Systematic Review On Treatment Of Stroke By Contralateral Acupuncture

Objective For evaluate the therapeutic effects of ipsilateral and contralateral acupuncture for stroke by systematic evaluation.Evidence-based medicine is provided for the evaluation of the curative effect and level of evidence in the treatment of stroke.In order to guide clinical application and promotion.Methods Develop the search terms and search formulas,make a comprehensive search of Chinese and English literature database(CNKI,VIP,Wan Fang,CBM,Pub Med,Web of Science,The Cochrane Library database)and collect the relevant literatures of clinical type in the treatment of wind stroke.According to inclusion and exclusion criteria,data included in the literature for quantitative synthetic analysis will be extracted.Follow the principles and methods of evidence-based medicine,using the Cochrane collaboration's Review Manager 5.3 software and comparing the contralateral and ipsilateral acupuncture treatment for stroke.The curative effect index including: efficiency,FMA,Barthel,neural function defect scores,VAS,blood viscosity,plasma viscosity,fibrinogen and so on.The GRADE pro GDT was used to create a summary table for the system evaluation and to evaluate the quality of the evidence.Results A total of 23 articles were finally retrieved and recruited,including 1713 patients with cerebral vascular accident(CVA),860 cases treated by contralateral needling and 853 by homolateral needling.The meta-analysis showed that: 13 of the studies included in the literature reported efficiency.According to the different stages of stroke,subgroup analysis from three stages of apoplexy in acute stage,recovery period and sequelae period respectively.Three subtypes all indicated that the effective rate of contralateral needling was superior to that of the acupuncture based on the affected side.[effective rate: acute stage RR=1.09,95%CI(1.01,1.18),Z=2.34,P=0.02;recovery period : RR=1.16,95%CI(1.07,1.26),Z=3.54,P=0.0004;sequelae period :RR=1.12,95%CI(1.03,1.21),Z=2.74,P=0.006].Moreover,7 studies have compared the effect of simple contralateral needling and simple affected side needling.The results show that: there was no significant difference in the effective rate between two groups in the acute period,but simple contralateral needling was more effective in the recovery period andsequelae period.[effective rate: acute stage RR=1.08,95%CI(0.99,1.17),Z=1.78,P=0.07;recovery period : RR=1.14,95%CI(1.00,1.30),Z=2.01,P=0.04;sequelae period:RR = 1.12,95%CI(1.03,1.21),Z=2.74,P=0.006].6 studies compared the changes of FMA.Results: the FMA value of the contralateral needling group is better than that of the homolateral needling group,which is more favorable for the recovery of motor function.[WMD=5.62,95%CI(4.14,7.10)Z=7.44,P<0.00001].3 studies evaluated the VAS score.[WMD=1.51,95%CI(0.87,2.15)Z=4.62,P<0.00001];14 studies used Barthel to evaluate the ability of daily living of stroke patients.[WMD=6.41,95% CI(4.07,8.75)Z=5.37,P<0.00001];8 studies evaluated the defect of nerve function.[WMD=0.84,95%CI(0.18,1.51)Z=2.48,P=0.01];The above results suggest that the improvement of the contralateral needling on FMA,VAS,daily living ability and defect of nerve function are better than that of the homolateral needling.In the aspect of biochemical indexes,3 items test the whole blood viscosity,[WMD=0.77,95%CI(0.36,1.18)Z=3.71,P=0.0002];2 items Involve fibrinogen [WMD=1.45,95%CI(-0.97,3.87)Z=1.17,P=0.24];Plasma viscosity was analyzed in the 3 items.[WMD=0.17,95%CI(0.06,0.29)Z=2.91,P=0.004].The whole blood viscosity and plasma viscosity in the contralateral needling group was better than those in the homolateral needling group,but there was no significant difference in the improvement of fibrinogen index between test group and control group.The GRADE evaluation of evidences quality showed that the quality of 2 evidences were MORDERATE,10 evidences were LOW and 1 item was VERYLOW,and the overall quality of the evaluation included was poor.Conclusion The contralateral needling is more effective than that of affected side.In the recovery and sequelaperiod of stroke,simple contralateral needling is superior to simple homolateral needling,while there is no significant difference in the efficacy between two groups at the acute stage of wind stroke.The contralateral needling for the improvement of patients' activities of daily living,motor function,neurologic impairment,muscle tension and other aspects are better than homolateral needling.