Acupuncture treatment vs. cognitive rehabilitation for post-stroke cognitive impairment: A systematic review and meta-analysis of randomized controlled trials

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

acupuncture side effects

 

The latest here:

Acupuncture treatment vs. cognitive rehabilitation for post-stroke cognitive impairment: A systematic review and meta-analysis of randomized controlled trials

Yang Liu^1,2†, Fuyan Chen^1,2*†, Peng Qin^1,2†, Lu Zhao^1,2, Xingping Li^1,2, Jiangqin Han^1,2, Zi Ke^1,2, Honghang Zhu^1,2 and Bangqi Wu^1,2

• ¹Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
• ²National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China

Background: Cognitive impairment is one of the common sequelae after stroke, which not only hinders the recovery of patients but also increases the financial burden on families. In the absence of effective therapeutic measures, acupuncture treatment has been widely used in China to treat post-stroke cognitive impairment (PSCI), but the specific efficacy is unclear. Therefore, this review aimed to evaluate the true efficacy of acupuncture treatment in patients with PSCI.

Methods: We searched eight databases [PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, the China National Knowledge Infrastructure (CNKI) database, and Wan fang database] from the inception to May 2022 for randomized controlled trials (RCTs) related to acupuncture treatment combined with cognitive rehabilitation (CR) for PSCI. Two investigators independently used a pre-designed form to extract valid data from eligible RCTs. The risk of bias was assessed through tools provided by the Cochrane Collaboration. The meta-analysis was implemented through Rev Man software (version 5.4). The strength of the evidence obtained was evaluated using GRADE profiler software. Adverse events (AEs) were collected by reading the full text and used to evaluate the safety of acupuncture treatment.

Results: Thirty-eight studies involving a total of 2,971 participants were included in this meta-analysis. Overall, the RCTs included in this meta-analysis were poor in methodological quality. The combined results showed that acupuncture treatment combined with CR showed significant superiority compared to CR alone in terms of improving cognitive function [Mean Difference (MD) = 3.94, 95% confidence intervals (CI): 3.16–4.72, P < 0.00001 (MMSE); MD = 3.30, 95%CI: 2.53–4.07, P < 0.00001 (MoCA); MD = 9.53, 95%CI: 5.61–13.45, P < 0.00001 (LOTCA)]. Furthermore, the combination of acupuncture treatment and CR significantly improved patients' self-care ability compared to CR alone [MD = 8.66, 95%CI: 5.85–11.47, P < 0.00001 (MBI); MD = 5.24, 95%CI: 3.90–6.57, P < 0.00001 (FIM)]. Meanwhile, subgroup analysis showed that MMSE scores were not sufficiently improved in the comparison of electro-acupuncture combined with CR versus CR alone (MD = 4.07, 95%CI: −0.45–8.60, P = 0.08). However, we also observed that electro-acupuncture combined with CR was superior to the use of CR alone in improving MoCA and MBI scores in patients with PSCI [MD = 2.17, 95%CI: 0.65–3.70, P = 0.005 (MoCA); MD = 1.74, 95%CI: 0.13–3.35, P = 0.03 (MBI)]. There was no significant difference in the occurrence of adverse events (AE) between acupuncture treatment combined with CR and CR alone (P > 0.05). The certainty of the evidence was rated low level because of flaws in the study design and considerable heterogeneity among the included studies.

Conclusion: This review found that acupuncture treatment combined with CR may have a positive effect on improving cognitive function and self-care ability in PSCI patients. However, our findings should be treated with caution owing to the existence of methodological quality issues. High-quality studies are urgently required to validate our results in the future.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338905, identifier: CRD42022338905.

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.

Effects of Acupuncture in Ischemic Stroke Rehabilitation: A Randomized Controlled Trial

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:

 

Effects of Acupuncture in Ischemic Stroke Rehabilitation: A Randomized Controlled Trial

Lixia Li^1†, Weifeng Zhu^1†, Guohua Lin^2*, Chuyun Chen^1*, Donghui Tang³, Shiyu Lin², Xiaorong Weng³, Liqin Xie¹, Lihong Lu¹ and Weilin Li⁴

• ¹Department of Acupuncture and Moxibustion, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China
• ²Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
• ³Department of Psychiatry, Liwan District Hospital of Chinese Medicine, Guangzhou, China
• ⁴Xin Hua College of Sun Yat-sen University, Guangzhou, China

Background: Acupuncture is a well-known treatment option for ischemic stroke recovery, but evidence of its effectiveness remains limited. This is a randomized controlled trial to evaluate the effectiveness of acupuncture treatment for ischemic stroke rehabilitation.

