Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis

Impossible to have effects except as a placebo. Energy meridians have never been proven to exist.
No mechanism of action is possible. 

But if you believe, have at it, recognizing these possible side effects;

• acupuncture side effects (1)

 

 

Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis

Shaonan Liu^1,2,3,4†, Claire Shuiqing Zhang^5†, Yiyi Cai^1,2,3,4,5, Xinfeng Guo^1,2,3,4, Anthony Lin Zhang⁵, Charlie Changli Xue^1,3,4,5* and Chuanjian Lu^1,3,4,5*

• ¹The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
• ²The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
• ³Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
• ⁴Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
• ⁵China–Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia

Background: Shoulder-hand syndrome (SHS) is prevalent in hemiplegic patients after stroke. Potential benefits of acupuncture were shown in recent clinical trials. This systematic review aimed to comprehensively evaluate the safety and efficacy of acupuncture for SHS in stroke patients.

Methods: Five English databases (PubMed, Embase, CINAHL, CENTRAL, and AMED) and four Chinese databases (CBM, CNKI, CQVIP, and Wanfang) were searched from their inceptions to January 2019. Randomized, controlled trials that evaluated the add-on effects of acupuncture to rehabilitation for post-stroke SHS were identified.

Results: Thirty-eight studies involving 3,184 participants fulfilled the eligible criteria and were included in the review. The overall meta-analysis showed that acupuncture combined with rehabilitation significantly improved motor function (upper-limb Fugl-Meyer Assessment (FMA): 34 studies, mean difference (MD) 8.01, 95% confidence interval (CI) [6.69,9.33]), and reduced pain (visual analog scale (VAS): 25 studies, MD −1.59, 95%CI [−1.86,−1.32]). It also improved activities of daily living (ADL) when compared with rehabilitation alone (ADL: 11 studies, MD 9.99, 95%CI [5.91,14.06]). However, the certainty of evidence of all these outcomes was assessed as “low.” Subgroup analyses of acupuncture stimulation types and treatment duration all showed significant add-on effects comparing with rehabilitation alone. The safety of acupuncture was unclear because there is a lack of detailed reporting of adverse events in most of the included studies.

Conclusions: Acupuncture therapy seems effective for motor function, pain relief and activities of daily living in stroke patients with mild SHS, when it is used in combination with rehabilitation. The low certainty of evidence downgrades our confidence in making recommendations to clinical practice.

Introduction

Shoulder-hand syndrome (SHS) is a common condition among people who have had a stroke, with its reported prevalence ranging from 12% to 49% (1, 2). The main symptoms of SHS include pain, hyperalgesia, joint swelling and limitations in range of motion (ROM) (3). Post-stroke SHS is also named type I complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (4). The key to effectively treating SHS is believed to be an expert multidisciplinary team that provides individualized therapy (5). There is a wide range of treatment options available to help manage post-stroke SHS, including physical therapy, medications, regional anesthesia techniques and neuromodulation. However, there is insufficient evidence to support their efficacy (5).

Acupuncture, one of the most popular traditional Chinese medicine therapies, has been widely used in the clinical management of stroke (6). Several systematic reviews have assessed its efficacy for improving stroke rehabilitation using outcomes in motor function recovery and disability, but results are inconsistent (7–11). Three reviews published before 2010 showed acupuncture did not improve motor function or dependency outcomes after rehabilitation (8, 9, 11). However, two more recently published reviews suggested acupuncture might aid rehabilitation in several areas, including motor function recovery and pain relief (7, 10).

Three systematic reviews specifically evaluating acupuncture for post-stroke SHS have been published (12–14). Two of these were published before 2013 (12, 13), so they don't include recently published clinical evidence. Moreover, one review including three studies did not perform quantitative synthesis due to clinical heterogeneity (13). The third review (14) does not evaluate the effectiveness of electro-acupuncture, and only two of its included studies evaluated the effectiveness of acupuncture combined with routine care. Considering electro-acupuncture is commonly used in the clinical management of stroke complications, the implication of the review results (14) for clinical practice is limited. Therefore, we conducted this systematic review looking at the most recent evidence of acupuncture (including electro-acupuncture) as an additional therapy in the clinical management of post-stroke SHS.