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Effectiveness of non-pharmacological therapies for treating post-stroke depression: A systematic review and network meta-analysis.
- Source :
-
General Hospital Psychiatry . Sep2024, Vol. 90, p99-107. 9p. - Publication Year :
- 2024
-
Abstract
- Post-stroke depression (PSD) is a common neurological and psychiatric sequelae following a stroke, often surpassing the primary effects of the stroke due to its strong correlation with high mortality rates. In recent years, non-pharmacological therapy has garnered significant attention as a supplementary treatment for PSD, becoming widely adopted in clinical practice. However, the efficacy of specific intervention strategies remains unclear. This study aimed to conduct a network meta-analysis (NMA) of published studies to compare the efficacy of different non-pharmacological therapies for treating PSD. We systematically searched five databases from inception through March 2024 to identify randomized controlled trials (RCTs) evaluating non-pharmacological therapies for the treatment of PSD. We considered individual intervention and intervention class. Intervention classes included traditional Chinese medicine (TCM), non-invasive electrotherapy stimulation (NIES), psychotherapy (PT), exercise therapy, hyperbaric oxygen, and combined interventions. The NMA was conducted using R and Stata software, following a frequency-based methodology. Assessment of methodological quality and risk of bias was conducted using the Risk of Bias assessment tool 2.0. Therapies were ranked using the P-score, and box-plots visualization, meta-regression, and sensitivity analysis, were performed to assess transitivity, heterogeneity, and consistency, respectively. The NMA included 43 studies with a total of 3138 participants. Random-effects models revealed significant efficacy for acupuncture (ACUP) (P-score = 0.92; pooled standardized mean difference (95% CI): −3.12 (−4.63 to −1.60)) and transcranial direct current stimulation (P-score = 0.85; −2.78 (−5.06 to −0.49)) compared to the treatment as usual (TAU) group. In categorical comparisons, TCM_PT (P-score = 0.82; −1.91 (−3.54 to −0.28)), TCM (P-score = 0.79; −1.65 (−2.33 to −0.97)), and NIES (P-score = 0.74; −1.54 (−2.62 to −0.46)) showed significant differences compared to TAU group. Furthermore, our results indicated no significant difference between PT and the control groups. However, Confidence in Network Meta-Analysis results indicated very low overall evidence grade. Limited evidence suggests that ACUP may be the most effective non-pharmacological therapy for improving PSD, and TCM_PT is the best intervention class. However, the evidence quality is very low, underscoring the need for additional high-quality RCTs to validate these findings, particularly given the limited number of RCTs available for each therapy. • Acupuncture showed the greatest improvement in depression symptoms in patients with post-stroke depression. • Given the overlap between stroke and depression symptoms, passive therapiesmay be more appropriate and efficacious for patients. • Categorical comparisons suggest that traditional Chinese medicine combined with psychotherapy may have the best efficacy in treating post-stroke depression. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ELECTROTHERAPEUTICS
*CHINESE medicine
*PSYCHOTHERAPY
*STATISTICAL models
*COMPUTER software
*EXERCISE therapy
*TREATMENT effectiveness
*META-analysis
*RANDOMIZED controlled trials
*DESCRIPTIVE statistics
*ACUPUNCTURE
*SYSTEMATIC reviews
*COMBINED modality therapy
*STROKE
*HYPERBARIC oxygenation
*TRANSCRANIAL direct current stimulation
*DATA analysis software
*CONFIDENCE intervals
*MENTAL depression
*REGRESSION analysis
*SENSITIVITY & specificity (Statistics)
*DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 01638343
- Volume :
- 90
- Database :
- Academic Search Index
- Journal :
- General Hospital Psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 179528902
- Full Text :
- https://doi.org/10.1016/j.genhosppsych.2024.07.011