SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neurorehabilitation
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1591620
This article is part of the Research TopicNew methods in neurorehabilitationView all 15 articles
Comparative Effectiveness of Multiple Different Non-pharmacologic Interventions for Post-stroke Constipation: A Bayesian Network Meta-analysis
Provisionally accepted
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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Background: Post-stroke constipation (PSC) is a common complication among stroke patients, with a positive correlation to stroke severity. Straining during defecation in constipated patients can increase intracranial pressure, posing a high risk for secondary strokes, negatively impacting prognosis, disease progression, and contributing to the development of depression and anxiety. Non-pharmacological interventions (NPIs), including traditional Chinese medicine (TCM) and rehabilitation approaches, have been explored due to challenges in advancing Western medical treatments. However, the optimal treatment remains unclear, necessitating guidance for clinical practice. This research employs Bayesian network meta-analysis (NMA) to identify the most effective NPIs for improving clinical outcomes and alleviating constipation in post-stroke patients. Methods: We conducted a NMA of randomized controlled trials to evaluate the relative efficacy of eight NPIs for PSC: acupuncture therapy (AT), acupoint catgut embedding (ACE), auricular therapy (ART), moxibustion (MT), abdominal massage (AM), point application (PA), physiotherapy (PT), and cognitive behavioral therapy (CBT). The primary outcome was the clinical effective rate (CER), and the secondary outcome was the Constipation Scoring System (CCS). To establish a comparative hierarchy of interventions, surface under the cumulative ranking curve (SUCRA) values were calculated, representing the probability of relative efficacy across treatments. Results: A comprehensive literature review identified 53 clinical studies with 5,813 participants to evaluate the relative efficacy of eight NPIs. ACE ranked highest for both CER and CCS (SUCRA = 94.7%, 97.8%), followed by PT (88.4%, 81.7%). In contrast, ART and AM ranked lower, indicating relatively less efficacy compared with other interventions. Conclusion: Acupoint catgut-embedding (ACE) may represent a potentially superior non-pharmacological intervention for improving clinical outcomes and reducing constipation severity in post-stroke patients. Physiotherapy (PT) also demonstrated favorable efficacy, ranking second in both clinical outcomes. However, further high-quality, multicenter clinical trials are needed to validate and refine these findings.
Keywords: Post-stroke constipation, non-pharmacologic interventions, Bayesian network meta-analysis, Alternative Therapies, Rehabilitation
Received: 11 Mar 2025; Accepted: 16 Sep 2025.
Copyright: © 2025 Feng, Wu, Dai, Liu, Luo and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fei Wang, wangfei896@163.com
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