GRADE in Systematic Reviews of Acupuncture for Stroke Rehabilitation: Recommendations based on High-Quality Evidence

Abstract

Systematic reviews (SRs) of randomized controlled trials (RCTs) have demonstrated acupuncture’s effectiveness in stroke rehabilitation. The current study reviews the quality of evidence in SRs of acupuncture in stroke rehabilitation, and rates the strength of recommendation for its use based on this evidence using the GRADE (grading of recommendations, assessment, development and evaluations) approach. A comprehensive literature search was performed using multiple databases (e.g., Medline, Embase) with advanced search strategies. Two authors independently selected articles, collected data, and assessed the methodological quality of each identified SR according to AMSTAR (a measurement tool to assess systematic reviews) and OQAQ (Oxman and Guyatt’s overview quality assessment questionnaire). Outcomes related to stroke rehabilitation were evaluated. SRs of high methodological quality (AMSTAR score ≥9 and OQAQ score ≥7) were graded using GRADE. Ultimately, acupuncture yields benefits in stroke rehabilitation (neurological function improvement: RR = 1.34; swallowing improvement: RR = 1.61, 1.49, 1.07; disability: SMD = 0.49 or 0.07). Poor evidentiary quality and insufficient information about harm led to weak recommendations. In conclusion, acupuncture may improve stroke rehabilitation, as the GRADE approach indicated a weak recommendation for acupuncture’s usage in this context.

Efficacy of acupuncture in the management of post-apoplectic aphasia: a systematic review and meta-analysis of randomized controlled trials

“…Previously, Zhang et al [11] and Wu et al [12] conducted meta-analyses of studies which performed acupuncture for poststroke rehabilitation and found that acupuncture provided significant benefits in stroke rehabilitation. The Ottawa Panel evidence-based clinical practice guidelines also identify acupuncture as one of the treatment options for post-stroke rehabilitation [13].…”

Critical roles of TRPV2 channels, histamine H1 and adenosine A1 receptors in the initiation of acupoint signals for acupuncture analgesia

“…Acupuncture is a traditional Chinese medical therapy that has a long history and remains widely used in contemporary clinical practice. Modern medical research has demonstrated that acupuncture has a significant therapeutic effect on chronic pain 1 , musculoskeletal pain 2 , knee osteoarthritis 3 , 4 , depression 5 , 6 , rhinitis 7 , postoperative rehabilitation of rectal cancer 8 , stroke 9 , 10 , hypertension 11 , angina pectoris 12 , and constipation 13 . In 2002, the WHO noted that acupuncture had an efficacy superior to that of control groups for up to 63 diseases, with significant efficacy for 28 of them 14 .…”

Effectiveness of multidisciplinary programmes for clinical pain conditions: An umbrella review

“…Additional SRs from other medical fields using GRADE have also produced similar results, e.g. a review of stroke rehabilitation resulted in a weak recommendation regarding acupuncture (73). One may argue that we used a low threshold of the sample size to evaluate the evidence compared with other studies (32,34,35,74).…”