Acupuncture in Poststroke Rehabilitation

Abstract

Background and Purpose-Acupuncture is a low-risk treatment with purported claims of effectiveness for poststroke rehabilitation. To comprehensively assess the efficacy of acupuncture in poststroke rehabilitation, we conducted a systematic review and meta-analysis of all randomized clinical trials of acupuncture for poststroke rehabilitation. Methods-We searched 7 English and 2 Chinese databases from inception to September 2009. Eligible studies included randomized clinical trials that evaluated the clinical efficacy of acupuncture in adult patients with disability after stroke. We extracted data on trial quality, protocol, and outcomes assessed. A summary OR was calculated based on pooled dichotomous results. I 2 was used to infer heterogeneity and we conducted metaregression to determine if specific covariates explained heterogeneity. Results-Thirty-five articles written in Chinese and 21 articles written in English were included. The overall quality of the studies was "fair" and most studies were small (median nϭ86; range, 16 to 241). The majority (80%) of the studies reported a significant benefit from acupuncture; however, there was some evidence of publication bias. In 38 trials, data were available for meta-analysis and metaregression, yielding an OR in favor of acupuncture compared with controls (ORϭ4.33, 95% CI: 3.09 to 6.08; I 2 ϭ72.4%). Randomization, modes of delivery, method of control, study source country, and reporting of randomization may explain some of the heterogeneity observed between the studies. Conclusions-Randomized clinical trials demonstrate that acupuncture may be effective in the treatment of poststroke rehabilitation. Poor study quality and the possibility of publication bias hinder the strength of this recommendation and argue for a large, transparent, well-conducted randomized clinical trial to support this claim and implement changes to clinical practice. (Stroke. 2010;41:e171-e179.)Key Words: acupuncture Ⅲ cerebral infarct Ⅲ cerebrovascular disease Ⅲ meta-analysis Ⅲ metaregression Ⅲ systematic review Ⅲ therapy S troke is responsible for increasingly high rates of mortality and disability worldwide. Due to an aging population, dietary changes, and work-related stress, stroke morbidity is on the rise and the age at first occurrence is getting younger. [1][2][3] According to the latest data issued by the American Heart Association, each year approximately 600 000 people experience a new stroke and 185 000 a recurrent stroke. 3 Besides resultant mortality, the high incidence (Ͼ50%) of poststroke disability brings a heavy burden to patients and their caregivers. 3 In the United States, the total societal and healthcare costs have risen from $53.6 billion in 2004 2 to $68.9 billion in 2009. 3 Acupuncture (Ac) has been used in traditional Chinese medicine for Ͼ3000 years as a treatment for many diseases and its use for poststroke rehabilitation in China is based on a large body of preclinical and clinical research. 4 The lack of English language publications has, however, impeded any ...

Acupuncture and stroke rehabilitation

“…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 studies would be required in order to show conclusive findings.…”

“…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.…”

“…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.…”

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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.

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“…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.…”