Acupuncture and stroke rehabilitation

Abstract

A cupuncture has been used in traditional Chinese medicine for more than 3000 years as a treatment for many diseases and is especially well accepted in China for rehabilitation after stroke.1 Several systematic reviews have suggested that acupuncture is effective in stroke rehabilitation; [2][3][4][5][6] however, the results were inconclusive because of extensive heterogeneity across trial outcomes and a high risk of bias.In this issue, Kong and colleagues report their finding of no specific effect of acupuncture on functional recovery after stroke.7 For their systematic review and meta-analysis, they included sham-controlled randomized clinical trials identified through a search of 25 databases and 12 major Korean traditional medicine journals from their inception to October 2009. Trials that compared acupuncture (with or without electrical stimulation) and sham acupuncture regardless of the age and sex of patients, and the stages (acute, subacute and chronic) and types of stroke (ischemic and hemorrhagic) were included. The outcome measures evaluated were neurologic deficit, activities of daily living, motor recovery, quality of life and adverse events. The methodologic quality of the trials was assessed using the Cochrane risk-of-bias criteria and the PEDro (Physiotherapy Evidence Database) scale. Kong and colleagues identified 664 potentially relevant studies, 10 of which were included in their systematic review.Lack of blinding in randomized trials has been shown to be associated with more exaggerated odds ratios for intervention effect, by 9% on average.8 Previous systematic reviews included not only randomized clinical trials that compared acupuncture with placebo or sham acupuncture but also ones that compared acupuncture with no acupuncture or other treatment.2-6 Kong and colleagues included only randomized clinical trials that compared acupuncture with sham acupuncture. Sham acupuncture includes the use of needles on nonacupuncture points or electrostimulation via electrodes attached to the skin. With the use of sham acupuncture as a control, participants are expected to be blinded to treatment allocation, with the result being a reduction in the risk of performance bias. Therefore, the results of the effects of acupuncture reported in sham-or placebo-controlled trials should be more valid and reliable. A recent systematic review and meta-analysis showed that the use of sham acupuncture may contribute to study heterogeneity and affect the results (odds ratio 0.57, 95% confidence interval 0.30-0.41). 6 It also showed no difference in effectiveness between sham acupuncture and true acupuncture. 6 The lack of a positive effect of acupuncture in stroke rehabilitation reported by Kong and colleagues should be interpreted with caution because of the following limitations.First, the studies included in their systematic review were small (8-120 participants). Although one of the benefits of meta-analysis is that a synthesis of inadequately powered studies can yield interesting findings, a large number of studi...

Acupuncture for Shoulder Pain After Stroke: A Systematic Review

“…Also, Wu et al 7 concluded that there is no clear evidence relating to the effects of acupuncture in subacute or chronic stroke. The systematic review performed for this report study focused on uncovering evidence of the effects of acupuncture for shoulder pain after stroke, instead of a broader assessment of pain after stroke.…”

“…5,6 Recent articles reviewing the efficacy and safety of acupuncture in stroke have appeared, but no clear effects of acupuncture were shown. 7,9 In the literature, there has been no systematic review assessing the effects of acupuncture for shoulder pain following stroke. Therefore, the aim of this study was to summarize and evaluate the results of relevant trials involving this area.…”

The role of electroacupuncture in stroke treatment: A systematic review of the literature

“…In a prospective randomized controlled trial, carried out in a stroke rehabilitation unit in Hong Kong among 106 patients with moderate or severe functional impairment 3 to 15 days after acute stroke, no additional improvement was shown in motor impairment or disability over a 10 week period in patients receiving traditional Chinese manual acupuncture as compared with the control . Moreover, systematic reviews and meta-analysis of nineteen trials involving 1576 patients did not find a statistically significant therapeutic benefit of traditional acupuncture on motor recovery for patients with subacute or chronic stroke Wu et al, 2008). However, a more recent comparative study of acupuncture versus EA regarding their effectiveness in treating post-stroke spastic paralysis showed that they were both effective and that EA was superior to traditional acupuncture alone (Yue et al, 2012).…”

Increased Brain Activation in Motor Cortex After Acupuncture Treatment for Motor Recovery in Chronic Stroke Patients

“…Acupuncture also induces changes in regional cerebral blood flow surrounding infarcts [6]. However, to date, no convincing scientific evidence from clinical trials has been published showing acupuncture to be effective as a therapy after stroke in enhancing functional improvement [7][8][9][10]. Furthermore, the neural mechanism of acupuncture in stroke patients has not yet been well defined [2].…”