Effect of pediatric Tuina on children's recurrent acute respiratory tract infections: a retrospective cohort study in Southern China

doi:10.19852/j.cnki.jtcm.2024.03.003

Journal of Traditional Chinese Medicine ›› 2024, Vol. 44 ›› Issue (3): 586-594.DOI: 10.19852/j.cnki.jtcm.2024.03.003

• Original articles • Previous Articles Next Articles

Effect of pediatric Tuina on children's recurrent acute respiratory tract infections: a retrospective cohort study in Southern China

YIN Lingjia¹, STÅLSBY LUNDBORG Cecilia², WU Darong³(), YANG Jinghua⁴, ALVESSON Helle Mølsted², CAI Jianxiong³, LU Taoying³, XIE Qianwen⁵, MARRONE Gaetano²

1 Department of Global Public Health, Karolinska Institutet, Stockholm 17177, Sweden; State Key Laboratory of Dampness Syndrome of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China; Outcome Assessment Research Team in Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China; Health Construction Administration Centre, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
2 Department of Global Public Health, Karolinska Institutet, Stockholm 17177, Sweden
3 State Key Laboratory of Dampness Syndrome of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China; Outcome Assessment Research Team in Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China; Health Construction Administration Centre, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
4 Department of Pediatrics, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
5 Outcome Assessment Research Team in Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China

Received:2023-01-22 Accepted:2023-05-25 Online:2024-06-15 Published:2024-04-30
Contact: Prof. WU Darong, State Key Laboratory of Dampness Syndrome of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China. darongwu@gzucm.edu.cn Telephone: +86-20-81887233-35842
Supported by:
National Key R & D Program of China: Intelligent Construction and Application Demonstration of Evidence-Based Systems for Key Diseases in Traditional Chinese Medicine(2019YFC1709800);Construction of Clinical and Basic Databases for 10 Key Diseases in Traditional Chinese Medicine(2019YFC1709802);Science and Technology Planning Project of Guangdong Province: the Opening and Operation of the Key Laboratory for Clinical Research on Traditional Chinese Medicine Syndromes in Guangdong Province(2017B030314166);Key-Area Research and Development Program of Guangdong Province: Systematic Research Project on Diagnostic Criteria for Diseases Related to Lingnan Dampness Syndrome(2020B1111100010)

Abstract

Abstract:

OBJECTIVE: To determine the effectiveness of pediatric Tuina (PT) in preventing recurrent acute respiratory tract infections (ARTIs) in children.

METHODS: This is a retrospective cohort study based on the electronic medical records of children with recurrent ARTIs in 2016. Children were divided into a PT group or a non-PT group, according to whether they had received PT or not in 2016. The primary outcome was the number of ARTI episodes in 2017 and 2018. The secondary outcomes were the number of ARTIs leading to outpatient department visits and outpatient antibiotic prescriptions due to ARTIs in the same time period. Negative binomial regressions were used to detect the association between PT and the outcomes.

RESULTS: A total of 2303 children were included in the analysis, including 94 in the PT group and 2209 in the non-PT group. Children who received PT six or more times in 2016 had fewer episodes of ARTIs in 2017 [incidence rate ratio (IRR): 0.59, 95% confidence interval (CI) (0.42-0.84)] and 2018 [IRR: 0.58, 95% CI (0.36-0.94)] and fewer outpatient department visits due to ARTIs in 2017 [IRR: 0.56, 95% CI (0.38-0.83)] than children who had not received PT in 2016. There was no significant difference in the number of outpatient antibiotic prescriptions between the two groups.

CONCLUSIONS: Receiving PT six or more times within one year is associated with a decrease in recurrent ARTIs in children in the following two years. Randomized controlled trials are needed for effect evaluation prior to establishing PT as a method for preventing recurrent ARTIs among children.

Key words: child, massage, pediatric Tuina, respiratory tract infections

YIN Lingjia, STÅLSBY LUNDBORG Cecilia, WU Darong, YANG Jinghua, ALVESSON Helle Mølsted, CAI Jianxiong, LU Taoying, XIE Qianwen, MARRONE Gaetano. Effect of pediatric Tuina on children's recurrent acute respiratory tract infections: a retrospective cohort study in Southern China[J]. Journal of Traditional Chinese Medicine, 2024, 44(3): 586-594.

