Urinary incontinence(UI)is common in women and affects the quality of life in female patients severely.But the clinical consideration and treatment are insufficient.Acupuncture and-moxibustion has been proposed as a p...Urinary incontinence(UI)is common in women and affects the quality of life in female patients severely.But the clinical consideration and treatment are insufficient.Acupuncture and-moxibustion has been proposed as a potentially effective intervention for female UI.Hence,the World Federation of Acupuncturemoxibustion Societies(WFAS)have initiated a project to develop the clinical practice guideline(CPG)on acupuncture and moxibustion for female UI towards global acupuncture practitioners.The CPG was developed according to the Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,referring to the principles of the World Health Organization Handbook for Guideline Development.During the development of the CPG,the guideline development group(GDG)played an important role,which is composed of multi-national and multi-disciplinary experts.The clinical questions,recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method and basing on the results of the latest systematic review.This article focuses on the recommendations in the CPG.The CPG contains ten recommendations for ten clinical questions,including nine conditional recommendations for the intervention,one conditional recommendations for either the intervention or the comparison.The CPG also provides one conventional filiform needle therapy protocol,two deep puncturing stimulation on lumbosacral acupoints therapy protocols,and four moxibustion therapy protocols,extracted from the included clinical evidence of this CPG.展开更多
Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023....Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023.This is the first clinical practice guideline(CPG)on acupuncture and moxibustion for allergic rhinitis approved by an international academic organization,which provides evidence-based recommendations and the practical therapeutic protocols for acupuncture practitioners globally.This CPG was developed by following Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,and the principles of the World Health Organization Handbook for Guideline Development.The members in the guideline development group(GDG)were from different countries,with different professions,and they played a critical role in the development of clinical questions,recommendations,and therapeutic protocols.Recommendations are the core of a CPG and the direct answers to clinical questions,due to which this article focuses on the recommendations of this CPG.The recommendations were developed by using the modified Delphi method and the GRADE grid rules,based on the updated systematic reviews of clinical evidence.A total of 15 recommendations for 15 clinical questions were developed in this CPG,including one strong recommendation for intervention based on high-quality evidence,three conditional recommendations for either the intervention or the comparison based on very low quality of evidence,and 11 conditional recommendations for the intervention based on very low quality of evidence.展开更多
The formulation of recommendations is a crucial step in the development of clinical practice guidelines,which requires tools provided by the GRADE methodology.These tools include the evidence quality assessment tool,t...The formulation of recommendations is a crucial step in the development of clinical practice guidelines,which requires tools provided by the GRADE methodology.These tools include the evidence quality assessment tool,the evidence summary tool,and the evidence-to-decision(EtD)framework.Although there is a methodologically guided standard pathway for formulating recommendations in clinical practice guidelines,it remains unclear how to translate this theoretical pathway into the practical process for formulating recommendations and what the specific steps in this process entail.Therefore,this paper takes the World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guidelines on Acupuncture and Moxibustion:Allergic Rhinitis as an example to detail the full process of formulating recommendations and summaries it into a three-step method.Step one:Collect original materials from different sources to create EtD table.Step two:Distribute and collect EtD table,and preliminarily gather the recommendation voting results.Step three:Organize"salami-slicing pattern"guideline development group consensus meeting to formulate recommendations.The three-step method for formulating recommendations in clinical practice guidelines fully utilizes the GRADE EtD table to provide guideline development group with decision-making foundation and reference from multiple dimensions,including the importance of clinical questions,balance of benefits and harms,quality of evidence,resource required,values and preferences,health equity,acceptability,and feasibility.This approach enhances the scientific and practical nature of guideline recommendations.This paper provides a standard operating procedure to formulate recommendations for the incoming clinical practice guidelines,which aims to establish a standard pathway for the formulation of acupuncture clinical practice guideline recommendations.展开更多
