Acupuncture for Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Overview

Journal Integr Med Res

Publisher Elsevier

Specialty Rehabilitation Medicine

Date 2024 Dec 17

PMID 39686968

Authors

Shanshan Huang

Yuting Wang

Yifan Wu

Puchen Huang

Yu Dong

Qiao Zhang

Mengjiao Zhao

Jingchun Zeng

Liming Lu

Xinxia Liu

Affiliations

Soon will be listed here.

Abstract

Objective: Assess the safety and effectiveness of acupuncture for acute ischemic stroke (AIS).

Methods: We conducted a comprehensive search across the PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang, and SinoMed databases from their inception until October 3, 2023. Two reviewers screened eligible randomized controlled trials (RCTs) according to criteria and extracted data using a pre-established form. Cochrane tool was used for risk of bias assessment, and Revman 5.3 was used for subsequent meta-analysis. The GRADE tool will be used to assess the quality of evidence.

Results: Thirty-one RCTs were included, involving 3604 patients. Meta-analysis showed that compared with conventional treatments (CTs), acupuncture combined with CTs could improve in National Institutes of Health Stroke Scale (NIHSS) and Efficiency (MD:1.70, 95 %CI [-2.27, -1.14], < 0.00001;RR: 1.21, 95 %CI [1.12, 1.31], < 0.00001,);On the Chinese Stroke Scale (CSS) and effectiveness based on CSS, acupuncture showed positive effects (MD:4.33, 95 %CI [-5.67, -2.98], < 0.00001; RR: 1.26, 95 %CI [1.13, 1.41], < 0.0001). Furthermore, ADL, Fugl-Meyer Assessment Scale (FMA), prognosis analyses also showed the effectiveness of acupuncture. (SMD: 0.98, 95 % CI [0.64, 1.31], < 0.00001; MD: 16.46, 95 %CI [12.56, 20.35], < 0.00001; RR: 0.38, 95 %CI [0.16, 0.89], = 0.03). However, the certainty of evidence was low.

Conclusion: According to current evidence, Acupuncture may be effective and safe for AIS. The future still needs high-quality evidence to support this conclusion.

References

Gladstone D, Danells C, Black S . The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002; 16(3):232-40. DOI: 10.1177/154596802401105171. View

Liu N, Huang X, Tian K, Li M, Chen W, Zhu C . [Effects of acupuncture and "Tongxinluo" capsule on plasma lysophosphatidic acid level in patients with acute cerebral infarction]. Zhen Ci Yan Jiu. 2015; 39(6):487-90, 511. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Gosman-Hedstrom G, Claesson L, Klingenstierna U, Carlsson J, Olausson B, Frizell M . Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients. Stroke. 1998; 29(10):2100-8. DOI: 10.1161/01.str.29.10.2100. View

Hatano S . Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ. 1976; 54(5):541-53. PMC: 2366492. View

Rao J, Tao Z, Bao Q, Jiang M, Zhou E, Cai X . Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis. Front Neurol. 2022; 13:893807. PMC: 9133336. DOI: 10.3389/fneur.2022.893807. View

Ld Zhong L, Zheng Y, Lau A, Wong N, Yao L, Wu X . Would integrated Western and traditional Chinese medicine have more benefits for stroke rehabilitation? A systematic review and meta-analysis. Stroke Vasc Neurol. 2021; 7(1):77-85. PMC: 8899656. DOI: 10.1136/svn-2020-000781. View

Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K . 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018; 49(3):e46-e110. DOI: 10.1161/STR.0000000000000158. View

Gao H, Gao X, Liang G, Ma B . Contra-lateral needling in the treatment of hemiplegia due to acute ischemic stroke. Acupunct Electrother Res. 2012; 37(1):1-12. DOI: 10.3727/036012912x13831831256041. View

10.

Song Y, Zhang X, Zhang J, Wang S, Bai Y, Xu B . [Effect of acupuncture on safety of rt-PA intravenous thrombolysis in patients with cerebral infarction: a randomized controlled trial]. Zhongguo Zhen Jiu. 2022; 42(9):961-5. DOI: 10.13703/j.0255-2930.20211104-k0003. View

11.

Zhang S, Wu B, Liu M, Li N, Zeng X, Liu H . Acupuncture efficacy on ischemic stroke recovery: multicenter randomized controlled trial in China. Stroke. 2015; 46(5):1301-6. DOI: 10.1161/STROKEAHA.114.007659. View

12.

Higgins J, Thompson S, Deeks J, Altman D . Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414):557-60. PMC: 192859. DOI: 10.1136/bmj.327.7414.557. View

13.

Li W, Xu S, Zeng C, Peng Y . [Electroacupuncture for acute ischemic stroke and its effect on plasma levels of IL-17 and IL-10]. Zhongguo Zhen Jiu. 2022; 42(8):849-52. DOI: 10.13703/j.0255-2930.20211005-k0001. View

14.

Streitberger K, Kleinhenz J . Introducing a placebo needle into acupuncture research. Lancet. 1998; 352(9125):364-5. DOI: 10.1016/S0140-6736(97)10471-8. View

15.

Banks J, Marotta C . Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007; 38(3):1091-6. DOI: 10.1161/01.STR.0000258355.23810.c6. View

16.

Duncan P, Goldstein L, Horner R, Landsman P, Samsa G, Matchar D . Similar motor recovery of upper and lower extremities after stroke. Stroke. 1994; 25(6):1181-8. DOI: 10.1161/01.str.25.6.1181. View

17.

Selim M, Foster L, Moy C, Xi G, Hill M, Morgenstern L . Deferoxamine mesylate in patients with intracerebral haemorrhage (i-DEF): a multicentre, randomised, placebo-controlled, double-blind phase 2 trial. Lancet Neurol. 2019; 18(5):428-438. PMC: 6494117. DOI: 10.1016/S1474-4422(19)30069-9. View

18.

Wang J, Xiong X . Current situation and perspectives of clinical study in integrative medicine in china. Evid Based Complement Alternat Med. 2012; 2012:268542. PMC: 3328953. DOI: 10.1155/2012/268542. View

19.

Peng L, Zhang C, Zhou L, Zuo H, He X, Niu Y . Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis. Clin Rehabil. 2017; 32(4):429-439. DOI: 10.1177/0269215517729528. View

20.

Wang C, Wu Z, Li N, Zhao Y, Tian F, Zhou X . Clinical curative effect of electric acupuncture on acute cerebral infarction: a randomized controlled multicenter trial. J Tradit Chin Med. 2015; 34(6):635-40. DOI: 10.1016/s0254-6272(15)30075-3. View