Proof-based medication (EBM) refers back to the medical course of that applies the very best analysis proof to scientific follow.1 The proof is especially from randomized managed trials with giant samples and systematic evaluate/meta-analysis.2 Because the core analysis technique of EBM, meta-analysis collects portions of present analysis outcomes and conducts a complete and systematic high quality analysis to achieve dependable conclusions,3 which is on the high of the proof pyramid with excessive repeatability and reliability.4,5
It’s essential to introduce EBM into the sphere of conventional Chinese language medication (TCM) characterised by syndrome differentiation and therapy if we need to make TCM from particular person to group.6,7 Acupuncture, as one of many necessary disciplines in TCM, is a straightforward, environment friendly, economical, and secure means for treating ache syndromes,8–11 power inflammatory issues,12,13 and different indications and has develop into a significant a part of worldwide complementary and different medication.14 With the event of EBM, the amount of literature on systematic evaluate/meta-analysis and pointers associated to acupuncture remedy is growing, which implies that acupuncture is turning into a standardized and regular remedy. Nonetheless, there’s nonetheless a scarcity of abstract and analysis of the literature and analysis outcomes on acupuncture, in addition to the classification of analysis instructions, promising and well-liked analysis areas, and developmental tendencies on this discipline.
CiteSpace is visualization software program that may establish new tendencies and display new dynamics.15,16 By co-occurrence and co-citation evaluation of authors, key phrases, and references in associated literature, we used CiteSpace to discover the present standing of analysis on systematic evaluate/meta-analysis of acupuncture remedy.
Supplies and Strategies
All knowledge had been obtained from the Internet of Science Core Assortment by way of the Zhejiang Chinese language Medical College Libraries web site on August thirtieth, 2020. It included solely these articles and critiques in English with out time limitations. The technique consisted of three components. First, “acupuncture” was used as the topic time period, mixed with corresponding free phrases reminiscent of electroacupuncture, auricular acupuncture, moxibustion, and so on., and a complete of 13,152 data had been retrieved. We then used “meta-analysis” and “systematic evaluate” as the topic phrases, mixed with corresponding free phrases reminiscent of meta-analysis, which retrieved a complete of 265,143 data. Lastly, we merged the above two queries, and 1786 data had been retrieved (See Table 1 for particular search methods and outcomes).
Desk 1 The Matter Search Queries
We manually deleted duplicate and irrelevant knowledge. In consequence, we retained 1189 data. Then, we imported the info into CiteSpace5.6.R5 to carry out bibliometric evaluation. The visible map primarily included nodes and the hyperlinks between nodes. The dimensions of the nodes indicated frequency, and the hyperlinks between nodes meant that these two nodes appeared collectively in the identical literature. The thicker the hyperlinks had been, the extra co-occurrence that they had. As well as, the colour of hyperlinks represented the yr they first appeared. The colour of the nodes represented the yr as nicely, and the hotter the colour, the newer the yr.17 The node with a purple ring confirmed excessive centrality, connecting the opposite two nodes and enjoying an necessary middleman function and is normally perceived as representing a turning level in a discipline.18 The parameters of CiteSpace5.6.R5 had been set as under: ①Time slicing was from 2008 to 2020, years per slice.1 ②All choices within the time period supply had been chosen. ③one node kind was chosen at a time. ④All thresholds had been (c,c,ccv:2,2,20;4,3,20;4,3,20) besides Figure 4B (c,c,ccv:10,10,20;4,3,20;4,3,20) and Figure 5A–C (c,c,ccv:5,5,20;4,3,20;4,3,20). ⑤Each determine’s pruning was (pathfinder, pruning sliced networks and pruning the merged community) besides Figures 4A and 5A–C (with out pruning).
Outcomes and Dialogue
A complete of 1189 data had been included, and the quantity of literature had constantly elevated over the previous 12 years (Figure 1), particularly in 2019. It might proceed to extend in 2020. From the outstanding enhance within the quantity of literature, we discovered nice significance was hooked up to EBM in acupuncture, which has additionally actively utilized fashionable medical analysis strategies to enhance the standard of scientific analysis and promote the event of acupuncture science.
