Acupuncture And Moxibustion For Spastic Paralysis After Stroke:A Systematic Review And Meta-analysis Of Randomized Controlled Trials

ObjectivesTo determine the efficacy and safety of acupuncture and moxibustion therapy in people with spastic paralysis after stroke,through evaluate the randomized controlled trials(RCT)of acupuncture and moxibustion therapy of spastic paralysis after stroke,both published at home and abroad.Search methodsWe searched the following four Chinese medical databases:China National Knowledge Infrastructure(1994 to February 2017),China Biological Medicine Database(1979 to Feb 2017),VIP Database(1989 to Feb 2017),and Wan Fang database(1999 to Feb 2017).We also searched the following three English medical databases:Cochrane Central Register of Controlled Trials(CENTRAL,Cochrane Library 2017,Issue 2),MEDLINE(1966 to Feb 2017),EMBASE(1980 to Feb 2017).Truly randomized controlled clinical trials among people with spastic paralysis after ischaemic or haemorrhagic stroke were included,comparing acupuncture and moxibustion involving needling with placebo acupuncture,no acupuncture,western medicine,traditional Chinese medicine or rehabilitation training.Two review authors independently selected trials for inclusion,assessed quality,extracted,cross-checked and then analysis the data.ResultsWe included 33 trials with a total of 2970 participants in the subacute or chronic stages of stroke.One of them was completed in Germany and the rest was completed in China.Two trials compared acupuncture versus placebo acupuncture,nine trials compared acupuncture versus rehabilitation,nineteen trials compared acupuncture plus rehabilitation versus rehabilitation alone,one trial compared acupuncture plus traditional Chinese medicine(TCM)intravenous injection versus TCM intravenous injection alone,two trials compared acupuncture plus TCM fuming versus TCM fuming alone.The methodological quality of most of the included trials was not high.The quality of evidence for the main outcomes was low or very low based on the assessment by the system of Cochrane.Compared with placebo acupuncture,acupuncture shows no evidence of differences in the changes of Ashworth Scale(MD 0.33,95%CI-1.12 to 0.47).Compared with rehabilitation,acupuncture had beneficial effects on the effective rate(RR 1.22,95%CI 1.07 to 1.40)and Fugl-Meyer Assessment(MD 10.66,95%CI 3.63 to 17.70)and Barthel Index(MD 14.84,95%CI 1.10 to 28.59)and Ashworth Scale(MD-0.52,95%CI:-0.73 to-0.32).Compared with rehabilitation alone,acupuncture plus rehabilitation had beneficial effects on the effective rate(RR 1.23,95%CI 1.17 to 1.29)and Fugl-Meyer Assessment(MD 12.24,95%CI 7.24 to 17.24)and Barthel Index(MD 11.84,95%CI 7.80 to 15.88)and Ashworth Scale(MD-0.41,95%CI-0.59 to-0.24)and Neurologic Defect Scale(MD-4.47,95%CI-5.58 to-3.36).Compared with TCM intravenous injection alone,acupuncture plus TCM intravenous injection had beneficial effects on the effective rate(RR 2.00,95%CI 1.33 to 3.01).Compared with TCM fuming alone,acupuncture plus TCM fuming had beneficial effects on the effective rate(RR 1.22,95%CI 1.05 to 1.41)and Fugl-Meyer Assessment(MD 8.07,95%CI 2.40 to 13.74),and there was no evidence of differences in the changes of Ashworth Scale(MD 0.09,95%CI-1.06 to 1.23).Side effects caused by acupuncture and intolerance of painat acupoints were reported in only one trial with 4 participants in the acupuncture groups.ConclusionsIt can be seen from the available evidence that acupuncture and moxibustion therapy can improve the recovery of motor function in patients with spastic paralysis after stroke,improve the ability of daily life and improve the neurological deficits,and the conclusion of acupuncture and moxibustion in alleviating the degree of limb spasm Inconsistent.In addition,acupuncture in the recent treatment of no serious adverse events,high safety.However,the long-term efficacy and safety of acupuncture and moxibustion treatment is unknown;and most of the experimental evidence is not high,the sample size is small,the overall methodological quality is poor,and the risk of high bias is more.The evidence so far is not enough to draw a clear conclusion on the efficacy of acupuncture in the treatment of spastic paralysis after stroke.It is suggested that in the future study,a large sample,multi-center,high-quality randomized controlled trial should be conducted,and follow-up observation should be added to further clarify the long-term efficacy and safety of acupuncture.