Sze Frank Kai-hoi, Wong Eric, Or Kevin K H, Lau Joseph, Woo Jean
Department of Medicine and Geriatrics, Shatin Hospital, N.T. Hong Kong.
Stroke. 2002 Nov;33(11):2604-19. doi: 10.1161/01.str.0000035908.74261.c9.
Acupuncture may be a promising treatment for poststroke paralysis. We conducted a meta-analysis, assessing the efficacy of acupuncture with and without stroke rehabilitation.
We identified randomized trials comparing acupuncture with no acupuncture within 6 months of stroke by searching MEDLINE, CINAHL, EMBASE, Cochrane Library, and Chinese medical literature databases. Two reviewers independently extracted data on study characteristics, patient characteristics, and impairment and disability outcomes. The outcome measures were internationally recognized or nationally approved. The fixed- and random-effects models were used to combine effect size and odds ratio across studies.
Fourteen trials with 1213 patients met all the inclusion criteria. For the comparison of acupuncture with no acupuncture in addition to stroke rehabilitation, the pooled random-effects estimates of the change in motor impairment and disability were 0.06 (95% CI, -0.12 to 0.24) and 0.49 (95% CI, 0.03 to 0.96), respectively, with heterogeneity in disability measures (P=0.05, chi(2) test). For the comparison of real with sham acupuncture, the pooled random-effects estimate of the change in disability was 0.07 (95% CI, -0.34 to 0.48). For the comparison of acupuncture with no acupuncture without stroke rehabilitation, the pooled random-effects estimate of the change in motor impairment was 0.46 (95% CI, -0.20 to 1.12), and the pooled random-effects odds ratio for disability was 12.5 (95% CI, 4.3 to 36.2), with no statistically significant heterogeneity (P=0.97 and P=0.12, respectively, chi(2) test), but the study quality was poor.
This meta-analysis suggests that with stroke rehabilitation, acupuncture has no additional effect on motor recovery but has a small positive effect on disability, which may be due to a true placebo effect and varied study quality. The efficacy of acupuncture without stroke rehabilitation remains uncertain, mainly because of the poor quality of such studies.
针灸可能是一种有前景的中风后瘫痪治疗方法。我们进行了一项荟萃分析，评估有或没有中风康复情况下针灸的疗效。
通过检索MEDLINE、CINAHL、EMBASE、Cochrane图书馆和中国医学文献数据库，我们确定了在中风6个月内比较针灸与不针灸的随机试验。两名评价者独立提取关于研究特征、患者特征以及损伤和残疾结局的数据。结局指标为国际认可或国家批准的指标。采用固定效应模型和随机效应模型合并各研究的效应量和比值比。
14项试验共1213例患者符合所有纳入标准。对于在中风康复基础上针灸与不针灸的比较，运动损伤和残疾变化的合并随机效应估计值分别为0.06（95%CI，-0.12至0.24）和0.49（95%CI，0.03至0.96），残疾测量存在异质性（P = 0.05，卡方检验）。对于真针灸与假针灸的比较，残疾变化的合并随机效应估计值为0.07（95%CI，-0.34至0.48）。对于没有中风康复情况下针灸与不针灸的比较，运动损伤变化的合并随机效应估计值为0.46（95%CI，-0.20至1.12），残疾的合并随机效应比值比为12.5（95%CI，4.3至36.2），无统计学显著异质性（分别为P = 0.97和P = 0.12，卡方检验），但研究质量较差。
这项荟萃分析表明，在中风康复的情况下，针灸对运动恢复没有额外影响，但对残疾有小的积极影响，这可能是由于真正的安慰剂效应和研究质量的差异。没有中风康复时针灸的疗效仍不确定，主要是因为此类研究质量较差。
