Complementary and alternative interventions for stroke recovery - a narrative overview of the published evidence.

OBJECTIVES

Stroke survivors dissatisfied with their progress often seek complementary and alternative interventions (CAI). This paper reviews the evidence for CAIs in stroke recovery.

METHODS

A literature search was performed for publications until December 2019 of CAI for stroke in Pubmed, Cochrane Library, EMBASE, CINAHL, AMED. Evidence was assessed according to Oxford Centre for Evidence-based Medicine criteria.

RESULTS

In a meta-analysis, reduced death or dependency compared to control at the end of follow-up and over the long term (≥3 months), OR 0.61(95%CI 0.46-0.79) and OR 0.67(95%CI 0.53-0.85) respectively, but was neutral against sham acupuncture. A Cochrane review of acupuncture vs. sham acupuncture in subacute or chronic stroke vs. showed no differences in motor function and quality of life. Three trials found favourable effects of on motor function (SMD=0.72, 95%CI 0.37-1.08, p<0.0001). Two trials showed compared to acupuncture reduced hemiplegic shoulder pain and upper-limb 'myodynamia'. A meta-analysis of for ischaemic stroke showed marked improvement in neurological deficit on stroke scales. There was no evidence for , . reduced the Modified Ashworth Scale in some muscle groups. improved Motricity Index and trunk control. and improved the Barthel Index. On meta-analysis, improved memory and anxiety, while improved activities of daily living, balance and walking ability. Studies were generally of poor quality.

CONCLUSIONS

The evidence for benefit of CAIs for stroke recovery is weak. More research is needed to justify these treatments for stroke, by well-conducted, adequately-sized, double-blinded, randomized controlled trials.