Acupuncture for stroke rehabilitation

  • Review
  • Intervention

Authors


Abstract

Background

Stroke is the second most common cause of death in the world and in China it has now become the main cause of death. It is also a main cause of adult disability and dependency. Acupuncture for stroke has been used in China for hundreds of years and is increasingly practiced in some Western countries. This is an update of the Cochrane review originally published in 2006 .

Objectives

To determine the efficacy and safety of acupuncture therapy in people with subacute and chronic stroke. We intended to test the following hypotheses: 1) acupuncture can reduce the risk of death or dependency in people with subacute and chronic stroke at the end of treatment and at follow-up; 2) acupuncture can improve neurological deficit and quality of life after treatment and at the end of follow-up; 3) acupuncture can reduce the number of people requiring institutional care; and 4) acupuncture is not associated with any intolerable adverse effects.

Search methods

We searched the Cochrane Stroke Group Trials Register (June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library 2015, Issue 7), MEDLINE (1966 to July 2015, Ovid), EMBASE (1980 to July 2015, Ovid), CINAHL (1982 to July 2015, EBSCO), and AMED (1985 to July 2015, Ovid). We also searched the following four Chinese medical databases: China Biological Medicine Database (July 2015); Chinese Science and Technique Journals Database (July 2015); China National Infrastructure (July 2015), and Wan Fang database (July 2015).

Selection criteria

Truly randomised unconfounded clinical trials among people with ischaemic or haemorrhagic stroke, in the subacute or chronic stage, comparing acupuncture involving needling with placebo acupuncture, sham acupuncture, or no acupuncture.

Data collection and analysis

Two review authors independently selected trials for inclusion, assessed quality, extracted and cross-checked the data.

Main results

We included 31 trials with a total of 2257 participants in the subacute or chronic stages of stroke. 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 Grades of Recommendation, Assessment, Development and Evaluation (GRADE).

Two trials compared real acupuncture plus baseline treatment with sham acupuncture plus baseline treatment. There was no evidence of differences in the changes of motor function and quality of life between real acupuncture and sham acupuncture for people with stroke in the convalescent stage.

Twenty-nine trials compared acupuncture plus baseline treatment versus baseline treatment alone. Compared with no acupuncture, for people with stroke in the convalescent phase, acupuncture had beneficial effects on the improvement of dependency (activity of daily living) measured by Barthel Index (nine trials, 616 participants; mean difference (MD) 9.19, 95% confidence interval (CI) 4.34 to 14.05; GRADE very low), global neurological deficiency (seven trials, 543 participants; odds ratio (OR) 3.89, 95% CI 1.78 to 8.49; GRADE low), and specific neurological impairments including motor function measured by Fugl-Meyer Assessment (four trials, 245 participants; MD 6.16, 95% CI 4.20 to 8.11; GRADE low), cognitive function measured by the Mini-Mental State Examination (five trials, 278 participants; MD 2.54, 95% CI 0.03 to 5.05; GRADE very low), depression measured by the Hamilton Depression Scale (six trials, 552 participants; MD -2.58, 95% CI -3.28 to -1.87; GRADE very low), swallowing function measured by drinking test (two trials, 200 participants; MD -1.11, 95% CI -2.08 to -0.14; GRADE very low), and pain measured by the Visual Analogue Scale (two trials, 118 participants; MD -2.88, 95% CI -3.68 to -2.09; GRADE low). Sickness caused by acupuncture and intolerance of pain at acupoints were reported in a few participants with stroke in the acupuncture groups. No data on death, the proportion of people requiring institutional care or requiring extensive family support, and all-cause mortality were available in all included trials.

Authors' conclusions

From the available evidence, acupuncture may have beneficial effects on improving dependency, global neurological deficiency, and some specific neurological impairments for people with stroke in the convalescent stage, with no obvious serious adverse events. However, most included trials were of inadequate quality and size. There is, therefore, inadequate evidence to draw any conclusions about its routine use. Rigorously designed, randomised, multi-centre, large sample trials of acupuncture for stroke are needed to further assess its effects.

摘要

针刺用于卒中的康复

研究背景

卒中是世界上第二常见的死亡原因,在中国,卒中已经成为最主要的死亡原因。它也是引起成人残疾和依赖(生活不能自理)的主要原因。针刺治疗卒中在中国已经应用了数百年,如今在一些西方国家越来越流行。本综述是2006年发表的Cochrane综述的更新版。

研究目的

为了确定针刺疗法对亚急性和慢性卒中人群的疗效和安全性。我们要验证以下假设:1)针刺可以降低亚急性和慢性卒中人群的死亡和依赖的风险(治疗结束和随访时期);2)针刺可以改善神经功能障碍和生活质量(治疗结束和随访结束);3)针刺可以降低住院治疗的必要性;4)针刺不会产生任何无法忍耐的不良反应。

检索策略

我们检索了Cochrane卒中组试验专业注册库(the Cochrane Stroke Group Trials Register)(2015年6月)、Cochrane临床对照试验中心注册库(CENTRAL;Cochrane Library2015年7期)、MEDLINE(1966年至2015年7月,Ovid)、EMBASE(1980年至2015年7月,Ovid)、CINAHL(1982年至2015年7月,EBSCO)和AMED(1985年至2015年7月,Ovid)。我们同时检索了4个中文医学数据库:中国生物医药数据库(2015年7月)、维普数据库(2015年7月)、中国知网(2015年7月)和万方数据库(2015年7月)。

标准/纳入排除标准

随机临床试验纳入的是梗塞或出血的亚急性或慢性的人群,对比针刺和安慰剂针刺、假针刺或不针刺。

数据收集与分析

两名综述作者独立筛选文献、评估质量、提取资料并核对数据。

主要结果

我们纳入31项试验共2257名卒中亚急性或慢性期的受试者。大部分试验的方法学质量是不高的。Grades of Recommendation, Assessment, Development and Evaluation(GRADE)系统的评估结果显示主要结果的证据质量是低或极低的。

两项试验对比了真针刺联合基础治疗和假针刺联合治疗。以上两组恢复期的患者之间在运动功能和生活质量方面没有差异。

29项试验对比了针刺联合基础治疗和单纯的基础治疗。相比于不针刺,接受针刺治疗的卒中恢复期人群在日常生活活动能力的依赖程度(Barthel指数;9项试验616名受试者;MD=9.19,95%CI=4.34 - 14.05;GRADE极低)、整体神经功能障碍(7项试验543名受试者;OR=3.89,95%CI=1.78 - 8.49;GRADE:低)和特定神经功能障碍(包括Fugl-Meyer评分评估的运动功能;4项试验245名受试者;MD=6.16,95%CI=4.20 - 8.11;GRADE:低)、认知功能(简易智力状态检查量表;5项试验278名受试者;MD=2.54,95%CI=0.03 - 5.05;GRADE:极低)、抑郁(Hamilton抑郁量表;6项试验552名受试者;MD=-2.58,95%CI=-3.28 - -1.87;GRADE:极低)、吞咽功能(饮水试验;2项试验200名受试者;MD=-1.11,95%CI=-2.08 - -0.14;GRADE:极低)、疼痛(视觉模拟评分;2项试验118名受试者;MD=-2.88,95%CI=-3.68 - -2.09;GRADE:低)方面均有改善。针刺组少数中风患者有针刺引起的不适和针刺痛不耐受。在所有纳入的试验中没有以下数据:死亡、需要机构介护或大量家庭支助的患者比例和全因死亡率。

作者结论

现有证据表明,针刺可能可以改善卒中恢复期人群的依赖性、整体神经功能障碍和一些特定神经功能障碍,且没有明显严重的不良事件。然而,大部分纳入的试验的质量和样本量均不足。因此,没有足够的证据用来得出关于其常规使用的任何结论。为了进一步评估针刺对卒中的影响,我们需要严格设计、随机、多中心、大样本量的试验。

Plain language summary

Acupuncture for stroke rehabilitation

Review question

Acupuncture is a treatment based on ancient Chinese medicine in which fine needles or pressure is applied at certain sites in the body for therapeutic purposes. We wanted to know whether acupuncture is effective in improving the recovery of daily activities, movement, and quality of life in people who had experienced a stroke more than one month previously.

Background

Stroke is a major cause of death in the world and can also cause severe disability. Acupuncture is a relatively simple, inexpensive and safe treatment that has been used in China for hundreds of years and is increasingly practiced in some Western countries. However, it remains uncertain whether the existing evidence is sufficiently reliable to recommend the routine use of acupuncture.

Study characteristics

We identified 31 studies to July 2015 for inclusion in the review. These included a total of 2257 participants who had had a stroke more than one month previously. They all investigated acupuncture aimed at promoting recovery compared with no acupuncture or sham acupuncture. Outcomes included measures of daily activities (activities of daily living), neurological function, movement, cognition, depression, swallowing, pain, and quality of life. Most of the studies (29/31) were conducted in China; the studies varied considerably with respect to the time of stroke, specific techniques used, and the frequency of acupuncture.

Key results

We found some evidence that acupuncture improved activities of daily living and a number of aspects of neurological function. However, these conclusions were based on studies with low quality evidence. No serious side effects were reported and there was no information on the effects of acupuncture on death or the need for institutional care.

Quality of the evidence

It proved difficult to reliably determine the quality of the evidence because of poor reporting of study characteristics. Therefore, we have described most conclusions as having low or very low quality evidence.

எளியமொழிச் சுருக்கம்

பக்கவாத புனர்வாழ்வுக்கு நுண்துளை (குத்தூசி) மருத்துவம்

திறனாய்வு கேள்வி

குத்தூசி சிகிச்சை, மெல்லிய ஊசிகளைக் கொண்டு உடலின் சில குறிப்பிட்ட இடங்களில் செலுத்தப்படும் ஒரு மருந்தில்லா சிகிச்சையாகும். பக்கவாதம் வந்து ஒரு மாதமோ அதற்கு மேலும் ஆனவர்களுக்கு அன்றாட வாழ்க்கையின் செல்யல்பாடுகள் செய்வது, அசைவுகள் மற்றும் வாழ்க்கை தரத்தில் மேம்பாடு அடைய நுண்துளை (குத்தூசி) மருத்துவம் உதவுமா ஏன்று நாங்கள் தெரிந்துகொள்ள விரும்பினோம்.

பின்னணி

இறப்பு மற்றும் கடுமையான இயலாமைக்கு பக்கவாதம் ஒரு பொதுவான காரணமாக உள்ளது. நுண்துளை (குத்தூசி) மருத்துவம் ஒரு எளிய, மலிவான மற்றும் பாதுகாப்பான சிகிச்சை முறை. இதனை சீனாவில் பல நூறு ஆண்டுகளாக பயன்படுத்தி வருகின்றனர் மேலும் மேலைநாடுகளில் இதன் பயன்பாடு அதிகரித்துள்ளது. வழக்கமான பயன்பாட்டிற்கு நுண்துளை (குத்தூசி) மருத்துவம் பயன்படுத்தலை சிபாரிசு செய்ய நம்பகமான ஆதாரங்கள் உள்ளனவா என்பது கேள்விக்குறியாக உள்ளது.

ஆய்வு பண்புகள்

இந்த திறனாய்வில் சேர்த்துக்கொள்ள ஜூலை 2015 வரை நாங்கள் 31 ஆய்வுகளை கண்டறிந்தோம். பக்கவாதம் வந்து ஒரு மாதத்திற்கு மேலான 2257 பங்கேற்பாளர்களை இதில் சேர்க்கப்பட்டுள்ளது. போலி நுண்துளை (குத்தூசி) மருத்துவம் அல்லது நுண்துளை (குத்தூசி) மருத்துவம் செய்யாதவர்களுடன் ஒப்பிடுகையில் நுண்துளை (குத்தூசி) மருத்துவம் மீட்டெழலை ஊக்குவிக்குமா என்பதை இவை ஆராய்ந்தன. தினசரி நடவடிக்கைகள் (அன்றாட வாழ்க்கை நடவடிக்கைகள் ADL) நரம்பியல் சம்பந்தப்பட்ட செயல்பாட்டு திறன், அசைவுகள், அறியும் ஆற்றல் (cognition), மனச்சோர்வு, விழுங்குதல், வலி, மற்றும் வாழ்க்கை தரம் போன்ற விளைவுபயன்கள் இதனுள் அடங்கும். பெரும்பாலான (29/31) ஆய்வுகள் சீனாவில் நடத்தப்பட்டன. இந்த ஆராய்ச்சிகள் பக்கவாதம் வந்த பின்இருந்த காலம், உபயோகித்த குறிப்பிட்ட யுக்தி மற்றும் நுண்துளை (குத்தூசி) மருத்துவம் செய்த கால நிகழ்விடைவெளி ஆகியவற்றைப் பொறுத்து ஆய்வுகள் குறிப்பிடத்தக்க மாற்றமுள்ளவையாக இருந்தன.

முக்கிய முடிவுகள்

நுண்துளை (குத்தூசி) மருத்துவம் நரம்பியல் சம்பந்தப்பட்ட செயல்பாட்டு திறன் மற்றும் அன்றாட வாழ்க்கை நடவடிக்கைகள் மேம்படுத்தும் என்பதற்கான சில ஆதாரங்கள் எங்களுக்கு கிட்டியது. எனினும், இந்த முடிவுகள் குறைந்த தர ஆதாரங்களின் அடிப்படையில் எடுக்கப்பட்டவை. இறப்பு அல்லது மருத்துவமனை நிறுவன பராமரிப்பு தேவைபடல் போன்ற வற்றை பற்றி எந்த ஒரு தகவலும் இல்லை மேலும் தீவிரபக்க விளைவுகள் எதுவும் தெரிவிக்கப் படவில்லை.

