Bazı Popüler Tamamlayıcı ve Alternatif Tıp Yöntemleri Hakkında Ne biliyoruz? Cochrane Veritabanı'nda Sistematik Bir Derleme

Year 2023, Volume: 21 Issue: 2, 261 - 336, 23.08.2023

Petek Eylül Taneri , Murat Civaner

https://doi.org/10.20518/tjph.1196149

Abstract

Amaç: Bu çalışma, Türkiye'de yasallaştırılan 14 tamamlayıcı ve alternatif tıp (TAT) yönteminin etkililiği ve güvenliğine ilişkin kanıt düzeyini araştırmayı amaçlamaktadır.

Yöntem: Akupunktur, apiterapi, hipnoterapi, sülük tedavisi, homeopati, kupa tedavisi, kayropraktik, proloterapi, osteopati, kurtçuk tedavisi, mezoterapi, müzik terapisi, refleksoloji, ozon tedavisi için Cochrane Sistematik Derleme Veritabanı’nda sistematik bir literatür taraması yapıldı. Taramadan sonra kalitatif senteze 287 çalışma dahil edildi. Kanıt kalitesi 'yüksek/orta/düşük' olarak sınıflandırıldı. Sistematik incelemelerin kalitesini değerlendirmek için AMSTAR-2 kullanıldı. Çalışma PROSPERO'ya (CRD42019127509) kaydedildi.

Bulgular: Akupunktur için çeşitli endikasyonlarda 16 düşük (LQE) ve dört orta kalitede kanıt (MQE) bulunurken, bu yöntemin 13 endikasyonda etkililiği olmadığı gösterilmiştir. Güvenliği konusunda altı LQE ve bir MQE vardır. Bir çalışma, apiterapinin etkililiğine dair yüksek kaliteli kanıtlar bulmuş ve balın yanık yaralarının iyileşmesini hızlandırdığı sonucuna varmıştır. Bazı endikasyonlar için üç LQE ve iki MQE düzeyinde kanıt bulunmuş ve beş çalışma etkililiği olmadığını göstermiştir; ancak güvenliliğine ilişkin kanıt bulunmamaktadır. Müzik terapisinin etkililiği üzerine 13 LQE ve üç MQE bulunurken, bir çalışma etkili olmadığını bildirmiştir. Dört çalışma, hipnoterapinin bazı durumlarda etkili olabileceğini gösteren LQE bulmuş ve bir çalışma etkisiz olduğunu saptamıştır. Osteopati ile ilgili olarak, bir çalışmada MQE ve bir çalışmada LQE bulunmuştur. Bir çalışma, kayropraktik etkililiği için LQE düzeyine kanıt bildirmiştir. Homeopatinin etkililiğine ilişkin tek kanıt düşük kalitededir ve dört çalışma bu yöntemin etkili olmadığını göstermiştir. Güvenliliği konusunda bir LQE bulunmaktadır.

Sonuç: Yeterli düzeyde kanıt bulunmadığı için Türkiye'de yasallaştırılmış bulunan 14 TAT yöntemi günlük tıbbi uygulamada kullanılmamalıdır. Bilimsel olarak yarar-zarar değerlendirmeleri yapabilmek için yüksek kalitede kanıt üretmeyi amaçlayan araştırmalara gereksinim vardır.

Keywords

Tamamlayıcı Tıp, Alternatif Tıp, Etkiliik, Güvenlilik, Sistematik derleme

What do we know about some popular methods of complementary and alternative medicine: An overview of Cochrane systematic reviews

Abstract

Objective: This study aims to investigate the level of evidence on the effectiveness and safety of 14 complementary and alternative medicine (CAM) methods that were legalized in Turkiye (Turkey).

Methods: A systematic literature search was conducted in the Cochrane Systematic Review Database for acupuncture, apitherapy, hypnotherapy, leech therapy, homeopathy, cupping therapy, chiropractic, prolotherapy, osteopathy, maggot therapy, mesotherapy, music therapy, reflexology, ozone therapy. After screening, 178 studies were included in the qualitative synthesis. Evidence quality was classified as ‘high/ moderate/low’. AMSTAR-2 was used to evaluate the quality of systematic reviews. This study was registered to PROSPERO(CRD42019127509).

Results: There are 16 low (LQE) and four moderate-quality evidence (MQE) of effectivity for various conditions were found for acupuncture, while it has no effectivity on 13 conditions. There are six LQE and one MQE on its safety. One study found high-quality evidence of the effectivity of apitherapy concluded honey accelerates healing of burn wounds. Thirteen LQE and three MQE showed the effectiveness of music therapy, while one study reported it as ineffective. Four studies found LQE showing hypnotherapy might be effective in some conditions, and one study found it was ineffective. Regarding osteopathy, one study found MQE, and one study found LQE. One study reported LQE for the effectiveness of chiropractic. The only evidence for the effectivity of homeopathy is of low quality and four studies have shown that it is not effective.

Conclusions: Since there is insufficient evidence, 14 CAM methods legalised in Turkiye should not be used
in routine medical practice. Future researches aiming to produce high-quality evidence are needed.

Keywords

Complementary medicine, alternative medicine, effectivity, safety, systematic review

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