Hindawi

Evidence-Based Complementary and Alternative Medicine

Volume 2022, Article ID 8080297, 10 pages
https://doi.org/10.1155/2022/8080297

Review Article
Effectiveness and Safety of Acupoint Catgut Embedding for the
Treatment of Poststroke Constipation: A Systematic Review
and Meta-Analysis

Mao Guo ,1,2 Xie Le ,2 Wang Qin-yu,3 Mao Ye,2 Zhou Sheng-qiang,2 Xie Yao,2
Wu Da-hua,2 and Liu Bai-yan 1,4
1
Hunan University of Chinese Medicine, Changsha 410208, Hunan, China
2
Affiliated Hospital of Hunan Academy of Chinese Medicine, Changsha 410006, Hunan, China
3
The People’s Hospital of Hunan Province, Changsha 410005, Hunan, China
4
Hunan Academy of Chinese Medicine, Changsha 410006, Hunan, China

Correspondence should be addressed to Liu Bai-yan; [email protected]

Received 23 March 2022; Accepted 18 June 2022; Published 5 July 2022

Academic Editor: Zhaolan Liu

Copyright © 2022 Mao Guo et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives. Acupoint catgut embedding therapy has shown effectiveness in treating functional constipation; however, relevant,
high-quality clinical evidence is scarce. This study aimed to systematically assess the effectiveness and safety of acupoint catgut
embedding in treating poststroke constipation. Methods. Correlative randomized controlled trials were identified through a
comprehensive literature search of PubMed, Cochrane Library/Cochrane Central Register of Controlled Trials, Web of Science,
Embase, China National Knowledge Internet, Chinese Biomedical Literature Database, Wanfang, and VIP databases from
inception until February 2022. Meta-analysis was performed using RevMan 5.3 software. Results. Fifteen trials involving 1084
patients were identified. The meta-analysis revealed that the acupoint catgut embedding group was significantly superior to the
non-catgut embedding group with regard to the efficacy rate (RR � 1.27, 95% CI (1.19, 1.37), P < 0.05), the first defecation time
(MD � −3.08, 95% CI (−4.53, −1.63), P < 0.05), the defecation sensation score (MD � −0.44, 95% CI (−0.61, −0.26), P < 0.05), the
degree of difficulty in defecation (MD � −0.73, 95% CI (−1.10, −0.37), P < 0.05), the PAC-QOL scale score (MD � −10.06, 95% CI
(−13.47, −6.64), P < 0.05), and the symptom integral (MD � −3.15, 95% CI (−3.60, −2.71), P < 0.05). However, there was no
significant difference in the stool property score (MD � 0.06, 95% CI (−0.39, 0.50), P > 0.05) as well as the incidence of adverse
reactions (RD � 0.01, 95% CI (−0.01, 0.03), P > 0.05) between the two groups. Conclusions. The results showed that acupoint catgut
embedding is probably an effective and safe acupuncture treatment strategy for poststroke constipation. Nevertheless, more
rigorously designed, standardized, large-sample, and multicenter randomized controlled designs are warranted to further verify
the findings of this study.

1. Introduction quality of life and prognosis of patients [3]. Constipation is

a common poststroke complication. Approximately, 30%
Stroke is the leading cause of death and disability in many to 60% of stroke patients develop constipation symptoms
parts of the world. Authoritative research shows that the after the event, which are mostly related to neurological
overall burden of stroke remains high worldwide and it is disorders, dependence, long-term hospitalization, and
predicted that stroke will continue to be among the top motor, cognitive, and communication disorders [4, 5].
three causes of death in the world until 2040 [1, 2]. Constipation markedly harms stroke patients as it can
Moreover, many stroke survivors endure physical and result in symptoms or diseases such as abdominal pain, bad
mental damage caused by some complications for a long breath, depression, and hemorrhoids. In addition, it can
duration after an acute stroke, which seriously affects the induce another stroke or other cerebrovascular events due
2 Evidence-Based Complementary and Alternative Medicine