Determine 1 The annual variety of publications on acupuncture remedy associated systematic evaluate/meta evaluation between 2008 to 2020.
Evaluation of Classes
After an evaluation by CiteSpace, 46 classes had been discovered. Table 2 reveals the frequency of the highest 10 classes. As we are able to see, Integrative & Complementary Drugs ranked first with 449 articles, adopted by Normal & Inside Drugs (340), Neuroscience & Neurology (102), Scientific Neurology (82), Obstetrics & Gynecology (47). Oncology (32), in ninth place, ranked first in centrality (0.36). By classes evaluation, we realized that systematic evaluate and meta-analysis associated to acupuncture had coated most medical disciplines, particularly basic medication, neurology, obstetrics and gynecology, and oncology.
Desk 2 The High 10 Classes on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
Evaluation of Journals and Cited Journals
The highest 10 journals are listed by the variety of publications in Table 3. Normally, they had been primarily complete such because the Journal of Various and Complementary Drugs (J Altern Complem Med) with out vital distinction within the variety of publications from Neural Regeneration Analysis (Neural Regen Res) and Supportive Care in Most cancers (Help Care Most cancers) and it steered that acupuncture had been extensively used within the therapy of tumor and neurological ailments to some extent.
Desk 3 The High 10 Journals on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
A cited journal map (Figure 2) included 680 nodes and 951 hyperlinks, and high 5 amongst them in frequency and centrality are proven in Table 4. The cited journals may very well be divided into 4 sorts: the primary was related to acupuncture, with a comparatively low influence issue, reminiscent of Acupuncture in Drugs (Acupunct Med), Journal of Various and Complementary Drugs (J Altern Complem Med), Proof-Based mostly Complementary and Various Drugs (Evid-based Compl Alt), and Scientific Journal of Acupuncture and Moxibustion (J Clin Acupunct Moxi). The second was associated to illness, reminiscent of Anesthesiology (Anesthesiology), Sleep Drugs Evaluations (Sleep Med Rev), Help Care in Most cancers (Help Care Most cancers). Cochrane Database of Systematic Evaluations (Cochrane Db Syst Rev) was the third kind in reference to EBM, and BMJ-British Medical Journal (BMJ-Brit Med J), Hong Kong Medical Journal (Hong Kong Med J) vesting in synthesizing journal had been the final kind. BMJ-Brit Med J with a excessive influence issue and ranked second within the frequency of cited journals. As well as, two of its paperwork about PRISMA statements for systematic evaluate and meta-analysis protocols and the Cochrane Collaboration device for randomized trials additionally ranked within the frequency of cited references. As a higher-level proof, RCT is commonly used for meta-analysis with a purpose to receive credible outcomes.
Desk 4 The High 5 Frequency and Centrality of Cited Journals on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
Distribution of Nations and Establishments
The distribution of nations map (Figure 3A) reveals 45 international locations had revealed associated literature, and the highest 5 international locations are displayed in Table 5. China was the most efficient one, publishing 683 articles, surpassing South Korea (196), England (145), United States (138), and Australia (91). By way of centrality, the highest 5 international locations had been Italy (1.12), Sweden (0.8), Denmark (0.55), Switzerland (0.41), and Germany (0.39), so we might see Italy and Sweden had shut cooperation with different international locations within the systematic evaluate and meta-analysis of acupuncture. As well as, some international locations shaped small-scale cooperative teams, however there was a scarcity of cooperation amongst international locations. Nonetheless, it didn’t absolutely characterize the dearth of cooperation within the software of acupuncture remedy amongst them.
Desk 5 The High 5 Frequency and Centrality of Nations on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
The distribution of establishments map (Figure 3B) consists of 425 nodes and 627 hyperlinks. Table 6 reveals the highest 5 establishments and Beijing College of Chinese language Drugs revealed probably the most articles (113), adopted by KyungHee College (102), which additionally ranked within the high three when it comes to centrality. Usually talking, the establishments had been principally universities, and a few had been hospitals. Chengdu College of Conventional Chinese language Drugs, as one of many EBM facilities, revealed 87 articles, and its affiliated hospital (Hospital Chengdu College of Conventional Chinese language Drugs) additionally revealed 19 articles. Nonetheless, one other EBM middle, Sichuan College, had fewer than 20 articles. Cooperation amongst establishments was principally nationwide, aside from some transnational cooperation, for instance, RMIT College positioned in Australia cooperated with Guangzhou College of Chinese language Drugs and Nanjing College of Chinese language Drugs, and the Korea Institute of Oriental Drugs collaborated with the College of Exeter of England and Beijing College of Chinese language Drugs. Most establishments, nonetheless, didn’t work intently collectively.