ஆதாரங்களின் தரம்

ஆராய்ச்சிகள் பற்றிய விவரங்களை வெளியிடுதலில் உள்ள குறைபாடுகளின் நிமித்தம் ஆதாரங்களின் தரத்தை நம்பகமாக தீர்மானிக்க கடினமாக இருந்தது. எனவே, நாங்கள் இந்த முடிவுகள் பெரும்பான்மையாக குறைவாக அல்லது மிகவும் குறைவான தரம் கொண்டவை என்று விவரித்துள்ளோம்.

மொழிபெயர்ப்பு குறிப்புகள்

மொழிபெயர்ப்பு: சி.இ.ப.ஏன்.அர்.குழு

Laički sažetak

Akupunktura za oporavak nakon moždanog udara

Istraživačko pitanje

Akupunktura je liječenje temeljeno na staroj kineskoj medicini ubadanja iglom ili pritiska na određena mjesta na tijelu u svrhu liječenja. U ovom Cochrane sustavnom pregldu stražena je učinkovitost akupunkture u oporavku dnevnih aktivnosti, kretanju i kvaliteti života u bolesnika koji su doživjeli moždani udar prije više od mjesec dana.

Dosadašnje spoznaje

Moždani udar je glavni uzrok smrti u svijetu i može biti uzrokom teškog invaliditeta. Akupunktura je relativno jednostavna, jeftina i sigurna metoda liječenja koja se stoljećima primjenjuje u Kini, te sve više u zapadnjačkim zemljama. Nije jasno koliko su pouzdani trenutni dokazi za rutinsku preporuku akupunkture.

Obilježja uključenih istraživanja

Pretraživanjem literature objavljene do srpnja 2015. pronađena je 31 studija koja je uključena u ovaj Cochrane sustavni pregled literature. Obuhvaćeno je 2257 bolesnika koji su preboljeli moždani udar prije više od mjesec dana. U svim studijama je istražen učinak akupunkture na ubrzanje oporavka u usporedbi sa skupinom ispitanika kod koje nije primjenjena akupunktura ili s lažnom akupunkturom. Ishodi su uključili učinak na dnevne aktivnosti, neurološku funkciju, kretanje, kognitivne sposobnosti, depresiju, gutanje, bol i kvalitetu života. Većina studija je provedena u Kini (29/31) i znatno se razlikuju prema vremenu koliko je prošlo od moždanog udara, vrstama tehnika i učestalosti primjene akupunkture.

Ključni rezultati

Nađeni su određeni dokazi da je akupunktura poboljšala dnevne aktivnosti i neke oblike neurološke funkcije. Ti zaključci proizlaze iz studija niske kvalitete dokaza. Nisu prikazane ozbiljne nuspojave i nema podataka o smrtnom ishodu kod primjene akupunkture ili potrebi za liječenjem u bolnici.

Kvaliteta dokaza

Teško je bilo pouzdano procijeniti kvalitetu dokaza zbog lošeg načina opisa studija. Stoga se zaključci temelje na dokazima niske ili vrlo niske kvalitete.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Vesna Kušec
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Streszczenie prostym językiem

Akupunktura w rehabilitacji po udarze mózgu

Pytanie badawcze

Akupunktura to leczenie oparte na starożytnej medycynie chińskiej, w której w celach terapeutycznych stosuje się cienkie igły lub uciskanie w wybranych miejscach ciała. Chcieliśmy wiedzieć, czy akupunktura jest skutecznie poprawia przywrócenie aktywności dnia codziennego, poruszania się oraz czy poprawia jakość życia u osób, które przeszły udar mózgu co najmniej miesiąc wcześniej.

Wprowadzenie

Udar mózgu jest główną przyczyną zgonów na świecie oraz może powodować ciężką niesprawność. Akupunktura jest relatywnie prostą, niedrogą oraz bezpieczną metodą leczenia, którą stosowano w Chinach od setek lat, a która jest coraz powszechniej praktykowana w niektórych krajach zachodnich. Jednakże, pozostaje niejasne czy istniejące dane naukowe są wystarczająco wiarygodne, aby rutynowo zalecać stosowanie akupunktury.

Charakterystyka badań

Zidentyfikowaliśmy 31 badań, które spełniały kryteria włączenia do przeglądu, opublikowanych do lipca 2015 r., . Badania obejmowały łącznie 2257 uczestników, którzy przebyli udar mózgu ponad miesiąc wcześniej. We wszystkich badaniach oceniano stosowanie akupunktury w celu wspierania powrotu do zdrowia po udarze w porównaniu do niestosowania akupunktury lub stosowania pozorowanej akupunktury. Punkty końcowe (wyniki) obejmowały pomiary codziennych aktywności (aktywności życia codziennego), czynności neurologicznych, poruszania się, czynności poznawczych, depresji, trudności w połykaniu, bólu oraz jakości życia. Większość badań (29/31) przeprowadzono w Chinach. Badania znacznie różniły się między sobą w odniesieniu do czasu wystąpienia udaru mózgu, stosowanych technik akupunktury oraz częstości wykonywania zabiegów akupunktury.

Główne wyniki

Odnaleźliśmy pewne dane wskazujące, że akupunktura poprawia wykonywanie czynności dnia codziennego oraz szereg aspektów z obszaru czynności neurologicznych. Jednakże, wnioski te opierają się na badaniach o niskiej jakości danych. Nie raportowano poważnych działań niepożądanych, również nie odnaleziono informacji o wpływie akupunktury na ryzyko zgonu lub potrzebę opieki instytucjonalnej nad pacjentem.

Jakość danych naukowych

Wiarygodna ocena jakości danych naukowych była trudna, ze względu na to, że podano niewiele danych na temat charakterystyki badań. Dlatego też, większość wniosków oparto na danych o niskiej lub bardzo niskiej jakości.

Uwagi do tłumaczenia

Tłumaczenie Magdalena Koperny Redakcja Joanna Zając

Ringkasan bahasa mudah

Akupunktur untuk pemulihan angin ahmar (strok)

Soalan ulasan

Akupunktur merupakan sejenis rawatan berasaskan perubatan Cina purba di mana jarum halus atau tekanan ditusukkan pada bahagian-bahagian tertentu dalam badan manusia bagi tujuan teraputik. Kami ingin mengetahui sama ada akupunktur berkesan dalam meningkatkan pemulihan aktiviti harian, pergerakan serta kualiti hidup individu yang pernah mengalami serangan strok lebih daripada sebulan sebelumnya.

Latar belakang

Angin ahmar atau strok merupakan satu punca kematian utama di seluruh dunia serta boleh menyebabkan kecacatan yang parah. Akupunktur ialah sejenis rawatan yang mudah, murah dan selamat yang telahpun diamalkan di negara China selama beberapa ratus tahun dan ia semakin dipraktikkan dalam sesetengah negara barat. Namun, ianya tidak jelas sama ada bukti yang sedia ada mencukupi untuk mengesyorkan kegunaan akupunktur secara rutin.

Ciri-ciri kajian

Kami telah mengenalpasti 31 kajian sehingga Julai 2015 untuk dimasukkan ke dalam ulasan ini. Kajian kajian ini melibatkan sejumlah 2257 peserta yang pernah mengalami serangan strok lebih daripada sebulan sebelumnya. Kesemua kajian menyelidik rawatan akupunktur untuk meningkatkan pemulihan berbanding dengan kumpulan yang tidak dapat akupunktur atau diberikan akupunktur 'sham' (tidak benar) Hasil kajian termasuk ukuran aktiviti-aktiviti harian, (aktiviti harian kehidupan) fungsi-fungsi neurologikal, pergerakan, kognisi, kemurungan, penelanan, kesakitan serta kualiti hidup. Kebanyakan kajian (29/31) dijalankan di negara China; kajian-kajian ini berbeza dengan ketara dari segi waktu serangan strok, teknik-teknik khusus yang digunakan, serta kekerapan akupunktur. neurologikal, pergerakan, kognisi, kemurungan, penelanan, kesakitan serta kualiti hidup.Kebanyakan kajian (29/31) dijalankan dinegara China; kajian-kajian ini berbeza dengan ketara dari segi waktu serangan strok, teknik-teknik khusus yang digunakan, serta kekerapan akupunktur.

Keputusan utama

Kami mendapati sedikit bukti bahawa akupunktur meningkatkan aktiviti harian dan beberapa aspek fungsi sistem neurologikal. Namun, rumusan ini adalah berdasarkan kajian-kajian yang berkualiti rendah. Tiada kesan sampingan teruk dilaporkan dan tidak ada maklumat mengenai kesan-kesan akupunktur pada kematian serta keperluan penjagaan institusi.

Kualiti bukti

Penentuan kualiti bukti yang diperolehi amat sukar disebabkan kelemahan dalam laporan ciri-ciri kajian. Oleh itu, kami telah menghuraikan yang kebanyakan rumusan itu memiliki bukti yang berkualiti rendah atau amat rendah.

Catatan terjemahan

Diterjemahkan oleh Yap Kar Suan (Melaka-Manipal Medical College). Disunting oleh Foo Sook Lee / Tan May Loong (Penang Medical College). Untuk sebarang pertanyaan sila hubungi dk_520_emily@hotmail.com

Laienverständliche Zusammenfassung

Akupunktur zur Rehabilitation von Schlaganfällen

Fragestellung

Akupunktur ist eine Behandlung, die auf der traditionellen chinesischen Medizin beruht. Dabei werden zur Therapie in bestimmte Hautpartien des Körpers Nadeln gestochen oder auf bestimmte Stellen Druck ausgeübt. Wir wollten herausfinden, ob Akupunktur mindestens einen Monat nach einem Schlaganfall hilft, Aktivitäten im Alltag, die Beweglichkeit oder die Lebensqualität zu erleichtern.

Hintergrund

Schlaganfälle sind weltweit eine häufige Todesursache und ein Grund für schwere Behinderungen. Akupunktur ist eine relativ einfache, kostengünstige und sichere Behandlung, die in China seit Hunderten von Jahren eingesetzt wird und vermehrt auch in westlichen Ländern Verbreitung findet. Es ist jedoch ungewiss, ob die vorhandenen Studiendaten ausreichen, um Akupunktur zur Behandlung von Menschen mit Schlaganfällen empfehlen zu können.

Studieneigenschaften

Wir haben 31 Studien gefunden, die diese Fragestellung untersucht haben und bis Juli 2015 veröffentlicht wurden. An den Studien nahmen insgesamt 2257 Menschen teil, die mindestens einen Monat zuvor einen Schlaganfall erlitten hatten. Die Studien verglichen Akupunktur zur Heilung mit Scheinakupunktur oder einer Gruppe, die keine zusätzliche Behandlung erhielt. Untersucht wurde, ob Akupunktur folgende Endpunkte verbessert: Aktivitäten des Alltags, neurologische Funktion, Beweglichkeit, geistige Leistungsfähigkeit, Depressionen, Schluckfunktion, Schmerzen und Lebensqualität. Von den 31 Studien wurden 29 in China durchgeführt. Sie unterschieden sich deutlich in Bezug auf den Zeitpunkt des Schlaganfalls, die angewendeten Akupunktur-Techniken und die Häufigkeit der Behandlung.

Hauptergebnisse

Wir fanden Evidenz dafür, dass Akupunktur die Aktivitäten des täglichen Lebens erleichtert und verschiedene neurologische Funktionen verbessert. Die Ergebnisse beruhen jedoch auf Studien mit Evidenz von niedriger Qualität. In den Studien wurde keine ernsthaften Nebenwirkungen berichtet. Es lagen keine Informationen dazu vor, ob Akupunktur eine Wirkung auf Mortalität oder die Notwendigkeit einer stationären Versorgung hat.

Qualität der Evidenz

Viele Studieneigenschaften wurden nicht gut berichtet. Daher war es schwierig, die Qualität der Evidenz verlässlich zu beurteilen. Aus diesem Grund haben wir angegeben, dass die meisten unserer Schlussfolgerungen auf Evidenz von niedriger oder sehr niedriger Qualität beruhen.

Anmerkungen zur Übersetzung

R. Büchter, freigegeben durch Cochrane Deutschland.

Резюме на простом языке

Иглоукалывание при реабилитации после инсульта

Вопрос обзора

Иглоукалывание - это лечение, базирующееся на древней Китайской медицине, при котором применяются тонкие иглы или давление на определенные участки тела в терапевтических целях. Мы хотели узнать, эффективно ли иглоукалывание для улучшения восстановления повседневной активности, движения и качества жизни у людей, перенесших инсульт более месяца назад.

Актуальность

Инсульт является одной из ведущих причин смерти во всем мире, который также может привести к тяжелой форме инвалидности. Иглоукалывание (акупунктура) является относительно простым, недорогим и безопасным лечением, которое применяется в Китае уже сотни лет и набирает популярность в некоторых западных странах. Однако до сих пор неясно, являются ли имеющиеся доказательства достаточно надежными, чтобы рекомендовать иглоукалывание в качестве стандартной процедуры.