to prolonged squatting and forced defecation, thereby who had poststroke constipation diagnosed according to
endangering the patient’s life. WHO criteria, not limited by gender and age; (3) the in-
Thus, maintaining smooth defecation following a stroke tervention groups received the acupoint catgut embedding
is critical for these patients’ prognosis. Currently, the clinical therapy, while the control groups received other therapies
treatment of poststroke constipation consists mainly of diet such as acupuncture, oral drugs, sham catgut embedding
adjustment, drug therapy (laxatives, kinetic agents), enema, therapy, and so on; (4) the observation indices included at
and surgery. However, some of these treatments are inef- least one of the following: efficacy rate, first defecation time,
fective, some are rejected because of poor tolerability, and defecation sensation score, degree of difficulty in defecation,
the majority have significant adverse effects. In addition, the stool property score, PAC-QOL scale score [9], symptom
recurrence rate of poststroke constipation is high [6, 7]. In integral, and adverse event; and (5) there was a complete and
supplementary and replacement therapies, acupoint catgut clear treatment course. The exclusion criteria were as fol-
embedding therapy is based on the theory of acupuncture lows: (1) literature published repeatedly or published by
and moxibustion in traditional Chinese medicine and uses more than one person in the same study (only the latest and
absorbable surgical sutures to produce lasting acupoint the most comprehensive one was retained) and (2) studies in
stimulation in the human body, especially for poststroke which the required data were unavailable, or studies for
constipation [8]. At present, high-quality clinical evidence of which attempts to contact the author to obtain missing data
the acupoint catgut embedding therapy for the treatment of were unsuccessful.
poststroke constipation is limited and the sample size of
most related clinical studies is inadequate. Moreover, the
efficacy, safety, and reliability of the acupoint catgut em- 2.3. Data Extraction. The contents of the data extracted
bedding therapy need to be improved. At the same time, mainly included the author, the year of publication, the
there is no systematic evaluation of this problem. In view of country, the intervention measures of the experimental group
this situation, this study used systematic evaluation and and the control group, the number of cases in the experi-
meta-analysis methods to evaluate the effectiveness and mental group and the control group, the course of treatment,
safety of the acupoint catgut embedding therapy in the the randomization method, and the outcome indicators.
treatment of poststroke constipation in order to provide a
more reliable reference for clinical practice. 2.4. Literature Quality Assessment. The Cochrane risk of bias
tool [10] was used to evaluate the quality of the eligible
2. Data and Methods randomized controlled trials. The tool mainly evaluated the
risk of bias from 6 areas: selection bias, implementation bias,
The protocol was prospectively registered with the Inter-
measurement bias, follow-up bias, report bias, and other
national Prospective Register of Systematic Reviews
biases. Each index was judged by “low risk,” “unclear,” and
(PROSPERO) database on 5 March, 2022, (registration
“high risk,” and the risk of bias distribution map was drawn.
number: CRD42022310504.) and the International Platform
of Registered Systematic Review and Meta-Analysis Pro-
tocols (INPLASY) on 13 February, 2022, (registration 2.5. Statistical Analysis. Revman5.3 software was used to
number INPLASY202220041). Literature search, data ex- draw the distribution map of the risk of bias and for meta-
traction, and quality evaluation were performed indepen- analysis. The counting data were expressed by relative risk
dently by two reviewers using the databases mentioned (RR) and its 95% confidence interval (CI). The measurement
above, and any disagreements were resolved by consensus or data were expressed by mean deviation (MD) and its 95%
by consulting a third experienced reviewer. confidence interval (CI). When I2 ≤ 50% and P > 0.10, the
fixed-effect model was used to combine the data. When
2.1. Search Strategy. A comprehensive search was performed I2 > 50% and P < 0.10, the random-effects model was used to
in PubMed, Cochrane Library/Cochrane Central Register of combine the data. When there was a large heterogeneity, the
Controlled Trials, Web of Science, Embase, China National sensitivity analysis was carried out using the one-by-one
Knowledge Internet, Chinese Biomedical Literature Data- elimination method to explore the source of heterogeneity.
base, Wanfang, and VIP databases from inception until When the number of articles included in each outcome
February 2022. The following keywords or free-text terms index was in the range of 2 to 10 articles, the publication bias
were used: (poststroke or after stroke or after apoplexy) and among the included studies was evaluated by the Egger test
(constipation or difficult defecation) and acupoint catgut using Stata16.0 software. P > 0.05 represents no significant
embedding and randomized controlled trial. There were no publication bias.
restrictions on countries, population characteristics, and
language for the search process. 3. Results
3.1. Literature Search Results. A total of 115 articles were
2.2. Inclusion and Exclusion Criteria. The inclusion criteria initially selected from eight databases after preliminary
were as follows: (1) the trials had to be RCTs that aimed to screening. Then, the inconsistent studies were excluded
evaluate the therapeutic effect of acupoint catgut embedding based on their titles and abstracts and 21 articles were
on constipation after a stroke; (2) the subjects were patients retained. Finally, the full texts of the remaining articles were
Evidence-Based Complementary and Alternative Medicine 3

