Objective: To evaluate the efficacy and safety of different antidepressants and anticonvulsants in the treatment of central poststroke pain (CPSP) by network meta-analysis and provide an evidence-based foundation for clinical practice. Methods: PubMed, Cochrane Library, EMBASE, CNKI, APA PsycINFO, Wanfang, VIP and other databases were searched by computer to find clinical randomized controlled studies (RCTs) on drug treatment of CPSP. The retrieval time limit was from the establishment of each database to July 2022. The quality of the included RCTs was evaluated using the bias risk assessment tool recommended by Cochrane. Stata 14.0 was used for network meta-analysis. Results: A total of 13 RCTs, 1040 patients and 9 drugs were finally included. The results of the network meta-analysis showed that the effectiveness ranking as rated by the visual analog scale (VAS) was gabapentin > pregabalin > fluoxetine > lamotrigine > duloxetine > serqulin > amitriptyline > carbamazepine > vitamin B. Ranking according to the numerical rating scale (NRS) was pregabalin > gabapentin > carbamazepine. Ranking derived from the Hamilton depression scale (HAMD) was pregabalin > duloxetine > gabapentin > amitriptyline. Conclusion: All nine drugs can relieve the pain of CPSP patients to different degrees; among them pregabalin and gabapentin have the most significant effect, and gabapentin and pregabalin also have the most adverse reactions. In the future, more multicenter, large sample, double-blind clinical randomized controlled trials need to be carried out to supplement and demonstrate the results of this study.

Objective: The aim of the study is to evaluate the effect of different traditional Chinese and western medicine rehabilitation techniques on motor dysfunction after stroke using a network meta-analysis. Methods: CNKI, Wanfang, PubMed, Embase, and Cochrane databases were searched from inception to September 2022. We independently searched and screened randomized controlled trials of rehabilitation techniques for poststroke motor dysfunction treatment, evaluated the quality, and analyzed the data using Stata 14.0. Results: Seventy-four randomized controlled trials involving nine rehabilitation techniques and 5128 patients were included. The results of network meta-analysis showed the following orders regarding improvement of the total scores of Fugl-Meyer Assessment, Action Research Arm Test, and Berg Balance Scale: biofeedback therapy > mirror therapy > repetitive transcranial magnetic stimulation > acupuncture therapy > transcranial direct current stimulation > Taichi > common therapy, virtual reality > transcranial direct current stimulation > repetitive transcranial magnetic stimulation > mirror therapy > common therapy, and acupuncture therapy > virtual reality > neuromuscular electrical stimulation > mirror therapy > common therapy > transcranial direct current stimulation, respectively. Conclusions: Biofeedback therapy had the best comprehensive effect, while virtual reality was the best intervention for improving the index of action research arm test and Fugl-Meyer Assessment–lower extremity. Acupuncture therapy improved lower limb balance function.

Objective: To evaluate the efficacy and safety of noninvasive therapies in the treatment of central poststroke pain (CPSP) by network meta-analysis and to provide an evidence-based basis for clinical practice. Methods: PubMed, Cochrane Library, EMBASE, CNKI, Wanfang, and VIP were searched for clinical randomized controlled studies on noninvasive therapy for CPSP. The retrieval time limit was from the establishment of each database to July 2022. The bias risk assessment tool recommended by Cochrane was used to evaluate the quality of the included randomized controlled trials (RCTs). Stata 14.0 was used for network meta-analysis, and Review Manager 5.3 software was used for traditional meta-analysis. Results: Twelve RCTs involving 8 treatment schemes and 641 patients were finally included. The results of the network meta-analysis showed the following rankings in visual analysis scale (VAS): super laser injury on stellate ganglia (SLI) > transcranial direct current stimulation (tDCS) > music therapy (MT) > repetitive transcranial magnetic stimulation (rTMS) > continuous theta burst stimulation (cTBS) > transcutaneous acupoint electrical stimulation (TAES) > common therapy (CT). The total clinical efficiency ranked as follows: psychological training of mindfulness (PT) > rTMS > CT. Clinical adverse reactions ranked as follows: rTMS > MT > CT > SLI. Conclusions: Noninvasive complementary therapy can effectively alleviate the pain of CPSP patients, and the efficacy and safety of SLI are relatively significant. However, due to the limitations of this study, the efficacy ranking cannot fully explain the advantages and disadvantages of clinical efficacy. In the future, more multicentre, large sample, double-blind clinical randomized controlled trials are needed to supplement and demonstrate the results of this study.

