Background and Purpose-A significant number of patients remain severely disabled after stroke despite rehabilitation with standard treatment modalities. Acupuncture has been reported as an alternative modality. This study aims to examine whether acupuncture has additional value to standard poststroke motor rehabilitation. Methods-A prospective randomized controlled trial (RCT) was carried out in a stroke rehabilitation unit in Hong Kong.One hundred six Chinese patients with moderate or severe functional impairment were included at days 3 to 15 after acute stroke. They were stratified into the moderate and the severe groups before randomization into the control arm receiving standard modalities of treatment, which included physiotherapy, occupational and speech therapy, and skilled medical and nursing care, and the intervention arm receiving in addition traditional Chinese manual acupuncture. A mean of 35 acupuncture sessions on 10 main acupoints were performed over a 10-week period. Outcome measures included Fugl-Meyer assessment, Barthel Index, and Functional Independence Measure, respectively, at weeks 0, 5, and 10, performed by blinded assessors. Results-At baseline, patients in each arm were comparable in all important prognostic characteristics. No statistically significant differences were observed between the 2 arms for any of the outcome measures at week 10 or outcome changes over time. Conclusions-Traditional

Background and Purpose-Acupuncture may be a promising treatment for poststroke paralysis. We conducted a meta-analysis, assessing the efficacy of acupuncture with and without stroke rehabilitation. Methods-We identified randomized trials comparing acupuncture with no acupuncture within 6 months of stroke by searching MEDLINE, CINAHL, EMBASE, Cochrane Library, and Chinese medical literature databases. Two reviewers independently extracted data on study characteristics, patient characteristics, and impairment and disability outcomes. The outcome measures were internationally recognized or nationally approved. The fixed-and random-effects models were used to combine effect size and odds ratio across studies. Results-Fourteen trials with 1213 patients met all the inclusion criteria. For the comparison of acupuncture with no acupuncture in addition to stroke rehabilitation, the pooled random-effects estimates of the change in motor impairment and disability were 0.06 (95% CI, Ϫ0.12 to 0.24) and 0.49 (95% CI, 0.03 to 0.96), respectively, with heterogeneity in disability measures (Pϭ0.05, 2 test). For the comparison of real with sham acupuncture, the pooled random-effects estimate of the change in disability was 0.07 (95% CI, Ϫ0.34 to 0.48). For the comparison of acupuncture with no acupuncture without stroke rehabilitation, the pooled random-effects estimate of the change in motor impairment was 0.46 (95% CI, Ϫ0.20 to 1.12), and the pooled random-effects odds ratio for disability was 12.5 (95% CI, 4.3 to 36.2), with no statistically significant heterogeneity (Pϭ0.97 and Pϭ0.12, respectively, 2 test), but the study quality was poor. Conclusions-This meta-analysis suggests that with stroke rehabilitation, acupuncture has no additional effect on motor recovery but has a small positive effect on disability, which may be due to a true placebo effect and varied study quality. The efficacy of acupuncture without stroke rehabilitation remains uncertain, mainly because of the poor quality of such studies.

The existing Danshen RCTs are not placebo-controlled and are of poor quality, therefore, there is no substantial evidence that Danshen is effective. Systematic review on RCTs comparing Danshen with other medicines does not support the notion that Danshen may be beneficial to disability improvement after acute ischaemic stroke.