Department of Research & Clinical Epidemiology, the Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada.
Stroke. 2010 Apr;41(4):e171-9. doi: 10.1161/STROKEAHA.109.573576. Epub 2010 Feb 18.
Acupuncture is a low-risk treatment with purported claims of effectiveness for poststroke rehabilitation. To comprehensively assess the efficacy of acupuncture in poststroke rehabilitation, we conducted a systematic review and meta-analysis of all randomized clinical trials of acupuncture for poststroke rehabilitation.
We searched 7 English and 2 Chinese databases from inception to September 2009. Eligible studies included randomized clinical trials that evaluated the clinical efficacy of acupuncture in adult patients with disability after stroke. We extracted data on trial quality, protocol, and outcomes assessed. A summary OR was calculated based on pooled dichotomous results. I(2) was used to infer heterogeneity and we conducted metaregression to determine if specific covariates explained heterogeneity.
Thirty-five articles written in Chinese and 21 articles written in English were included. The overall quality of the studies was "fair" and most studies were small (median n=86; range, 16 to 241). The majority (80%) of the studies reported a significant benefit from acupuncture; however, there was some evidence of publication bias. In 38 trials, data were available for meta-analysis and metaregression, yielding an OR in favor of acupuncture compared with controls (OR=4.33, 95% CI: 3.09 to 6.08; I2=72.4%). Randomization, modes of delivery, method of control, study source country, and reporting of randomization may explain some of the heterogeneity observed between the studies.
Randomized clinical trials demonstrate that acupuncture may be effective in the treatment of poststroke rehabilitation. Poor study quality and the possibility of publication bias hinder the strength of this recommendation and argue for a large, transparent, well-conducted randomized clinical trial to support this claim and implement changes to clinical practice.
针灸是一种低风险的治疗方法，据称对中风后的康复有效。为了全面评估针灸在中风康复中的疗效，我们对所有针灸治疗中风后康复的随机临床试验进行了系统评价和荟萃分析。
我们从建库到 2009 年 9 月检索了 7 个英文数据库和 2 个中文数据库。纳入的研究包括评估针灸对成人中风后残疾患者临床疗效的随机临床试验。我们提取了试验质量、方案和评估结果的数据。基于汇总的二分类结果计算了汇总 OR。我们使用 I(2)来推断异质性，并进行荟萃回归以确定是否有特定的协变量可以解释异质性。
共纳入 35 篇中文文献和 21 篇英文文献。研究的总体质量为“一般”，且多数研究规模较小（中位数 n=86；范围 16-241）。大多数（80%）研究报告针灸有显著疗效；然而，存在一定的发表偏倚。在 38 项试验中，有数据可用于荟萃分析和荟萃回归，结果显示针灸组优于对照组（OR=4.33，95%CI：3.09-6.08；I2=72.4%）。随机化、传递方式、对照方法、研究来源国和随机化报告可能解释了研究间观察到的部分异质性。
随机临床试验表明，针灸可能对中风康复治疗有效。较差的研究质量和发表偏倚的可能性限制了这一推荐的强度，并呼吁进行一项大型、透明、精心设计的随机临床试验，以支持这一主张并对临床实践进行改革。