Figures/Tables 4

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Characteristic	All (n = 2303)	Non-PT group (n = 2209)		PT group (n = 94)		Test value
Age in months (median, 25%-75%)	36.0 (24.0-48.0)	36.0 (24.0-48.0)		36.0 (24.0-48.0)	1.644^a		0.10
Sex [n (%)]					3.338^b		0.07
Female	1014 (44.0)	964 (43.6)		50 (53.2)
Male	1289 (56.0)	1245 (56.4)		44 (46.8)
Medical insurance type [(n (%)]					13.272^b		0.01
No insurance	813 (35.3)	785 (35.5)		28 (29.8)
Resident insurance	1188 (51.6)	1143(51.7)		45 (47.9)
Governmental employee insurance-district level	129 (5.6)	124 (5.6)		5 (5.3)
Governmental employee insurance-city level	116 (5.0)	106 (4.8)		10 (10.6)
Governmental employee insurance-province level	57 (2.5)	51 (2.3)		6 (6.4)
Number of outpatient visits due to ARTIs (mean±SD)	11.6±4.6	11.5±4.6		12.8±5.2		-2.629^a		0.01
Number of episodes of ARTIs (mean±SD)	7.3±1.6	7.3±1.6		7.6±1.9		-1.418^a		0.16
Number of visits due to upper ARTIs (mean±SD)	8.5±4.4	8.5±4.4		9.1±4.4		-1.528^a		0.13
Number of visits due to lower ARTIs (mean±SD)	3.1±3.5	3.1±3.5		3.7±3.8		-1.688^a		0.09
Number of children prescribed with antibiotics at least once [(n (%)]	1308.0±56.8	1257.0±56.9		51.0±54.3		0.300^b		0.61
Number of outpatient antibiotics prescriptions (mean±SD)	1.2±1.5	1.2±1.5		1.2±1.6		0.401^a		0.76
Antibiotics [(n (%)]
Cefixime (J01DD08)	345 (15.0)	330 (14.9)		15 (16.0)		0.073^b		0.79
Cefaclor (J01DC04)	211 (9.2)	203 (9.2)		8 (8.5)		0.050^b		0.82
Cefprozil (J01DC10)	147 (6.4)	145 (6.6)		2 (2.1)		2.970^b		0.09
Ceftriaxone (J01DD04)	52 (2.3)	48 (2.2)		4 (4.3)		1.772^b		0.18
Cefuroxime (J01DC02)	15 (0.7)	15 (0.7)		0 (0.0)		0.643^b		0.42
Cefradine (J01DB09)	1 (0.0)	1 (0.0)		0 (0.0)		0.043^b		0.84
Azithromycin (J01FA10)	884 (38.4)	848 (38.4)		36 (38.3)		0.0003^b		0.99
Amoxicillin and clavulanate potassium (J01CR02)	7 (0.3)	7 (0.3)		0 (0.0)		0.2988^b		0.58
Amoxicillin (J01CA04)	2 (0.1)	2 (0.1)		0 (0.0)		0.085^b		0.77
Roxithromycin (J01FA06)	2 (0.1)	2 (0.1)		0 (0.0)		0.085^b		0.77
Clindamycin (J01FF01)	95 (4.1)	91 (4.1)		4 (4.3)		0.004^b		0.95
Other Western medicine [(n (%)]
Pidotimod (L03AX05)	772 (33.5)	739 (33.5)		33 (35.1)		0.111^b		0.74
Oseltamivir (J05AH02)	640 (27.8)	611 (27.7)		29 (30.9)		0.458^b		0.50
Montelukast sodium (R03DC03)	1,155 (50.2)	1,113 (50.4)		42 (44.7)		1.173^b		0.28
Nebulized inhalation therapy [(n (%)]	2093 (91.0)	2012 (91.1)		81 (86.2)		2.625^b		0.11
Drugs used for nebulized inhalation therapy [(n (%)]
Salbutamol sulfate (R03CC02)	1727 (75.0)	1661 (75.2)		66 (70.2)		1.192^b		0.27
Budesonide (R03BA02)	982 (42.6)	940 (42.6)		42 (44.7)		0.167^b		0.68
Ipratropium bromide (R03BB01)	1183 (51.4)	1130 (51.2)		53 (56.4)		0.987^b		0.32
Xinju	999 (43.4)	965 (43.7)		34 (36.2)		2.073^b		0.15
Houning	1372 (59.6)	1322 (59.8)		50 (53.2)		1.658^b		0.20
Nasal irrigation [(n (%)]	182 (7.9)	182 (8.2)		0 (0.8)		8.409^b		0.01
Chinese medicine and therapies [(n (%)]
Chinese herb decoction	2236 (97.1)		2142 (97.0)	94 (100.0)		2.937^b		0.09
Application with herbal cream on acupoints	1324 (57.5)		1261 (57.1)	63 (67.0)		3.643^b		0.06
Application with intermediate frequency equipment on acupoints	1920 (83.4)		1844 (83.5)	76 (80.9)		0.448^b		0.50
Application with laser on acupoints	488 (21.2)		467 (21.1)	21 (22.3)		0.078^b		0.78
Acupuncture	4 (0.2)		4 (0.2)	0 (0.0)		0.171^b		0.68
Ear acupoints therapy	56 (2.4)		53 (2.4)	3 (3.2)		0.239^b		0.63
Cupping	3 (0.1)		3 (0.1)	0 (0.0)		0.128^b		0.72
Moxibustion	10 (0.4)		10 (0.5)	0 (0.0)		0.427^b		0.51
Bee needle acupuncture	10 (0.4)		10 (0.5)	0 (0.0)		0.427^b		0.51
Application with infrared ray on body	10 (0.4)		9 (0.4)	1 (1.1)		0.899^b		0.34

