Effectiveness of Acupuncture for Early Recovery of Bowel Function in Cancer: A Systematic Review and Meta-Analysis

Table 2

Level of evidence (GRADE).

Outcomes	Illustrative assumed risk	comparative (95% CI)	Relative effect (95% CI)	Number of participants (studies)	Quality of the evidence	Comments
Time to first flatus		The mean time to first flatus in the intervention groups was 0.82 standard deviations lower (1.47 to 0.17 lower)		571 (8 studies)	⊕⊕  ⊝⊝; low^1	SMD −0.82 (−1.47 to −0.17)
Time to first defecation		The mean time to first defecation in the intervention groups was 0.98 standard deviations lower (1.73 to 0.22 lower)		572 (8 studies)	⊕⊕  ⊝⊝; low^1	SMD −0.98 (−1.73 to −0.22)
Pain score		The mean pain score in the intervention groups was 0.05 standard deviations lower (0.35 lower to 0.25 higher)		409 (5 studies)	⊕  ⊝⊝⊝; very low^1	SMD −0.05 (−0.35 to 0.25)
Opioids consumption		The mean opioids consumption in the intervention groups was 0.38 standard deviations lower (0.59 to 0.17 lower)		363 (5 studies)	⊕  ⊝⊝⊝; very low^1	SMD −0.38 (−0.59 to −0.17)
Length of hospital stay		The mean length of hospital stay in the intervention groups was 0.18 standard deviations lower (0.46 lower to 0.1 higher)		282 (4 studies)	⊕  ⊝⊝⊝; very low^1	SMD −0.18 (−0.46 to 0.1)
Postoperative ileus	184 per 1000	184 per 1000 (90 to 338)	RR 1 (0.58 to 1.69)	319 (4 studies)	⊕  ⊝⊝⊝; very low^1
	92 per 1000	92 per 1000 (43 to 186)
Time to first bowel sound		The mean time to first bowel sound in the intervention groups was 2.35 standard deviations lower (4.74 lower to 0.03 higher)		193 (3 studies)	⊕  ⊝⊝⊝; very low^1	SMD −2.35 (−4.74 to 0.03)
Acupressure-time to first flatus		The mean acupressure-time to first flatus in the intervention groups was 0.69 standard deviations lower (1.06 to 0.31 lower)		114 (2 studies)	⊕  ⊝⊝⊝; very low^1	SMD −0.69 (−1.06 to 0.31)
Acupressure-time to defecation		The mean acupressure-time to defecation in the intervention groups was 7.75 lower (18.15 lower to 2.65 higher)		114 (2 studies)	⊕  ⊝⊝⊝; very low^1	SMD −0.28 (−0.65 to 0.08)

basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI); CI: confidence interval; RR: risk ratio; high quality: further research is very unlikely to change our confidence in the estimate of effect; moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; very low quality: we are very uncertain about the estimate.