Objectives: To evaluate the efficacy and safety of different electromagnetic therapies for the treatment of post-stroke insomnia (PSI). Thus, we conducted a network meta-analysis to provide evidence-based insights for clinical practice. Methods: Databases such as PubMed, Excerpt Medica Database (Embase), Cochrane Library Central Register of Controlled Trials, APA PsycInfo, China National Knowledge Infrastructure Database, Wanfang, and SinoMed were used to retrieve randomized controlled trials (RCTs) on electromagnetic therapy for PSI, with a search deadline of Sep 2024 for each database. The Cochrane bias risk assessment tool was used to evaluate the quality of the included RCTs. Stata was used for network meta-analysis. Results: We included 28 RCTs involving 2353 patients across 12 different treatment regimens. The surface under the cumulative ranking results showed that the ranking of Pittsburgh sleep quality index decline was: cranial electrotherapy stimulation>low frequency repetitive transcranial magnetic stimulation (LF-rTMS)>infra-low frequency repetitive transcranial magnetic stimulation (ILF-rTMS)>fastigial nucleus stimulation (FNS)>transcranial direct current stimulation (tDCS)>low frequency electric stimulation (L-FES)>high frequency repetitive transcranial magnetic stimulation (HF-rTMS)>middle frequency repetitive transcranial magnetic stimulation (MF-rTMS)>sham stimulation (SS)>common treatment (CT); Ranking of Hamilton depression scale decline degree: HF-rTMS > LF-rTMS > tDCS > SS>continuous theta-burst stimulation (cTBS)>MF-rTMS > CT; national Institute of health stroke scale decline ranking: HF-rTMS > LF-rTMS > SS > L-FES>electroencephalographic biomimetic stimulation>CT > cTBS; Clinical total effective rate ranking: LF-rTMS > FNS > ILF-rTMS > L-FES > CT>repetitive transcranial acupuncture stimulation. Conclusions: Different electromagnetic therapies can effectively improve sleep quality in PSI patients, and the efficacy and safety of LF-rTMS are significant. However, owing to the limitations of this study, the efficacy ranking cannot fully explain the advantages and disadvantages of clinical efficacy. In the future, additional multicentre, large-sample, double-blind, clinical, and randomized controlled trials are required to supplement and demonstrate the results of this study. Strengths and limitations of this study: This is the first study to conduct network meta-analysis on PSI treatment with different electromagnetic therapies. Simultaneously, we refined the classification based on different frequency patterns of the same therapy, and the results can serve as a reference for clinical workers. This study had some limitations: A large proportion of low-quality literature may lead to biased results; Lack of subgroup analysis, mainly because the number of studies included was not very high, and the quality of most studies was low. Basic information such as stroke site and onset time were not detailed, which may increase the possibility of inconsistency and clinical heterogeneity. After all, detailed subgroup analysis based on the stage or location of stroke can provide more meaningful clinical guidance.

Background: To evaluate the efficacy of multiple acupoint combinations for the treatment of post-stroke cognitive impairment (PSCI) using a network meta-analysis method. Methods: Searches for clinical randomized controlled trials (RCTs) of various types of acupuncture treatments for post-stroke cognitive dysfunction were conducted, data were extracted from studies selected according to the inclusion criteria, and the RCTs included in the analysis were assessed separately for risk of literature bias. Network meta-analysis was performed using Stata 14.0. Results: Sixteen RCTs involving 1257 patients were included, which involved 9 groups of acupoint treatment plans. The best treatment plan for improving the mini-mental state examination score of PSCI was a cephalic plexus spur (99.7%). The best treatment option for improving the montreal cognitive assessment score for PSCI was Zishen Yisui acupuncture therapy (ZSYSA) (77.3%). The best option for improving the barthel index score of PSCI was ZSYSA (99.2%). In terms of improving the overall clinical outcomes of PSCI, the best treatment option for improving the overall clinical effectiveness of PSCI is ZSYSA Therapy (92.2%). Conclusion: The analysis of all results shows that ZSYSA can significantly improve PSCI compared to other acupuncture therapies. Strengths and limitations of this study: This is the 1^st study on the treatment of PSCI with different acupoint combinations based on a network meta-analysis method, which provides a reference for clinical rehabilitation workers; all included studies were randomized controlled trials, which increased the reliability of this study. Limitations; The number of relevant clinical studies retrieved was too small, and all included clinical trials were located in China; therefore, there is a great possibility of publication bias; Most of the included studies did not clearly explain the random distribution mode, follow-up, distribution concealment, or other experimental conditions. Therefore, selection and reporting biases cannot be excluded, suggesting that the quality of the literature is not high; Because of the strict inclusion criteria, the number of studies was limited, and subgroup analysis could not be performed according to the time of onset and the length of the disease course.

Objective. Physical therapy combined with acupuncture is the current research hotspot in the treatment of poststroke cognitive impairment, but which combination treatment is the best is still controversial. Based on the network meta-analysis method, we evaluated the efficacy of various physical therapies combined with acupuncture for the treatment of poststroke cognitive impairment. Methods. We retrieved diverse randomized controlled trials of various physical therapies combined with acupuncture for the treatment of cognitive dysfunction after stroke. We selected studies, extracted data, and evaluated the risk of literature bias for the included randomized controlled trials. We used STATA 14.0 for the current network meta-analysis. Results. Fifteen randomized controlled trials involving 1288 patients were included, which involved 7 treatment plans that included 3 control treatment plans and 4 acupuncture treatment plans combined with physical therapy. The best treatment plan for improving the Mini-Mental State Examination score of poststroke cognitive impairment is acupuncture combined with hyperbaric oxygen therapy. The best treatment option for improving the Montreal Cognitive Assessment score of poststroke cognitive impairment is acupuncture combined with hyperbaric oxygen therapy. The best option for improving the Barthel index score of poststroke cognitive impairment is acupuncture combined with transcranial magnetic stimulation. In terms of improving the overall clinical effectiveness of poststroke cognitive impairment, the best treatment option is acupuncture combined with transcranial magnetic stimulation. Conclusion. The analysis of all the results shows that acupuncture combined with hyperbaric oxygen therapy can significantly improve poststroke cognitive impairment compared with other combined treatments. However, due to the overall quality and quantity of the included studies, more randomized controlled trials focusing on clinical research on acupuncture combined with physical therapy for poststroke cognitive impairment are required to support the current evidence. This trial is registered with CRD42020200092.