Characteristic	All (n = 2303)	Non-PT group (n = 2209)		PT group (n = 94)		Test value
Age in months (median, 25%-75%)	36.0 (24.0-48.0)	36.0 (24.0-48.0)		36.0 (24.0-48.0)	1.644^a		0.10
Sex [n (%)]					3.338^b		0.07
Female	1014 (44.0)	964 (43.6)		50 (53.2)
Male	1289 (56.0)	1245 (56.4)		44 (46.8)
Medical insurance type [(n (%)]					13.272^b		0.01
No insurance	813 (35.3)	785 (35.5)		28 (29.8)
Resident insurance	1188 (51.6)	1143(51.7)		45 (47.9)
Governmental employee insurance-district level	129 (5.6)	124 (5.6)		5 (5.3)
Governmental employee insurance-city level	116 (5.0)	106 (4.8)		10 (10.6)
Governmental employee insurance-province level	57 (2.5)	51 (2.3)		6 (6.4)
Number of outpatient visits due to ARTIs (mean±SD)	11.6±4.6	11.5±4.6		12.8±5.2		-2.629^a		0.01
Number of episodes of ARTIs (mean±SD)	7.3±1.6	7.3±1.6		7.6±1.9		-1.418^a		0.16
Number of visits due to upper ARTIs (mean±SD)	8.5±4.4	8.5±4.4		9.1±4.4		-1.528^a		0.13
Number of visits due to lower ARTIs (mean±SD)	3.1±3.5	3.1±3.5		3.7±3.8		-1.688^a		0.09
Number of children prescribed with antibiotics at least once [(n (%)]	1308.0±56.8	1257.0±56.9		51.0±54.3		0.300^b		0.61
Number of outpatient antibiotics prescriptions (mean±SD)	1.2±1.5	1.2±1.5		1.2±1.6		0.401^a		0.76
Antibiotics [(n (%)]
Cefixime (J01DD08)	345 (15.0)	330 (14.9)		15 (16.0)		0.073^b		0.79
Cefaclor (J01DC04)	211 (9.2)	203 (9.2)		8 (8.5)		0.050^b		0.82
Cefprozil (J01DC10)	147 (6.4)	145 (6.6)		2 (2.1)		2.970^b		0.09
Ceftriaxone (J01DD04)	52 (2.3)	48 (2.2)		4 (4.3)		1.772^b		0.18
Cefuroxime (J01DC02)	15 (0.7)	15 (0.7)		0 (0.0)		0.643^b		0.42
Cefradine (J01DB09)	1 (0.0)	1 (0.0)		0 (0.0)		0.043^b		0.84
Azithromycin (J01FA10)	884 (38.4)	848 (38.4)		36 (38.3)		0.0003^b		0.99
Amoxicillin and clavulanate potassium (J01CR02)	7 (0.3)	7 (0.3)		0 (0.0)		0.2988^b		0.58
Amoxicillin (J01CA04)	2 (0.1)	2 (0.1)		0 (0.0)		0.085^b		0.77
Roxithromycin (J01FA06)	2 (0.1)	2 (0.1)		0 (0.0)		0.085^b		0.77
Clindamycin (J01FF01)	95 (4.1)	91 (4.1)		4 (4.3)		0.004^b		0.95
Other Western medicine [(n (%)]
Pidotimod (L03AX05)	772 (33.5)	739 (33.5)		33 (35.1)		0.111^b		0.74
Oseltamivir (J05AH02)	640 (27.8)	611 (27.7)		29 (30.9)		0.458^b		0.50
Montelukast sodium (R03DC03)	1,155 (50.2)	1,113 (50.4)		42 (44.7)		1.173^b		0.28
Nebulized inhalation therapy [(n (%)]	2093 (91.0)	2012 (91.1)		81 (86.2)		2.625^b		0.11
Drugs used for nebulized inhalation therapy [(n (%)]
Salbutamol sulfate (R03CC02)	1727 (75.0)	1661 (75.2)		66 (70.2)		1.192^b		0.27
Budesonide (R03BA02)	982 (42.6)	940 (42.6)		42 (44.7)		0.167^b		0.68
Ipratropium bromide (R03BB01)	1183 (51.4)	1130 (51.2)		53 (56.4)		0.987^b		0.32
Xinju	999 (43.4)	965 (43.7)		34 (36.2)		2.073^b		0.15
Houning	1372 (59.6)	1322 (59.8)		50 (53.2)		1.658^b		0.20
Nasal irrigation [(n (%)]	182 (7.9)	182 (8.2)		0 (0.8)		8.409^b		0.01
Chinese medicine and therapies [(n (%)]
Chinese herb decoction	2236 (97.1)		2142 (97.0)	94 (100.0)		2.937^b		0.09
Application with herbal cream on acupoints	1324 (57.5)		1261 (57.1)	63 (67.0)		3.643^b		0.06
Application with intermediate frequency equipment on acupoints	1920 (83.4)		1844 (83.5)	76 (80.9)		0.448^b		0.50
Application with laser on acupoints	488 (21.2)		467 (21.1)	21 (22.3)		0.078^b		0.78
Acupuncture	4 (0.2)		4 (0.2)	0 (0.0)		0.171^b		0.68
Ear acupoints therapy	56 (2.4)		53 (2.4)	3 (3.2)		0.239^b		0.63
Cupping	3 (0.1)		3 (0.1)	0 (0.0)		0.128^b		0.72
Moxibustion	10 (0.4)		10 (0.5)	0 (0.0)		0.427^b		0.51
Bee needle acupuncture	10 (0.4)		10 (0.5)	0 (0.0)		0.427^b		0.51
Application with infrared ray on body	10 (0.4)		9 (0.4)	1 (1.1)		0.899^b		0.34