Identification
Records identified through Additional records identified
database searching through other sources
(n =115) (n =0)

Records after duplicates removed

(n=106)
Screening

Records screened
(n=106)

Excluded by title & abstract(n=89)

Full-text articles assessed

for eligibility
Eligibility

(n =21)
Full-text articles excluded (n=6)
−Not meet the inclusion criteria
(n =5)
−Data missing (n =1)
Studies included in
qualitative synthesis
(n=15)
Included

Studies included in
quantitative synthesis
(meta-analysis)
(n=15)

Figure 1: Flowchart of the literature selection process.

evaluated, and the studies not meeting the inclusion criteria studies was assessed, and the results (I2 � 0% and P > 0.10)
were excluded. Thus, 15 studies [11–25]were eligible for our indicated that there was no heterogeneity among the
systematic review. The specific search process and study studies. Thus, the fixed-effects model was used to combine
selection are shown in Figure 1, and a detailed description of the data. The results revealed that the efficacy rate of the
the general data is shown in Table 1. acupoint catgut embedding group was higher than that of
the control group (RR � 1.27, 95% CI (1.19, 1.37), P < 0.05)
(Figure 3).
3.2. Quality Assessment of the Included Trials. We assessed the
risk of bias in all the eligible articles. Randomization was
mentioned in all the trials, including the following: 6 studies 3.3.2. First Defecation Time. Six studies reported the first
[12, 16, 20, 22–24] were randomized into groups by the defecation time of patients who received acupoint catgut
random number table method, 2 studies [13, 14] were ran- embedding for the treatment of poststroke constipation. The
domly divided into groups by statistical software, 2 studies heterogeneity of the studies was evaluated, and the results
[17, 21] was randomly divided according to the order of en- (I2 � 94% and P < 0.10) revealed a high degree of hetero-
rollment, and 5 articles [11, 15, 18, 19, 25] did not describe the geneity among the studies; therefore, the random-effects
specific method of randomization. Only two studies did not model was adopted. The results showed that the first def-
describe the blinding of outcome assessment. Methodological ecation time of the acupoint catgut embedding group was
quality evaluation of the risk of bias is shown in Figure 2. The shorter than that of the control group (MD � −3.08, 95% CI
chart shows that there were many studies on low risk of bias, (−4.53, −1.63), P < 0.05) (Figure 4).
suggesting that the quality of the literature was acceptable.
3.3.3. Defecation Sensation Score [20]. Four studies reported
3.3. Outcome Measures the defecation sensation score of acupoint catgut embedding
receivers for the treatment of poststroke constipation. The
3.3.1. Efficacy Rate. Twelve studies reported the efficacy rate heterogeneity of the eligible studies was tested, and the
of acupoint catgut embedding for the treatment of post- results (I2 � 0% and P > 0.10) showed that there was no
stroke constipation. The heterogeneity of the eligible heterogeneity among the studies. Hence, the fixed-effects
 4

Table 1: Basic information of the eligible studies.

