Acupuncture for Stroke Rehabilitation
Graeme J. Hankey MD, FRCP Section Editor
Stroke is the third leading cause of death in Western society; in China it is the second most common cause of death in cities and the third in rural areas. It is also a main cause of adult disability and dependency. Despite considerable research efforts on multiple treatment modalities, there is still no single rehabilitation intervention demonstrated unequivocally to aid stroke recovery. This reality drives people to search for other modalities of treatment in an attempt to further improve the outcome of stroke rehabilitation, such as acupuncture.
Acupuncture can cause multiple biological responses, including circulatory and biochemical effects. These responses can occur locally or close to the site of application, or at a distance. They are mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery.1–4
Acupuncture has been well accepted by Chinese patients and is widely used to improve motor, sensation, speech, and other neurological functions in patients with stroke. As a therapeutic intervention, acupuncture is also increasingly practiced in some Western countries.2,5 However, it remains uncertain whether the existing evidence is scientifically rigorous enough so that acupuncture can be recommended for routine use.
The objective was to assess the efficacy and safety of acupuncture for patients with stroke in the subacute or chronic stage.
We performed a sensitive electronic search of multiple reference databases in late 2005, including Cochrane Stroke Group Trials Registry, the Cochrane Complementary Medicine Field Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE(Ovid), EMBASE, CINAHL, AMED, the Chinese Biological Medicine Database, the National Center for Complementary and Alternative Medicine Register, and the National Institute of Health Clinical Trials Database. We included all randomized clinical trials among patients with ischemic or hemorrhagic stroke, in the subacute or chronic stage, which compared acupuncture involving needling with either placebo acupuncture, sham acupuncture, or no acupuncture. Two review authors independently selected trials for inclusion, assessed quality, extracted, and cross-checked the data.
Five trials (368 patients) met the inclusion criteria. Methodological quality was considered inadequate in all trials. Although the overall estimate from 4 trials suggested the odds of improvement in global neurological deficit was higher in the acupuncture group compared with the control group (odds ratio [OR] 6.55, 95% confidence interval [CI] 1.89 to 22.76; see Figure), this estimate may not be reliable because there was substantial heterogeneity (I2=68%). One trial showed no significant improvement of motor function between the real acupuncture group and the sham acupuncture group (OR 9.00, 95% CI 0.40 to 203.30), but the confidence interval was wide and included clinically significant effects in both directions. No data on death, dependency, institutional care, change of neurological deficit score, quality of life, or adverse events were available.
Implications for Practice
This systematic review does not provide evidence to support the routine use of acupuncture for patients with subacute or chronic stroke.
Implications for Research
The widespread use of acupuncture, the promising results with less severe side effects, lower cost, and the insufficient quality of the available trials warrant further research. Large sham or placebo-controlled trials are needed to confirm or refute the available evidence.
The authors acknowledge the support and suggestions of Hazel Fraser and the editors of Cochrane Stroke Group for their assistance in the preparation of this review; in particular, we acknowledge the help of Brenda Thomas with developing the search strategy used, and Dr Livia Candelise, Dr Andrew Vickers, Dr Steff Lewis, and lead editor Prof Peter Sandercock for their very helpful comments. We also thank Kelvin Tsoi and Wilson Tam for providing us with statistical support; and Yanling Zhang, Jun Li and Hongwei Zhang for copying trials.
- Received May 16, 2007.
- Accepted June 1, 2007.
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