Acupuncture for Shoulder Pain After Stroke: A Systematic Review

e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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“…This was suggested by Lee and colleagues 124 in a recent systematic review of this topic. They found 7 RCTs, all showing positive effects.…”

Section: Assessment Prevention and Treatment Of Hemiplegic Shouldermentioning

confidence: 83%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,169

840

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“…Three reviews (12.5%) analyzed acupuncture as an acute stroke intervention [18,19,20], 6 (25%) analyzed it as an approach to stroke rehabilitation [21,22,23,24,25,26], and the remaining 15 (62.5%) analyzed it as an intervention to treat various stroke-related disorders. Of these 15 reviews, 4 focused on poststroke motor dysfunction [27,28,29,30], 4 on poststroke dysphagia [31,32,33,34], 2 on poststroke depression [35,36], and 1 review on each of poststroke hiccup [37], poststroke urinary incontinence [38], shoulder-hand syndrome [29], shoulder pain [39] and apoplectic aphasia [40]. The OQAQ quality of 10 reviews was rated as ‘good', 6 were rated as ‘moderate' and 8 as ‘poor'.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining reviews included in our overview focused on other stroke-related disorders: 2 examined poststroke depression [35,36] and single reviews examined poststroke hiccup [37], poststroke urinary incontinence [38], shoulder-hand syndrome [41], shoulder pain [39] and apoplectic aphasia [40]. Data in only one review on poststroke depression [36] and one on poststroke hiccup [37] suggested that acupuncture was superior to control treatments, but the authors in those studies did not draw any firm conclusions about the therapeutic efficacy of acupuncture due to the low quality of included trials or the small number of study participants.…”

Section: Resultsmentioning

confidence: 99%

Overview of Systematic Reviews and Meta-Analyses of Acupuncture for Stroke

Zhang

Wang

Liu³

2013

Neuroepidemiology

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Background: We aimed to systematically overview published systematic reviews and meta-analyses in order to identify whether and when acupuncture is an effective treatment for stroke and stroke-related disorders. We also hoped to identify the best directions for future research in this area. Methods: Systematic reviews and meta-analyses of randomized controlled trials (RCTs) and quasi-RCTs evaluating the efficacy of acupuncture to treat stroke or stroke-related conditions were included. Electronic searches were conducted in the Cochrane Database of Systematic Reviews, Ovid MEDLINE, CINAHL, Ovid EMBASE, EBSCO Allied and Complementary Medicine (AMED) database, Chinese Biological Medicine Database, and Chinese National Knowledge Infrastructure Database. Two authors independently assessed the compliance of studies with eligibility criteria, and extracted data from included studies. The quality of systematic reviews was assessed according to the Overview Quality Assessment Questionnaire. Results: A total of 24 systematic reviews were included, of which 4 (16.7%) were Cochrane systematic reviews and 20 (83.3%) were non-Cochrane reviews. Acupuncture was analyzed as an acute stroke intervention in 3 reviews (12.5%), as an approach to stroke rehabilitation in 6 (25%), and as an intervention to treat various stroke-related disorders in the remaining 15 (62.5%). Reviews analyzing death or dependency/disability as the primary outcome reported no statistically significant difference between acupuncture and nonacupuncture control treatments. In contrast, reviews in which the outcome was improvement in global neurological deficit scores or performance on the video-fluoroscopic swallowing study test or water-swallowing test often reported that acupuncture was superior to control treatment. The quality of 10 reviews was ‘poor', 6 reviews were ‘moderate' and 8 were ‘good'. Conclusions: The available evidence suggests that acupuncture may be effective for treating poststroke neurological impairment and dysfunction such as dysphagia, although these reported benefits should be verified in large, well-controlled studies. On the other hand, the available evidence does not clearly indicate that acupuncture can help prevent poststroke death or disability, or ameliorate other aspects of stroke recovery, such as poststroke motor dysfunction. These findings suggest that researchers should focus on the potential application of acupuncture to treat poststroke neurological impairment and dysfunction and on the development of more precise tools to assess these improvements after stroke.

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“…Our trial focused on the pain caused by spasticity and showed that acupuncture is effective at reducing the severity of limb pain. Two recent systematic reviews also concluded that acupuncture is an effective treatment modality for poststroke shoulder pain [17] and spasticity [18]. The obvious between-group difference in posttest VAS scales might indirectly show that acupuncture results in a reduction in the degree of pain caused by spasticity.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of Acupuncture as Treatment for Complications of Cerebrovascular Accidents: A Randomized, Sham‐Controlled, Subject‐ and Assessor‐Blind Trial

Liao

Chen

et al. 2017

Evidence-Based Complementary and Alternative Medicine

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Background and Purpose. The effect of acupuncture as treatment for poststroke complications is questionable. We performed a randomized, sham-controlled double-blind study to investigate it. Methods. Patients with first-time acute stroke were randomized to receive 24 sessions of either real or sham acupuncture during an eight-week period. The primary outcome measure was change in National Institute of Health Stroke Scale (NIHSS) score. Secondary outcome measures included changes in Barthel Index (BI), Instrumental Activities of Daily Living (IADL), Hamilton Depression Rating Scale (HAM-D), and Visual Analogue Scale (VAS) for pain scores. Results. Of the 52 patients who were randomized to receive acupuncture (n = 28) or placebo (n = 24), 10 patients in the acupuncture group and 9 patients in the placebo group failed to complete the treatment. In total, 18 patients in the acupuncture group and 15 patients in the control group completed the treatment course. Reduction in pain was significantly greater in the acupuncture group than in the control group (p value = 0.04). There were no significant differences in the other measures between the two groups. Conclusions. Acupuncture provided more effective poststroke pain relief than sham acupuncture treatment. However, acupuncture had no better effect on neurological, functional, and psychological improvement.

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Acupuncture for Shoulder Pain After Stroke: A Systematic Review

Cited by 55 publications

References 17 publications

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery

Overview of Systematic Reviews and Meta-Analyses of Acupuncture for Stroke

Clinical Evaluation of Acupuncture as Treatment for Complications of Cerebrovascular Accidents: A Randomized, Sham‐Controlled, Subject‐ and Assessor‐Blind Trial

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