Interventions Number of cases

First author Year of publication Country Type of study Outcome
Treatment group Control group Treatment group Control group
LiLi Zeng [11] 2018 China RCT ACE NACE 30 30 ①, ⑦
Huiming Deng [12] 2019 China RCT ACE NACE 29 29 ①, ⑤
Yonggang Hao [13] 2020 China RCT ACE NACE 30 30 ⑦
Jia Du [14] 2020 China RCT ACE NACE 105 105 ④, ⑤, ⑥, ⑧
Zhihong Zou [15] 2014 China RCT ACE NACE 50 50 ①
Heyi Yang [16] 2012 China RCT ACE NACE 24 20 ①, ②
Wenfeng Wu [17] 2011 China RCT ACE NACE 30 30 ⑦
Jinying Guo [18] 2012 China RCT ACE NACE 35 35 ①, ②
Zipei Zeng [19] 2012 China RCT ACE NACE 40 40 ①
Liangyu Huang [20] 2018 China RCT ACE NACE 30 28 ①, ②, ③, ④, ⑥, ⑦, ⑧
Xizong Jin [21] 2016 China RCT ACE NACE 20 20 ①, ②, ③, ④, ⑤
Xiyang Sun [22] 2019 China RCT ACE NACE 30 30 ①, ②, ③, ④, ⑤, ⑥, ⑦, ⑧
Fengyi Guan [23] 2018 China RCT ACE NACE 32 32 ①, ⑥, ⑦, ⑧
Ying Gao [24] 2020 China RCT ACE NACE 30 30 ①, ③, ④, ⑤, ⑥, ⑦, ⑧
Guifang Luan [25] 2018 China RCT ACE NACE 30 30 ①, ②, ⑦
① Efficacy rate; ② first defecation time; ③ defecation sensation score; ④ degree of difficulty in defecation; ⑤ stool property score; ⑥ PAC-QOL scale score; ⑦ symptom integral; ⑧ adverse event; ACE: acupoint
catgut embedding; NACE: nonacupoint catgut embedding.
Evidence-Based Complementary and Alternative Medicine
Evidence-Based Complementary and Alternative Medicine 5

Random sequence generation (selection bias)

Allocation concealment (selection bias)
Blinding of participants and personnel (performance bias)
Blinding of outcome assessment (detection bias)
Incomplete outcome data (attrition bias)
Selective reporting (reporting bias)
Other bias

0 25 50 75 100
(%)

Low risk of bias

Unclear risk of bias
Liangyu Huang 2018 High risk of bias

Huiming Deng 2019

Yonggang Hao 2020

Guifang Luan 2018

Zhihong Zou 2014

Wenfeng Wu 2011

Fengyi Guan 2018

Jinying Guo 2012
Xiyang Sun 2019
Zipei Zeng 2012

Xizong Jin 2016

Heyi Yang 2012

Ying Gao 2020

Lili Zeng 2018

Jia Du 2020

Random sequence generation (selection bias)

+

+
Allocation concealment (selection bias)
?

Blinding of participants and personnel (performance bias)

−

−
?

?
?

Blinding of outcome assessment (detection bias)

+

+
+

+
?

Incomplete outcome data (attrition bias)

+

Selective reporting (reporting bias)

+

Other bias
−

+
−
?

Figure 2: Literature quality risk bias chart.

Experimental Control Weight Risk Ratio Risk Ratio

Study or Subgroup
Events Total Events Total (%) M-H, Fixed, 95% CI M-H, Fixed, 95% CI
Fengyi Guan 2018 29 32 21 32 7.8 1.38 [1.05, 1.82]
Guifang Luan 2018 29 30 20 30 7.4 1.45 [1.12, 1.88]
Heyi Yang 2012 18 22 14 20 5.4 1.17 [0.83, 1.66]
Huiming Deng 2019 27 29 21 29 7.8 1.29 [1.01, 1.64]
Jinying Guo 2012 32 35 26 35 9.6 1.23 [0.99, 1.53]
Liangyu Huang 2018 27 30 22 28 8.4 1.15 [0.91, 1.44]
Lili Zeng 2018 28 30 16 30 5.9 1.75 [1.24, 2.48]
Xiyang Sun 2019 27 30 25 30 9.2 1.08 [0.88, 1.32]
Xizong Jin 2016 17 20 15 20 5.5 1.13 [0.83, 1.55]
Ying Gao 2020 27 30 22 30 8.1 1.23 [0.96, 1.57]
Zhihong Zou 2014 48 50 40 50 14.8 1.20 [1.03, 1.39]
Zipei Zeng 2012 37 40 27 40 10.0 1.37 [1.09, 1.73]

