key: cord-0694667-u5mblp05
authors: Xu, Xiao; Shi, Ya-Nan; Wang, Rong-Yun; Liu, Ting; Xu, Jingming; Mao, Wen; Sun, Qiu-Hua
title: Home-based traditional Chinese medicine nursing interventions for discharged patients with COVID-19: A rapid review of Chinese Guidelines
date: 2020-07-16
journal: Integr Med Res
DOI: 10.1016/j.imr.2020.100479
sha: caff5fd77e5f7f9cf50c46b1cfb9f359710e23cf
doc_id: 694667
cord_uid: u5mblp05

BACKGROUND: The aim of this review is to comprehensively summarize and analyze the current guidelines on home-based traditional Chinese medicine (TCM) nursing interventions for discharged patients with COVID-19. METHODS: Eight data sources were searched until June 28, 2020. The frequency of home-based TCM nursing interventions and the use of specific acupuncture points recommended in Chinese guidelines for discharged COVID-19 patients were computed and analyzed. RESULTS: In total, we identified five Chinese guidelines that provide for home-based TCM nursing interventions for discharged patients with COVID-19. Moxibustion and acupressure were singled out as the most frequently used of the 11 home-based TCM nursing interventions recommended by these guidelines. RN12 and ST36 were the two most promoted acupuncture points for moxibustion and acupressure interventions for these patients. CONCLUSIONS: The present review showed the important role of home-based TCM nursing interventions for discharged COVID-19 patients. However, direct evidence of their efficacy is still insufficient.

The novel coronavirus SARS-CoV-2 has resulted in a global pandemic of coronavirus disease 2019 (COVID-19). 1 Given the absence of a vaccine or effective antiviral drugs against SARS-CoV-2, traditional Chinese medicine (TCM) has been highly recommended in Chinese treatment guidelines for COVID-19. 2 According to a recent report from the National Administration of Traditional Chinese Medicine, TCM coupled with Western medicine therapy was found to have a superior effect on improving the clinical symptoms, decreasing the length of hospital stay, and preventing the deterioration of the condition of patients with COVID-19 3 than the recourse to Western medicine alone.

Thanks to the successful implementation of integrated TCM and Western medicine therapy, a total of 78,580 patients in China have been cured and discharged from the hospital as of April 26, 2020. However, a large number of cured patients, especially those who were affected by severe forms of the disease, may continue to experience fatigue, sleep dysfunction, ache, respiratory dysfunction, anxiety, insomnia and lack of appetite even after their discharge from the hospital. Approximately 84.3% of them are in urgent need of professional TCM rehabilitation. 4 However, the public health crisis caused by the outbreak of the novel coronavirus has prevented these discharged patients from consulting TCM physicians at rehab outpatient clinics, since they are isolated at home. Therefore, home-based TCM nursing interventions have become an important method to promote the rehabilitation and health of COVID-19 discharged patients, particularly under the current circumstances.

Home-based TCM nursing interventions are family-centered non-invasive self-care technologies, which are established under the guidance of the basic theory of TCM. 5 TCM nursing interventions are very popular and highly favored by the Chinese population owing to their advantages of self-administration, simplicity, convenience, effectiveness, and low cost. 6 Thus, they are very suitable for discharged patients with COVID-19 who are isolated at home. Notably, home-based TCM nursing interventions have been used successfully in previous epidemic outbreaks, including SARS 7 and H1N1 influenza. 8 Recently, Ang et al. 9 demonstrated the therapeutic effectiveness of TCM in treating patients with COVID-19 at the recovery stage. The aim of this review is to further summarize and analyze the current guidelines on home-based TCM nursing interventions for discharged patients with COVID-19.

In order to identify guidelines for home-based TCM nursing intervention, the following data sources were searched from their inception until June 28, 2020: The search terms were "COVID-19," "SARS-COV-2," "novel coronavirus," "coronavirus disease 2019," "severe acute respiratory syndrome coronavirus 2," "2019-nCoV," "2019-CoV," and specific TCM nursing interventions ("TCM nursing," "moxibustion," "cupping," "gua sha," "acupressure," "fumigation," "TCM exercise," etc.). Supplementary 1 shows the detailed search strategy. Any indexed terms equivalent to "COVID-2019" and "TCM nursing interventions" were also included in order to extend coverage.

Only guidelines regarding home-based TCM nursing interventions for discharged patients with COVID-19 were included in this study. Discharged patients are defined as meeting the following discharge criteria: 10 (1) 

Two reviewers (Xu and Shi) conducted data extraction independently in accordance with a pre-defined standard data extraction sheet, cross-checked the results and examined any discrepancies. Inconsistent opinions were resolved via a discussion. If no consensus was achieved, the third reviewer (Sun) arbitrated the disagreements. The 

In total, five guidelines on home-based TCM nursing interventions for discharged COVID-19 patients were identified. Two of these were issued by province-level municipalities (Beijing and Tianiin), one by the authorities of the Sichuan province, one by the National Administration of Traditional Chinese Medicine, and the remaining one by the University Hospital in Wuhan city. The detailed flow chart of the selection process is shown in Figure 1 .

