OBJECTIVE: To evaluate the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage through a network Meta-analysis.

METHODS: A computer-based search was conducted in 8 databases, including China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, PubMed, Cochrane Library, Web of Science, Scopus, and Embase, from their inception until February 19, 2023. Randomized controlled trials (RCTs) investigating the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage were included. Two researchers independently screened the literature, extracted data from the included studies, and performed quality assessment using the Cochrane Collaboration's standards. The software Stata 17.0 was used to create a network evidence graph for each combination of Traditional Chinese Medicine external treatment methods and rehabilitation training, and to generate a publication bias funnel plot. Network Meta-analysis was conducted using RevMan 5.3 to assess the risk of bias in the included studies, with mean difference (MD) used for continuous variables and odds ratio (OR) used for dichotomous variables. If there was good consistency among the included studies (P > 0.05), a consistency model was applied for data analysis. If there was poor consistency among the included studies (P < 0.05), an inconsistency model was used.

RESULTS: A total of 27 studies involving 2113 patients with limb dysfunction caused by cerebral hemorrhage were included. The results of the network Meta-analysis indicated that the combined use of 7 Traditional Chinese Medicine external treatment methods and rehabilitation training was more effective in improving limb function in patients with cerebral hemorrhage compared to rehabilitation training alone. In terms of improving simplified Fugl-Meyer Assessment (FMA) scores, the effectiveness ranking was as follows: acupuncture + rehabilitation training > Acupoint sticking therapy + rehabilitation training > massage + rehabilitation training > electroacupuncture + rehabilitation training > moxibustion + rehabilitation training > Traditional Chinese Medicine therapy+ rehabilitation training > Chinese herbal fumigation + rehabilitation training. In terms of improving Barthel Index (BI) scores, the effectiveness ranking was as follows: electroacupuncture + rehabilitation training > Acupoint sticking therapy + rehabilitation training > acupuncture + rehabilitation training > massage + rehabilitation training > moxibustion + rehabilitation training > Traditional Chinese Medicine fumigation + rehabilitation training > Traditional Chinese Medicine therapy+ rehabilitation training.

CONCLUSION: Based on existing literature evidence, our findings suggest the following: (a) The combination of the seven commonly used external treatment methods with rehabilitation training is superior to using rehabilitation training alone for the treatment of hemiplegia resulting from cerebral hemorrhage. (b) In terms of improving FMA scores, the combination of acupuncture and rehabilitation training shows the most significant effectiveness. (c) In terms of improving BI scores, the combination of electro-acupuncture and rehabilitation training demonstrates the most significant effectiveness. Therefore, we still need more multicenter, large-sample, high-quality randomized controlled trials to further validate the findings of this study.