Liu Yaning, Tang Yuqi, Wang Linjia, Yu Pei, Wang Can, Zeng Lichuan, Yuan Jing, Zhao Ling
Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Front Neurol. 2024 Jul 10;15:1415792. doi: 10.3389/fneur.2024.1415792. eCollection 2024.
The lower limb motor dysfunction caused by stroke is one of the main sequelae affecting patients' ability to live normally in the later period. Acupuncture treatment of limb movement dysfunction after stroke has been recommended by authoritative guidelines for reducing limb spasticity, enhancing limb strength and so on. However, the efficacy of different acupuncture methods in treating lower limb motor dysfunction after stroke remains controversial.
In this paper, network meta-analysis (NMA) was used to prioritize various acupuncture intervention combinations commonly used in clinical practice, try to screen the acupuncture intervention scheme with the highest clinical efficacy and safety, and explore its rationality in guiding clinical practice.
We searched a total of 4,312 studies from 8 databases and 2 clinical trial registries, and selected 43 articles for systematic review. We used pairwise meta-analysis and network meta-analysis to evaluate the efficacy and ranking of various acupuncture interventions. At the same time, the risk of bias, publication bias, and sensitivity of included randomized controlled trials were analyzed. The main outcome indicator was Fugl-Meyer assessment of lower extremity (FMA-LE), and the secondary outcome indicators were Modified Barthel Index (MBI), Berg balance scale (BBS) and Modified Ashworth scale (MAS).
A total of 4,134 patients in 43 studies were included. The intervention included 9 acupuncture-related treatments, of which 20.9% were classified as high-risk. Among the four outcome indicators in pairwise meta-analysis, the effect of body acupuncture combined with conventional rehabilitation has the highest comprehensive credibility in terms of efficacy and safety comparing with conventional rehabilitation [SMD = 1.14, 95%CI (0.81, 1.46)], [SMD = 1.35, 95%CI (0.97, 1.72)], [SMD = 1.22, 95%CI (0.39, 2.05)], [SMD = 1.21, 95%CI (0.74, 1.44)]. In addition, multiple intervention methods, for example, warm acupuncture plus rehabilitation treatment for MBI and electroacupuncture plus body acupuncture plus rehabilitation treatment for BBS, may increase certain additional effects on different outcome indicators.
This study proves that body acupuncture combined with rehabilitation treatment is the most widely used intervention method with the highest evidence quality in the treatment of lower limb motor dysfunction after stroke. However, for some other acupuncture methods, large samples and high-quality clinical randomized controlled trials are still needed to be fully verified.
中风所致下肢运动功能障碍是影响患者后期正常生活能力的主要后遗症之一。权威指南推荐针刺治疗中风后肢体运动功能障碍，以减轻肢体痉挛、增强肢体力量等。然而，不同针刺方法治疗中风后下肢运动功能障碍的疗效仍存在争议。
本文采用网状Meta分析（NMA）对临床常用的各种针刺干预组合进行排序，试图筛选出临床疗效和安全性最高的针刺干预方案，并探讨其指导临床实践的合理性。
我们从8个数据库和2个临床试验注册库共检索到4312项研究，筛选出43篇文章进行系统评价。我们采用成对Meta分析和网状Meta分析来评估各种针刺干预的疗效和排名。同时，分析纳入的随机对照试验的偏倚风险、发表偏倚和敏感性。主要结局指标为下肢Fugl-Meyer评估（FMA-LE），次要结局指标为改良Barthel指数（MBI）、Berg平衡量表（BBS）和改良Ashworth量表（MAS）。
43项研究共纳入4134例患者。干预措施包括9种针刺相关治疗，其中20.9%被列为高风险。在成对Meta分析的四个结局指标中，与传统康复相比，体针联合传统康复在疗效和安全性方面的综合可信度最高[标准化均数差（SMD）=1.14，95%置信区间（CI）（0.81，1.46）]，[SMD=1.35，95%CI（0.97，1.72）]，[SMD=1.22，95%CI（0.39，2.05）]，[SMD=1.21，95%CI（0.74，1.44）]。此外，多种干预方法，如温针加康复治疗用于MBI，电针加体针加康复治疗用于BBS，可能对不同结局指标增加一定的附加效果。
本研究证明，体针联合康复治疗是治疗中风后下肢运动功能障碍中应用最广泛、证据质量最高的干预方法。然而，对于其他一些针刺方法，仍需要大样本、高质量的临床随机对照试验进行充分验证。