Total (95% CI) 378 374 100.0 1.27 [1.19, 1.37]

Total events 346 269
Heterogeneity: Chi2 = 9.86, df = 11 (P = 0.54); I2 = 0%
0.5 0.7 1 1.5 2
Test for overall effect: Z = 6.72 (P < 0.00001)
Favours [experimental] Favours [control]

Figure 3: The forest plot of the efficacy rate.

6 Evidence-Based Complementary and Alternative Medicine

Study or Subgroup Experimental Control Weight Mean Difference Mean Difference

Mean SD Total Mean SD Total (%) IV, Random, 95% CI IV, Random, 95% CI
Guifang Luan 2018 11.41 9.44 30 23.48 11.95 30 5.4 −12.07 [−17.52, −6.62]
Heyi Yang 2012 5.2 2 22 9.1 4.3 20 15.9 −3.90 [−5.96, −1.84]
Jinying Guo 2012 21.36 5.6 35 34.32 8.72 35 10.1 −12.96 [−16.39, −9.53]
Liangyu Huang 2018 1.02 0.62 30 2.39 0.51 29 23.3 −1.37 [−1.66, −1.08]
Xiyang Sun 2019 1.27 1.22 30 1.53 1.25 30 22.6 −0.26 [−0.89, 0.37]
Xizong Jin 2016 0.7 0.97 20 1.2 1 20 22.6 −0.50 [−1.11, 0.11]

Total (95% CI) 167 164 100.0 −3.08 [−4.53, −1.63]

Heterogeneity: Tau2 = 2.33; Chi2 = 81.99, df = 5 (P < 0.00001); I2 = 94%
Test for overall effect: Z = 4.17 (P < 0.0001) −10 −5 0 5 10
Favours [experimental] Favours [control]

Figure 4: The forest plot of first defecation time.

Experimental Control Weight Mean Difference Mean Difference

Study or Subgroup
Mean SD Total Mean SD Total (%) IV, Fixed, 95% CI IV, Fixed, 95% CI
Liangyu Huang 2018 0.64 0.42 30 1.12 0.38 29 75.9 −0.48 [−0.68, −0.28]
Xiyang Sun 2019 1.53 1.25 30 1.87 1.17 30 8.4 −0.34 [−0.95, 0.27]
Xizong Jin 2016 0.6 0.94 20 1 1.02 20 8.6 −0.40 [−1.01, 0.21]
Ying Gao 2020 1.27 1.34 30 1.4 1.3 30 7.1 −0.13 [−0.80, 0.54]

Total (95% CI) 110 109 100.0 −0.44 [−0.61, −0.26]

Heterogeneity: Chi2= 1.09, df = 3 (P = 0.78); I2 = 0%
−1 −0.5 0 0.5 1
Test for overall effect: Z = 4.81 (P < 0.00001)
Favours [experimental] Favours [control]

Figure 5: The forest plot of the defecation sensation score.

