School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China; School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Special Administrative Region.
Int J Nurs Stud. 2018 Jun;82:129-138. doi: 10.1016/j.ijnurstu.2018.03.013. Epub 2018 Mar 22.
Spasticity is a common post-stroke complication, and it results in substantial deterioration in the quality of life of patients. Although potential positive effects of warm-needle moxibustion on spasticity after stroke have been observed, evidence on its definitive effect remains uncertain.
This study aimed to summarize clinical evidence pertaining to therapeutic effects and safety of warm-needle moxibustion for treating spasticity after stroke.
Randomized controlled trials were reviewed systematically on the basis of the Cochrane Handbook for Systematic Reviews of Interventions. The report follows the PRISMA statement.
Ten electronic databases (PubMed, CENTRAL, EMBASE, AMED, CINAHL, Web of Science, CBM, CNKI, WanFang, and VIP) were explored, and articles were retrieved manually from two Chinese journals (The Journal of Traditional Chinese Medicine and Zhong Guo Zhen Jiu) through retrospective search. Randomized controlled trials with warm-needle moxibustion as treatment intervention for patients with limb spasm after stroke were included in this review. The risk of bias assessment tool was utilized in accordance with Cochrane Handbook 5.1.0. All included studies reported spasm effect as primary outcome. Effect size was estimated using relative risk, standardized mean difference, or mean difference with a corresponding 95% confidence interval. Review Manager 5.3 was utilized for meta-analysis.
Twelve randomized controlled trials with certain methodological flaws and risk of bias were included, and they involved a total of 878 participants. Warm-needle moxibustion was found to be superior to electroacupuncture or acupuncture in reducing spasm and in promoting motor function and daily living activities. Pooled results for spasm effect and motor function were significant when warm-needle moxibustion was compared with electroacupuncture or acupuncture. A comparison of daily living activities indicated significant differences between warm-needle moxibustion and electroacupuncture. However, no difference was observed between warm-needle moxibustion and acupuncture.
Warm-needle moxibustion may be a promising intervention to reduce limb spasm as well as improve motor function and daily living activities for stroke patients with spasticity. However, evidence was not conclusive. Rigorously designed randomized controlled trials with sample sizes larger than that in the included trials should be conducted for verification.
痉挛是中风后的常见并发症，会导致患者生活质量大幅下降。虽然温针灸对中风后痉挛有潜在的积极影响，但确切疗效仍不确定。
本研究旨在总结温针灸治疗中风后痉挛的疗效和安全性的临床证据。
系统评价基于 Cochrane 干预系统评价手册进行随机对照试验。本报告遵循 PRISMA 声明。
检索了 10 个电子数据库（PubMed、CENTRAL、EMBASE、AMED、CINAHL、Web of Science、CBM、CNKI、万方和 VIP），并通过回溯检索从中国两种期刊（《中国中医药杂志》和《中国针灸》）手动检索文章。本综述纳入了以温针灸作为治疗中风后肢体痉挛患者的干预措施的随机对照试验。使用 Cochrane 手册 5.1.0 的偏倚风险评估工具进行评估。所有纳入的研究均报告痉挛效应为主要结局。使用相对风险、标准化均数差或均数差及其相应的 95%置信区间来估计效应量。使用 Review Manager 5.3 进行荟萃分析。
纳入了 12 项存在一定方法学缺陷和偏倚风险的随机对照试验，共涉及 878 名参与者。温针灸在降低痉挛、促进运动功能和日常生活活动方面优于电针或针刺。与电针或针刺相比，温针灸在痉挛效应和运动功能方面的汇总结果具有统计学意义。日常生活活动的比较表明，温针灸与电针之间存在显著差异，但温针灸与针刺之间无差异。
温针灸可能是一种有前途的干预措施，可以减轻中风后痉挛患者的肢体痉挛，改善运动功能和日常生活活动。然而，证据并不确定。应进行设计更严谨、样本量大于纳入试验的随机对照试验进行验证。