Desk 6 The High 5 Frequency and Centrality of Establishments on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
Evaluation of Authors and Cited Authors
The authors co-occurrence map (Figure 4A) reveals the cooperative relationships among the many authors, and it accommodates 90 nodes and 198 hyperlinks. Table 7 reveals the highest 10 authors when it comes to publication quantity and centrality. Probably the most prolific writer, with 65 papers on this discipline, is Myeong Soo Lee from the Korea Institute of Oriental Drugs, and he’s additionally the founding father of the Worldwide Society for Complementary Drugs Analysis and a advisor to the Cochrane Collaboration in complementary and different medication. The second-ranked writer was Edzard Ernst, a professor of complementary medication on the College of Exeter, who has revealed over 30 articles along with Myeong Soo Lee, and their articles coated many ailments, reminiscent of musculoskeletal ache, stroke, most cancers ache, arrhythmia, Parkinson’s illness, rheumatoid arthritis, and others.19–24 Jianping Liu, Hugh MacPherson, Fanrong Liang, Ying Li, Zhishun Liu, Byung-Cheul Shin, and Tae-young Choi all shaped a small cooperative group individually, whereas beforehand there was little cooperation amongst teams.
Desk 7 The High 5 Frequency and Centrality of Authors on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
A complete of 354 nodes and 445 hyperlinks (Figure 4B) constituted the map of cited authors. J.P.T. Higgins was probably the most cited writer, adopted by D Moher, Hugh MacPherson, Edzard Ernst, and Klaus Linde. The highest 5 cited authors when it comes to centrality (Table 8) included G. Deng, Patricia M. Barnes, E. Manheimer, D.C. Cherkin, and M.Okay. Garcia. Higgins was the writer of Cochrane Handbook for Systematic Evaluations of Interventions Model 5.1.0,25 and it instructed researchers to observe scientific procedures to acquire credible outcomes. D. Moher, rating second, authored the PRISMA assertion about systematic critiques and meta-analyses,26–28 and was at all times cited along with Higgins. Clearly, they’ve had vital tutorial affect within the discipline. It’s value mentioning that though the articles by the top-ranked cited authors had been principally revealed earlier than 2010, they’ve been ceaselessly cited previously 2 years, which means that acupuncture researchers are paying extra consideration to EBM. Just one article written by Klaus Linde about an RCT of acupuncture for migraine was a scientific research.29
Desk 8 The High 5 Frequency and Centrality of Cited Authors on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
Evaluation of Cited References
A complete of 173 references had been extracted from 1189 data to research cited references (Figure 5A). The highest 10 references in frequency and centrality are listed in Tables 9 and 10. Moreover, decide the data construction of this discipline, cluster evaluation was carried out. With a modularity Q of 0.6392 and a imply silhouette of 0.6803, the cluster map (Figure 5B) consisted of 173 nodes and 538 hyperlinks. And the worth of modularity Q and imply silhouette meant that the clusters had been rational.
Desk 9 The High 10 Frequency of Cited References on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
Desk 10 The High 10 Centrality of Cited References on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
In response to the rating of frequency and centrality in cited references, most had been methodological research, they usually had been at all times known as the requirements for conducting analysis, which included probably the most cited reference, Cochrane Handbook for Systematic Evaluations of Interventions and the second most-cited one, STRICTA.25,30 As well as, we discovered 4 PRISMA statements used to information and standardize the plan for systematic evaluate and meta-analysis.26–28,31 The Grading of Suggestions Evaluation, Improvement and Analysis (GRADE) guideline written by H. Balshem was used to evaluate the standard of proof,32 which can be listed within the two tables. Within the rating checklist, just one systematic evaluate, written by A.J. Vickers in 2012 on acupuncture therapy of power ache ascended to the sixth place,33 and it was revealed within the Archives of Inside Drugs, which has been renamed JAMA Inside Drugs whose influence issue was 18.652. It was value mentioning that this reference ranked first in centrality and his different meta-analysis of a person affected person affected by power ache ranked eighth,34 which signifies the writer and the 2 articles had a dominant affect within the discipline.