Характеристика исследований

Мы выявили 31 исследование, по состоянию на июль 2015 года, для включения в этот обзор. В эти исследования были включены в общей сложности 2257 участников, перенесших инсульт более месяца назад. Во всех исследованиях иглоукалывание, направленное на содействие восстановлению, сравнивали с отсутствием применения иглоукалывания или с имитацией иглоукалывания. Исходы включали измерения уровня повседневной активности (ежедневной деятельности), неврологической функции, движений, когнитивной функции, депрессии, функции глотания, боли и качества жизни. Большинство исследований (29 из 31) были проведены в Китае; исследования значительно различались относительно времени перенесенного инсульта, используемых определенных техник и частотой проведения иглоукалывания.

Основные результаты

Мы нашли некоторые доказательства того, что иглоукалывание улучшает повседневную активность и ряд аспектов неврологической функции. Однако, эти выводы были основаны на исследованиях с низким качеством доказательств. Не было зарегистрировано серьезных побочных эффектов, а также не было информации о влиянии иглоукалывания на смертность или необходимость ухода в специальных учреждениях.

Качество доказательств

Оказалось непросто надежно определить качество доказательств из-за плохого представления характеристик исследований. Таким образом, мы описали большинство выводов как выводы, исходящие из доказательств низкого или очень низкого качества.

Заметки по переводу

Перевод: Лепехина Анна Алексеевна. Редактирование: Прокопов Дмитрий Юрьевич, Юдина Екатерина Викторовна. Координация проекта по переводу на русский язык: Cochrane Russia - Кокрейн Россия (филиал Северного Кокрейновского Центра на базе Казанского федерального университета). По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: cochrane.russia.kpfu@gmail.com; cochranerussia@kpfu.ru

概要

针刺用于卒中的康复

系统综述问题

针刺是一种基于中医理论的疗法,应用细针或压力作用于身体特定位置(穴位)以达到治疗的目的。我们想要知道针刺是否可以有效改善卒中患者(病程超过1个月)的日常生活活动、运动情况和生活质量。

背景

卒中是导致死亡的主要原因之一,也会导致严重的残疾。针刺是相对简单、低廉和安全的疗法,已经在中国使用了数百年,如今在一些西方国家越来越流行。然而,仍然没有足够可靠的证据推荐针刺作为常规应用的疗法。

研究特征

我们共纳入31项研究(至2015年7月)。这些研究共包含2257名受试者,这些受试者均为病程超过1个月的卒中患者。这些研究旨在对比针刺和不针刺或假针刺促进恢复的疗效。结果指标包括日常生活活动(日常生活活动能力)、神经功能、运动、认知、抑郁、吞咽、疼痛和生活质量。大多数研究(29/31)在中国进行,卒中的时间、特定技法的使用和针刺的频率在这些研究之间存在很大的差异。

主要结果

我们发现一些证据表明针刺可以改善日常生活活动能力和大量的神经功能。然而,这些结论是基于低质量的研究得出的。没有研究报告严重的副作用,以及针刺对死亡的影响和对住院治疗的必要程度。

证据质量

因为缺乏研究特征的报告,确定证据质量的可靠性是非常困难的。因此,我们基于低或极低质量的证据描述了大部分研究的结论。

翻译注解

译者:杜深星(温州医科大学附属东阳医院);审校:李静(北京中医药大学循证医学中心) 2018年3月5日

Summary of findings(Explanation)

Summary of findings for the main comparison. 
  1. 1 Downgraded by two levels for very serious risk of bias (none of the trials used adequate allocation concealment, nor blinding of participants or researchers. Also, most of them were at risk of attrition bias).
    2 Downgraded by one level for serious inconsistency (due to substantial heterogeneity, I2 = 57%).
    3 Downgraded by one level for this trial did not use blinding of participants or researchers.

Acupuncture + baseline treatment versus baseline treatment alone

Patient or population: adults with stroke

Settings: inpatients
Intervention: Acupuncture + baseline treatment
Comparison: baseline treatment

OutcomesAnticipated absolute effects* (95% CI)Relative effect
(95% CI)
№ of participants
(studies)
Quality of the evidence
(GRADE)
Comments
Risk with baseline treatmentRisk with Acupuncture + baseline treatment
Improvement of dependency at the end of treatment
assessed with Barthel Index
The mean improvement of dependency at the end of treatment was 0The mean improvement of dependency at the end of treatment in the intervention group was 9.19 undefined more (4.34 more to 14.05 more)-616
(9 RCTs)
⊕⊝⊝⊝
VERY LOW1,2
Substantial heterogeneity
in results. Most studies
were at high or unclear risk
of bias. All of the studies were
carried out in China
Improvement of global neurological deficit at the end of treatment
assessed with Modified Edinburgh and Scandinavian Stroke Scale
The mean improvement of global neurological deficit at the end of treatment was 0The mean improvement of global neurological deficit at the end of treatment in the intervention group was 2.39 undefined fewer (3.34 fewer to 1.43 fewer)-240
(4 RCTs)
⊕⊕⊝⊝
LOW1
Most studies
were at high or unclear risk
of bias. All of the studies were
carried out in China
Improvement of global neurological deficit at the end of treatmentStudy populationOR 3.89
(1.78 to 8.49)
543
(7 RCTs)
⊕⊕⊝⊝
LOW1
Most studies
were at high or unclear risk
of bias. All of the studies were
carried out in China
674 per 1000890 per 1000
(787 to 946)
Moderate
733 per 1000914 per 1000
(830 to 959)
Improvement of motor function at the end of treatment - upper and lower extremities motor function (FMA)
assessed with Fugl-Meyer Assessment
The mean improvement of motor function at the end of treatment - upper and lower extremities motor function was 0The mean improvement of motor function at the end of treatment - upper and lower extremities motor function in the intervention group was 6.16 undefined more (4.2 more to 8.11 more)-245
(4 RCTs)
⊕⊕⊝⊝
LOW1
Most studies
were at high or unclear risk
of bias. All of the studies were
carried out in China
Improvement of motor function at the end of treatment - general motor function
assessed with Motor assessment scale
The mean improvement of motor function at the end of treatment - general motor function was 0The mean improvement of motor function at the end of treatment - general motor function in the intervention group was 4.53 undefined more (2.99 more to 6.07 more)-60
(1 RCT)
⊕⊕⊝⊝
LOW1
 
Improvment of general motor function at the end of follow up
assessed with Fugl-Meyer Assessment
follow-up: mean 3 months
The mean improvement of general motor function at the end of follow-up was 0The mean improvement of general motor function at the end of follow-up in the intervention group was 7.59 more (0.98 more to 14.2 more)-(1 RCT)⊕⊕⊕⊝
MODERATE3
 
Improvement of motor function at the end of treatment
assessed with Fugl-Meyer Assessment
Study populationOR 2.41
(0.98 to 5.96)
125
(2 RCTs)
⊕⊕⊝⊝
LOW1
 
710 per 1000855 per 1000
(705 to 936)
Moderate
720 per 1000861 per 1000
(716 to 939)
Improvement of cognitive function at the end of treatment
assessed with Mini-mental state examination
The mean improvement of cognitive function at the end of treatment was 0The mean improvement of cognitive function at the end of treatment in the intervention group was 2.54 undefined more (0.03 more to 5.05 more)-278
(5 RCTs)
⊕⊝⊝⊝
VERY LOW1,2
Substantial heterogeneity
in results. Most studies
were at high or unclear risk
of bias. All of the studies were
carried out in China

Improvment of cognitive function at the end of follow-up
assessed with Mini-mental state examination

follow-up: 1 month

The mean improvement of cognitive function at the end of follow up was 0The mean improvement of cognitive function at the end of follow-up in the intervention group was 3.47 undefined more (2.43 more to 4.51 more)-71
(1 RCT)
⊕⊕⊝⊝
LOW1
 
Improvement of cognitive function at the end of treatment
assessed with: Mini-mental state examination
Study populationOR 3.82
(1.89 to 7.72)
166
(3 RCTs)
⊕⊕⊝⊝
LOW1
 
512 per 1000800 per 1000
(665 to 890)
Moderate
533 per 1000814 per 1000
(684 to 898)
Improvement of depression at the end of treatment
assessed with Hamilton Depression Scale
The mean improvement of depression at the end of treatment was 0The mean improvement of depression at the end of treatment in the intervention group was 2.58 undefined fewer (3.28 fewer to 1.87 fewer)-552
(6 RCTs)
⊕⊝⊝⊝
VERY LOW1,2
Substantial heterogeneity
in results. Most studies
were at high or unclear risk
of bias. All of the studies were
carried out in China
Improvement of depression at the end of treatment
assessed with Hamilton Depression Scale
Study populationOR 2.03
(1.10 to 3.72)
342
(4 RCTs)
⊕⊕⊝⊝
LOW1
Most studies
were at high or unclear risk
of bias. All of the studies were
carried out in China
784 per 1000880 per 1000
(799 to 931)
Moderate
807 per 1000894 per 1000
(821 to 939)
Improvement of swallowing function at the end of treatmentThe mean improvement of swallowing function at the end of treatment was 0The mean improvement of swallowing function at the end of treatment in the intervention group was 1.11 undefined fewer (2.08 fewer to 0.14 fewer)-200
(2 RCTs)
⊕⊝⊝⊝
VERY LOW1,2
 
Improvement of pain at the end of treatment
assessed with Visual Analogue Scale
The mean improvement of pain at the end of treatment was 0The mean improvement of pain at the end of treatment in the intervention group was 2.88 undefined fewer (3.68 fewer to 2.09 fewer)-118
(2 RCTs)
⊕⊕⊝⊝
LOW1
 
Improvement of sleep quality at the end of treatment
assessed with Rhone Planck Sleepiness Scale
The mean improvement of sleep quality at the end of treatment was 0The mean improvement of sleep quality at the end of treatment in the intervention group was 1.09 undefined fewer (2.37 fewer to 0.19 more)-60
(1 RCT)
⊕⊕⊕⊝
MODERATE3
 
Improvement of spasticity at the end of treatment
assessed with Modified Ashworth Spasticity Rating Scale
The mean improvement of spasticity at the end of treatment was 0The mean improvement of spasticity at the end of treatment in the intervention group was 0.4 undefined fewer (0.64 fewer to 0.16 fewer)-60
(1 RCT)
⊕⊕⊝⊝
LOW1
 
Improvement of quality of life at the end of treatment
assessed with MOS SF-36
The mean improvement of quality of life was 0The mean improvement of quality of life in the intervention group was 2.73 undefined more (0.54 fewer to 6 more)-71
(1 RCT)
⊕⊕⊝⊝
LOW1
 
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Background

Description of the condition

Stroke is the second leading cause of death in the world (GBD2013 2015). In the USA, stroke accounted for about one of every 19 deaths in 2010. On average, someone dies of stroke every four minutes (Go 2014). In 2013, stroke has become the leading cause of death in cities and rural areas in China (GBD2013 2015). Although age-standardised rates of stroke mortality have decreased worldwide in the past two decades, the absolute numbers of people with first stroke (16.9 million), stroke survivors (33 million), stroke-related deaths (5.9 million), and disability-adjusted life-years (DALYs) lost (102 million) in 2010 were still high and had significantly increased since 1990 (68%, 84%, 26%, and 12% increase, respectively), imposing a great burden on families and communities in low-income and middle-income countries (Feigin 2014). Despite considerable research efforts on multiple treatment modalities, there is still no single rehabilitation intervention demonstrated unequivocally to aid recovery. This reality drives people to search for other modalities of treatment in an attempt to further improve the outcome of stroke rehabilitation, such as acupuncture and Chinese herbal medicine.

Description of the intervention

Acupuncture is one of the main modalities of treatment in traditional Chinese medicine and can be traced back more than 3000 years in China (Wu 1996). Being a relatively simple, inexpensive, and safe treatment compared with other conventional interventions, acupuncture has been well accepted by Chinese patients and is widely used to improve motor, sensation, speech, and other neurological functions in people with stroke. As a therapeutic intervention, acupuncture is also increasingly practiced in some Western countries (Hegyi 2012; Johansson 1993; NIH 1998; Salom-Moreno 2014; Schaechter 2007; Wayne 2005). .

How the intervention might work

Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses, including circulatory and biochemical effects. These responses can occur locally or close to the site of application, or at a distance. They are mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery (Jansen 1989; Johansson 1993; Magnusson 1994; Sun 2001; Wang 2001 ). In summary, possible mechanisms of the effects of acupuncture on neurological conditions include stimulation of neuronal cell proliferation (Cheng 2008), facilitation of neural plasticity (Ren 2008), reduction of the post-ischaemic inflammatory reaction (Liu 2009a), and prevention of neuronal apoptosis (Zhang 2008a).

Why it is important to do this review

There are a large number of studies of the clinical efficacy of acupuncture in stroke rehabilitation published in the world, especially in China, but not all demonstrate a beneficial effect on stroke rehabilitation (Hu 1993; Johansson 2001; Sun 2001; Sze 2002; Zhan 2014; Zhang 1996; Zhang 2015). Many systematic reviews of trials of acupuncture in stroke rehabilitation have been conducted (Ernst 1996; Hopwood 1996; Kong 2010; Li 2014; Park 2001; Smith 2002; Sze 2002; Wu 2010a). These reviews, however, included mainly trials with stroke patients in either the acute, or subacute, and chronic stages. Some reviews only focused on specific types of stroke (Liu 2005; Wang 2012a; Zheng 2011a), or needling (Dong 2013; Kim 2010; Zhou 2013), or neurologic deficits (Lim 2015; Long 2012; Liu 2014a; Park 2014; Qi 2009; Wong 2012; Zhang 2009a; Zhang 2012a; Zhang 2014a; Zhu 2011a). Knowing that a large number of clinical studies had been completed since this review was originally published in 2006 (Wu 2006), we aimed to conduct an up-to-date systematic review of publications regardless of subtype of stroke, or needling, or neurologic deficits.

