干预成分分析法(ICA)用于识别系统评价中中医复杂干预关键特征的理论探究——以推拿治疗膝骨关节炎为示例的ICA应用

Theoretical Exploration of Intervention Component Analysis(ICA)Identifying the Critical Features of Traditional Chinese Medicine Complex Interventions——Application of ICA on Tuina Treatment for Knee Osteoarthritis as an Example

中医复杂干预具有个性化、动态化、时空观等特点,如何实施过程标准化、如何说明复杂方案中不同干预措施的作用机制、如何构建和阐述复杂干预方案背后的理论依据是中医复杂干预研究的重点。干预成分分析法(Intervention component analysis,ICA)是一种识别不同干预措施间影响结局变化关键特征的定性分析技术,适用于现有理论无法解释干预方案对结局影响,或方法学评价中存在干预措施信息描述不全面等情况。本文以推拿治疗膝骨关节炎为示例探索ICA应用,研究经过综合对比推拿治疗KOA有效性的证据、识别推拿治疗KOA的手法特征,进而阐明推拿治疗KOA的作用机理,明确了推拿手法治疗KOA的关键要素,其中治疗部位、治疗目的及相应手法应用是影响疗效的关键要素,治疗中手法力度、患者病情变化及治疗后危险因素是维持疗效、保证安全性的关键要素。本文仅以推拿为示例探索ICA方法,但是针灸穴位多样、中药方剂复杂等在ICA方法的应用尚未开展,因此,研究者需要进一步改进ICA以适合中医干预措施研究分析的最佳条件,欢迎学界同仁批评指正。

Complex intervention of traditional Chinese medicine has the characteristics of individuality,dynamic and time space view.That how to implement process standardization,how to explain the mechanism of action of different interventions in complex treatment and how to establish the theoretical basis of the complex intervention become the key point of TCM complex intervention study.Intervention Component Analysis(ICA)is a qualitative Analysis technique to identify key characteristics of different interventions affecting outcome changes.It is suitable for situations where existing theories cannot explain the impact of Intervention schemes on outcome,or intervention information description is incomplete in methodological evaluation.ICA could not solve complex intervention in clinical trials of traditional Chinese medicine report fully and analyzes in-depth problems such as insufficient understanding,background factors,to assist the key feature of complex intervention affect curative effect of traditional Chinese medicine and its theoretical basis.In this paper,the application of ICA in the treatment of knee osteoarthritis by Tuina was explored,the evidence of the effectiveness of Tuina in the treatment of KOA was comprehensively compared,the characteristics of Tuina in the treatment of KOA were identified,and the mechanism of Tuina in the treatment of KOA was elucidated,and the key elements of Tuina in the treatment of KOA were clarified.Among them,the targeted areas,the purpose of treatment and the application of corresponding manipulations were the key factors affecting the efficacy.The strength of manipulations during treatment,the changes of the patient's condition and the risk factors after treatment were the key factors to maintain the efficacy and ensure the safety.However,the application of acupuncture points and complex traditional Chinese medicine prescriptions in ICA has not been carried out.Therefore,researchers need to further improve the ICA to suit the best conditions for the research and analysis of TCM interventions.Criticism and corrections from academic colleagues are welcome.