Methods: Rehabilitation training was provided to the control group. In acupuncture arm 1, these acupoints were derived from the ancient books, including GV20 (baihui), GV26 (shuigou), PC9 (zhongchong), ST6 (jiache), ST4 (dicang), LI15 (jianyu), LI11 (quchi), LI4 (hegu), GB30 (huantiao), GB31 (fengshi), GB34 (yanglingquan), and GB39 (xuanzhong). In acupuncture arm 2, the acupoints used were GV20 (baihui), PC6 (neiguan), LI11 (quchi), LI10 (shousanli), SJ5 (waiguan), LI4 (hegu), GB30 (huantiao), ST36 (zusanli), GB34 (yanglingquan), SP6 (sanyinjiao), ST41 (jiexi), and LR3 (taichong), which were extracted from Acupuncture and Moxibustion Science. After acupuncture, the needles were left in for 30 min and manually manipulated every 10 min. The three groups received treatment once a day, 5 times a week for 2 weeks. The primary outcome was the National Institutes of Health Stroke Scale (NIHSS), and the secondary outcomes were the Barthel Index (BI) and the Modified Ashworth Scale (MAS). Outcomes were measured in patients both before and after treatment.

Results: A total of 497 patients with ischemic stroke were randomized into either arm 1 (159 cases), arm 2 (173 cases), or the control group (165 cases). After 2 weeks of treatment, the NIHSS scores for arm 1 were lower than those of the control group (P = 0.017); the BI scores were higher in arm two than that in the control group at T2 (P = 0.016) and follow-up (P = 0.020). Additionally, there was no significant difference between arm one and the control group for either the BI scores or the MAS scores (P > 0.05) and no significant difference between arm two and the control group for the MAS scores or the NIHSS scores (P > 0.05).

Conclusion: The clinical efficacy of arm 1 and arm 2 (acupuncture groups) was superior to that of the control group, but there was no difference between the effects of the two acupuncture groups.

Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, identifier: ChiCTR-IOR-16008627.

Background

Stroke is widespread around the world. According to recent reports (1–3) the incidence of stroke in China is 274–379 per 100,000 people, of which ischemic stroke accounts for 60–70%. Three-fourths of stroke survivors are left with disability of varying degrees and about 40% are severely disabled. In China, the care for patients with stroke imposes heavy economic burdens on both the state and many families.

Ischemic stroke is the common term for cerebral infarction, which disrupts cerebral artery blood flow through several pathways, such as cerebral arteriosclerosis or cerebral artery thrombosis, causing hypoxia and ischemic necrosis in local brain tissue. This results in corresponding neurologic deficits (4). The clinical manifestations of ischemic stroke are focal neurological deficits such as hemiplegia, aphasia, dysphagia, visual impairment, and mental disturbances. Ultra-early thrombolysis has been used widely in the acute phase of stroke. However, due to its time-restricted application, the probability of thrombolysis is only 2.4% (5). This leaves intravenous or oral medications, rehabilitation training, and prevention of complications as the primary treatment measures for most patients with stroke.

Acupuncture has been used for the treatment of stroke since ancient times. The stroke symptoms and acupoints were recorded in the earliest Chinese medicine canon named the Yellow Emperor's Inner Classics (Huang-Di-Nei-Jing in Chinese), while the syndrome differentiation of stroke and its treatment were described in the Comprehensive Achievements of Acupuncture and Moxibustion (Zhen-Jiu-Da-Cheng in Chinese). This provides a theoretical basis for the treatment of apoplexy by acupuncture. At present, new acupuncture theories and techniques are still being developed. These include body acupuncture, scalp acupuncture, electrical acupuncture, and eye acupuncture. Effective treatment is dependent on the proper choice of acupuncture points. The acupoints in this study were selected based on ancient literature and Acupuncture and Moxibustion Science (6). They were chosen because of their wide application, frequent use, and direct curative effect. These acupoints possess the following characteristics: they are connected to the yang meridians. The Du Meridian, the Large Intestine Meridian, the Stomach Meridian, and the Gallbladder Meridian are the most relevant yang meridians in this regard. Since GV20 is the meeting of various yang meridians, it is the most frequently selected acupoint, which has the effect of awakening the brain and pacifying the spirit (Xingnaoanshen) and expelling wind to open the orifices (Qufengkaiqiao) (7). The Stomach Meridian and the Large Intestine Meridian have the functions of harmonizing Qi and blood and relieving limbs and joints. The Gallbladder Meridian is related to tendons and has the function of stimulating the circulation of the blood and relaxing the muscles and joints. In Chinese medicine, yin and yang balance is important to maintain the physiological equilibrium of the human body. The acupoints on the yang meridians have the effect of replenishing yang qi. However, patient with apoplexy often shows symptoms such as paralysis and aphasia that belong to Yin syndrome. This is in line with the viewpoint of treating yin disease with Yang. The other feature of the selected acupoints in this study is that they have a unique therapeutic effect and a specific name. The main ones are the convergence points (Jiao-hui-xue) and the He acupoints, in which Jiao-hui acupoints enable the Qi and blood of meridians to communicate with each other for the treatment of the disease of intersecting meridians. The He acupoint is one of the five Shu points (Wu-shu-xue) and it is the acupoint with the greatest Qi and blood. Therefore, it is easier to mobilize Qi and blood in the treatment of apoplexy by needling such acupoints. This provides a sound theoretical basis for effective stroke treatment (8–10). However, acupuncture's clinical efficacy needs further validation in clinical trials.

A prospective randomized controlled trial was conducted to explore an effective scheme for acupuncture treatment of ischemic stroke and to provide scientific evidence for the effectiveness of acupuncture for stroke rehabilitation.