The aim of this review was to systematically analyse all the randomised controlled trials of acupuncture for subacute and chronic stroke to provide the best available evidence to inform clinical practice and further research planning on stroke treatment.

Objectives

To determine the efficacy and safety of acupuncture therapy in people with subacute and chronic stroke. We intended to test the following hypotheses: 1) acupuncture can reduce the risk of death or dependency in people with subacute and chronic stroke at the end of treatment and at follow-up; 2) acupuncture can improve neurological deficit and quality of life after treatment and at the end of follow-up; 3) acupuncture can reduce the number of people requiring institutional care; and 4) acupuncture is not associated with any intolerable adverse effects.

Methods

Criteria for considering studies for this review

Types of studies

In the review, we included randomised controlled clinical trials (RCTs) comparing acupuncture with at least one control group that used placebo, sham treatment, or conventional treatment in people with subacute (one to three months since onset) or chronic stroke (over three months since onset). We excluded trials using quasi-randomisation or the allocation of participants using alternation, case record numbers, dates of birth, day of the week, or controlled trials using any other non-random allocation methods.

Types of participants

Trials involving participants of any age or sex with ischaemic or haemorrhagic stroke in the subacute (one to three months since onset) or chronic phases (over three months since onset) were eligible. Stroke must have been diagnosed according to the World Health Organization definition (rapidly developed clinical signs of focal (or global) disturbances of cerebral function, lasting more than 24 hours or leading to death, with no other apparent cause than of vascular origin (Asplund 1988)), or confirmed by computerised tomography (CT), or magnetic resonance imaging (MRI). We did not include trials of participants with subarachnoid haemorrhage or subdural haematoma. We also excluded trials that included people in the acute phase of stroke (within one month since onset).

Types of interventions

We included trials evaluating acupuncture therapy that involved needling after stroke onset at the subacute or chronic phases, regardless of times of treatment or length of treatment period. We included either traditional acupuncture, in which the needles were inserted in classical meridian points, or contemporary acupuncture, in which the needles were inserted in non-meridian or trigger points, regardless of the source of stimulation (for example, hand or electrical stimulation). We excluded trials in which the acupuncture treatment did not involve needling, such as acupressure or laser acupuncture.

The control interventions were placebo acupuncture, sham acupuncture, or other conventional treatment. Placebo acupuncture refers to a needle attached to the skin surface (not penetrating the skin but at the same acupoints) (Van Tulder 2000). Sham acupuncture refers to:

  1. a needle placed in an area close to but not in the acupuncture points (Van Tulder 2000);

  2. subliminal skin electrostimulation via electrodes attached to the skin (SCSSS 1999).

The comparisons we investigated were:

  1. acupuncture only compared with placebo or sham treatment;

  2. acupuncture in addition to baseline medication or treatment compared with placebo or sham treatment in addition to baseline medication or treatment;

  3. acupuncture in addition to baseline medication or treatment compared with baseline medication or treatment alone.

We excluded trials that compared different forms of acupuncture only and we also excluded trials reporting only physiological or laboratory parameters.

Types of outcome measures

We included trials that used at least one of the following outcome measures.

Primary outcomes

Death or dependency at the end of follow-up (at least three months or longer after stroke onset). We defined dependency as dependent on others in activities of daily living, based on the correlated definition of the Barthel scores (Activities of Daily Living, ADL) as a score of less than 60 or an Oxford handicap grade 3 to 6 (Sulter 1999), or the trialists' own definition.

Secondary outcomes
  1. The proportion of people requiring institutional care or requiring extensive family support at the end of follow-up (at three months or longer after stroke onset). Family care is the main form of care for severely dependent people in developing countries.

  2. Changes of neurological deficit after acupuncture treatment and at the end of follow-up (at three months or longer after stroke onset). The measures could focus on specific impairment (for example, Motricity Index, or Motor Assessment Scale, which assess only motor function), or global neurological deficit (for example, the National Institute of Health Stroke Scale, European Stroke Scale, the Scandinavian Stroke Scale) or two kinds of Chinese Stroke Recovery Scales, which involve motor, sensory and other impaired neurological functions. The Chinese Stroke Recovery Scale 1 (CSRS 1) refers to "the Revised Diagnostic Criteria of Acute Cerebral Infarction" formulated by the second National Academic Symposium on Cerebrovascular Diseases of the Chinese Medical Association in 1986, which is similar to the Revised Scandinavian Stroke Scale (RSSS). The Chinese Stroke Recovery Scale 2 (CSRS 2) refers to "the Chinese Stroke Recovery Scale based on principles of traditional Chinese medicine".

  3. Death from any causes during the entire treatment and follow-up period.

  4. Quality of life (QOL) at the end of follow-up (at three months or longer after stroke onset). This could be measured by the Nottingham Health Profiles or Spiter Quality of Life Index.

  5. Possible adverse events including dizziness, difficulty in tolerating electrostimulation, infection, puncture of a lung, heart tamponades, spinal cord injury, disrupted pacemaker function; and presumed to be caused by acupuncture or electrostimulation. We evaluated the number of participants developing at least one severe adverse event listed above.

Search methods for identification of studies

See the 'Specialized register' section in the Cochrane Stroke Group module. We searched for all trials in all languages and arranged translation of relevant papers where necessary.

Electronic searches

Original searches (2005)

We initially obtained relevant trials from the following sources with no language restriction.

  1. Cochrane Stroke Group Trials Register (November 2005).

  2. Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2005, Issue 3).

  3. MEDLINE (1966 to November 2005) combined with the Cochrane highly sensitive search strategy for identifying RCTs in MEDLINE (Dickersin 1994).

  4. EMBASE (1980 to November 2005). Modified MEDLINE search and combined with the Cochrane highly sensitive search strategy for identifying RCTs in EMBASE (Lefebvre 1996).

  5. Chinese Stroke Trials Register (November 2005).

  6. Chinese Acupuncture Trials Register (November 2005).

  7. Trials Register of the Cochrane Complementary Medicine Field (November 2005).

  8. CINAHL (1982 to November 2005).

  9. AMED (the Allied and Complementary Medicine Database, 1985 to November 2005).

  10. Chinese Biological Medicine Database (CBM-disc, 1979 to November 2005).

  11. National Center for Complementary and Alternative Medicine Register (http://nccam.nih.gov/clinical trials/) and National Institute of Health Clinical Trials Database (http://clinicaltrials.gov) (searched November 2005).

Review update (2015)

We searched CENTRAL and the Cochrane Stroke Group Trials Register as above for new trials. We obtained relevant new trials from the following sources with no language restriction in the updated review.

  1. Cochrane Stroke Group Trials Register (June 2015; Appendix 1).

  2. Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 7) ( Appendix 2).

  3. MEDLINE (July 2015; Ovid; Appendix 3).

  4. EMBASE (July 2015; Ovid; Appendix 4).

  5. CINAHL (July 2015; EBSCO;Appendix 5).

  6. AMED (the Allied and Complementary Medicine Database, July 2015; Ovid; Appendix 6).

  7. Chinese Biological Medicine Database (July 2015; Appendix 7).

  8. Chinese Science and Technique Journals Database (to July 2015; Appendix 8).

  9. China National Infrastructure (to July 2015; Appendix 9).

  10. WanFang database (to July 2015; Appendix 10).

Searching other resources

Original searches (2005)
  1. We handsearched four Chinese journals relevant to acupuncture (from 1980 to November 2005):

    1. Acupuncture Research;

    2. Chinese Acupuncture and Moxibustion;

    3. Journal of Clinical Acupuncture and Moxibustion;

    4. Shanghai Journal of Acupuncture and Moxibustion.

  2. We checked the reference lists of all relevant papers identified, including two systematic reviews (Park 2001; Sze 2002), for further published and unpublished trials.

Review update (2015)

We searched the reference lists of all relevant papers identified.

Data collection and analysis

Selection of studies

Two review authors (AY, LX) independently checked the titles and abstracts of trials for inclusion based on the selection criteria outlined above. We retrieved the full text of the article if there was any doubt whether the article should be excluded or not. In cases of disagreement between the two review authors, a third member of the stroke research group (JLT or HMW) reviewed the information to decide on inclusion or exclusion of an article.

Data extraction and management

Two review authors (AY, L) independently extracted information on participants, methods, interventions, outcomes, and results by using a self-developed data extraction form. We translated studies not in English or Chinese before assessment. Where more than one publication for a study existed, we grouped reports together and we used the publication with the most complete data. Where relevant outcomes were only published in earlier versions, we used these data. We resolved disagreements by involving a third review author (JLT or HMW) or through discussion.

Assessment of risk of bias in included studies

We assessed the following items using the Cochrane risk of bias assessment tool (Higgins 2011a; Appendix 11).

  1. Was there adequate sequence generation?

  2. Was allocation adequately concealed?

  3. Was knowledge of the allocated interventions adequately prevented during the study?

  4. Were incomplete outcome data adequately addressed?

  5. Are reports of the study free of suggestion of selective outcome reporting?

  6. Was the study apparently free of other problems that could put it at a risk of bias?

Two review authors (AY, LX) independently assessed risk of bias; any disagreements were resolved by a third review author (JLT or HMW).

Measures of treatment effect

For dichotomous outcomes (e.g. death or dependency, adverse effects), we expressed the results as odds ratios (ORs) with 95% confidence intervals (CIs). For continuous outcomes (e.g. quality of life), we used the mean difference (MD), or the standardised mean difference (SMD) if different scales were used.

Assessment of heterogeneity

We tested heterogeneity between trial results using a standard Chi2 test on N-1 degrees of freedom, with a threshold value of P < 0.1, and with the I² test (Higgins 2003). I2 values of 25%, 50% and 75% correspond to low, medium and high levels of heterogeneity.

Assessment of reporting biases

If we identified a sufficient number of studies, we planned to examine for potential publication bias using a funnel plot (Sterne 2011).

Data synthesis

We pooled data using the random-effects model but we also used the fixed-effect model to ensure robustness of the model chosen and susceptibility to outliers.

Subgroup analysis and investigation of heterogeneity

We planned to undertake subgroup analyses to explore possible sources of heterogeneity (e.g. participants, interventions, and study quality). Heterogeneity among participants could be related to the type and severity of stroke. Post-stroke neurological recovery is known to be obvious within three months, especially post-stroke motor recovery, and is unlikely beyond six months, so heterogeneity in treatments could be related to times to start of treatment. Mixing patients with interval from stroke onset of less than three months, three to six months, and more than six months in one sample would make the assessment of the efficacy of an intervention methodologically unsound. If appropriate data were available, we planned a subgroup analysis to compare participants with different times to start of treatment (within three months, three to six months, and after six months) using the method outlined by Deeks 2001.

Sensitivity analysis

If appropriate data were available, we planned a sensitivity analysis to assess the effects of including only those trials:

  1. that were double blind;

  2. with adequate concealment of randomisation;

  3. published in a language other than Chinese.

Results

Description of studies

Results of the search

2006 version

For the 2006 version of this review, we identified 6402 potentially relevant articles, retrieved 50 full-text articles, and included five trials with 368 participants (Dai 1997; Li 1997a; Lun 1999; Naeser 1992; Wang 2001).

2015 update

For the update of this review, we identified 5874 potentially relevant articles from January 2005 to July 2015. Of these, we retrieved 371 full-text articles for further assessment and included 26 trials with 1889 participants (Bao 2012; Chou 2009; Gao 2014a; Guo 2011; Guo 2012; Huang 2008a; Ke 2015; Li 2010a; Li 2011a; Li 2013a; Liu 2013a; Sun 2013a; Sun 2015; Wang 2011a; Wang 2012; Wu 2008; Wu 2011a; Wu 2013a; Xu 2013; Yao 2014; Zhan 2014; Zhang 2013a; Zhang 2015; Zheng 2014; Zhou 2014; Zhu 2007). There are four relevant ongoing studies (Fu 2011; Liu 2013b; Xie 2006; Zhong 2010; Characteristics of ongoing studies). In total, we have included 31 trials in this updated review. Results of the search are displayed in Figure 1.

Figure 1.

Study flow diagram.

Included studies

A total of 31 trials were eligible for inclusion in this systematic review. For details of each included trial please see the Characteristics of included studies table.

Participants

Of the 31 included trials, 29 were conducted in China, one in the UK, and one in the USA.

The age of participants ranged from 24 to 95 years. More men than women were included in 23 trials (between 47% and 75% men) (Bao 2012; Dai 1997; Guo 2011; Guo 2012; Huang 2008a; Ke 2015; Li 2010a; Li 2011a; Liu 2013a; Lun 1999; Sun 2013a; Wang 2001; Wang 2011a; Wang 2012; Wu 2008; Wu 2011a; Yao 2014; Zhan 2014; Zhang 2013a; Zhang 2015; Zheng 2014; Zhou 2014; Zhu 2007). Three trials did not describe the gender of the participants (Li 1997a; Li 2013a Naeser 1992). The range of time from stroke onset was from one month to 8.5 years.

