Ask an answerable question (PICO)：
The World Health Organization (WHO) has predicted that chronic obstructive pulmonary disease (COPD) will become the third global leading cause of death by 2030. Although acupoint stimulation, a traditional Chinese medicine (TCM) technique, can help improve the respiratory function of patients with COPD, its overall efficacy has not been extensively discussed by systematic reviews. Therefore, this study utilized a systematic review and meta-analysis to verify the efficacy of acupoint stimulation in improving the lung function, exercise tolerance, and quality of life (QoL) of patients with COPD.
The Method and Analysis of Literature Review：
Based on the five steps of evidence-based nursing, the study first determined keywords and their synonyms in the PICO framework, with P representing “chronic obstructive pulmonary disease,” I representing “acupoint stimulation, acupuncture,” and O representing “pulmonary function, pulmonary function test, and “quality of life.” Subsequently, the Boolean operators AND and OR were used to search for the keywords in six Chinese and English electronic databases, namely CINAHL, PubMed, Cochrane Library, Embase, Airiti Library, and China National Knowledge Infrastructure (CNKI). The search ended with 125 studies, which were further screened for randomized controlled trials (RCTs) conducted within the last decade. After studies that failed to meet the inclusion criteria were excluded, five RCTs were eventually included.
Critical Appraisal：
Critical appraisal was independently reviewed by three reviewers who used the revised tool for Risk of Bias (RoB 2.0) developed by the Cochrane collaboration. Results indicated that the attrition rates of all five included RCTs were acceptable, and there was no selective reporting. However, none of the five RCTs stated whether the evaluation results were blinded. Next, the Review Manager (RevMan 5.4) software was adopted for meta-analysis, which suggested that acupoint stimulation not only increased both the forced expiratory volume in one-second percentage predicted (FEV1% pre) and the forced expiratory volume in one second (FEV1) of patients with COPD but also improved their exercise tolerance and QoL.
Results, Conclusions and Recommendations：
The results of systematic review and meta-analysis supported the evidence that acupoint stimulation could improve the lung function, exercise tolerance, and QoL of patients with COPD. However, due to the small number of RCTs reviewed by this study, the clinical application of the conclusion should be approached with caution. In addition, further studies with better research quality are required.