Then the cluster view map (Figure 5B) utilizing log-likelihood assessments (LLR) to seek out out the distribution from the key phrases of literature comprised 9 clusters the place all Silhouettes had been better than 0.6, and thru it we’d have a basic thought of well-liked analysis areas. The most important cluster was “randomized managed trials,” which contained 40 references. “Sham acupuncture,” “in vitro fertilization,” and “propranolol” had been additionally energetic clusters. From the timeline view map (Figure 5C), clusters 2, 3, 4, and seven had been heat in shade, which represents the most recent analysis. Clusters 0 and eight had been comparable, which meant they had been related in some phrases. Cluster 8 started in 2004 and lasted solely 6 years, whereas cluster 0 started in 2005 and there have been references cited with excessive frequency showing virtually yearly after 2007.25,30,31,33,35
Evaluation of Key phrases
The key phrases co-occurrence map (Figure 6A), consisting of 487 nodes and 850 hyperlinks, recognized well-liked analysis matters, and the burst map (Figure 6B) mirrored the analysis frontiers inside a sure interval.36 The highest 10 key phrases based on frequency and centrality are listed in Table 11. We discovered that “ache,” “osteoarthritis,” and “incapacity” had been the principle issues within the meta-analysis of acupuncture remedy, which indicated that acupuncture has been extensively utilized to the therapy of those ailments.
Desk 11 The High 10 Frequency and Centrality of Key phrases on Acupuncture Remedy Associated Systematic Evaluate/Meta Evaluation
Along with “osteoarthritis,” the key phrases “low again ache” and “knee” had the next power within the quotation burst and lasted for about 3 years, indicating that meta-analysis analysis on these ailments had come to the forefront after 2010 however has been quickly reducing since 2014. As for interventions, “electroacupuncture” ranked in Table 11 indicating it gained in reputation, and we should always choose the frequency based mostly on the illness. Some research found electroacupuncture might lower ache considerably.37–40 After consulting the unique literature, we additionally grew to become conscious of the hyperlinks between it and a few key phrases reminiscent of “power spinal ache,”41 “ache aid,”42 and “analgesia”.43 “Randomized managed trial” had a excessive frequency, as a result of RCT had develop into an increasing number of well-liked in scientific research of TCM with the event of EBM. It’s value mentioning that double-blind ranked eleventh. Blinded research assist keep away from investigator bias and make sure the objectivity of the outcomes. Due to the traits of acupuncture, it’s arduous to implement blinded research. At current, the single-blind technique was most generally utilized in contributors or assessors solely, and the double blind was set for each of them slightly than the implementer.44–46
Within the burst map (Figure 6B), the latest burst key phrases had been “protocol,” “community meta-analysis” and “grownup.” The key phrase “placebo,” with 7.8885 power stood out from 2008 to 2012, exhibiting that the choice and software of placebo had develop into a well-liked analysis subject within the scientific analysis on acupuncture throughout this era to some extent, and the generally used placebo primarily included sham acupuncture, reminiscent of “shallow needling,” “non-penetrating needles,” and “non- acupuncture level”.47 Individuals had been blinded by the above strategies in some research, however whether or not it was a real sham was nonetheless disputed and had not been extensively used.48–50
Then we utilized a time-zone evaluate to explain the tendencies and interactions of themes over time (Figure 6C). For interventions, most analysis was targeted on “electroacupuncture,” “acupressure,” and “laser acupuncture,” and extra consideration was given to “moxibustion” in 2010. After 2010, we discovered no subsequent research of different acupuncture remedies. By way of illness and remedy, “ache,” “low again ache,” “anxiousness,” and “osteoarthritis” had been the analysis sizzling matters in 2008. In 2009, these had been “insomnia,” “most cancers,” “breast most cancers,” and “sizzling flash” and the appliance of remedy reminiscent of “rehabilitation” was expanded. As well as, analysis on “mechanism” started to extend. Later, analysis matters included on “stroke,” “knee,” “neck ache,” “melancholy,” “in vitro fertilization,” “fatigue,” “knee osteoarthritis,” and “dysfunction,” successively. In 2015, consideration