Item	Number of ARTIs episodes in 2017		Number of ARTIs episodes in 2018
Item	Crude IRR (95% CI)	Adjusted IRR (95% CI)^a	Crude IRR (95% CI)	Adjusted IRR (95% CI)^a
Non-PT	REF	REF	REF	REF
PT	0.96 (0.81-1.13)	0.91 (0.78-1.07)	1.08 (0.86-1.36)	1.03 (0.83-1.29)
Number of PT in 2016
0	REF	REF	REF	REF
1-2	0.98 (0.77-1.25)	1.00 (0.80-1.26)	1.10 (0.79-1.54)	1.19 (0.87-1.64)
3-5	1.10 (0.82-1.46)	1.04 (0.79-1.36)	1.30 (0.87-1.93)	1.16 (0.79-1.69)
≥6	0.73 (0.51-1.04)	0.59 (0.42-0.84)^b	0.75 (0.46-1.22)	0.58 (0.36-0.94)^c

Item	Number of ARTIs episodes in 2017		Number of ARTIs episodes in 2018
Item	Crude IRR (95% CI)	Adjusted IRR (95% CI)^a	Crude IRR (95% CI)	Adjusted IRR (95% CI)^a
Non-PT	REF	REF	REF	REF
PT	0.96 (0.81-1.13)	0.91 (0.78-1.07)	1.08 (0.86-1.36)	1.03 (0.83-1.29)
Number of PT in 2016
0	REF	REF	REF	REF
1-2	0.98 (0.77-1.25)	1.00 (0.80-1.26)	1.10 (0.79-1.54)	1.19 (0.87-1.64)
3-5	1.10 (0.82-1.46)	1.04 (0.79-1.36)	1.30 (0.87-1.93)	1.16 (0.79-1.69)
≥6	0.73 (0.51-1.04)	0.59 (0.42-0.84)^b	0.75 (0.46-1.22)	0.58 (0.36-0.94)^c

Item	The number of outpatient visits due to ARTIs in 2017		The number of outpatient visits due to ARTIs in 2018
Item	Crude IRR (95% CI)	Adjusted IRR (95% CI)^a		Crude IRR (95% CI)	Adjusted IRR (95% CI)^a
Non-PT	REF	REF	REF		REF
PT	0.99 (0.81-1.22)	0.97 (0.80-1.16)	1.12 (0.86-1.46)		1.07 (0.83-1.37)
Number of massages in 2016
0	REF	REF	REF		REF
1-2	1.01 (0.76-1.35)	1.06 (0.82-1.40)	1.07 (0.73-1.58)		1.22 (0.85-1.75)
3-5	1.17 (0.83-1.66)	1.13 (0.82-1.56)	1.37 (0.87-2.18)		1.19 (0.77-1.83)
≥6	0.73 (0.48-1.11)	0.56 (0.38-0.83)^b	0.89 (0.52-1.54)		0.62 (0.37-1.06)

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Effect of pediatric Tuina on children's recurrent acute respiratory tract infections: a retrospective cohort study in Southern China

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