Chinese guidelines on acupuncture for post-stroke dysphagia – quality assessment and evidence analysis

Clinical practice guidelines (CPGs) set quality standards for effective and safe practices, which should be supported by robust evidence. We aimed to identify and evaluate the quality of current Chinese CPGs regarding the use of acupuncture for post-stroke dysphagia and to compare their supporting evidence.

Four Chinese databases and two websites were searched to identify relevant CPGs. Two reviewers independently screened the titles, abstracts, and full texts. Two authors assessed the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II).

After title/abstract and full-text screening, and removal of duplicates and irrelevant CPGs, 13 CPGs remained. The CPGs were published between 2011 and 2024. Moreover, ten guidelines were affiliated with hospitals/universities, while three did not indicate their authors’ affiliations. The CPGs were sponsored by the World Health Organization, professional committees, and the National Administration of Traditional Chinese Medicine. Among the 13 guidelines, four Western medicine guidelines were published by the same first author (on behalf of the Stroke Association) in 2012, 2017, 2019, and 2023. Evaluation using AGREE II revealed that the quality of the 13 CPGs varied. Specifically, five, two, and six guidelines were graded A, B, and C, respectively. The CPGs were backed by poor and often outdated evidence. Notably, only one CPG was developed by professionals with knowledge regarding acupuncture, eight CPGs were mainly developed by traditional Chinese or integrative medicine doctors, and the remaining four CPGs were developed by Western medicine doctors.

It is important to improve the quality of CPGs and their underlying evidence. Additionally, CPGs should be developed by research methodologists and appropriately qualified clinicians.