There were five trials involving participants with interval from stroke onset between one to three months (Huang 2008a; Li 2013a; Naeser 1992; Wu 2013a; Zhou 2014), 10 trials more than three months (Dai 1997; Bao 2012; Chou 2009; Gao 2014a; Guo 2012; Li 2011a; Liu 2013a; Sun 2013a; Sun 2015; Zhang 2013a), and 16 trials including participants with interval from stroke onset of either less than three months or more than three months (Guo 2011; Ke 2015; Li 1997a; Li 2010a; Lun 1999; Wang 2001; Wang 2011a; Wang 2012; Wu 2008; Wu 2011a; Xu 2013; Yao 2014; Zhan 2014; Zhang 2015; Zheng 2014; Zhu 2007).

Seven trials included participants with ischaemic stroke only (Dai 1997; Bao 2012; Huang 2008a; Naeser 1992; Wu 2011a; Zhang 2015; Zhou 2014). Five trials did not describe the type of stroke (Guo 2012; Li 2011a; Sun 2015; Xu 2013; Zhan 2014). All other trials included participants with ischaemic and haemorrhagic stroke (Chou 2009; Gao 2014a; Guo 2011; Ke 2015; Li 1997a; Li 2010a; Li 2013a; Liu 2013a; Lun 1999; Sun 2013a; Wang 2001; Wang 2011a; Wang 2012; Wu 2008; Wu 2013a; Yao 2014; Zhang 2013a; Zheng 2014; Zhu 2007). All of the included trials used CT or MRI to confirm the diagnosis of stroke. The severity on entry was mild to severe in two trials (Dai 1997; Naeser 1992), without a definition of severity or not stated in the remaining 29 trials (Bao 2012; Chou 2009; Gao 2014a; Guo 2011; Guo 2012; Huang 2008a; Ke 2015; Li 1997a; Li 2010a; Li 2011a; Li 2013a; Liu 2013a; Lun 1999; Sun 2013a; Sun 2015; Wang 2001; Wang 2011a; Wang 2012; Wu 2008; Wu 2011a; Wu 2013a; Xu 2013; Yao 2014; Zhan 2014; Zhang 2013a; Zhang 2015; Zheng 2014; Zhou 2014; Zhu 2007).

Interventions

Two trials compared real acupuncture plus baseline treatment with sham acupuncture plus baseline treatment (Chou 2009; Naeser 1992); the remaining 29 trials compared acupuncture plus baseline medication or treatment with baseline medication or treatment alone. None of the trials compared acupuncture only with placebo or sham treatment.

Among the included trials there were 10 three-armed trials (Dai 1997; Guo 2011; Huang 2008a; Li 1997a; Li 2013a; Sun 2015; Wang 2001; Wu 2013a; Zhang 2013a; Zhang 2015) and one four-armed trial (Wu 2008) comparing acupuncture plus baseline medication or treatment with baseline medication treatment alone, one kind of acupuncture with another kind of acupuncture, or acupuncture only with other treatment. In this review, the baseline medication or treatment included Western medicine (WM), traditional Chinese medicine (TCM), non-pharmacological therapy, or a combination. WM included aspirin and other conventional drug therapies.

With one exception (Chou 2009), none of the other 30 included trials reported the acupuncture rationale or acupuncturists' background, including duration of relevant training, length of clinical experience and expertise in the specific condition. The acupuncture interventions used varied considerably across trials. Nineteen trials used only manual stimulation (Bao 2012; Dai 1997; Gao 2014a; Guo 2012; Huang 2008a; Ke 2015; Li 1997a; Li 2011a; Li 2013a; Lun 1999; Wang 2001; Wang 2011a; Wang 2012; Wu 2008; Wu 2013a; Xu 2013; Zhan 2014; Zhang 2015; Zheng 2014), four used only electrical stimulation (Chou 2009; Naeser 1992; Sun 2015; Wu 2011a), and eight used the combination of manual and electrical stimulation (Guo 2011; Li 2010a; Liu 2013a; Sun 2013a; Yao 2014; Zhang 2013a; Zhou 2014; Zhu 2007). Acupuncture point prescriptions were not consistent, with 15 trials involving either scalp or body acupoints (Chou 2009; Guo 2012; Huang 2008a; Ke 2015; Li 2011a; Li 2013a; Liu 2013a; Lun 1999; Wang 2001; Wang 2011a; Wang 2012; Wu 2013a; Zhan 2014; Zhang 2013a; Zhang 2015), and 16 trials using both body and scalp acupoints (Bao 2012; Dai 1997; Gao 2014a; Guo 2011; Li 1997a; Li 2010a; Naeser 1992; Sun 2013a; Sun 2015; Wu 2008; Wu 2011a; Xu 2013; Yao 2014; Zheng 2014; Zhou 2014; Zhu 2007). Numbers of points used ranged from one to 27 points in all included trials. The needle retention time was 15 to 40 minutes in all included trials. Thirteen trials reported the achievement of 'deqi', an irradiating feeling said to indicate effective needling (Bao 2012; Chou 2009; Dai 1997; Li 2010a; Li 2011a; Liu 2013a; Lun 1999; Sun 2013a; Sun 2015; Wang 2001; Yao 2014; Zheng 2014; Zhu 2007). Information on needle type was available in 13 trials (Bao 2012; Chou 2009; Dai 1997; Li 2010a; Lun 1999; Liu 2013a; Naeser 1992; Sun 2013a; Sun 2015; Wu 2011a; Yao 2014; Zheng 2014; Zhu 2007). The length of treatment period ranged from one to 24 weeks with the number of treatment sessions varying from six to 120 sessions and the frequency of treatment from five sessions per week to two sessions per day.

Outcomes

The most commonly reported outcomes were dependency, global neurological deficit, and specific neurological impairment after acupuncture treatment. Thirteen trials evaluated the effect of acupuncture on dependency (activities of daily living) at the end of acupuncture treatment. The measures employed included the Barthel Index (BI) or modified Barthel Index (MBI) in 11 trials (Bao 2012; Huang 2008a; Ke 2015; Li 2010a; Wang 2012; Wu 2011a; Yao 2014; Zhan 2014; Zhang 2015; Zheng 2014; Zhou 2014) and the Physical Self-maintenance Scale (PSMS) combined with Instrumental Activities of Daily Living Scale (IADL) in two trials (Li 2011a; Sun 2013a). Twelve trials measured the global neurological deficit score or the proportion of participants with an improvement of global neurological deficit at the end of acupuncture treatment (Dai 1997; Gao 2014a; Guo 2011; Huang 2008a; Li 1997a; Lun 1999; Sun 2013a; Wang 2001; Yao 2014; Zhang 2015; Zhou 2014; Zhu 2007). The measures employed included NIHSS, CSRS1 (e.g. MESSS ) and CSRS2 (TCM). Six trials evaluated the effect of acupuncture on motor function measured with Fugl-Meyer scale (FMA) and Motor assessment scale after treatment (Li 2013a; Wang 2011a; Wang 2012; Wu 2011a; Yao 2014; Zhou 2014). Eighteen trials evaluated the effect of acupuncture on specific neurological impairments (e.g. cognitive function; swallowing function; depression) at the end of treatment (Bao 2012; Gao 2014a; Guo 2011; Guo 2012; Li 2010a; Li 2011a; Liu 2013a; Sun 2013a ;Sun 2015; Wang 2011a; Wu 2008; Wu 2011a; Wu 2013a; Xu 2013; Yao 2014; Zhang 2013a; Zheng 2014; Zhou 2014). Two trials reported quality of life measured with the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) (Chou 2009; Sun 2013a). Only five trials reported information on adverse events (Li 2010a; Sun 2013a; Sun 2015; Zhang 2013a; Zhou 2014). None of the 31 included trials provided any information on death, proportion of participants requiring institutional care or extensive family support after acupuncture treatment or at the end of follow-up.

Excluded studies

Of the 12,276 citations identified from English and Chinese databases, we excluded 11,855 citations during the initial screening of titles and abstracts. The main reasons for these exclusions were as follows.

  1. Not stroke.

  2. Studies not RCT.

  3. Stroke duration since onset less than 30 days.

  4. Acupuncture not involving needling: such as acupressure; laser acupuncture.

  5. Studies comparing different kinds of acupuncture therapies.

  6. Review articles.

We retrieved a total of 421 potentially eligible studies for screening of the full-text papers.

Of the 421 potentially eligible studies, we excluded 390 studies for the following reasons.

  1. Questionable randomisation.

  2. Comparing two different methods of acupuncture.

  3. Stroke duration since onset less than 30 days.

  4. Duplicates.

  5. Others: abstract, review.

For details please see the Characteristics of excluded studies table.

Risk of bias in included studies

Please see Characteristics of included studies for details of the methodological quality, and Figure 2 and Figure 3 for summaries of the risk of bias findings in all included trials.

Figure 2.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Figure 3.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Allocation

Random sequence generation

Thirteen trials randomly assigned participants to groups by using random number tables (Bao 2012; Huang 2008a; Gao 2014a; Li 2010a; Sun 2013a; Wang 2011a; Wang 2012; Wu 2013a; Yao 2014; Wu 2011a; Zhan 2014; Zhang 2015; Zheng 2014). The remaining 18 trials did not report their methods of random sequence generation.

Allocation concealment

Of the 31 included trials, only three trials reported adequate allocation concealment by using sealed envelopes (Sun 2015; Zhang 2013a; Zhou 2014).

Blinding

Zhang 2013a reported that participants, their physicians, and outcome assessors were not blinded. Zhou 2014 reported that the investigators were blinded but the participants were not. Naeser 1992 reported that the participants were blinded without describing the method in detail. No information on blinding was available in the remaining 28 trials.

Incomplete outcome data

Seven trials reported withdrawals, but the results were not analysed on an intention-to-treat basis (Chou 2009; Gao 2014a; Li 2010a; Sun 2013a; Zhan 2014; Zheng 2014; Zhou 2014). There was no statement on dropouts or withdrawals in any of the remaining 24 trials. For each of these 24 trials, the number of participants randomised was the same as participants analysed, so it appears that there were no exclusions from the trials after randomisation. We concluded that, although the results appeared to be analysed by intention-to-treat, we cannot be certain about this.

Selective reporting

The included trials in this review did not report some clinically important outcomes, such as death, requiring Institutional care, and all-cause mortality. Of the 31 included studies, only five studies reported adverse events (Li 2010a; Sun 2013a; Sun 2015; Zhang 2013a; Zhou 2014), therefore we assumed that this may have constituted some degree of reporting bias.

Other potential sources of bias

There was insufficient information reported to determine if there were any other potential sources of bias.

Effects of interventions

See: Summary of findings for the main comparison

Acupuncture plus baseline treatment versus sham acupuncture plus baseline treatment

Two trials compared real acupuncture plus baseline treatment with sham acupuncture plus baseline treatment (Chou 2009; Naeser 1992).

Changes of specific neurological impairments after acupuncture treatment and at the end of follow-up

One trial with 16 participants evaluated the effect of acupuncture on the improvement of motor function after treatment by using a categorical approach rather than continuous scales (Naeser 1992). It showed that real acupuncture was not superior to sham acupuncture in the improvement of motor function for participants with stroke in the convalescent stage (OR 9.00, 95% CI 0.40 to 203.30; Analysis 1.1), but the confidence interval was very wide and included clinically significant effects in both directions.

Another trial with 33 participants evaluated the effect of acupuncture on the change of cognitive function after treatment (Chou 2009 ).There were significant improvements in orientation (MD 4.21, 95% CI 1.78 to 6.64), perception (MD 5.32, 95% CI 0.93 to 9.71), and praxis (MD 3.80, 95% CI 2.12 to 5.48) among participants in the real acupuncture group compared with the sham acupuncture group, but acupuncture was not superior to control in the improvement of visuomotor organisation (MD 2.76, 95% CI -0.58 to 6.10), thinking operation (MD 0.12 95% CI -0.64 to 0.88), and memory (MD 0.35, 95% CI- 0.43 to 1.13) (Analysis 1.2).

Quality of life at the end of follow-up

One trial with 33 participants evaluated health-related quality of life measured by means of self-report using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Stroke-Specific Quality of Life Scale (SS-QOL) (Chou 2009). It showed that real acupuncture was not superior to sham acupuncture in the improvement of health-related quality of life measured by the SF-36 (physical component summary: MD -2.66, 95% CI -10.57 to 5.25; mental component summary: MD 11.52, 95% CI -1.76 to 24.80; Analysis 1.3), and the SS-QOL (language: MD 13.34, 95% CI -3.02 to 29.70; personality: MD 3.10, 95% CI -11.73 to 17.93; Analysis 1.4) from baseline to week eight among participants with stroke in the convalescent stage.

No data on death or dependency, the proportion of people requiring institutional care or requiring extensive family support, death from any cause and possible adverse events were available in these two trials (Chou 2009; Naeser 1992).

Acupuncture plus baseline treatment versus baseline treatment alone

Twenty-nine trials compared acupuncture plus baseline treatment with baseline treatment alone (Bao 2012; Dai 1997; Gao 2014a; Guo 2011; Guo 2012; Huang 2008a; Ke 2015; Li 1997a; Li 2010a; Li 2011a; Li 2013a; Liu 2013a; Lun 1999; Sun 2013a; Sun 2015; Wang 2001; Wang 2011a; Wang 2012; Wu 2008; Wu 2011a; Wu 2013a; Xu 2013; Yao 2014; Zhan 2014; Zhang 2013a; Zhang 2015; Zheng 2014; Zhou 2014; Zhu 2007).

Death or dependency at the end of treatment and follow-up

No data on death at the end of treatment or follow-up were available in any of the included trials.

