Is manual or electro-acupuncture beneficial for adult patients with disability after stroke?
Date of publication of the systematic review: April 2010
Design
Systematic review of 56 randomized controlled trials (RCTs).
Participants
5650 adults patients (>18 years) with disability due either to ischemic or hemorrhagic stroke within acute status (1 month after stroke) or in disability (0.8 to 24 years post stroke).
Intervention
Manual or electro acupuncture were administered on scalp and/or body (average treatment duration 4.5 weeks, range from 2 to 10 weeks).
Comparator
Comparison : Acupuncture plus routine treatment versus sham acupuncture plus routine treatment or routine treatment only.
Baseline treatments for both groups were physical rehabilitation, conventional medication or traditional Chinese medicines.
Major Outcomes
Outcome 1: Rehabilitation (clear clinical improvement as reported in each included trial on outcome measures including physical assessment, disability and motor assessments, and any other validated scales for stroke assessment).
Settings
Among all 56 trials, 42 trials were conducted in mainland China, 6 in Europe, 4 in the United States, 1 in Hong Kong and 3 in Taiwan. The reviewers did not state whether the trials were conducted in inpatient or outpatient settings. Practitioner training was mentioned in studies conducted outside of mainland China.
Comparison    Acupuncture plus routine treatment versus sham acupuncture plus routine treatment or routine treatment only
Main Results
Compared to no extra treatment or sham acupuncture, the addition of acupuncture to baseline treatment showed significant improvement on rehabilitation (pooled odds ratio (pooled OR): 4.33, 95% CI: 3.09 to 6.08). The improvement on rehabilitation was still significant for patients in mainland China (pooled OR: 4.49, 95% CI: 3.16 to 6.39) but not significant for patients outside of mainland China (pooled OR: 3.33, 95% CI: 0.75 to 14.88). Several factors may affect the effect estimate, including country of origin, manual versus electric acupuncture, the use of sham control and the reporting of randomization.
Comparison: Acupuncture plus routine treatment versus sham acupuncture plus routine treatment or routine treatment only among patients with disability after stroke
Outcomes (units) No. of studies (Total number of participants) No. of events/No. of participants Heterogeneity test (I2) Pooled OR (95% CI) Overall quality of evidence*
Intervention Comparator
In all patients
1 (NA) 38 (3984) Not reported Not reported 72.4% 4.33 (3.09 to 6.08) Moderate
In patients in mainland China
1 (NA) 35 (Not reported) Not reported Not reported 69.8% 4.49 (3.16 to 6.39) Low
In patients outside mainland China
1 (NA) 3 (Not reported) Not reported Not reported 2.49% 3.33 (0.75 to 14.88) Moderate
Keys: OR: odds ratio; CI: confidence interval.
Comparison    Acupuncture plus routine treatment versus sham acupuncture plus routine treatment or routine treatment only
Main Results
Compared to no extra treatment or sham acupuncture, the addition of acupuncture to baseline treatment showed significant improvement on rehabilitation (pooled odds ratio (pooled OR): 4.33, 95% CI: 3.09 to 6.08). The improvement on rehabilitation was still significant for patients in mainland China (pooled OR: 4.49, 95% CI: 3.16 to 6.39) but not significant for patients outside of mainland China (pooled OR: 3.33, 95% CI: 0.75 to 14.88). Several factors may affect the effect estimate, including country of origin, manual versus electric acupuncture, the use of sham control and the reporting of randomization.
Comparison: Acupuncture plus routine treatment versus sham acupuncture plus routine treatment or routine treatment only among patients with disability after stroke
Outcomes (units) In all patients 1 (NA) In patients in mainland China 1 (NA) In patients outside mainland China 1 (NA)
No. of studies (Total number of participants) 38 (3984) 35 (Not reported) 3 (Not reported)
No. of events/No. of participants Intervention Not reported Not reported Not reported
Comparator Not reported Not reported Not reported
Pooled OR (95% CI) 4.33 (3.09 to 6.08) 4.49 (3.16 to 6.39) 3.33 (0.75 to 14.88)
Overall quality of evidence* Moderate Low Moderate
Keys: OR: odds ratio; CI: confidence interval.
Conclusion
Benefits
Compared to no extra treatment or sham acupuncture, the addition of acupuncture to baseline treatment can benefit stroke patients with disability in the important outcome: rehabilitation. For outcome 1 in all patients, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. For outcome 1 in patients in mainland China, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect. For outcome 1 in patients outside mainland China, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
Adverse effects were generally poorly reported and details were not provided in this review.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/20167912
The synopsis is based on the following article:
Wu P, Mills E, Moher D, Seely D. Acupuncture in poststroke rehabilitation: a systematic review and meta-analysis of randomized trials. Stroke. 2010 Apr;41(4):e171-9.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.