Maximum Benefit Optimization Of Acupuncture And Moxibustion Programs In Stroke Patients With Motor Dysfunction By Comparative Effectiveness Research

Objective: To explore the effectiveness of acupuncture and moxibustion therapy(AMT)in the treatment of motor dysfunction after stroke,and to evaluate the clinical efficacy and health economics of different programs of AMT to select the maximum benefit optimization program for stroke patients.Methods: Firstly,based on the Real-World study(RWS)method,302 patients with stroke hospitalized in Yongchuan Hosptital of Chongqing Medical University from January 2015 to December 2018 were admitted in and divided into acupuncture group and non-acupuncture group according to whether they were exploured to acupuncture or not on the basis of routine rehabilitation treatment.The propensity score was used to balance the confounding factors between groups.The scores of modified barthel index scale(MBI)and modified rankin scale(MRS)were evaluated at 3months after stroke.Secondly,based on the method of ComparativeEffectiveness Research(CER),489 patients with stroke during recovery phase were selected from January 2015 to December 2018 in Yongchuan Hosptital of Chongqing Medical University and Yongchuan traditional Chinese medical Hospital.All included patients were divided into four groups according to their practical AMT program: acupuncture and moxibustion(group a,n=54),acupuncture alone(group b,n=73),electroacupuncture and moxibustion(group c,n=147)and electroacupuncture alone(group d,n=215).All patients in four groups were treated with scalp acupuncture equally.Fugl-meyer(FMA)scale,MBI scale were performed among groups at the recruitment and 2 weeks and 3 months after treatment.The costs of each course were compared among groups for the cost-effectiveness analysis and selecteing the maximum benefit optimization program.Results:Part 1: 83 pairs were successfully matched through propensity score matching in the Real-World study.Combined with age,NHISS score at admission,lesion size,multivariate regression revealed that acupuncture intervention was independently associated with good functional outcome in the MBI score [OR =3.81,95% CI(1.61,8.98),p=0.002] and MRS score [OR =5.33,95% CI(1.83,15.53),p=0.002 ]at 3months.Part 2: In the Comparative Effectiveness Research,there was no significant difference in FMA scores among groups at 2 weeks(p>0.05),while there was significant difference at 3 mouths(p<0.05),respectivelywere between group b and group c(p<0.05),group b and group d(p<0.05),indicating that the curative effect of group c and group d were better than that of group b.Similarly there was no significant difference in MBI scores among groups at 2 weeks(p>0.05),while on the contrary at 3mouths(p<0.05).At 3 months,the difference between group c and b,group d and b,group a and d were statistically significant(p<0.05),while there were no significant difference between other two groups(p>0.05).In addition,for every increasing point in FMA and MBI scores,the cost of group d was the lowest among groups after 2 weeks' and 3 months' treatment.Sensitivity analysis suggested that if the cost of acupuncture,electroacupuncture and moxibustion rised,the cost / effect ratio of group d was still the lowest;while if only the cost of electroacupuncture rised,the effctiveness of group c could be better than that of group a and group b in the long term;the cost / effect ratio decreased in the groups whose effect value of FMA and MBI scores increased.Conclusion: The application of AMT based on routine rehabilitation therapy showed better therapeutic effect for the patients with comprehensive motor dysfunction and limited activities of daily living after stroke,among which the program of scalp-acupuncture combined with electroacupuncture had the advantage of cost-effectiveness.