Eleven trials with a total of 956 participants measured improvement of dependency after acupuncture treatment by using continuous scales only (Barthel Index (BI), Modified Barthel Index (MBI) and Activity of Daily Living Scale (ADL)) (Bao 2012; Huang 2008a; Ke 2015; Li 2010a; Li 2011a; Wang 2012; Wu 2011a; Yao 2014; Zhan 2014; Zhang 2015; Zheng 2014). There was significant improvement in dependency measured by the BI, the MBI, and the ADL Scale among participants in the acupuncture group compared with the control group (BI: MD 9.19, 95% CI 4.34 to 14.05; participants = 616; studies = 9; I² = 95%; MBI: MD 3.44, 95% CI 0.30 to 6.58; participants = 60; studies = 1; ADL: MD 7.80, 95% CI 6.04 to 9.56; participants = 62; studies = 1; Analysis 2.1). Heterogeneity was significant and may be attributable to differences in severity of stroke, times of evaluation from stroke onset, and types of stroke.

One trial with 147 participants evaluated the effect of acupuncture on the improvement of dependency measured by the BI at the end of three months' follow-up (Zhou 2014). There was a beneficial effect of acupuncture on the improvement of dependency for participants with stroke in the convalescent stage (MD 7.49, 95% CI 1.79 to 13.19; Analysis 2.2). One trial with 71 participants evaluated the effect of acupuncture on the improvement of dependency measured by the ADL scale at the end of one month's follow-up (Sun 2013a). It also showed a beneficial effect of acupuncture on the improvement of dependency (MD 3.83, 95% CI 2.67 to 4.99; Analysis 2.2).

Proportion requiring institutional care or requiring extensive family support at the end of follow-up

No data on the proportion of participants requiring institutional care or extensive family support at the end of follow-up were available in these 29 trials.

Changes of global neurological deficit after acupuncture treatment and at the end of follow-up

Eight trials measured global neurological deficit at the end of treatment and follow-up by using continuous scales. Of these, four trials evaluated the effect of acupuncture on global neurological function measured by the Modified Edinburgh and Scandinavian Stroke Scale (Gao 2014a; Huang 2008a; Zhang 2015; Zhu 2007). There was a significant decrease in the neurological deficit score among participants in the acupuncture group compared with the control group (MD -2.39, 95% CI -3.34 to -1.43; participants = 240; studies = 4; I² = 23%; Analysis 2.3). Two trials evaluated the effect of acupuncture on global neurological function measured by the Neurological Function Deficit Scale (NFDS) (Guo 2011; Yao 2014). There was no significant improvement in global neurological function among participants in acupuncture group compared with control group (MD -1.02, 95% CI -5.80 to 3.76; participants = 123; studies = 2; I² = 19%; Analysis 2.3). One trial evaluated the effect of acupuncture on the improvement of global neurological function measured by the NFDS at the end of one month follow-up (Sun 2013a). It showed a beneficial effect of acupuncture on the improvement of global neurological function (MD -6.15, 95% CI -7.09 to -5.21; Analysis 2.4). One trial evaluated the effect of acupuncture on the improvement of global neurological function by using the National Institue of Health Stroke Scale (NIHSS) at the end of three months' follow-up (Zhou 2014). There was no significant improvement in global neurological function among participants in acupuncture group compared with control group (MD -0.83, 95% CI -1.94 to 0.28; Analysis 2.4).

Seven trials with a total of 543 participants measured improvement of global neurological deficit after acupuncture treatment by using categorical approaches only (CSRS 1 and CSRS 2) rather than continuous scales, for example changes of global neurological deficit score (Dai 1997; Huang 2008a; Li 1997a; Lun 1999; Wang 2001; Yao 2014; Zhang 2015). There was significant heterogeneity among the seven trials (I² = 55%), which was possibly due to differences in outcome measurements used, times of evaluation from stroke onset, and types of stroke. This means that the overall estimate of treatment effect is not reliable. Hence, the apparent improvement of global neurological deficit in the acupuncture group compared with the control group should be interpreted with caution (OR 3.89, 95% CI 1.78 to 8.49; participants = 543; studies = 7; I² = 55%; Analysis 2.5).

Changes of specific neurological impairments after acupuncture treatment and at the end of follow-up

Of the 31 included trials, 20 measured specific neurological impairment at the end of treatment and follow-up, mainly including motor function, cognitive function, speech function, depression, swallowing function, pain, sleep, and spasticity.

Motor function

Four trials used the Fugl-Meyer Assessment (FMA) to measure motor function in the upper and lower extremities at the end of treatment (Li 2013a; Wang 2011a; Wu 2011a; Yao 2014). Acupuncture was superior to no acupuncture in the improvement of motor function in the upper and lower extremities (MD 6.16, 95% CI 4.20 to 8.11; participants = 245; studies = 4; I² = 28%; Analysis 2.6). One trial with 60 participants evaluated the effect of acupuncture on the improvement of general motor function measured by the Motor Assessment Scale at the end of treatment (Wang 2012). There was a significant difference between the two groups (MD 4.53, 95% CI 2.99 to 6.07; Analysis 2.6). One trial with 147 participants evaluated the effect of acupuncture on the improvement of general motor function measured by the FMA at the end of three months' follow-up (Zhou 2014). There was a beneficial effect of acupuncture on the improvement of general motor function for participants with stroke in the convalescent stage (MD 7.59, 95%CI 0.98 to 14.20; Analysis 2.7).

Two trials measured improvement of motor function after acupuncture treatment by using categorical approaches (FMA) (Li 2013a; Wang 2011a). There was no significant improvement in motor function among participants in the acupuncture group compared with the control group (OR 2.41, 95% CI 0.98 to 5.96; Analysis 2.8).

Cognitive function

Five trials evaluated the effect of acupuncture on the improvement of cognitive function measured by the Mini-Mental State Examination (MMSE) at the end of treatment (Bao 2012; Li 2010a; Li 2011a; Liu 2013a; Zheng 2014). Acupuncture was superior to no acupuncture in the improvement of cognitive function for participants with stroke in the convalescent stage (MD 2.54, 95% CI 0.03 to 5.05; participants = 278; studies = 5; I² = 98%; Analysis 2.9). The significant heterogeneity between the trials was possibly due to differences in times of evaluation from stroke onset, severity on entry, needling details, and outcome measurements used. Two trials measured this outcome by using the Montreal Cognitive Assessment Scale (MoCA) at the end of treatment (Bao 2012; Zheng 2014). There was also a beneficial effect of acupuncture on the improvement of cognitive function for participants with stroke in the convalescent stage (MD 1.34, 95% CI 0.76 to 1.92; participants = 120; studies = 2; I² = 0%; Analysis 2.9). The difference in one trial in which cognitive function was evaluated by the Revised Hasegawa Dementia Scale (HDS-R) was significant too (Li 2010a) (MD 1.26, 95% CI 0.29 to 2.23; participants = 46; studies = 1; Analysis 2.9). One trial evaluated the effect of acupuncture on the improvement of cognitive function measured by MMSE at the end of one month's follow-up (Sun 2013a). There was a significant difference between the two groups (MD 3.47, 95% CI 2.43 to 4.51; Analysis 2.10).

Three trials measured improvement of cognitive function after acupuncture treatment by using categorical approaches (MMSE) (Bao 2012; Li 2010a; Zheng 2014). There was no significant heterogeneity among them. It showed that acupuncture was beneficial for the improvement of cognitive function in participants with stroke in the convalescent stage (OR 3.82, 95% CI 1.89 to 7.72; participants = 166; studies = 3; I² = 0%; Analysis 2.11 ). One trial with 46 participants evaluated this outcome measured by categorical approaches (HDS-R). It also showed that acupuncture was beneficial for the improvement of cognitive function in participants with stroke in the convalescent stage (OR 4.02, 95% CI 1.12 to 14.46; Analysis 2.11).

Depression

Six trials evaluated the effect of acupuncture on the improvement of depression measured by the Hamilton Depression Scale (HAMD) at the end of treatment (Guo 2011; Gao 2014a; Sun 2015; Wu 2008; Zhang 2013a; Zhou 2014). There was a beneficial effect of acupuncture on the improvement of depression for participants with stroke in the convalescent stage (MD -2.58, 95% CI -3.28 to -1.87; participants = 552; studies = 6; I² = 71%; Analysis 2.12). One trial measured this outcome by using the Symtoms of Traditional Chinese Medicine (TCM) depression scale (Gao 2014a). There was also a beneficial effect of acupuncture on the improvement of depression for participants with stroke in the convalescent stage (MD -1.57, 95% CI -2.96 to -0.18; Analysis 2.12).

Four trials measured improvement of depression after acupuncture treatment by using categorical approaches (HAMD) (Gao 2014a; Sun 2015; Wu 2008; Zhang 2013a). There was no significant heterogeneity among them. It also showed that acupuncture was beneficial for the improvement of depression in participants with stroke in the convalescent stage (OR 2.03, 95% CI 1.10 to 3.72; participants = 342; studies = 4; I² = 0%; Analysis 2.13).

Swallowing function

Three trials evaluated the effect of acupuncture on the improvement of swallowing function at the end of treatment (Guo 2012; Wu 2013a; Xu 2013). Acupuncture was superior to no acupuncture in the improvement of dysphagia measured by a drinking test in two trials (Wu 2013a; Xu 2013) (MD -1.11, 95% CI -2.08 to -0.14; participants = 200; studies = 2; I² = 96%; Analysis 2.14). The difference was also significant in another trial in which dysphagia was evaluated categorically by a drinking test (Guo 2012) (OR 95.29, 95% CI 10.93 to 830.86; Analysis 2.15).

Pain

Two trials evaluated the effect of acupuncture on the improvement of pain measured by the Visual Analogue Scale (VAS) (Wang 2011a; Yao 2014). There was a significant decrease in scores among participants in the acupuncture group compared with the control group (MD -2.88, 95% CI -3.68 to -2.09; participants = 118; studies = 2; I² = 0%; Analysis 2.16). It showed that acupuncture was superior to no acupuncture in the improvement of pain.

Sleep

One trial evaluated the effect of acupuncture on the improvement of sleep quality measured by the Rhone Planck Sleepiness Scale (Zhang 2013a). There was no significant improvement in sleep quality among participants in the acupuncture group compared with the control group (MD -1.09, 95% CI -2.37 to 0.19; Analysis 2.17).

Spasticity

One trial evaluated the effect of acupuncture on the improvement of spasticity measured by the Modified Ashworth Spasticity Rating Scale (Wu 2011a). There was a beneficial effect of acupuncture on the improvement of spasticity for participants with convalescent stroke (MD -0.40, 95% CI -0.64 to -0.16; participants = 60; studies = 1; Analysis 2.18).

Death from any cause during the whole treatment and follow-up period

No data on death from any cause during the period of treatment and follow-up were available in these 29 trials.

Quality of life at the end of follow-up

One trial reported no significant change in health-related quality of life measured by means of self-report using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF- 36) from baseline to one month after treatment among participants in the acupuncture group compared with the control group (Sun 2013a) (MD 2.73, 95% CI -0.54 to 6.00; participants = 71; studies = 1; Analysis 2.19).

Possible adverse events

Adverse events were reported in five trials (Li 2010a; Sun 2013a; Sun 2015; Zhang 2013a; Zhou 2014). Of these, three trials reported no obvious adverse events related to acupuncture (Li 2010a; Sun 2015; Zhang 2013a). Zhou 2014 reported bleeding, haematoma, and pain at the acupoint in the acupuncture group and Sun 2013a found itchiness of the skin at the acupoint in one participant in the acupuncture group. No other serious adverse events were reported.

Subgroup analysis

We were unable to perform pre-determined subgroup analyses based on time of starting acupuncture and stroke severity because most trials did not provide information for the specified outcomes.

Sensitivity analysis

We were unable to perform the predetermined sensitivity analyses for trials with adequate concealment of randomisation and blinding, and that were published in languages other than Chinese because most trials did not provide the necessary data.

Publication bias

Nine trials comparing acupuncture plus baseline treatment with baseline treatment alone evaluated the effect of acupuncture on the improvement of dependency measured by the Barthel Index. Based on these nine trials, we produced a funnel plot to check for publication bias in this systematic review. We found that the funnel plot was asymmetric (Figure 4).

Figure 4.

Funnel plot of comparison 2, Acupuncture + baseline treatment versus baseline treatment alone, outcome: 2.1 Improvement of dependency at the end of treatment.

Although funnel plot asymmetry has long been equated with publication bias, the funnel plot should be seen as a generic means of displaying small-study effects. Small-study effects may be due to factors other than publication bias, such as poor methodological quality leading to spuriously inflated effects in smaller studies, true heterogeneity, artefactual, and chance (Sterne 2011).

Discussion

Summary of main results

We included 31 trials in this review, with a total of 2257 participants in the subacute or chronic stage of stroke. Two trials were conducted outside China (Chou 2009; Naeser 1992) and the remaining 29 trials were conducted in China. The present review on acupuncture for stroke is also not representative of different racial groups.

The results revealed the following.

  1. Compared with no acupuncture, for people with stroke in the subacute or chronic stage, acupuncture may have a beneficial effect on improving dependency (activities of daily living); global neurological deficiency; and specific neurological impairments including motor function, cognitive function, depression, swallowing function, pain, and spasticity.

  2. Acupuncture was not superior to sham acupuncture or no acupuncture on improving the quality of life in people with stroke in the subacute or chronic stage.

  3. There were no serious adverse events reported in people with stroke in the convalescent stage using acupuncture.

  4. Currently there is no evidence from the included RCTs for the effect of acupuncture on death, requiring institutional care, and all-cause mortality in people with stroke in the subacute or chronic stage.

