Department of Oriental Rehabilitation Medicine, College of Oriental Medicine, Wonkwang University, Iksan, South Korea.
CMAJ. 2010 Nov 9;182(16):1723-9. doi: 10.1503/cmaj.091113. Epub 2010 Sep 27.
Acupuncture is frequently advocated as an adjunct treatment during stroke rehabilitation. The aim of this review was to assess its effectiveness in this setting.
We searched 25 databases and 12 major Korean traditional medicine journals from their inception to October 2009. We included randomized controlled trials, with no language restrictions, that compared the effects of acupuncture (with or without electrical stimulation) with sham acupuncture. We assessed the methodologic quality of the trials using the Cochrane risk-of-bias criteria and the PEDro (Physiotherapy Evidence Database) scale.
Ten of 664 potentially relevant studies met our inclusion criteria. For acute and subacute stages after stroke, we included seven trials. A meta-analysis of the five studies that assessed functionality did not show a significant difference in favour of acupuncture, with high heterogeneity. A post-hoc sensitivity analysis of three trials with low risk of bias did not show beneficial effects of acupuncture on activities of daily living at the end of the intervention period (n = 244; standard mean difference 0.07, 95% confidence interval [CI] -0.18 to 0.32; I(2) = 0%) or after follow-up (n = 244; standard mean difference 0.10, 95% CI -0.15 to 0.35; I(2) = 0%). For the chronic stage after stroke, three trials tested effects of acupuncture on function according to the Modified Ashworth Scale; all failed to show favourable effects.
Our meta-analyses of data from rigorous randomized sham-controlled trials did not show a positive effect of acupuncture as a treatment for functional recovery after stroke.
针刺常被推荐作为中风康复治疗的辅助手段。本研究旨在评估针刺在这种情况下的疗效。
我们检索了 25 个数据库和 12 种主要的韩国传统医学期刊，检索时间从建库至 2009 年 10 月。我们纳入了比较针刺（有或无电刺激）与假针刺的随机对照试验，且对语言不设限制。我们采用 Cochrane 偏倚风险标准和 PEDro（物理治疗证据数据库）量表评估了试验的方法学质量。
在 664 项潜在相关研究中，有 10 项符合我们的纳入标准。对于中风后的急性期和亚急性期，我们纳入了 7 项试验。对 5 项评估功能的研究进行的 meta 分析并未显示针刺具有显著的疗效优势，异质性较高。对 3 项低偏倚风险试验的事后敏感性分析也显示，在干预结束时（n = 244；标准均数差 0.07，95%置信区间 [CI] -0.18 至 0.32；I² = 0%）或随访结束时（n = 244；标准均数差 0.10，95% CI -0.15 至 0.35；I² = 0%），针刺对日常生活活动能力并无有益影响。对于中风后的慢性期，3 项试验根据改良 Ashworth 量表评估了针刺对功能的影响；所有试验均未显示出有利影响。
我们对严格的随机假对照试验数据进行的 meta 分析并未显示针刺作为中风后功能恢复的一种治疗方法具有积极作用。
