Table 3

Recommendations based on evidence level for traditional Chinese medicine content in Western medicine clinical practice guidelines

Recommendation levelGuideline titleTreatmentRecommendation contents
Level IChinese guidelines on diagnosis and management for cognitive impairment and dementiaChinese herbal preparationGinkgo leaf preparation has a mild effect in slowing down memory in older patients (grade A evidence).
Does not stop or slow down the development from MCI to dementia (grade A evidence)
Chinese guidelines on rehabilitation treatment for stroke (2011 full version)*Traditional Chinese medicineFor stroke rehabilitation, traditional Chinese medicine therapies can be added to conventional rehabilitation therapy (grade A evidence)
Guidelines on management for stroke rehabilitation (Simplify)†Traditional Chinese medicineIn the rehabilitation process of stroke, traditional Chinese medical therapies can be included as part of conventional rehabilitation therapy (grade A evidence)
Level IIChinese guidelines on prevention and treatment for acute ischaemic stroke (2010)AcupunctureDecision to choose acupuncture should take into account the patient's willingness to have acupuncture (level II recommendation, grade B evidence)
Chinese guidelines on rehabilitation treatment for stroke (2011 full version)
Guidelines on the management for stroke rehabilitation (Simplify)
Acupuncture


Acupuncture
Acupuncture can speed up physical recovery and improve motor ability during the flaccid paralysis stage of stroke patients (level II recommendation, grade B evidence).
Acupuncture may be used in bulbar paralysis patients (level II recommendation, grade B evidence).
Acupuncture may be used for bulbar paralysis patients (level II recommendation, grade B evidence)
Chinese guidelines on diagnosis and management for cognitive impairment and dementia (V): dementia therapyChinese herbal medicine and Chinese herbal preparationGinkgo leaf may improve the neuropsychic symptoms and slow down the disease progression of dementia (grade B evidence).
Ginkgo leaf extract does not reduce the incidence of AD in elderly people with mild cognitive impairment (grade B evidence). Salvia officinalis extract is able to improve cognitive function in mild and moderate AD patients and relieve the symptoms of agitation (grade B evidence)
Level IIIChinese guidelines on prevention and treatment for acute ischemic stroke (2010)Chinese patent medicineDecision to use acupuncture (level II recommendation, Grade B evidence) should take patient's willingness into consideration,
Chinese proprietary medicine (level III recommendation, grade C evidence)
Chinese guidelines of rehabilitation treatment for stroke (2011 full version)MassageRecommendation of massage for patients with severe limb spasm to relieve fatigue and muscular tension (level III recommendation, grade C evidence)
Chinese guidelines on rehabilitation treatment for stroke (2011 full version)MassageRecommendation of massage for patients with severe limb spasm to relieve fatigue and muscular tension (level III recommendation, grade C evidence)
  • Quality evidence based on GRADE: A, high quality; B, moderate quality; C, low quality; D, very low quality.

  • Quality level based on GRADE:

  • 1. High: we are very confident that the true effect lies close to that of the estimate of the effect.

  • 2. Moderate: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect but there is a possibility that it is substantially different.

  • 3. Low: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

  • 4. Very low: we have very little confidence in the effect estimate; the effect is likely to be substantially different from the estimate of effect.

  • *Although the two articles have partially similar content, we regarded them as different guidelines because of different form and part of the content.

  • †If level of evidence involved did not identify a specific standard, it was assessed based on GRADE standards.86

  • AD, Alzheimer's disease; GRADE, Grading of Recommendations, Assessment, Development and Evaluation; MCI, mild cognitive impairment.