Efficacy of traditional Chinese medicine nursing in stroke: a systematic review and meta-analysis

Not really objective so not repeatable interventions.

The objectivity of Traditional Chinese Medicine (TCM) is a complex topic. While some aspects, like the use of specific diagnostic instruments (like a tissue compliance meter) and data analysis in research, can be considered objective, the core tenets of TCM, such as Yin and Yang, Qi, and meridians, are based on traditional philosophical and empirical observations rather than modern scientific methods.

 Efficacy of traditional Chinese medicine nursing in stroke: a systematic review and meta-analysis

Yanling Chen1, Hongyan Li1, Zhe Wu2*† and Mingyuan Jiao3*†

1Nursing Department, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China

2Rehabilitation Department, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China

3Research and Teaching Department, Jinhua Maternal and Child Health Care Hospital, Jinhua, China

Edited by

Mohsen Khosravi, Zahedan University of Medical Sciences, Iran

Reviewed by

Massimo Tusconi, University of Cagliari, Italy

Qinwei Fu, McMaster University, Canada

*Correspondence

Zhe Wu, zhewu2024@zju.edu.cn; Mingyuan Jiao, jiaoiao7685@163.com

†These authors share last authorship

Received 01 July 2025

Accepted 28 July 2025

Published 12 August 2025

Citation

Chen Y, Li H, Wu Z and Jiao M (2025) Efficacy of traditional Chinese medicine nursing in stroke: a systematic review and meta-analysis. Front. Neurol. 16:1657802. doi: 10.3389/fneur.2025.1657802

Objective: Some clinical studies have suggested that traditional Chinese medicine (TCM) nursing techniques may promote better recovery in stroke patients compared to conventional neurological nursing. However, high-quality evidence-based research is still lacking. This study selected two outcome indicators—motor function and activities of daily living (ADL)—to systematically evaluate the efficacy of TCM nursing techniques in the rehabilitation of stroke patients.

Methods: Seven major Chinese and English databases were systematically searched. The Fugl-Meyer Assessment (FMA) and the Modified Ashworth Scale (MAS) were used to evaluate motor function, while the Barthel Index (BI) was used to assess ADL. Subgroup analyses were conducted based on study characteristics to explore potential sources of heterogeneity.

Results: A total of 18 studies involving 1,419 patients were included. Meta-analysis results showed that, compared with conventional care, the TCM nursing group demonstrated significantly better outcomes in FMA (SMD = 1.92, p = 0.0066), MAS (SMD = −0.82, p = 0.0416), and BI (SMD = 1.34, p < 0.0001). Meta-regression and subgroup analyses indicated that nursing model, stroke type, and risk of bias were not sources of heterogeneity.

Conclusion: Compared to conventional care, TCM nursing techniques can significantly improve spasticity in stroke patients, and also provide some benefits for limb motor function and ADL. Given the high heterogeneity and poor GRADE assessment of FMA and BI, the above results should be interpreted with caution.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251006204.

Keywords

stroke; traditional Chinese medicine; nursing; motor function; activities of daily living; meta-analysis

1 Introduction

Stroke is one of the leading causes of disability and death worldwide. According to the WHO, stroke is the second leading cause of death globally and a major contributor to long-term disability. Each year, approximately 12.2 million new cases of stroke occur worldwide, with ischemic stroke accounting for around 62.4% and hemorrhagic stroke for about 37.6% (1). In recent years, the incidence and mortality rates of stroke have shown an upward trend globally, imposing a heavy economic and caregiving burden on both families and society. Moreover, even among stroke survivors, many are left with varying degrees of neurological impairments, such as motor dysfunction, speech difficulties, and cognitive decline, which severely affect their quality of life. Nursing, as an essential part of clinical treatment, plays a crucial role in stroke rehabilitation.

The American Heart Association’s guidelines on stroke patient care suggest that conventional neurological nursing can be summarized into four main areas: basic care, early mobilization, psychological and nutritional support. Basic care includes preventing pulmonary and urinary tract infections (aspiration prevention), gastrointestinal and bladder care (constipation, urinary incontinence, and urinary retention), preventing pulmonary embolism and deep vein thrombosis, fall prevention, and skin care (pressure ulcer prevention), with common methods such as repositioning, maintaining patency of tubes, and limb immobilization. Early mobilization aims to prevent joint contractures and maintain joint range of motion. Psychological and nutritional support help to maintain immune function, improve adherence to rehabilitation, and enhance therapeutic outcomes (2, 3). Although these nursing interventions play an important role in the rehabilitation process of stroke patients, they primarily focus on preventing stroke complications, with limited direct effects on improving neurological impairments. Furthermore, conventional neurological nursing tends to follow a relatively uniform model, with limited individualized interventions tailored to the patient’s specific needs. This often leads to slow recovery and, in some cases, increases the risk of stroke recurrence. Therefore, it is imperative to explore more integrated and efficient nursing approaches, making it a key focus in the field of stroke care research.

In recent years, traditional Chinese medicine (TCM) nursing techniques have been widely applied in the rehabilitation of stroke patients and have demonstrated certain clinical advantages. In 2015, the National Administration of Traditional Chinese Medicine officially recognized 18 standardized TCM nursing techniques, including acupoint injection, acupoint massage, acupoint application, herbal hot compress, cupping, scraping, herbal iontophoresis, topical herbal application, herbal cold compress, herbal warm-moist compress, herbal enema, herbal fumigation, auricular acupoint pressing, wax therapy, indirect moxibustion, wheat-grain moxibustion, suspended moxibustion, and herbal soaking (4). These methods are grounded in the holistic theory and meridian doctrine of TCM, aiming to regulate the flow of Qi and blood, dredge meridians, and enhance visceral function to promote neurological recovery. Research has shown that acupoint massage can relieve muscle spasticity and improve motor function in paretic limbs (5). Meanwhile, moxibustion and herbal fumigation, through thermal stimulation and transdermal absorption of herbal components, can improve local blood circulation and facilitate neural repair (6, 7).

Compared to conventional nursing, TCM nursing techniques offer several notable advantages. First, TCM nursing techniques are based on the TCM syndrome differentiation and treatment system, which complements individualized care content and aligns with current research trends. Second, some TCM nursing methods, such as massage and moxibustion, not only focus on preventing complications but also have certain neuroprotective effects, which help to promote the recovery of motor function and activities of daily living. Third, TCM nursing techniques are easy to perform, suitable for both inpatient and home care, and highly compatible with rehabilitation training, aligning with current research trends in continuous care.

Although some clinical studies have suggested that TCM nursing techniques may improve neurological function and quality of life in stroke patients, high-quality evidence from clinical trials is still lacking. On one hand, the sample sizes in existing studies are generally small, and there are certain limitations in study design, which may affect the reliability of the findings. On the other hand, some studies have failed to strictly control for confounding factors, and lack randomized controlled trials (RCTs) or large multi-center studies, limiting the generalizability of their conclusions. Against this background, this study aims to provide a comprehensive assessment of the efficacy of TCM nursing techniques in stroke rehabilitation through a systematic review and meta-analysis. The focus will be on their impact on motor function and activities of daily living (ADL), as well as exploring potential factors influencing efficacy. The findings of this study will provide higher-quality evidence for stroke nursing care and offer valuable insights for future clinical practice and research.

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