Comparison of Needle-Warming Moxibustion and Other Physical Therapies for Lumbar Disc Herniation: A Meta-analysis

Abstract

Background. Needle-warming moxibustion (NWM) demonstrates a controversial effect on lumbar disc herniation (LDH). This study is aimed at comparing the efficacy of NWM and conventional acupuncture or other physical therapies on LDH through a meta-analysis. Methods. Potentially eligible literatures were retrieved and screened from electronic databases. The subject of the literature was a comparison of NWM and conventional acupuncture or other physical therapies for LDH. The methodological quality was evaluated by the Jadad scale. The chi-square test was used for the heterogeneity test. Subgroup analysis was used to explore the source of heterogeneity. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was used to describe the effect size. The publication bias was evaluated by Egger’s test. Results. The effective rate of NWM in the treatment of LDH was significantly higher than that of conventional acupuncture ( $\text{RR}=1.27,95\%\text{CI}\left[1.18,1.36\right],P<0.00001$ ) and lumbar traction ( $\text{RR}=1.12,95\%\text{CI}\left[1.06,1.18\right],P<0.0001$ ) There was no significant difference in the effective rate between NWM and electric acupuncture for LDH ( $\text{RR}=1.06,95\%\text{CI}\left[0.98,1.14\right],P=0.17$ ). VAS of LDH patients treated with NWM was lower than conventional acupuncture ( $\text{MD}=-1.51,95\%\text{CI}\left[-1.70,-1.31\right],P<0.00001$ ) and lumbar traction ( $\text{MD}=-2.64,95\%\text{CI}\left[-2.79,-2.49\right],P<0.00001$ ) but statistically insignificant with electric acupuncture ( $\text{MD}=-0.31,95\%\text{CI}\left[-0.72,0.09\right],P=0.13$ ). JOA scores of LDH patients treated with NWM were higher than those with conventional acupuncture ( $\text{MD}=2.24,95\%\text{CI}\left[1.04,3.45\right],P=0.0003$ ) and lumbar traction ( $\text{MD}=10.76,95\%\text{CI}\left[10.45,11.07\right],P<0.00001$ ) but statistically insignificant with electric acupuncture ( $\text{MD}=0.25,95\%\text{CI}\left[-0.95,1.45\right],P=0.69$ ). The long-term effective rate of NWM on LDH was higher than that of conventional acupuncture ( $\text{MD}=3.13,95\%\text{CI}\left[2.12,4.61\right],P<0.00001$ ). In this study, no heterogeneity ( $P>0.10,I^2<50\%$ ) and publication bias ( $P>0.05$ ) among the literature were noted. Conclusion. The effect of NWM on LDH was superior to traction therapy and conventional acupuncture therapy, but similar to electric acupuncture for LDH. High-quality randomized controlled trials were still needed to confirm the results.