(Stroke. 2001;32:1934.)
© 2001 American Heart Association, Inc.
Letters to the Editor |
Acupuncture and Stroke Rehabilitation
Continuum Center for Health and Healing, Beth Israel Medical Center, New York, New York
To the Editor:
In a carefully controlled, randomized clinical trial, Johansson et al1 concluded that acupuncture had no effect on functional improvement in stroke, thus contradicting most of the previous randomized clinical trials studying this relationship, including their own groundbreaking research.2,3 However, inspection of their Figure 1 indicates that the acupuncture group improved over a 12-month period by approximately 61 Barthel points, while the transcutaneous electrical nerve stimulation group improved by only 46 points and the subliminal stimulation group by 49 points. In other words, the median improvement of the acupuncture group, over and above the improvement seen in the control groups, was 12 to 15 points. This is not a trivial difference, despite the authors’ claim that this is a small difference in outcomes. Additionally, the interquartile range at 12 months clearly showed a lower boundary much closer to the median than in either of the 2 control conditions, which suggests that a greater proportion of the subjects received some benefit from the intervention when compared with the control conditions. In their original study,2 Johansson et al reported that the acupuncture group improved by 46.9 points while the standard-of-care control group improved by 26.2 points, producing a difference of 20.7 points in favor of the acupuncture group over a no-intervention control group. While the maximum relative improvement in the current study (15 points) is somewhat smaller than the 20.7 points in the original study, the absolute improvement of 61 points in this study certainly compares favorably to the 26.2-point improvement of the
for the Steering Committee of the, Swedish Collaboration on Sensory Stimulation After Stroke