than 0.05.
Safety data were limited. Tuina+acupoint application exhibited the lowest rate of adverse events derived from only 5 RCTs assessing 3 interventions. Serious adverse events, discontinuations, and general tolerability were not reported. The sparse evidence network precludes definitive comparative safety conclusions. Funding or conflicts of interest were not reported.
The practice relevance suggests Tuina-based combination therapies showed a potential advantage over drug monotherapy in enhancing both the Total effective rate and PSQI score for insomnia. However, the findings are exploratory and further verification through high-quality RCTs is needed. The setting was not reported.
What this means for you:
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View Original Abstract ↓
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.
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