Acupuncture During Stroke Rehabilitation
To the Editor:
The systematic review and meta-analysis by Wu et al1 is 1 of 17 (not 5, as Wu et al state) similar reviews already available on the subject of acupuncture for stroke.2 Most of the reliable reviews drew negative conclusions.2
The discrepancy between the findings of Wu et al1 and our results may be attributable to several factors. For instance, Wu et al1 rely heavily on the Chinese studies. These have repeatedly been shown to virtually never produce negative results,3,4 which casts doubt on their reliability. Wu et al1 pool all of the available data regardless of types of control intervention; cautious intepretation is thus advisable. Wu et al1 use odd ratios, which, compared to risk ratios, inflate the overall effect size. Several of the primary studies included by Wu et al1 adopted a study design that is incapable of generating negative results.5 Wu et al1 also confirm that in “all the studies in which sham acupuncture was used, no differential effectiveness from true acupuncture was found.”
Given all of these caveats, we find it difficult to agree with their overall conclusion that “acupuncture may be effective in the treatment of poststroke rehabilitation”1 and arrive at a dramatically different verdict: acupuncture is not an evidence-based treatment during stroke rehabilitation.2
Wu P, Mills E, Moher D, Seely D. Acupuncture in poststroke rehabilitation. A systematic review and meta-analysis of randomized trials. Stroke. 2010; 41: e171–e179.
Ernst E, Lee MS, Choi TY. Acupuncture for stroke rehabilitation? An overview of systematic reviews. Perfusion. 2010; In press.
Tang JL, Zhan SY, Ernst E. Review of randomised controlled trials of traditional Chinese medicine. BMJ. 1999; 319: 160–161.