model was applied to combine the data. The results dem- a high degree of heterogeneity among the studies (I2 � 84%
onstrated that the defecation sensation score of the acupoint and P < 0.10), the random-effects model was adopted. The
catgut embedding group was lower than that of the control results showed that the PAC-QOL scale score of the acupoint
group (MD � −0.44, 95% CI (−0.61, −0.26), P < 0.05) catgut embedding group was lower than that of the control
(Figure 5). group (MD � −10.06, 95% CI (−13.47, −6.64), P < 0.05)
(Figure 8).
3.3.4. Degree of Difficulty in Defecation [14]. Five studies
reported the degree of difficulty in defecation for patients 3.3.7. Symptom Integral. Eight studies reported the symp-
who received acupoint catgut embedding for the treatment tom integral of acupoint catgut embedding for the treatment
of poststroke constipation and the heterogeneity of the of poststroke constipation. Heterogeneity assessment
studies was assessed. The results (I2 � 78% and P < 0.10) revealed that there was little heterogeneity among the studies
revealed a high degree of heterogeneity among the studies. (I2 � 31% and P > 0.10). Therefore, the fixed-effects model
Therefore, the random-effects model was used. The results was used. The results demonstrated that the symptom in-
indicated that the degree of difficulty in defecation of the tegral of the acupoint catgut embedding group was lower
acupoint catgut embedding group was lower than that of the than that of the control group (MD � -3.15, 95% CI (-3.60,
control group (MD � -0.73, 95% CI (-1.10, -0.37), P < 0.05) -2.71), P < 0.05) (Figure 9).
(Figure 6).
3.3.8. Adverse Events. The incidence of adverse events of
3.3.5. Stool Property Score [14]. Five studies reported the acupoint catgut embedding for the treatment of poststroke
stool property score of acupoint catgut embedding receivers constipation was reported in five studies. As there was no
for the treatment of poststroke constipation. There was a heterogeneity among the included studies (I2 � 0% and
high degree of heterogeneity among the studies (I2 � 86% P > 0.10), the fixed-effects model was utilized to combine the
and P < 0.10), and the random-effects model was applied. data. The results revealed that there was no significant
The results revealed that there was no significant difference difference in the incidence of adverse events between the two
in stool property scores between the two groups. (MD � 0.06, groups. (RD � 0.01, 95% CI (-0.01, 0.03), P > 0.05)
95% CI (-0.39, 0.50), P > 0.05) (Figure 7). (Figure 10).

4. Sensitivity Analysis
3.3.6. PAC-QOL Scale Score. The PAC-QOL scale score of
acupoint catgut embedding receivers for the treatment of Because of the high heterogeneity among the studies in-
poststroke constipation was reported in five studies. The cluded in the first defecation time, the degree of difficulty in
heterogeneity of the studies was determined. Since there was defecation, the stool property score, and PAC-QOL scale
Evidence-Based Complementary and Alternative Medicine 7

Study or Subgroup Experimental Control Weight Mean Difference Mean Difference

Mean SD Total Mean SD Total (%) IV, Random, 95% CI IV, Random, 95% CI
Jia Du 2020 0.92 0.67 101 1.87 0.98 99 25.7 −0.95 [−1.18, −0.72]
Liangyu Huang 2018 0.64 0.42 30 1.84 0.45 29 26.0 −1.20 [−1.42, −0.98]
Xiyang Sun 2019 1.27 1.11 30 1.33 1.21 30 16.4 −0.06 [−0.65, 0.53]
Xizong Jin 2016 0.4 0.82 20 1.1 1.02 20 16.7 −0.70 [−1.27, −0.13]
Ying Gao 2020 1.33 1.21 30 1.67 1.3 30 15.2 −0.34 [−0.98, 0.30]

Total (95% CI) 211 208 100.0 −0.73 [−1.10, −0.37]

Heterogeneity: Tau2 = 0.12; Chi2 = 17.94, df = 4 (P = 0.001); I2 = 78%
Test for overall effect: Z = 3.98 (P < 0.0001) −1 −0.5 0 0.5 1
Favours [experimental] Favours [control]

Figure 6: The forest plot of degree of difficulty in defecation.

Study or Subgroup Experimental Control Weight Mean Difference Mean Difference

Mean SD Total Mean SD Total (%) IV, Random, 95% CI IV, Random, 95% CI
Huiming Deng 2019 3.28 0.51 29 2.71 0.49 29 18.4 0.57 [0.31, 0.83]
Jia Du 2020 2.37 0.73 105 1.83 0.64 105 18.5 0.54 [0.35, 0.73]
Liangyu Huang 2018 16.28 3.42 30 25.48 3.31 29 11.2 −9.20 [−10.92, −7.48]
Xiyang Sun 2019 1.47 1.04 30 1.33 1.21 30 17.4 0.14 [−0.43, 0.71]
Xizong Jin 2016 0.7 0.97 20 1.3 0.84 20 17.4 −0.60 [−1.16, −0.04]
Ying Gao 2020 1.13 1.25 30 1.87 1.28 30 17.1 −0.74 [−1.38, −0.10]