Background:Urinary incontinence(Ul)is a common condition that bothers women's lives,including stress urinary incontinence(SUI),urgency urinary incontinence(UUI)and mixed urinary incontinence(MuI).The current non-s...Background:Urinary incontinence(Ul)is a common condition that bothers women's lives,including stress urinary incontinence(SUI),urgency urinary incontinence(UUI)and mixed urinary incontinence(MuI).The current non-surgical treatment of Western medicine includes pelvic floor muscle training(PFMT),medication,electric stimulation,etc.,all of which have varied limitations.For instance,the patients are poor in compliance with PFMT and medication results in frequent adverse effects.Being one of the featured treatments of TCM,moxibustion has several merits including safety,low cost and simple operation.In recent years,the clinical evidences prove increasingly that moxibustion may be effective for women with Ul.However,there is no high-quality systematic review of moxibustion for this disease.Objective:To evaluate the effect and safety of moxibustion on UI(including SUI,UUI and MUI)among women.Methods:From the inception to October 13,2022,the data of the randomized controlled trials(RCTs)of moxibustion on UI among women were collected from CNKI,WanFang Data,VIP,SinoMed,Web of Science,Pubmed,EMBASE and Cochrane Library databases.Two investigators screened the articles independently and extracted the data according to the inclusion and exclusion criteria developed in advance.Using the risk of bias assessment tool of Cochrane Handbook,the included RCTs were evaluated.With RevMan 5.3 software,meta-analysis was performed,and the GRADE tool was adopted to assess evidence certainty of different outcomes.Results:A total of 1176 articles were retrieved and 19 of them with 1397 patients were eligible and included in the review.In experimental groups,moxibustion combined with PFMT was used,while in control groups PFMT was applied alone.And the subjects were all women with SUI.Meta-analysis showed that compared with PFMT alone,moxibustion combined with PFMT reduced the urine leakage volume(1-hour pad test)(MD=-1.95,95%CI[-2.32,-1.57],P<0.001),the frequency of Ul in 24-hour(MD=-0.64,95%CI[-0.88,-0.40],P<0.001)and the score of the short form of International Consultation on Incontinence Questionnaire(ICIQ-SF)of women with SUI(MD=-2.53,95%CI[-3.43,-1.63],P<0.001);and this combined intervention measure did not increase significantly the adverse events(RR=0.82,95%CI[0.15,4.6],P=0.82).GRADE assessment showed that the UI frequency in 24-hour and the incidence of adverse events were rated as low quality,the urine leakage volume of 1-hour pad test and ICIQ-SF score were very low quality.Conclusion:Compared with PFMT alone,the intervention combined with moxibustion greatly reduced the urine leakage volume and UI frequency and improved the quality of life(QoL)among women with SUI with favorable safety.Moxibustion could be effective supplementary therapy on sUI among women.However,due to the high risk of bias of the included trials and low certainty of evidence,more highquality clinical studies are needed to verify the above findings.展开更多
Objective:Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines(CPGs).This study aims to formulate the key clinical questions and outcomes for the CPG on acupunc...Objective:Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines(CPGs).This study aims to formulate the key clinical questions and outcomes for the CPG on acupuncture and moxibustion for allergic rhinitis(AR).Methods:PICO(patient,intervention,comparator,and outcome)question survey,Delphi survey,and consensus conference of the guideline development group(GDG)were employed.PICO questionnaires were used to gather and analyze the target users’key demands and interests.The GDG then selected the critical clinical questions and outcomes via a mixed method of Delphi survey and consensus conference.Results:Fifteen potential clinical questions and ten types of outcomes were formulated based on the analysis of 123 responses from seventeen countries on five continents.After two rounds of the Delphi survey and complete discussions,a consensus was reached by the GDG that all potential questions were included.After three rounds of the Delphi survey and complete debate,the consensus was reached that nine outcomes were considered important.Conclusion:Fifteen key clinical questions and nine important outcomes were formulated for the CPG.These covered issues elicited the most attention from global users in acupuncture therapy and AR.The results will contribute to the CPGs development and future clinical studies.展开更多
基金Supported by the National Key R&D Program of China:2019YFC17122002019YFC1712203。