Overall completeness and applicability of evidence

In this systematic review, a substantial number of the included studies were conducted in China and were published in Chinese. Our electronic searching successfully identified studies for which an abstract was available in Chinese, as well as a number of studies based on English titles. However, we believe it is likely that we will not have identified all relevant Chinese trials, in particular those for which only English titles were available and those not published in journals included in the electronic databases that we searched. The asymmetric funnel plot further proved that there was existing publication bias in this systematic review (Figure 4).

Many of the relevant trials that we included were published only as brief reports. This was frequently the case for studies published in Chinese, for which published versions were often less than two pages long. Although we contacted study authors, when possible, to confirm study eligibility, we did not have the time or resources to contact all study authors for further information on trial design or study results. Thus, in general the completeness of study information is low, resulting in a high number of studies for which risk of bias is classed as 'unclear'.

Characteristics of participants

The studies included In this review were predominantly conducted in China, so the review is not representative of different racial groups. The type and severity of stroke may alter the effects of acupuncture on people with stroke. From the available information, it was not possible to perform pre-specified subgroup analyses comparing people with different severities of stroke, and different times to start of treatment after stroke. This was due firstly, to the limited number studies for the specified outcomes, secondly, to only some of the included trials reporting data on severity, and thirdly, to most trials not clearly defining the interval between stroke onset and the start of the intervention treatment, and including participants with a mix of different intervals from stroke onset to start of intervention treatment.

Properties of interventions

The quality of acupuncture treatment is closely related to its effectiveness. Misleading results may have occurred if the treatment schedules were inadequate or administered by unskilled practitioners. However, information on the experience and training of the acupuncturists who gave the treatments was available in only one trial (Chou 2009). Furthermore, the acupuncture techniques, the number of acupoints, the number and duration of sessions, and the duration of the intervention period varied across trials. Some trials reported that the acupuncture points, the number of sessions, and the duration of treatment were individualised according to the practical conditions in each stroke patient. From the scarce description of treatment in all trials, it is difficult to evaluate if the acupuncture treatment was valid or not. The consensus of an international group of experienced acupuncturists and researchers was that clinical trials of acupuncture must use an optimal form of treatment, defined by examining standard texts and by surveying and consulting experts, and must be reported by using Revised Standards for Reporting Interventions in ClinicalTrials of Acupuncture (STRICTA) (Hugh 2010).

Outcomes measures

Efficacy

Because post-stroke neurological recovery is known to be obvious within three months, especially post-stroke motor recovery, and unlikely beyond six months, mixing people with interval from stroke onset of less than three months, three to six months, and more than six months in one sample would make the assessment of the efficacy of an intervention methodologically unsound. From the available information, it was not possible to perform pre-specified subgroup analyses comparing people with different times to start of treatment (within three months, three to six months, and after six months) for each outcome. This was due to the limited amount of data, the varied outcome measurements, or both, in this systematic review.

The long-term goal of treatment for stroke is to reduce mortality and disability, and ultimately to prolong survival and improve quality of life. Data available from the included trials were mainly secondary outcomes. There was a lack of data from RCTs on clinically relevant outcomes at long-term follow up, such as mortality and quality of life. The lack of reliable evidence on primary outcomes meant that we were unable to draw conclusions about the influence of acupuncture on stroke.

Adverse events

Of the 31 included trials with a total of 2257 participants in the convalescent phase of stroke, only one participant was reported to have suffered from bleeding and three participants were reported to have suffered from intolerance to pain at acupoints. There were no serious adverse events reported. From the available evidence, it appears that acupuncture is a safe treatment when used for people with stroke. However, it should be noted that this result was based on insufficient information from five trials with a small number of participants (Li 2010a; Sun 2013a; Sun 2015; Zhang 2013a; Zhou 2014). Most trials in this systematic review did not report whether any adverse events relevant to acupuncture were apparent in their participants. The reasons for insufficient reporting of adverse events were possibly as follows. Firstly, Chinese practitioners perceive acupuncture as free of side effects, secondly, because these are rare events, data from RCTs will almost never be sufficient to prove or disprove a causal relationship between a complementary and alternative medicine (CAM) therapy and a rare adverse event, and thirdly, study authors reported positive effects without reporting adverse events as well. However, some studies demonstrated that serious adverse events have been associated with acupuncture, such as infections (HIV, hepatitis, subacute bacterial endocarditis) caused by non-sterile needles, or complications (pneumothorax, cardiac tamponade) caused by tissue trauma, but the incidence of adverse events was unknown (Ernst 1997).

Quality of the evidence

The current available evidence shows that acupuncture may have beneficial effects on the improvement of dependency, global neurological deficiency, and specific neurological deficiency in some dimensions. Unfortunately due to low methodological quality with regard to methods of randomisation, allocation concealment and blinding of assessment of most included trials, and probable publication bias, there is currently insufficient evidence to support the routine use of acupuncture for people with stroke in the convalescent stage. The general low methodological quality of the included trials of acupuncture for stroke prohibited meaningful sensitivity analyses to illuminate the robustness of the results of the review to the exclusion of those trials with inadequate methodology. It was also not possible to perform sensitivity analysis to confirm the robustness of the results of the review to the exclusion of Chinese trials, because only two non-Chinese trials were included. However, this systematic review provides comprehensive and updated information on the effects of acupuncture for stroke in the convalescent stage for clinical practice. Therefore, further research on acupuncture for stroke is worthwhile in future.

Potential biases in the review process

The major limitations of this review are related to the weakness inherent in the available published literature on acupuncture for stroke. While most studies reported global and specific neurological deficit results, the measurement of the outcomes varied considerably across trials. The combined results from studies with such wide variation were unreliable. Furthermore, many studies did not provide detailed information on the severity of the disease, the exact time of starting the acupuncture treatment, the modalities of acupuncture technique and acupuncturist's background, and possible adverse effects relevant to acupuncture treatment. This brings the generalisability of the results into question.

Another limitation of this systematic review is that publication bias might be present, as indicated by the asymmetric funnel plot for the effect of acupuncture on the improvement of dependency measured by the Barthel Index. Although we undertook extensive literature searches, we still could not exclude the possibility that studies with negative findings remain unpublished.

Authors' conclusions

Implications for practice

Although acupuncture may have positive effects in stroke rehabilitation and there were no reported serious adverse events, the small number of low quality studies and the probability of publication bias means that there was insufficient evidence to support the routine use of acupuncture for people with subacute or chronic stroke.

Implications for research

The widespread use of acupuncture, the promising results with less severe side effects, lower cost, and the insufficient quality of the available trials warrant further research. Large sham or placebo-controlled trials are needed to confirm or refute the available evidence. The following features should be addressed in further studies.

  1. Detailed reporting of the generation of the allocation sequence and allocation concealment.

  2. Application and clear description of blinding.

  3. Use of placebo or sham acupuncture as the control.

  4. Clear definition of the modality of acupuncture, and acupuncture technique based on evidence or a consensus of experts (STRICTA).

  5. Use of standard validated outcome measures.

  6. Reporting of clinically important outcome measures at long-term follow-up, such as mortality and quality of life.

  7. Adverse events critically assessed by standardised monitoring or an effective self-report system. Attention should be paid to rare, severe adverse events relevant to acupuncture.

  8. The study should be reported according to the STRICTA criteria (Hugh 2010) in conjunction with the CONSORT statement (Schulz 2010).

Acknowledgements

We thank Mrs Hazel Fraser for providing us with relevant trials and systematic reviews from the Cochrane Stroke Group Trials Register and Mrs Brenda Thomas for her help with developing the search strategy and helpful comments. We express our gratitude to Dr Valentina Assi, Dr Bo Wu, lead editor Prof Peter Langhorne, Julie Gildie, and Tam Watson for their very helpful comments.

Data and analyses

Download statistical data

Comparison 1. Acupuncture plus baseline treatment versus sham acupuncture plus baseline treatment
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
1 Improvement of motor function1 Odds Ratio (M-H, Fixed, 95% CI)Totals not selected
2 Improvement of cognitive function1 Mean Difference (IV, Fixed, 95% CI)Totals not selected
2.1 Orientation1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
2.2 Perception1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
2.3 Praxis1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
2.4 Visuomotor organisation1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
2.5 Thinking operation1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
2.6 Memory1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
2.7 Attention1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
3 Improvement of Health-Related Quality of Life (MOS SF-36)1 Mean Difference (IV, Fixed, 95% CI)Totals not selected
3.1 Physical component summary1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
3.2 Mental component summary1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
4 Improvement of Stroke-Specific Quality of Life(SS QOL)1 Mean Difference (IV, Fixed, 95% CI)Totals not selected
4.1 Language1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
4.2 Personality1 Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]
Analysis 1.1.

Comparison 1 Acupuncture plus baseline treatment versus sham acupuncture plus baseline treatment, Outcome 1 Improvement of motor function.

Analysis 1.2.

Comparison 1 Acupuncture plus baseline treatment versus sham acupuncture plus baseline treatment, Outcome 2 Improvement of cognitive function.

Analysis 1.3.

Comparison 1 Acupuncture plus baseline treatment versus sham acupuncture plus baseline treatment, Outcome 3 Improvement of Health-Related Quality of Life (MOS SF-36).

Analysis 1.4.

Comparison 1 Acupuncture plus baseline treatment versus sham acupuncture plus baseline treatment, Outcome 4 Improvement of Stroke-Specific Quality of Life(SS QOL).

Comparison 2. Acupuncture plus baseline treatment versus baseline treatment alone
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
1 Improvement of dependency at the end of treatment11 Mean Difference (IV, Random, 95% CI)Subtotals only
1.1 Barthel Index9616Mean Difference (IV, Random, 95% CI)9.19 [4.34, 14.05]
1.2 Modified Barthel Index160Mean Difference (IV, Random, 95% CI)3.44 [0.30, 6.58]
1.3 ADL162Mean Difference (IV, Random, 95% CI)7.80 [6.04, 9.56]
2 Improvement of dependency at the end of follow-up2 Mean Difference (IV, Random, 95% CI)Subtotals only
2.1 Barthel index1147Mean Difference (IV, Random, 95% CI)7.49 [1.79, 13.19]
2.2 ADL171Mean Difference (IV, Random, 95% CI)3.83 [2.67, 4.99]
3 Improvement of global neurological deficit at the end of treatment6 Mean Difference (IV, Random, 95% CI)Subtotals only
3.1 Modified Edinburgh and Scandinavian Stroke Scale4240Mean Difference (IV, Random, 95% CI)-2.39 [-3.34, -1.43]
3.2 Neurological function deficit scale2123Mean Difference (IV, Random, 95% CI)-1.02 [-5.80, 3.76]
4 Improvement of global neurological deficit at the end of follow-up2 Mean Difference (IV, Random, 95% CI)Subtotals only
4.1 Neurological function deficit scale171Mean Difference (IV, Random, 95% CI)-6.15 [-7.09, -5.21]
4.2 NIHSS1147Mean Difference (IV, Random, 95% CI)-0.83 [-1.94, 0.28]
5 Improvement of global neurological deficit at the end of treatment7543Odds Ratio (M-H, Random, 95% CI)3.89 [1.78, 8.49]
6 Improvement of motor function at the end of treatment5 Mean Difference (IV, Fixed, 95% CI)Subtotals only
6.1 Upper and lower extremities motor function(Fugl-Meyer Assessment)4245Mean Difference (IV, Fixed, 95% CI)6.16 [4.20, 8.11]
6.2 General motor function (Motor assessment scale)160Mean Difference (IV, Fixed, 95% CI)4.53 [2.99, 6.07]
7 Improvment of general motor function at the end of follow-up (Fugl-Meyer Assessment)1 Mean Difference (IV, Fixed, 95% CI)Subtotals only
8 Improvement of motor function at the end of treatment (Fugl-Meyer Assessment)2125Odds Ratio (M-H, Random, 95% CI)2.41 [0.98, 5.96]
9 Improvement of cognitive function at the end of treatment5 Mean Difference (IV, Random, 95% CI)Subtotals only
9.1 MMSE5278Mean Difference (IV, Random, 95% CI)2.54 [0.03, 5.05]
9.2 MoCA2120Mean Difference (IV, Random, 95% CI)1.34 [0.76, 1.92]
9.3 HDS-R146Mean Difference (IV, Random, 95% CI)1.26 [0.29, 2.23]
10 Improvment of cognitive function at the end of follow-up (MMSE)171Mean Difference (IV, Fixed, 95% CI)3.47 [2.43, 4.51]
11 Improvement of cognitive function at the end of treatment3 Odds Ratio (M-H, Random, 95% CI)Subtotals only
11.1 MMSE3166Odds Ratio (M-H, Random, 95% CI)3.82 [1.89, 7.72]
11.2 HDS-R146Odds Ratio (M-H, Random, 95% CI)4.02 [1.12, 14.46]
12 Improvement of depression at the end of treatment6 Mean Difference (IV, Fixed, 95% CI)Subtotals only
12.1 HAMD6552Mean Difference (IV, Fixed, 95% CI)-2.58 [-3.28, -1.87]
12.2 Symptoms of TCM depression scale160Mean Difference (IV, Fixed, 95% CI)-1.57 [-2.96, -0.18]
13 Improvement of depression at the end of treatment (HAMD)4342Odds Ratio (M-H, Random, 95% CI)2.03 [1.10, 3.72]
14 Improvement of swallowing function at the end of treatment (Water drinking test)2200Mean Difference (IV, Random, 95% CI)-1.11 [-2.08, -0.14]
15 Improvement of swallowing function at the end of treatment (Water drinking test)160Odds Ratio (M-H, Random, 95% CI)95.29 [10.93, 830.86]
16 Improvement of pain at the end of treatment (Visual Analogue Scale)2118Mean Difference (IV, Fixed, 95% CI)-2.88 [-3.68, -2.09]
17 Improvement of sleep quality at the end of treatment (Rhone Planck Sleepiness Scale)160Mean Difference (IV, Fixed, 95% CI)-1.09 [-2.37, 0.19]
18 Improvement of spasticity at the end of treatment (Modified Ashworth Spasticity Rating Scale)160Mean Difference (IV, Fixed, 95% CI)-0.4 [-0.64, -0.16]
19 Improvement of quality of life at the end of treatment (MOS SF-36)171Mean Difference (IV, Fixed, 95% CI)2.73 [-0.54, 6.00]
Analysis 2.1.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 1 Improvement of dependency at the end of treatment.

