Efficacy and safety of dissimilar acupuncture intervention time-points in treating stroke: a systematic review and network meta-analysis

Abstract

Background: Impairment of motor function and activities of daily living is very common in post-stroke patients. Acupuncture has been used in stroke for a long time. Although growing evidence supports the beneficial effects of acupuncture, there is still no clear conclusion on the optimal intervention time-point for acupuncture in stroke. Thus, we tried to assess the efficacy and safety of dissimilar acupuncture intervention time-points by network meta-analysis (NMA). Methods: A retrieval was performed in several databases from beginning to October 2020. We only enrolled randomized controlled trials (RCTs) testing acupuncture for stroke, and the outcome indicators measured were Fugl-Meyer assessment (FMA) score, Barthel Index (BI), and adverse events.Results: Thirty-eight trials involving 3,836 participants were included in this NMA, the vast majority of which had a low or unclear risk of selection bias, detection bias, reporting bias, attrition bias, but had a high risk of performance bias. The results showed as following: (I) acupuncture treatment (Acu) is significantly more effective than non-acupuncture treatment (Non-Acu) with a good safety. (II) In terms of FMA, acupuncture within 48 h post-stroke (Acu I) was superior to acupuncture within 2-15 d post-stroke (Acu II)[standard mean difference (SMD): 7.17; 95% confidence interval (CI), 1.11 to 13.22], acupuncture within 16-30 d post-stroke (Acu III) (SMD: 20.73; 95% CI, 13.68 to 27.78), acupuncture within 1 month to half a year post-stroke (Acu IV) (SMD: 26.95; 95% CI, 14.88 to 39.02). As for BI, Acu I was the optimal timepoint, comparing with Acu III (SMD: 15.18; 95% CI, 8.97 to 21.39) and Acu IV (SMD: 22.88; 95% CI, 11.07 to 34.69). (III) Results of ranking indicated that Acu was better than Non-Acu at a similar stage in improving FMA and BI, while Acu I was the optimal intervention time-point, followed by Acu II.Conclusions: Although the credibility of our conclusions is low, our NMA indicates that acupuncture can be beneficial for stroke survivors with good safety. In terms of improvement in FMA score and BI, the soon use of acupuncture the better the efficacy. The optimal acupuncture intervention time-point for stroke is within 48 h post-stroke, and the significant validity period lasts until 15 days after onset.

The impact of acupuncture on neuroplasticity after ischemic stroke: a literature review and perspectives

“…In terms of clinical research, a systematic review and network meta-analysis on the efficacy and safety of dissimilar acupuncture intervention time-points in treating stroke found that the faster the acupuncture intervention, the more effective it is in improving FMA score and BI. The optimal time point for acupuncture intervention is within 48 h after stroke, and the significant validity period lasts until 15 days after onset (Zhuo et al, 2021 ). Therefore, both clinical and basic studies suggest that acupuncture treatment within 24 and 48 h after cerebral infarction is more beneficial.…”

An overview of the evidence to guide decision-making in acupuncture therapies for early recovery after acute ischemic stroke

“…Generally, we define the acute phase as within 2 weeks ( 34 ). Moreover, the effect of acupuncture might be more significant during this period ( 16 ). Based on this premise, to further determine the optimum initiation time of acupuncture therapies, it is recommended to observe the difference in the efficacy of patients receiving acupuncture therapies within 6, 24, or 48 h of stroke onset.…”

“…Since oxidative damage is the most severe within 24 h after onset ( 15 ), it is of great significance to investigate the efficacy and safety of acupuncture for ischemic stroke during the acute stage. A network meta-analysis also showed that the optimal time-point of acupuncture for stroke was within 48 h post-stroke, and the vital validity period lasted until 15 days after the attack ( 16 ). However, the paucity of systematic evaluation of evidence certainty is the reason why acupuncture therapies cannot be brought to the bedside of patients with AIS.…”

Acupuncture for ischemic stroke: where are we now?

“…In addition, they noted that acupuncture treatment within 48 h after IS may be beneficial to the early recovery of motor function. A recent meta-analysis that included 38 trials involving 3,836 subjects also evaluated patients for motor function and activities of daily living impairment and found that the optimal time point for acupuncture intervention for stroke was within 48 hours after stroke, which was significantly valid until 15 days after onset [95] . Another retrospective study of 5,046 patients also found similar results, that early initiation and increased frequency of acupuncture may facilitate the recovery of limb motor function after IS [49] .…”