Total (95% CI) 244 243 100.0 −1.03 [−1.94, −0.12]

2 2 2
Heterogeneity: Tau = 1.15; Chi = 148.21, df = 5 (P < 0.00001); I = 97%
Test for overall effect: Z = 2.23 (P = 0.03) −2 −1 0 1 2
Favours [experimental] Favours [control]

Figure 7: The forest plot of the stool property score.

Study or Subgroup Experimental Control Weight Mean Difference Mean Difference

Mean SD Total Mean SD Total (%) IV, Random, 95% CI IV, Random, 95% CI
Fengyi Guan 2018 36.06 12.45 32 43.59 12.27 32 14.9 −7.53 [−13.59, −1.47]
Jia Du 2020 24.29 4.47 105 38.54 6.71 105 26.6 −14.25 [−15.79, −12.71]
Liangyu Huang 2018 16.28 3.42 30 25.48 3.31 29 26.3 −9.20 [−10.92, −7.48]
Xiyang Sun 2019 62.63 14.44 30 73.67 13.94 30 12.5 −11.04 [−18.22, −3.86]
Ying Gao 2020 33.27 8.54 30 40.07 8.35 30 19.6 −6.80 [−11.07, −2.53]
Total (95% CI) 227 226 100.0 −10.06 [−13.47, −6.64]
2 2 2
Heterogeneity: Tau = 10.78; Chi = 25.42, df = 4 (P < 0.0001); I = 84%
−20 −10 0 10 20
Test for overall effect: Z = 5.77 (P < 0.00001)
Favours [experimental] Favours [control]

Figure 8: The forest plot of the PAC-QOL scale score.

Study or Subgroup Experimental Control Weight Mean Difference Mean Difference

Mean SD Total Mean SD Total (%) IV, Fixed, 95% CI IV, Fixed, 95% CI
Fengyi Guan 2018 9.05 6.65 32 12.83 8 32 1.5 −3.78 [−7.38, −0.18]
Guifang Luan 2018 13.95 5.34 30 16.43 6.01 30 2.4 −2.48 [−5.36, 0.40]
Liangyu Huang 2018 7.78 1.35 30 11.62 1.16 29 48.4 −3.84 [−4.48, −3.20]
Lili Zeng 2018 3.63 1.56 30 5.97 1.68 30 29.6 −2.34 [−3.16, −1.52]
Wenfeng Wu 2011 6.95 4.77 30 9.87 4.52 30 3.6 −2.92 [−5.27, −0.57]
Xiyang Sun 2019 8.55 2.92 30 10.55 4.54 30 5.3 −2.00 [−3.93, −0.07]
Ying Gao 2020 7.73 4.39 30 10.3 4.53 30 3.9 −2.57 [−4.83, −0.31]
Yonggang Hao 2020 6.12 3.811 30 9.43 3.94 30 5.2 −3.31 [−5.27, −1.35]

Total (95% CI) 242 241 100.0 −3.15 [−3.60, −2.71]

Heterogeneity: Chi2 = 10.19, df = 7 (P = 0.18); I2 = 31%
−4 −2 0 2 4
Test for overall effect: Z = 13.85 (P < 0.00001)
Favours [experimental] Favours [control]

Figure 9: The forest plot of Symptom integral.

