The effect of traditional Chinese medicine education programs on people's subhealth status: A systematic review of clinical studies

Introduction: Subhealth status is an intermediate state between health and disease. If relevant risk factors are addressed appropriately, better health can be restored. Traditional Chinese medicine (TCM) health education is helpful for cultivating self-care awareness, ensuring the accumulation of health knowledge and modifying poor habits and behaviors. This review aimed to systematically review the evidence for the effect of TCM health education on subhealth status. Methods: The Cochrane library, PubMed, and four Chinese databases were searched for clinical studies exploring the effect of TCM education on subhealth status. Randomized controlled trials (RCTs), quasi-RCTs, cohort, case-control, and cross-sectional studies were included. The primary outcomes were prevalence of subhealth and subhealth status score. Appropriate tools were used to assess quality (e.g. risk of bias tool for RCTs). Results: Of the 1559 citations, one RCT and four cross-sectional studies were included after 125 full-text reading. The quality of all included studies was generally poor. A meta-analysis of three cross-sectional studies (n=2802) showed no difference in subhealth prevalence between people accepting TCM education and those not (Risk ratio 0.92; 95% confidence interval (CI) 0.82-1.02). The trial result (n=80) favored integration therapy of TCM education and general health education versus general education on overall subhealth status (Mean difference -13.90; 95% CI -19.54 to -8.26). Conclusions: The effect of TCM education on subhealth is unclear based on the current evidence, as cross-sectional studies cannot provide a causal link and only one poor quality RCT was available. Better designed RCTs are needed to provide definitive conclusions.