文摘Urinary incontinence(UI)is common in women and affects the quality of life in female patients severely.But the clinical consideration and treatment are insufficient.Acupuncture and-moxibustion has been proposed as a potentially effective intervention for female UI.Hence,the World Federation of Acupuncturemoxibustion Societies(WFAS)have initiated a project to develop the clinical practice guideline(CPG)on acupuncture and moxibustion for female UI towards global acupuncture practitioners.The CPG was developed according to the Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,referring to the principles of the World Health Organization Handbook for Guideline Development.During the development of the CPG,the guideline development group(GDG)played an important role,which is composed of multi-national and multi-disciplinary experts.The clinical questions,recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method and basing on the results of the latest systematic review.This article focuses on the recommendations in the CPG.The CPG contains ten recommendations for ten clinical questions,including nine conditional recommendations for the intervention,one conditional recommendations for either the intervention or the comparison.The CPG also provides one conventional filiform needle therapy protocol,two deep puncturing stimulation on lumbosacral acupoints therapy protocols,and four moxibustion therapy protocols,extracted from the included clinical evidence of this CPG.
基金Supported by the National Key Research and Development Program of China:2019YFC17122002019YFC1712203。
文摘Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023.This is the first clinical practice guideline(CPG)on acupuncture and moxibustion for allergic rhinitis approved by an international academic organization,which provides evidence-based recommendations and the practical therapeutic protocols for acupuncture practitioners globally.This CPG was developed by following Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,and the principles of the World Health Organization Handbook for Guideline Development.The members in the guideline development group(GDG)were from different countries,with different professions,and they played a critical role in the development of clinical questions,recommendations,and therapeutic protocols.Recommendations are the core of a CPG and the direct answers to clinical questions,due to which this article focuses on the recommendations of this CPG.The recommendations were developed by using the modified Delphi method and the GRADE grid rules,based on the updated systematic reviews of clinical evidence.A total of 15 recommendations for 15 clinical questions were developed in this CPG,including one strong recommendation for intervention based on high-quality evidence,three conditional recommendations for either the intervention or the comparison based on very low quality of evidence,and 11 conditional recommendations for the intervention based on very low quality of evidence.
基金Supported by the National Key Research and Development Program of China:2019YFC17122002019YFC1712203。
文摘The formulation of recommendations is a crucial step in the development of clinical practice guidelines,which requires tools provided by the GRADE methodology.These tools include the evidence quality assessment tool,the evidence summary tool,and the evidence-to-decision(EtD)framework.Although there is a methodologically guided standard pathway for formulating recommendations in clinical practice guidelines,it remains unclear how to translate this theoretical pathway into the practical process for formulating recommendations and what the specific steps in this process entail.Therefore,this paper takes the World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guidelines on Acupuncture and Moxibustion:Allergic Rhinitis as an example to detail the full process of formulating recommendations and summaries it into a three-step method.Step one:Collect original materials from different sources to create EtD table.Step two:Distribute and collect EtD table,and preliminarily gather the recommendation voting results.Step three:Organize"salami-slicing pattern"guideline development group consensus meeting to formulate recommendations.The three-step method for formulating recommendations in clinical practice guidelines fully utilizes the GRADE EtD table to provide guideline development group with decision-making foundation and reference from multiple dimensions,including the importance of clinical questions,balance of benefits and harms,quality of evidence,resource required,values and preferences,health equity,acceptability,and feasibility.This approach enhances the scientific and practical nature of guideline recommendations.This paper provides a standard operating procedure to formulate recommendations for the incoming clinical practice guidelines,which aims to establish a standard pathway for the formulation of acupuncture clinical practice guideline recommendations.
