Kwon, Chang-Young
(Department of Clinical Korean Medicine, Graduate School of KyungHee University)
,
Suh, Hyo-Weon
(Department of Clinical Korean Medicine, Graduate School of KyungHee University)
,
Choi, Eun-Ji
(Department of Clinical Korean Medicine, Graduate School of KyungHee University)
,
Chung, Sun-Yong
(Department of Korean Neuropsychiatry, Gangdong KyungHee University Hospital)
,
Kim, Jong-Woo
(Department of Korean Neuropsychiatry, Gangdong KyungHee University Hospital)
Objectives: The aim of this review was to investigate whether evidence of complementary and alternative medicine (CAM) was reflected in clinical practice guidelines (CPGs) for insomnia based on relevant clinical trials. Methods: We conducted a systematic search on domestic and international CPG data...
Objectives: The aim of this review was to investigate whether evidence of complementary and alternative medicine (CAM) was reflected in clinical practice guidelines (CPGs) for insomnia based on relevant clinical trials. Methods: We conducted a systematic search on domestic and international CPG databases and medical databases. In addition, we conducted manual searches of relevant articles. Three authors independently searched and selected relevant studies; any disagreement was resolved by discussion. We extracted and analyzed the following data: published language, country, development group, participants, interventions, presence or absence of recommendations for CAM, level of evidence, grade of recommendation for CAM, and methods of development. Results: We identified 8,241 records from domestic and international databases, and 22 CPGs were included. Eleven of the 22 CPGs mentioned CAM interventions including herbal medicine, relaxation, acupuncture moxibustion, Tai Chi, meditation, hypnosis, biofeedback, Tuina, and external herbal medicine. However, most of the CPGs indicated 'no recommendation' or 'weak recommendation' for CAM interventions. Only Valeriana dageletiana Nakai and relaxation were considered to have experimental evidence. Valeriana dageletiana Nakai was recommended for improvement of sleep latency, sleep maintenance, total sleeping time, and sleep cycle. Relaxation was recommended as effective intervention for relieving physical and psychological arousal. Conclusions: Despite systematic reviews and randomized controlled trials on CAM for insomnia, most of the CPGs for insomnia did not reflect the evidence obtained. Further CPGs for insomnia should be developed by considering the current advanced studies in the field of CAM.
Objectives: The aim of this review was to investigate whether evidence of complementary and alternative medicine (CAM) was reflected in clinical practice guidelines (CPGs) for insomnia based on relevant clinical trials. Methods: We conducted a systematic search on domestic and international CPG databases and medical databases. In addition, we conducted manual searches of relevant articles. Three authors independently searched and selected relevant studies; any disagreement was resolved by discussion. We extracted and analyzed the following data: published language, country, development group, participants, interventions, presence or absence of recommendations for CAM, level of evidence, grade of recommendation for CAM, and methods of development. Results: We identified 8,241 records from domestic and international databases, and 22 CPGs were included. Eleven of the 22 CPGs mentioned CAM interventions including herbal medicine, relaxation, acupuncture moxibustion, Tai Chi, meditation, hypnosis, biofeedback, Tuina, and external herbal medicine. However, most of the CPGs indicated 'no recommendation' or 'weak recommendation' for CAM interventions. Only Valeriana dageletiana Nakai and relaxation were considered to have experimental evidence. Valeriana dageletiana Nakai was recommended for improvement of sleep latency, sleep maintenance, total sleeping time, and sleep cycle. Relaxation was recommended as effective intervention for relieving physical and psychological arousal. Conclusions: Despite systematic reviews and randomized controlled trials on CAM for insomnia, most of the CPGs for insomnia did not reflect the evidence obtained. Further CPGs for insomnia should be developed by considering the current advanced studies in the field of CAM.
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문제 정의
However recommendations of CPG varied from nation to nation or society to society, as the recommendations are presented not only by the evidences, but also the social circumstances, medical resources, economic feasibilities, and so on. In this review, we performed systematic search of CPGs on insomnia, and investigated the evidence level and recommendations of CAM therapy to assess current status of CAM therapy in CPGs on insomnia.
제안 방법
With CPGs which met our inclusion criteria, we investigated basic characteristics of the CPGs including language, country, type of developer, target population, intervention, presence of CAM therapy, evidence levels and recommendations of CAM therapy, and method of grading recommendations by reviewing full-text of CPGs. The analysis was performed by 3 authors (CY, HW, EJ) independently, and every disagreement was solved by discussion.
대상 데이터
Totally 8,241 records were searched, among them 631 records were searched from CPG DBs and 7,610 records from medical DBs. After 3 duplicates removed, 8,208 records, which were not CPG or not related with insomnia, were excluded by title and abstract, and 30 records were screened. The 30 records were reviewed by full text to find relevant CPGs.
We conducted searches on several medical DBs to investigate comprehensively. In foreign DBs, PubMed, CNKI (China National Knowledge Infrastructure), and J-STAGE (Japan Science and Technology Information Aggregator, Electronic) were used. The keywords were ‘insomnia’, ‘sleep disorder’, ‘practice guideline’, and ‘CPG’.
Totally 8,241 records were searched, among them 631 records were searched from CPG DBs and 7,610 records from medical DBs. After 3 duplicates removed, 8,208 records, which were not CPG or not related with insomnia, were excluded by title and abstract, and 30 records were screened.
성능/효과
2. The most frequently stated CAM therapy was herbal medicine, and statement on the efficacy of Valeriana dageletiana Nakai was a majority.
3. In acupuncture and moxibustion, most of CPGs mentioned that the efficacy of acupuncture on insomnia is still unclear due to insufficient evidence.
4. The reasons why CPGs for insomnia didn’t mention CAM or recommended it weakly can be considered that most developers of CPGs included in this review were western researchers, the latest CAM researches were not reflected, and the quantitative and qualitative limitations of CAM researches were existed.
As a result, CAM, including traditional oriental medicine, couldn’t be reflected in CPGs based on EBM, and it was recommended weakly with low-quality of evidence.
후속연구
5. Further CPGs have to address CAM therapies as alternative and complementary therapeutic options on insomnia, and to evaluate the practical effectiveness of CAM its experts should be included in development group as well as latest CAM researches need to be considered.
An evidence-based CPG conducted in USA, 201429), mentioned that some studies reported acupuncture, especially ear acupuncture, improved senile insomnia, but further studies were needed.
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