8 Evidence-Based Complementary and Alternative Medicine

Study or Subgroup Experimental Control Weight Risk Difference Risk Difference

Events Total Events Total (%) M-H, Fixed, 95% CI M-H, Fixed, 95% CI
Fengyi Guan 2018 1 32 0 32 14.5 0.03 [−0.05, 0.11]
Jia Du 2020 0 101 0 99 45.3 0.00 [−0.02, 0.02]
Liangyu Huang 2018 1 30 0 28 13.1 0.03 [−0.06, 0.12]
Xiyang Sun 2019 0 30 0 30 13.6 0.00 [−0.06, 0.06]
Ying Gao 2020 0 30 0 30 13.6 0.00 [−0.06, 0.06]

Total (95% CI) 223 219 100.0 0.01 [−0.01, 0.03]

Total events 2 0
Heterogeneity: Chi2 = 1.54, df = 4 (P = 0.82); I2 = 0%
−0.1 −0.05 0 0.05 0.1
Test for overall effect: Z = 0.76 (P = 0.45)
Favours [experimental] Favours [control]

Figure 10: The forest plot of adverse events.

score, were eliminated by the one-by-one method to conduct 0

sensitivity analysis. The main source leading to the increase
in heterogeneity was not found in the sensitivity analysis of
the stool property score, the first defecation time, and the 0.05
degree of difficulty in defecation. Therefore, the results

SE (log[RR])
obtained were relatively stable and reliable. The literature of
0.1
Jia Du was found to be the main source of increasing
heterogeneity in the sensitivity analysis of the PAC-QOL
scale score. After excluding this article, the PAC-QOL scale 0.15
score of the patients in the experimental group that received
the catgut embedding therapy was still lower than that of the
control group, and the difference between the two groups 0.2
0.5 0.7 1 1.5 2
was statistically significant (P < 0.05). Thus, the result ob-
RR
tained was still relatively stable and reliable.
Figure 11: The funnel plot of the efficacy rate.
5. Publication Bias Analysis
The efficacy rate of the outcome indices was included in
more than 10 studies. The publication bias was evaluated Thus, the process of catgut embedding can be completed
using a funnel chart. Visually, the points on the funnel chart promptly, which forms the long-term stimulatory effect of
were scattered and not entirely symmetrical, which indicated acupuncture points, realizing the long-term therapy mode.
the possibility of a publication bias (Figure 11). Since the Acupoint embedding is similar in principle to acupuncture
number of studies with first defecation time, defecation and moxibustion but has other advantages. In this therapy,
sensation score, degree of difficulty in defecation, stool the acupuncture effect is substituted with repeated stimu-
property score, PAC-QOL scale score, symptom integral, lation of acupoints using implanted thread bodies. The se-
and adverse event as outcomes was less than 10, all outcome lection of acupoints and the number of thread bodies are
indicators could not effectively evaluate the publication bias determined according to disease severity. Following acu-
with a funnel chart. Therefore, the Egger test was used to point catgut embedding, the stimulation of acupoints by
evaluate the publication bias and the results revealed that thread bodies with movement is similar to acupuncture,
there was no publication bias (P > 0.05). which can dredge meridians, regulate viscera, strengthen the
body’s resistance, and eliminate pathogen. Moreover, the
6. Discussion curative effect is stable and lasting [27] Reports show [28]
that the mechanism of the acupoint catgut embedding
Constipation, a common complication of stroke, seriously therapy for constipation may stimulate related acupoints
threatens the health of stroke patients. Constipation not only and parasympathetic nerves, increasing intestinal peristalsis.
affects the quality of life of patients but also induces various This therapy can simultaneously inhibit sympathetic nerves,
diseases. In severe cases, excessive defecation could increase increasing colorectal fluid secretion, and lubrication.
blood pressure and endanger the health of stroke patients. This systematic review and meta-analysis of the effec-
Therefore, alleviating constipation is essential to improving tiveness and safety of acupoint catgut embedding for the
the quality of life of stroke patients [26]. Although drugs are treatment of poststroke constipation have some limitations
effective in treating poststroke constipation, people are due to the quality of the literature selected. First, the studies
paying increasing attention to adverse drug reactions. used various acupoints. Second, there is no unified standard
Acupoint catgut embedding is a novel treatment mo- for the specific operation of acupoint embedding, such as the
dality. By implanting modern biomedical materials into the embedding method and acupoint selection. Third, the effi-
patient’s acupoint tissues, the catgut can remain in the body. cacy will also be affected by the operator’s technical level, the
Evidence-Based Complementary and Alternative Medicine 9

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