Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
Complement Ther Clin Pract. 2020 Aug;40:101176. doi: 10.1016/j.ctcp.2020.101176. Epub 2020 Apr 21.
Hemiplegia after stroke is one of the main dysfunctions in stroke patients. Acupuncture had been widely used for poststroke spastic hemiplegia (PSSH), but the efficiency was unclear. This study aimed to examine the efficiency and safety of acupuncture for individuals with PSSH.
We searched nine databases from their inception to 27 July 2019. Randomized controlled trials (RCTs) of acupuncture for the treatment of PSSH met the screening criteria. The quality of methodology was evaluated by Cochrane's risk of bias tool. RevMan 5.3 was used to perform the meta-analysis. The primary outcome was the Fugl-Myer Assessment (FMA) score, and the secondary outcomes were the Ashworth Scale for Spasticity (ASS) and Barthel Index (BI) scores. To evaluated the safety of acupuncture therapy, researchers scanned the full text to collect adverse events.
Researchers retrieved 2452 articles in total, after screening, thirty-eight studies with 2628 participants of were included. In this meta-analysis, twenty-seven trials revealed that acupuncture therapy was associated with an increase in FMA scores compared with rehabilitation training (RT) (MD: 8.43, 95% CI, 6.57 to 10.28, p < 0.00001, I = 75%). According to the analysis of subgroup of interventions, ten trials showed that manual acupuncture (MA) plus RT was associated with an increase in FMA compared with RT (MD: 10.84, 95% CI, 9.29 to 13.29, p < 0.00001, I = 24%), three trials showed that electroacupuncture (EA) plus RT was associated with an improvement in FMA compared with RT (MD: 9.44, 95% CI, 1.00 to 17.88, p = 0.03, I = 81%), twelve trials showed that MA was associated with an increase in FMA compared with RT (MD: 5.48, 95% CI, 2.07 to 8.89, p = 0.002, I = 74%), and one trials showed that EA was associated with an improvement in FMA compared with RT (MD: 11.35, 95% CI, 5.03 to 17.67, p = 0.0004). According to the analysis of subgroup of treatment duration, four trials used acupuncture therapy for more than 1 month, revealed that acupuncture therapy was associated with an increase in FMA scores compared with RT (MD: 9.24, 95% CI, 0.42 to 18.06, p = 0.04, I = 93%). Thirty-two trials used acupuncture therapy for less than or equal to 1 month, revealed that acupuncture therapy was associated with an increase in FMA scores compared with RT (MD: 8.32, 95% CI, 6.56 to 10.09, p < 0.00001, I = 61%). Six trials indicated that acupuncture therapy was better than RT in terms of the ASS (MD: 0.46, 95% CI, -0.65 to -0.27, p < 0.00001, I = 67%), twenty-four trials indicated that acupuncture therapy was better than RT in terms of the BI scores (MD: 8.32, 95% CI, 5.30 to 11.35, p < 0.00001, I = 88%). In general, the methodologies of the RCTs were of poor quality. Two RCTs reported no adverse events, one trial reported five adverse events without severe influence, others did not mention.
This review discovered that acupuncture might be a safe and effective adjuvant therapy for individuals with PSSH. Nevertheless, there were methodological limitations in the included RCTs, and well-designed and large-scale studies should be carried out to confirm our results.
中风后偏瘫是中风患者的主要功能障碍之一。针灸在治疗中风后痉挛性偏瘫（PSSH）方面得到了广泛应用，但疗效尚不明确。本研究旨在评估针灸治疗 PSSH 的疗效和安全性。
我们从建库到 2019 年 7 月 27 日检索了 9 个数据库。符合筛选标准的针刺治疗 PSSH 的随机对照试验（RCT）纳入研究。采用 Cochrane 偏倚风险工具评价方法学质量。RevMan 5.3 进行荟萃分析。主要结局是 Fugl-Meyer 评估（FMA）评分，次要结局是 Ashworth 量表（ASS）和 Barthel 指数（BI）评分。为评估针灸治疗的安全性，研究者扫描全文以收集不良事件。
研究者共检索到 2452 篇文章，经筛选后，38 项研究共纳入 2628 名患者。在这项荟萃分析中，27 项试验表明与康复训练（RT）相比，针灸治疗可使 FMA 评分增加（MD：8.43，95%CI，6.57 至 10.28，p<0.00001，I=75%）。根据干预措施的亚组分析，10 项试验表明与 RT 相比，手针（MA）加 RT 可使 FMA 评分增加（MD：10.84，95%CI，9.29 至 13.29，p<0.00001，I=24%），3 项试验表明与 RT 相比，电针（EA）加 RT 可改善 FMA 评分（MD：9.44，95%CI，1.00 至 17.88，p=0.03，I=81%），12 项试验表明与 RT 相比，MA 可使 FMA 评分增加（MD：5.48，95%CI，2.07 至 8.89，p=0.002，I=74%），1 项试验表明与 RT 相比，EA 可改善 FMA 评分（MD：11.35，95%CI，5.03 至 17.67，p=0.0004）。根据治疗持续时间的亚组分析，4 项试验使用针灸治疗超过 1 个月，结果表明与 RT 相比，针灸治疗可使 FMA 评分增加（MD：9.24，95%CI，0.42 至 18.06，p=0.04，I=93%）。32 项试验使用针灸治疗 1 个月或以下，结果表明与 RT 相比，针灸治疗可使 FMA 评分增加（MD：8.32，95%CI，6.56 至 10.09，p<0.00001，I=61%）。6 项试验表明与 RT 相比，针灸治疗在 ASS 方面更好（MD：0.46，95%CI，-0.65 至 -0.27，p<0.00001，I=67%），24 项试验表明与 RT 相比，针灸治疗在 BI 评分方面更好（MD：8.32，95%CI，5.30 至 11.35，p<0.00001，I=88%）。一般来说，RCT 的方法学质量较差。两项 RCT 报告无不良事件，一项试验报告 5 例不良事件但无严重影响，其他试验未提及。
本综述发现针灸可能是治疗 PSSH 的一种安全有效的辅助疗法。然而，纳入的 RCT 存在方法学局限性，应开展设计良好、规模较大的研究来证实我们的结果。
