Effectiveness and safety of acupuncture for post-stroke spasticity: A systematic review and meta-analysis

You have got to be kidding:

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

But you're also using appeal to antiquity  which is not scientific

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

• acupuncture side effects (1)

 The latest here:

 

Effectiveness and safety of acupuncture for post-stroke spasticity: A systematic review and meta-analysis

Chen Xue^1†, Chengzhi Jiang^2†, Yuanyuan Zhu^3†, Xiaobo Liu¹, Dongling Zhong¹, Yuxi Li¹, Huiling Zhang¹, Wenjing Tang¹, Jian She¹, Cheng Xie¹, Juan Li^1*, Yue Feng^4* and Rongjiang Jin^1*

• ¹School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
• ²Department of Rehabilitation Medicine, Sichuan Science City Hospital, Mianyang, China
• ³Department of Rehabilitation Medicine, Integrated Traditional Chinese and Western Medicine Hospital of Panzhihua City, Panzhihua, China
• ⁴The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China

Objective: This systematic review and meta-analysis aimed to comprehensively evaluate the effectiveness and safety of acupuncture for post-stroke spasticity.

Methods: Nine electronic databases were searched from their inception to 6 June 2022, to identify randomized-controlled trials (RCTs) that investigated the effectiveness and safety of acupuncture for post-stroke spasticity. Two reviewers independently screened the studies, extracted the data, assessed the risk of bias. The reporting quality of interventions in controlled trials of acupuncture was evaluated using Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The RevMan 5.4 and R 4.2.0 software were used for statistical analysis.

Results: A total of 88 eligible studies were included, involving 6,431 individuals. The pooled data demonstrated that acupuncture combined with conventional rehabilitation (CR) was superior to CR in reducing the Modified Ashworth Scale (MAS) score (standardized mean difference [SMD] = −0.73; 95% CI = −0.83 to −0.63; I² = 65%; low certainty of evidence). The favorable results were also observed in comparisons of acupuncture vs. CR (SMD = −0.22, 95% CI = −0.36 to −0.07; I² = 49%; moderate certainty of evidence). Subgroup analysis showed that acupuncture treatment with a frequency of once or twice a day was more effective than CR. In addition, the antispasmodic effect of acupuncture treatment increased with more sessions. Four studies explicitly reported slight acupuncture-related adverse events.

Conclusion: Acupuncture could be recommended as adjuvant therapy for spasticity after stroke. However, due to the high risk of bias and heterogeneity of the included studies, the effectiveness of acupuncture for post-stroke spasticity remains to be confirmed.

Introduction

Spasticity is one of the most common complications after stroke with a prevalence of 30–80% (1). As a motor dysfunction after the central nervous system lesions, spasticity is characterized by a velocity-dependent increase in tonic stretch reflex with exaggerated tendon jerks (2). Spasticity often results in several clinical symptoms, including joint contractures, deformities, swelling, and pain, which severely limits the motor functions of patients with stroke (3). Moreover, the presence of spasticity may interfere with self-care ability of patients, reduce their quality of life and lead to depressive symptoms (4). More importantly, spasticity brings a heavy financial burden to families and society. According to statistics, approximately 50% family members have to reduce work hours or even stop working to take care of patients with spasticity after stroke (5). The direct cost for patients with spasticity is US$84,195 during the 1st year after stroke, which were four times higher than those without spasticity (6).

Currently, there are quite a few therapeutic strategies (e.g., physiotherapy, oral spasmolytics, injections of botulinum toxin) to treat post-stroke spasticity, while the therapeutic effect of spasticity is unsatisfactory. In terms of physiotherapy, the limited effect and long-term treatment course may lead to poor compliance (7). The effect of oral spasmolytics is not long-lasting, and prolonged use of these drugs might cause multiple side effects, such as hepatotoxicity and muscle weakness (8). Repetitive injections of botulinum toxin may result in the formation of neutralizing antibodies and attenuate the treatment efficacy (9). Therefore, there is a need for an effective and safe therapy for post-stroke spasticity.

Acupuncture, as a pragmatic and safe traditional Chinese medicine (TCM) treatment (10), has been used for the rehabilitation of patients with post-stroke spasticity (11). Several SRs have explored the effectiveness of acupuncture for spasticity in stroke survivors. Notwithstanding, they showed inconsistent results (12–19). With the emergence of new randomized-controlled trials (RCTs) in recent years, we plan to conduct this SR and meta-analysis to update the evidence of the effectiveness and safety of acupuncture for post-stroke spasticity.

Methods

The protocol of this SR has been registered on PROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=129779 (registration ID: CRD42019129779) and published in advance (20). We conducted this study strictly in compliance with A Measurement Tool to Assess Systematic Reviews (AMSTAR 2.0) (21) and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 (PRISMA) statement (22). The completed PRISMA checklist is shown in Supplementary File 1.

Literature search

We performed a literature search in the following databases from their inception to 6 June 2022: PubMed, Embase, the Cochrane Library, Web of Science, Epistemonikos Database, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wangfang Database. Comprehensive search strategies applied to the above databases were developed by a professional library staff (DLZ), which used logical operators to link subject terms and free words together. The detailed search strategies of all databases are shown in Supplementary File 2. We also searched the Chinese Clinical Trial Registry and ClinicalTrials.gov to identify possible eligible trials. Potential articles were hand-searched from gray literature, reference lists of included studies, and relevant SRs. In addition, we also consulted the experts in this field.

More at link.