Moxibustion for treating patients with post-stroke depression: a systematic review and meta-analysis

Background: To assess the effectiveness and safety of moxibustion for post-stroke depression (PSD). Methods: A search was conducted in the following English and Chinese databases: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature (CBM), VIP and Wanfang. The outcomes included Hamilton Depression Rating Scale (HAMD), effective rate, and Modified Edinburgh-Scandinavian Stroke Scale (MESSS) scale. The formulation of search strategy, data extraction, and quality evaluation of involved studies was performed according to Cochrane handbook guidelines. The software RevMan 5.4 and Stata 16 were used for data analysis. The evidence quality of each outcome was evaluated by GRADEpro guideline development tool (GDT). Results: A total of 14 trials with 863 participants were included. A certain risk of bias of unclear or high was detected in the included studies. Compared with the control group, adding moxibustion could change the value of HAMD [standardized mean difference (SMD) = -1.17; 95% confidence interval (CI): -1.55 to -0.79; I-2=85.5%; P<0.01] and the effective rate [risk ratio (RR) = 1.22; 95% CI: 1.13 to 1.32; I-2=0.0%; P=0.56], and the differences in the MESSS scale (SMD = -0.72; 95% CI: -1.06 to -0.38; I-2=0.0%; P=0.80) had statistical differences. The certainty was low in effective rate, and very low in HAMD and MESSS. Besides, moxibustion was shown to be generally safe. Discussion: This review found that moxibustion may be an effective intervention for PSD. However, the results of this study have a certain limitation. The benefits of moxibustion for PSD need to be confirmed in the future by more high-quality randomized controlled trials (RCTs).