Study: Acupuncture and Stroke Recovery

reference

Kong JC, Lee MS, Shin BC, Song YS, Ernst E. Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials.CMAJ. 2010;182(16):1723-1729.

design

Meta-analysis of randomized controlled trials comparing the effects of acupuncture with sham acupuncture. Ten of 664 potentially relevant studies met the inclusion criteria. For acute and subacute stages after stroke, the authors included seven studies.

Results

The meta-analysis of 5 studies targeting functionality showed no significant difference in favor of acupuncture with high heterogeneity. A post hoc sensitivity analysis of three low risk of bias studies showed no beneficial effects of acupuncture on activities of daily living at the end of the intervention period. In the chronic stage after a stroke, three studies tested the effects of acupuncture on function according to the modified Ashworth scale. All showed no positive effects.

interpretation

Meta-analyses of data from strictly randomized, sham-controlled trials showed no beneficial effect of acupuncture as a treatment for functional recovery after stroke. Few randomized, sham-controlled trials have tested the effectiveness of acupuncture during stroke rehabilitation.

discussion

According to the authors of this study, there are several possible explanations for these results: acupuncture may be ineffective, existing studies may be poorly designed, or the treatment may not have been administered properly. For example, several of the studies included patients treated more than six months after a stroke, which may be too long after the injury to expect significant improvements. In addition, treatment protocols varied significantly in the type of acupuncture treatments used, whether or not electroacupuncture was included, the number and frequency of visits, and other treatment variables.

It is commendable that the authors did not rely exclusively on English-language studies, but rather conducted extensive research to include all clinically relevant studies they could find, including those from China, Japan and Korea, where acupuncture is used in post-stroke treatment much more frequently than in the West and is often much closer to the stroke event than in the West, which may lead to could lead to more positive results. For example, in my 21+ years as a licensed acupuncturist, I have only treated a relative handful of post-acupuncturist patients. They were recovering from a stroke, and all had had their stroke at least six months ago, significantly limiting the expected effectiveness of the treatment.

Although this meta-analysis is the most comprehensive I have ever reviewed, I have some concerns about the study design. In their interpretation, the authors admit that sham acupuncture is not ineffective and has been proven to produce physiological effects.¹Reducing 664 studies to just 10 that compared “real” versus “sham” acupuncture may have resulted in selection based on criteria that excluded studies that may have shown real and positive effects.

Reducing 664 studies to just 10 that compared “real” versus “sham” acupuncture may have resulted in selection based on criteria that excluded studies that may have shown real and positive effects.

It may also be an indication of selection bias. For example, 18 studies used animals, 52 were uncontrolled studies, and 172 were excluded because they did not use a sham or placebo control. One hundred and twenty-one studies compared two different types of acupuncture treatment. It is possible that some of these studies have shown more beneficial effects.

For example, in 1997, researchers Hopwood and Lewith published a preliminary study of 6 patients who had suffered a stroke within three months of acupuncture treatment.2 Each patient was treated with electroacupuncture daily for two weeks, with a two-week transition period during which the patients were treated with placebo electrotherapy. A consistent increase in motor function, assessed using the Motricity Index, was observed following electroacupuncture treatments, leading the authors to conclude that acupuncture may have beneficial effects on patients recovering from stroke.

It is noteworthy that while the study authors did not find statistical significance for the results of their analysis, specific analyzes of activities of daily living showed a slight trend of improvement favoring those treated with real acupuncture over sham acupuncture.

While this is a comprehensive review of studies evaluating the effects of acupuncture on stroke recovery and an important study in the field, further research is clearly needed, particularly when offering patients treatment as close to their stroke as possible.