Sensory stimulation promotes normalization of postural control after stroke.

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

Section: Table 3 Impairments and Complications Of Strokementioning

confidence: 99%

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confidence: 99%

Does Acupuncture Have Additional Value to Standard Poststroke Motor Rehabilitation?

Sze

Wong²,

Xiang³

et al. 2002

“…Of the 13 randomized controlled trials, 9 2-4,16,33-37 met the inclusion criteria. Two 38,39 were excluded because they were long-term follow-up studies of previously reported samples, 3,4 and 2 40,41 were excluded because they did not compare acupuncture with no acupuncture. Among the 9 randomized controlled trials, 6 2-4,33,34,37 compared acupuncture plus conventional stroke rehabilitation with conventional stroke rehabilitation alone (Table 1), 1 16 compared acupuncture plus conventional care with conventional care alone (Table 2), and 3 33,35,36 contained arms comparing real acupuncture plus conventional stroke rehabilitation with sham acupuncture plus conventional stroke rehabilitation (Tables 1 and 2).…”

Section: Qualitative Findingsmentioning

confidence: 99%

Does Acupuncture Improve Motor Recovery After Stroke?

Sze

Wong

et al. 2002

124

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 acupuncture group also spent fewer days in nursing homes and rehabilitation wards compared with the control group. In a follow-up study by Magnusson et al, 7 it was shown that the acupuncture treatment had enhanced recovery of the postural function, an improvement that was still evident after 2 years. In a study by Sällström et al 8 in subacute stroke patients, the acupuncture group improved significantly more than the control group, as assessed by motor function, ADL, and quality of life.…”

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confidence: 97%

Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life

Gosman‐Hedström

Claesson

Klingenstierna

et al. 1998

105

Background and Purpose-A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients. These studies vary in inclusion criteria, sample size, and evaluation methods. The present study was designed to investigate whether electroacupuncture treatment favorably affects stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. Methods-One hundred four consecutive patients Ͼ40 years of age admitted to hospital because of an acute stroke were randomized to 3 groups: deep, superficial, and no acupuncture treatment. The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after randomization and was given twice a week for 10 weeks. All patients underwent conventional stroke rehabilitation as well. Two occupational therapists, blinded regarding the patients' allocation, evaluated the treatment effects. The assessments were performed 4 times during the first year after randomization by means of interviews and observations. Results-There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months. Regarding the Nottingham Health Profile, the no acupuncture group had somewhat fewer mobility problems. No differences in health care and social services were found between the groups. Conclusions-The present study does not give support to the previous studies, which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. (Stroke. 1998;29:2100-2108.)