Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study

Abstract

Background: Post-stroke dysphagia (PSD) affects the quality of life in stroke patients, impairs their rehabilitation ability, and causes other complications following stroke. Currently, there is currently some understanding of PSD risk factors, but its protective factors remain largely unknown.Objective: To analyze the effects of acupuncture (AP) on dysphagia in stroke patients and explore its potential as a preventive therapy.Methods: Patients with a diagnosis of stroke from 2010 to 2019 were selected and followed until 2020, utilizing factors such as age, gender, stroke location, stroke type, and baseline comorbidity. To compare the incidence of dysphagia, equal numbers of stroke patients treated with and without AP (n = 1,809) were matched by 1:1 propensity scoring. The Cox proportional hazards model and Kaplan-Meier method were used to assess the risk of dysphagia as an outcome measure.Results: The stroke patients treated with AP had a lower risk of dysphagia after adjusting for age, gender, stroke location, stroke type, and baseline comorbidity [adjusted hazard ratio (AHR) = 0.43, 95% confidence interval = 0.37–0.49] compared with those in the non-AP cohort. AP also decreased the risk of PSD among different gender groups. The risk ratios were AHR = 0.45 and AHR = 0.33 for males and females, respectively. AP also reduced the risk for PSD among different age groups. The risk ratios were AHR = 0.20, AHR = 0.37, AHR = 0.41, and AHR = 0.45 for the 18–39, 40–59, 60–79, and >80 years-old groups. Regarding stroke types (ischemic, hemorrhagic, and mixed type), patients treated with AP had a lower risk (AHR = 0.47, 0.28 and 0.17, respectively). With respect to stroke location, the risk of PSD in AP-treated patients was decreased regardless of location: brain stem (AHR = 0.41), diencephalon (AHR = 0.13), or multiple lesions (AHR = 0.40), the risk of PSD in AP-treated patients was decreased. For all baseline comorbidities, AP attenuated the risk of dysphagia. The cumulative incidence of dysphagia was remarkably lower in the AP group than in the non-AP group (log-rank test, P = 0.000).Limitations: First, this was a single-center clinical retrospective study. Second, we did not classify the severity of stroke and dysphagia. Third, all data were extracted manually. Lastly, the sample size was relatively small. Thus, future studies with larger sample sizes are warranted to verify our findings.Conclusion: Acupuncture treatment attenuates the risk of dysphagia in stroke patients. Future research should increase the sample size and elaborate further on the details of the AP protocol.

Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review

“…Treatment and nursing care of patients with dysphagia after stroke is a holistic process from swallowing assessment to rehabilitation, emphasizing multidisciplinary participation and comprehensive training [ 37 – 39 ]. The assessment of dysphagia after stroke should be based on the clinical manifestations of patients, and fully consider the advantages of assessment methods, so as to improve the accuracy and effectiveness of dysphagia screening and treatment [ 40 – 42 ].…”

Exploring the rules of related parameters in acupuncture for post-stroke dysphagia based on data mining

“…The report indicates that patients with infratentorial strokes had worse swallowing functions compared to those with supratentorial strokes. However, a single-center retrospective study showed that the risk of PSD was reduced in patients receiving acupuncture treatment, regardless of whether the stroke occurred in the brainstem [adjusted hazard ratio (AHR) = 0.41], thalamus (AHR = 0.13), or was a multifocal lesion (AHR = 0.40) (57). Although the results indicate that acupuncture treatment can reduce the risk of dysphagia in stroke patients across various demographics, including different ages, sexes, stroke types, sites, and baseline comorbidities (57), we recognize the need to further elucidate the application of acupuncture techniques in diverse clinical settings.…”

Acupuncture for ischemic stroke: where are we now?

“…This suggests that acupuncture may repair the connections between the upper motor neurons and motor nuclei of the medulla oblongata [25] . Another propensity score-matched cohort study matched 3,618 patients with IS between 2010 and 2020 using acupuncture and non-acupuncture and showed that acupuncture treatment reduced the risk of dysphagia in stroke patients [109,118] . Unfortunately, this was a single-center study, and follow-up is pending.…”