was paid to “epidemiology,” and “rat” grew to become a sizzling subject within the subsequent yr. It was fascinating that the research populations in numerous intervals had been additionally totally different, and the topics had been principally “girls” in 2009, “youngsters” in 2013, “postmenopausal girls” in 2015, “males” in 2016, and “grownup” in 2018. By way of comparisons, “placebo” and “medication” dominated in 2008, and “sham acupuncture” rose in 2010. Examine sorts additionally modified. “Scientific trial,” “RCT,” “meta-analysis,” and “systematic evaluate” had been well-liked in 2008 and a few trial design elements reminiscent of “double blind” and “multicenter research” appeared used. No vital modifications occurred till 2012, when “guideline” grew to become well-liked, as did “protocol” in 2016 and “community meta-analysis” in 2017. Lastly, with respect to end result indexes, “bias,” “threat,” and “high quality” had been the most typical phrases in 2008, and “security,” “high quality of life,” “effectiveness,” “prevalence,” and “restoration” had been generally noticed in 2009 and thereafter. We predict that the analysis on sizzling matters sooner or later would possibly focus on the design and enchancment of acupuncture analysis protocols, in addition to the event and promotion of pointers for the appliance of acupuncture.
In abstract, we investigated the scope of acupuncture remedy associated to systematic critiques and meta-analysis analysis over the previous 12 years by bibliometric evaluation. The annual publications regularly elevated and coated most disciplines, particularly basic medication, neurology, obstetrics and gynecology, and oncology. Most publications appeared within the Journal of Various and Complementary Drugs. China and South Korea had been probably the most prolific international locations in publishing, and the most efficient establishment was Beijing College of Chinese language Drugs, adopted by KyungHee College. The writer with probably the most publications was from South Korea as nicely, however the cooperation between totally different international locations and establishments has been inadequate. Subsequently, contacts and communication needs to be strengthened to advertise the appliance of acupuncture remedy.
In response to the cited references and key phrases, the principle dysfunction handled was ache, whereas EA gained probably the most consideration when it comes to interventions. Researchers hooked up nice significance to worldwide requirements within the systematic evaluate/meta-analysis of acupuncture remedy, such because the Cochrane Handbook, STRICTA, and PRISMA statements. It was tough to implement the blinded research and the collection of placebo was nonetheless not uniform. We predict that enhancing the standard of analysis could develop into a well-liked subject.
Lastly, there are some limitations on this research. First, we analyzed solely the articles and critiques in English recorded within the Internet of Science Core Assortment, so our findings is probably not complete sufficient. As well as, we manually deleted knowledge irrelevant to the subject and a few errors might need occurred on this course of. Nonetheless, we imagine that our findings can nonetheless be used to explain the general sizzling matters and tendencies on this discipline. It’s essential to additional analyze the appliance of acupuncture, reminiscent of the particular software of sorts/modes of acupuncture and stimulation parameters, with a purpose to perceive the effectiveness of acupuncture. Extra rigorous analysis needs to be carried out sooner or later.
EBM, evidence-based medication; Freq, frequency; RCT, randomized managed trial; EA, electro-acupuncture; STRICTA, Requirements for Reporting Interventions in Scientific Trials of Acupuncture; PRISMA, most well-liked reporting objects for systematic evaluate and meta-analysis; GRADE, The Grading of Suggestions Evaluation, Improvement and Analysis.
The authors want to categorical their appreciation to Professor CM Chen, who invented CiteSpace, which is free to make use of.
All authors contributed to knowledge evaluation, drafting or revising the article, have agreed on the journal to which the article will likely be submitted, gave ultimate approval of the model to be revealed, and conform to be accountable for all elements of the work.
There isn’t any funding to report.
The authors declare that there aren’t any conflicts of curiosity relating to the publication of this paper.
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