The details of TCM nursing interventions are summarized in Table 1 

In total, we identified five Chinese guidelines that provide for home-based TCM nursing interventions for discharged COVID-19 patients. Moxibustion and acupressure were identified as the most frequently used methods among the 11 home-based TCM nursing interventions prescribed by these guidelines. In addition, RN12 and ST36 were the most recommended acupuncture points for moxibustion and acupressure for these patients.

Firstly, although we have reviewed and summarized the available guidelines regarding home-based TCM nursing interventions for discharged patients with COVID-19, direct evidence of their effectiveness is still insufficient. Secondly, most of the guidelines included in this study provided incomplete information on the details of each home-based TCM nursing intervention. Thirdly, we were unable to find relevant guidelines which specifically target pediatric COVID-19 patients. Lastly, we limited our search to a period ending on June 28, 2020. As a result, information that has been updated by the Chinese government since that date in this review.

Previously, a single review performed by Zhang et al. 11 Chinese texts only, rather than evidence-based guidelines. Thus, important TCM nursing interventions such as auricular acupressure or gua sha were omitted. In comparison, our review provides more detailed information on the recommended acupuncture points and the frequency of home-based TCM nursing interventions, which may help patients perform these self-administrated interventions at home.

According to our results, moxibustion and acupressure play dominant roles amongst the 11 home-based TCM nursing interventions recommended for discharged patients with COVID-19. Moxibustion may effectively strengthen the body's ability to restore yang and promote the primary Qi. Although no randomized controlled trial was carried out in their study to ascertain the effectiveness and safety of these interventions for discharged COVID-19 patients, Huang et al. 12 revealed that moxibustion may relieve anxiety and improve the symptoms of anorexia and shortness of breath for inpatient with mild forms of the disease. Moreover, the previous systematic review and clinical trials provided indirect evidence of the effectiveness of acupressure in the treatment of allergic respiratory diseases 13 and severe viral pneumonia. 14 The most frequently selected acupuncture points were found to be ST36 and RN12, shu and mu respectively, which are part of the stomach channel. Thus, moxibustion or acupressure at ST36 and RN12 can strengthen the spleen and stomach Qi so as to J o u r n a l P r e -p r o o f improve the appetite of the patients. In summary, these specific interventions may have a beneficial effect on discharged patients with COVID-19. However, we cannot provide a recommendation as there still lack randomized controlled trials (RCTs) examining their effectiveness in the treatment of these patients.

Further well-designed RCTs on home-based TCM nursing interventions for discharged patients with COVID-19 are urgently needed. Incidentally, several RCT protocols have recently been incorporated into the Chinese clinical trial registry (http://www.chictr.org.cn/). The completion of clinical trials will provide additional evidence, which will facilitate the generalization of results and the rational application of home-based TCM nursing interventions for discharged COVID-19 patients.

It is worth noting that current TCM nursing research still lacks evidence-based nursing concepts, and high-quality clinical trials are scarce in this field. 5 Thus, ongoing RCTs regarding home-based TCM nursing interventions for discharged patients with COVID-19 should strictly follow the Consolidated Standards of Reporting Trials (CONSORT) statement. 15 Considering the nature of TCM nursing interventions, participant blinding was not always possible. However, statistician and outcome assessor blinding should be implemented in order to minimize the risk of detection bias.

Moreover, researchers studying TCM nursing should also refer to a core outcome set for COVID-19 (COS-COVID) in setting clinical outcomes. 16 In conclusion, this review has shown the important role played by home-based TCM J o u r n a l P r e -p r o o f 

The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak -an update on the status

China National Health Commision. Guideline on diagnosis and treatment of COVID-19

Press conference of the joint prevention and control mechanism of state council on

Insights on the development of TCM nursing

Introducing traditional Chinese nursing: a review of concepts, theories and practices

Nursing SARS patients by combination of TCM with Western Medicine

TCM nursing of H1N1 influenza A. Contemporary nurses

Herbal medicine and pattern identification for treating COVID-19: a rapid review of guidelines

A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia

Analysis and Suggestion of Traditional Chinese Medicine Nursing for Discharged Patients with New Coronavirus Pneumonia (COVID-19)

Clinical observation of heat-sensitive moxibustion treatment for coronavirus disease

Acupressure for respiratory allergic diseases: a systematic review of randomised controlled trials

Treatment of 40 cases of severe viral pneumonia with Chinese medicine combined with acupressure

Improving the quality of reporting of randomized controlled trials. The CONSORT statement

We would like to appreciate and respect all nurses, doctors and TCM practitioners on the coronavirus front line.J o u r n a l P r e -p r o o f

The authors declare that there is no conflict of interest. Not