基金Supported by National Key R&D Program of China:2019YFC1712200.
文摘Background:Urinary incontinence(Ul)is a common condition that bothers women's lives,including stress urinary incontinence(SUI),urgency urinary incontinence(UUI)and mixed urinary incontinence(MuI).The current non-surgical treatment of Western medicine includes pelvic floor muscle training(PFMT),medication,electric stimulation,etc.,all of which have varied limitations.For instance,the patients are poor in compliance with PFMT and medication results in frequent adverse effects.Being one of the featured treatments of TCM,moxibustion has several merits including safety,low cost and simple operation.In recent years,the clinical evidences prove increasingly that moxibustion may be effective for women with Ul.However,there is no high-quality systematic review of moxibustion for this disease.Objective:To evaluate the effect and safety of moxibustion on UI(including SUI,UUI and MUI)among women.Methods:From the inception to October 13,2022,the data of the randomized controlled trials(RCTs)of moxibustion on UI among women were collected from CNKI,WanFang Data,VIP,SinoMed,Web of Science,Pubmed,EMBASE and Cochrane Library databases.Two investigators screened the articles independently and extracted the data according to the inclusion and exclusion criteria developed in advance.Using the risk of bias assessment tool of Cochrane Handbook,the included RCTs were evaluated.With RevMan 5.3 software,meta-analysis was performed,and the GRADE tool was adopted to assess evidence certainty of different outcomes.Results:A total of 1176 articles were retrieved and 19 of them with 1397 patients were eligible and included in the review.In experimental groups,moxibustion combined with PFMT was used,while in control groups PFMT was applied alone.And the subjects were all women with SUI.Meta-analysis showed that compared with PFMT alone,moxibustion combined with PFMT reduced the urine leakage volume(1-hour pad test)(MD=-1.95,95%CI[-2.32,-1.57],P<0.001),the frequency of Ul in 24-hour(MD=-0.64,95%CI[-0.88,-0.40],P<0.001)and the score of the short form of International Consultation on Incontinence Questionnaire(ICIQ-SF)of women with SUI(MD=-2.53,95%CI[-3.43,-1.63],P<0.001);and this combined intervention measure did not increase significantly the adverse events(RR=0.82,95%CI[0.15,4.6],P=0.82).GRADE assessment showed that the UI frequency in 24-hour and the incidence of adverse events were rated as low quality,the urine leakage volume of 1-hour pad test and ICIQ-SF score were very low quality.Conclusion:Compared with PFMT alone,the intervention combined with moxibustion greatly reduced the urine leakage volume and UI frequency and improved the quality of life(QoL)among women with SUI with favorable safety.Moxibustion could be effective supplementary therapy on sUI among women.However,due to the high risk of bias of the included trials and low certainty of evidence,more highquality clinical studies are needed to verify the above findings.
基金Supported by the National Key R&D Program of China:2019YFC1712200。
文摘Objective:Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines(CPGs).This study aims to formulate the key clinical questions and outcomes for the CPG on acupuncture and moxibustion for allergic rhinitis(AR).Methods:PICO(patient,intervention,comparator,and outcome)question survey,Delphi survey,and consensus conference of the guideline development group(GDG)were employed.PICO questionnaires were used to gather and analyze the target users’key demands and interests.The GDG then selected the critical clinical questions and outcomes via a mixed method of Delphi survey and consensus conference.Results:Fifteen potential clinical questions and ten types of outcomes were formulated based on the analysis of 123 responses from seventeen countries on five continents.After two rounds of the Delphi survey and complete discussions,a consensus was reached by the GDG that all potential questions were included.After three rounds of the Delphi survey and complete debate,the consensus was reached that nine outcomes were considered important.Conclusion:Fifteen key clinical questions and nine important outcomes were formulated for the CPG.These covered issues elicited the most attention from global users in acupuncture therapy and AR.The results will contribute to the CPGs development and future clinical studies.
