Xue Chen, Jiang Chengzhi, Zhu Yuanyuan, Liu Xiaobo, Zhong Dongling, Li Yuxi, Zhang Huiling, Tang Wenjing, She Jian, Xie Cheng, Li Juan, Feng Yue, Jin Rongjiang
School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Department of Rehabilitation Medicine, Sichuan Science City Hospital, Mianyang, China.
Front Neurol. 2022 Aug 17;13:942597. doi: 10.3389/fneur.2022.942597. eCollection 2022.
This systematic review and meta-analysis aimed to comprehensively evaluate the effectiveness and safety of acupuncture for post-stroke spasticity.
Nine electronic databases were searched from their inception to 6 June 2022, to identify randomized-controlled trials (RCTs) that investigated the effectiveness and safety of acupuncture for post-stroke spasticity. Two reviewers independently screened the studies, extracted the data, assessed the risk of bias. The reporting quality of interventions in controlled trials of acupuncture was evaluated using Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The RevMan 5.4 and R 4.2.0 software were used for statistical analysis.
A total of 88 eligible studies were included, involving 6,431 individuals. The pooled data demonstrated that acupuncture combined with conventional rehabilitation (CR) was superior to CR in reducing the Modified Ashworth Scale (MAS) score (standardized mean difference [SMD] = -0.73; 95% CI = -0.83 to -0.63; = 65%; low certainty of evidence). The favorable results were also observed in comparisons of acupuncture vs. CR (SMD = -0.22, 95% CI = -0.36 to -0.07; = 49%; moderate certainty of evidence). Subgroup analysis showed that acupuncture treatment with a frequency of once or twice a day was more effective than CR. In addition, the antispasmodic effect of acupuncture treatment increased with more sessions. Four studies explicitly reported slight acupuncture-related adverse events.
Acupuncture could be recommended as adjuvant therapy for spasticity after stroke. However, due to the high risk of bias and heterogeneity of the included studies, the effectiveness of acupuncture for post-stroke spasticity remains to be confirmed.
本系统评价和荟萃分析旨在全面评估针刺治疗脑卒中后痉挛的有效性和安全性。
检索9个电子数据库自建库至2022年6月6日的数据，以识别研究针刺治疗脑卒中后痉挛有效性和安全性的随机对照试验（RCT）。两名研究者独立筛选研究、提取数据、评估偏倚风险。采用《针刺临床试验干预措施报告修订标准》（STRICTA）评估针刺对照试验中干预措施的报告质量。使用RevMan 5.4和R 4.2.0软件进行统计分析。
共纳入88项合格研究，涉及6431例个体。汇总数据表明，针刺联合传统康复（CR）在降低改良Ashworth量表（MAS）评分方面优于CR（标准化均数差[SMD]=-0.73；95%CI=-0.83至-0.63；I²=65%；证据确定性低）。在针刺与CR的比较中也观察到了相似的结果（SMD=-0.22，95%CI=-0.36至-0.07；I²=49%；证据确定性中等）。亚组分析表明，每天针刺1次或2次比CR更有效。此外，针刺治疗的解痉效果随着疗程增加而增强。4项研究明确报告了轻微的针刺相关不良事件。
针刺可作为脑卒中后痉挛的辅助治疗方法。然而，由于纳入研究的偏倚风险高和异质性大，针刺治疗脑卒中后痉挛的有效性仍有待证实。