The effect of combined scalp acupuncture and cognitive training in patients with stroke on cognitive and motor functions

And just why would you try acupuncture?

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)

 The latest here:

The effect of combined scalp acupuncture and cognitive training in patients with stroke on cognitive and motor functions

NeuroRehabilitation , Volume 46(1) , Pgs. 75-82.

NARIC Accession Number: J83403.  What's this?
ISSN: 1053-8135.
Author(s): Xiong, Jian ; Zhang, Zhichao ; Ma, Yan ; Li, Zuhong ; Zhou, Fang ; Qiao, Na ; Liu, Qi ; Liao, Weijing.
Publication Year: 2020.
Number of Pages: 8.

Abstract: 

Study investigated the effect of combined scalp acupuncture and cognitive training on cognitive and motor functioning in patients with stroke during the recovery stage. Seventy patients with post-stroke cognitive impairment were randomly divided into an experimental group and a control group. Patients in the experimental group additionally received scalp acupuncture and cognitive training, while the control group received sham scalp acupuncture and cognitive training. The cognitive and motor functioning of all patients were assessed using Mini Mental State Examination (MMSE) and Loewenstein Occupational Therapy Cognition Assessment (LOTCA), and the Fugl-Meyer assessment (FMA), respectively, before and 12 weeks after treatment. In addition, the plasma brain-derived neurotrophic factor and nerve growth factor (NGF) levels were measured from peripheral blood samples using ELISA kits. After 12 weeks, the MMSE, LOTCA and FMA scores were significantly higher in the experimental group than in the control group. In the experimental group, there was an improvement in the total MMSE score, orientation, spatial executive function, the total LOTCA score, and the score of command of language orientation post-treatment. Significant improvements of BDNF and NGF were found in the experimental group after treatment, while only significant improvements of NGF was found in the control group after treatment. Both BDNF and NGF in the experiment group were higher than those in the control group at the last day of treatment. Combined scalp acupuncture and cognitive training can efficiently enhance cognitive and motor functions in patients with stroke during the recovery stage, which may be a more effective rehabilitation treatment after stroke than routine therapy and rehabilitation training alone.
Descriptor Terms: ALTERNATIVE MEDICINE, BIOCHEMISTRY, BRAIN, COGNITIVE DISABILITIES, INTERVENTION, MOTOR SKILLS, STROKE, THERAPY.


Can this document be ordered through NARIC's document delivery service*?: Y.
Get this Document: https://content.iospress.com/articles/neurorehabilitation/nre192942.

Citation: Xiong, Jian , Zhang, Zhichao , Ma, Yan , Li, Zuhong , Zhou, Fang , Qiao, Na , Liu, Qi , Liao, Weijing. (2020). The effect of combined scalp acupuncture and cognitive training in patients with stroke on cognitive and motor functions.  NeuroRehabilitation , 46(1), Pgs. 75-82. Retrieved 5/15/2020, from REHABDATA database.

Acupuncture combined with modern rehabilitation therapy for post-stroke flaccid paralysis

Zero point in reading this. 

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)

The latest here:

Acupuncture combined with modern rehabilitation therapy for post-stroke flaccid paralysis

Thigh haematoma following acupuncture treatment in a patient on warfarin

Be careful out there, I'm sure your doctor warned you of all these side effects of warfarin. Not sure why anyone would believe in acupuncture anyway.
http://casereports.bmj.com/content/2012/bcr-2012-006676.full
picture at the link.

Description

A 82-year-old woman on warfarin for atrial-fibrillation was admitted via the acute medical take having developed a large haematoma in the right thigh (picture). She gave a history of recent acupuncture treatment for trochanteric bursitis. Acupuncture treatment had been given in the community and we do not know if the therapist was aware of the fact she was being treated with warfarin, nor do we know if enquiry was made about the state of anticoagulant control at the time of needle insertion. Retrospective examination of the anticoagulant clinic records revealed that her international normalized ration (INR) was 2.4 at the time of needle insertion.

Ultrasound scan confirmed that the haematoma extended deeply into the right buttock and upper thigh.

Her haemoglobin dropped to 8.7 g/dl compared to 12.1 g/dl before acupuncture therapy. Her INR was 2.2 on the day of admission, she was on stable dose of warfarin and there was no concomitant drug interaction.

Warfarin was stopped and she was given oral vitamin K to reverse her INR, she did not require a blood transfusion. She made a good recovery and her haematoma has gradually resolved.

The rationale for using warfarin was reviewed (repeated ECG was sinus rhythm) and a decision was taken to withhold further warfarin therapy.

Acupuncture is widely practised in developed health economies.1 It is estimated that 2.5–10% of the UK population receive non-conventional treatments (‘alternative therapy’) each year and that only 10% of these are via referral in the NHS.2 Acupuncture is the most commonly used of the non-conventional treatments. Acupuncture can be associated with serious adverse events like bleeding and subcutaneous haematoma 6.1%.3

Learning points

• Acupuncture can be associated with serious adverse events like subcutaneous haematoma especially in patients on warfarin.
• Acupuncture should be used with caution in patients on warfarin.