Analysis 2.2.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 2 Improvement of dependency at the end of follow-up.

Analysis 2.3.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 3 Improvement of global neurological deficit at the end of treatment.

Analysis 2.4.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 4 Improvement of global neurological deficit at the end of follow-up.

Analysis 2.5.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 5 Improvement of global neurological deficit at the end of treatment.

Analysis 2.6.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 6 Improvement of motor function at the end of treatment.

Analysis 2.7.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 7 Improvment of general motor function at the end of follow-up (Fugl-Meyer Assessment).

Analysis 2.8.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 8 Improvement of motor function at the end of treatment (Fugl-Meyer Assessment).

Analysis 2.9.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 9 Improvement of cognitive function at the end of treatment.

Analysis 2.10.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 10 Improvment of cognitive function at the end of follow-up (MMSE).

Analysis 2.11.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 11 Improvement of cognitive function at the end of treatment.

Analysis 2.12.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 12 Improvement of depression at the end of treatment.

Analysis 2.13.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 13 Improvement of depression at the end of treatment (HAMD).

Analysis 2.14.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 14 Improvement of swallowing function at the end of treatment (Water drinking test).

Analysis 2.15.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 15 Improvement of swallowing function at the end of treatment (Water drinking test).

Analysis 2.16.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 16 Improvement of pain at the end of treatment (Visual Analogue Scale).

Analysis 2.17.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 17 Improvement of sleep quality at the end of treatment (Rhone Planck Sleepiness Scale).

Analysis 2.18.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 18 Improvement of spasticity at the end of treatment (Modified Ashworth Spasticity Rating Scale).

Analysis 2.19.

Comparison 2 Acupuncture plus baseline treatment versus baseline treatment alone, Outcome 19 Improvement of quality of life at the end of treatment (MOS SF-36).

Appendices

Appendix 1. Cochrane Stroke Group Trials Register search strategy

Stage: Late treatment (> 30 days)

Disease: Not specified

Condition: Not specified

Intervention type: Complementary medical therapy

Intervention code: Acupuncture

Appendix 2. CENTRAL search strategy

The Cochrane Library, June 2015

#1 [mh ^"cerebrovascular disorders"] or [mh "basal ganglia cerebrovascular disease"] or [mh "brain ischemia"] or [mh "carotid artery diseases"] or [mh "cerebral small vessel diseases"] or [mh "intracranial arterial diseases"] or [mh "intracranial embolism and thrombosis"] or [mh "intracranial hemorrhages"] or [mh ^stroke] or [mh "brain infarction"] or [mh ^"stroke, lacunar"] or [mh ^"vasospasm, intracranial"] or [mh ^"vertebral artery dissection"]

#2 (stroke or poststroke or "post-stroke" or cerebrovasc* or brain next vasc* or cerebral next vasc* or cva* or apoplex* or SAH):ti,ab

#3 ((brain* or cerebr* or cerebell* or intracran* or intracerebral) near/5 (isch*emi* or infarct* or thrombo* or emboli* or occlus*)):ti,ab

#4 ((brain* or cerebr* or cerebell* or intracerebral or intracranial or subarachnoid) near/5 (haemorrhage* or hemorrhage* or haematoma* or hematoma* or bleed*)):ti,ab

#5 [mh ^hemiplegia] or [mh ^paresis]

#6 (hemipleg* or hemipar* or paresis or paretic):ti,ab

#7 [mh ^"brain injuries"] or [mh ^"brain injury, chronic"]

#8 #1 or #2 or #3 or #4 or #5 or #6 or #7

#9 [mh ^acupuncture] or [mh ^"acupuncture therapy"] or [mh ^"acupuncture analgesia"] or [mh ^"acupuncture, ear"] or [mh ^electroacupuncture] or [mh ^meridians] or [mh ^"acupuncture points"] or [mh ^"trigger points"]

#10 (acupuncture* or electroacupuncture or "electro-acupuncture" or acupoint* or meridians or needling):ti,ab

#11 ((meridian or non-meridian or trigger) near/10 point*):ti,ab

#12 #9 or #10 or #11

#13 #8 and #12

Appendix 3. MEDLINE search strategy

MEDLINE (Ovid) November 2005 to July 2015

1. cerebrovascular disorders/ or exp basal ganglia cerebrovascular disease/ or exp brain ischemia/ or exp carotid artery diseases/ or exp cerebral small vessel diseases/ or exp intracranial arterial diseases/ or exp "intracranial embolism and thrombosis"/ or exp intracranial hemorrhages/ or stroke/ or exp brain infarction/ or stroke, lacunar/ or vasospasm, intracranial/ or vertebral artery dissection/

2. (stroke or poststroke or post-stroke or cerebrovasc$ or brain vasc$ or cerebral vasc$ or cva$ or apoplex$ or SAH).tw.

3. ((brain$ or cerebr$ or cerebell$ or intracran$ or intracerebral) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$)).tw.

4. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracranial or subarachnoid) adj5 (haemorrhage$ or hemorrhage$ or haematoma$ or hematoma$ or bleed$)).tw.

5. hemiplegia/ or exp paresis/

6. (hemipleg$ or hemipar$ or paresis or paretic).tw.

7. brain injuries/ or brain injury, chronic/

8. or/1-7

9. acupuncture/ or acupuncture therapy/ or acupuncture analgesia/ or acupuncture, ear/ or electroacupuncture/ or meridians/ or acupuncture points/ or trigger points/

10. (acupuncture$ or electroacupuncture or electro-acupuncture or acupoint$ or meridians or needling).tw.

11. ((meridian or non-meridian or trigger) adj10 point$).tw.

12. 9 or 10 or 11

13. 8 and 12

14. Randomized Controlled Trials as Topic/

15. random allocation/

16. Controlled Clinical Trials as Topic/

17. control groups/

18. clinical trials as topic/ or clinical trials, phase i as topic/ or clinical trials, phase ii as topic/ or clinical trials, phase iii as topic/ or clinical trials, phase iv as topic/

19. double-blind method/

20. single-blind method/

21. Placebos/

22. placebo effect/

23. cross-over studies/

24. randomized controlled trial.pt.

25. controlled clinical trial.pt.

26. (clinical trial or clinical trial phase i or clinical trial phase ii or clinical trial phase iii or clinical trial phase iv).pt.

27. (random$ or RCT or RCTs).tw.

28. (controlled adj5 (trial$ or stud$)).tw.

29. (clinical$ adj5 trial$).tw.

30. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw.

31. (quasi-random$ or quasi random$ or pseudo-random$ or pseudo random$).tw.

32. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.

33. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.

34. (cross-over or cross over or crossover).tw.

35. (placebo$ or sham).tw.

36. trial.ti.

37. (assign$ or allocat$).tw.

38. controls.tw.

39. or/14-38

40. 13 and 39

41. exp animals/ not humans/

42. 40 not 41

Appendix 4. EMBASE search strategy

EMBASE (Ovid) November 2005 to July 2015

1. cerebrovascular disease/ or exp basal ganglion hemorrhage/ or exp brain hematoma/ or exp brain hemorrhage/ or exp brain infarction/ or exp brain ischemia/ or exp carotid artery disease/ or cerebral artery disease/ or exp cerebrovascular accident/ or exp intracranial aneurysm/ or exp occlusive cerebrovascular disease/ or stroke unit/ or stroke patient/

2. (stroke or poststroke or post-stroke or cerebrovasc$ or brain vasc$ or cerebral vasc$ or cva$ or apoplex$ or SAH).tw.

3. ((brain$ or cerebr$ or cerebell$ or intracran$ or intracerebral) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$)).tw.

4. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracranial or subarachnoid) adj5 (haemorrhage$ or hemorrhage$ or haematoma$ or hematoma$ or bleed$)).tw.

5. hemiparesis/ or hemiplegia/ or paresis/

6. (hemipleg$ or hemipar$ or paresis or paretic).tw.

7. brain injury/ or acquired brain injury/

8. or/1-7

9. acupuncture/ or acupuncture analgesia/ or electroacupuncture/ or acupuncture needle/

10. (acupuncture$ or electroacupuncture or electro-acupuncture or acupoint$ or meridians or needling).tw.

11. ((meridian or non-meridian or trigger) adj10 point$).tw.

12. 9 or 10 or 11

13. 8 and 12

14. Randomized Controlled Trial/ or "randomized controlled trial (topic)"/

15. Randomization/

16. Controlled clinical trial/ or "controlled clinical trial (topic)"/

17. control group/ or controlled study/

18. clinical trial/ or "clinical trial (topic)"/ or phase 1 clinical trial/ or phase 2 clinical trial/ or phase 3 clinical trial/ or phase 4 clinical trial/

19. Crossover Procedure/

20. Double Blind Procedure/

21. Single Blind Procedure/ or triple blind procedure/

22. placebo/ or placebo effect/

23. (random$ or RCT or RCTs).tw.

24. (controlled adj5 (trial$ or stud$)).tw.

25. (clinical$ adj5 trial$).tw.

26. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw.

27. (quasi-random$ or quasi random$ or pseudo-random$ or pseudo random$).tw.

28. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.

29. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.

30. (cross-over or cross over or crossover).tw.

31. (placebo$ or sham).tw.

32. trial.ti.

33. (assign$ or allocat$).tw.

34. controls.tw.

35. or/14-34

36. 13 and 35

37. (exp animals/ or exp invertebrate/ or animal experiment/ or animal model/ or animal tissue/ or animal cell/ or nonhuman/) not (human/ or normal human/ or human cell/)

38. 36 not 37

Appendix 5. CINAHL search strategy

CINAHL (EBSCO) November 2005 to July 2015

S1 -(MH "Cerebrovascular Disorders") OR (MH "Basal Ganglia Cerebrovascular Disease+") OR (MH "Carotid Artery Diseases+") OR (MH "Cerebral Ischemia+") OR (MH "Cerebral Vasospasm") OR (MH "Intracranial Arterial Diseases+") OR (MH "Intracranial Embolism and Thrombosis") OR (MH "Intracranial Hemorrhage+") OR (MH "Stroke") OR (MH "Vertebral Artery Dissections")

S2 -(MH "Stroke Patients") OR (MH "Stroke Units")

S3 -TI ( stroke* or poststroke or apoplex* or cerebral vasc* or brain vasc* or cerebrovasc* or cva* or SAH ) or AB ( stroke* or poststroke or apoplex* or cerebral vasc* or brain vasc* or cerebrovasc* or cva* or SAH )

S4 -TI ( brain or cerebr* or cerebell* or intracran* or intracerebral) or AB ( brain or cerebr* or cerebell* or intracran* or intracerebral)

S5 -TI ( ischemi* or ischaemi* or infarct* or thrombo* or emboli* or occlus*) or AB ( ischemi* or ischaemi* or infarct* or thrombo* or emboli* or occlus*)

S6 -S4 and S5

S7 -TI ( brain* or cerebr* or cerebell* or intracerebral or intracran* or subarachnoid ) or AB ( brain* or cerebr* or cerebell* or intracerebral or intracran* or subarachnoid )

S8 -TI ( haemorrhage* or hemorrhage* or haematoma* or hematoma* or bleed* ) or AB ( haemorrhage* or hemorrhage* or haematoma* or hematoma* or bleed* )

S9 -S7 and S8

S10 -(MH "Hemiplegia")

S11 -TI ( hemipleg* or hemipar* or paresis or paretic ) or AB ( hemipleg* or hemipar* or paresis or paretic )

S12 -(MH "Brain Injuries")

S13 -S1 OR S2 OR S3 OR S6 OR S9 OR S10 OR S11 OR S12

S14 -(MH "Acupuncture") OR (MH "Acupuncture Analgesia") OR (MH "Acupuncture Anesthesia") OR (MH "Acupuncture, Ear") OR (MH "Electroacupuncture") OR (MH "Meridians") OR (MH "Acupuncture Points") OR (MH "Acupuncturists") OR (MH "Trigger Point")

S15 -TI (acupuncture* or electroacupuncture or electro-acupuncture or acupoint* or meridians or needling) OR AB (acupuncture* or electroacupuncture or electro-acupuncture or acupoint* or meridians or needling)

S16 -TI ((meridian or non-meridian or trigger) N10 point*) or AB ((meridian or non-meridian or trigger) N10 point*)

S17 -S14 OR S15 OR S16

S18 -S13 AND S17

Appendix 6. AMED search strategy

AMED (Ovid) November 2005 to July 2015

1. cerebrovascular disorders/ or cerebral hemorrhage/ or cerebral infarction/ or cerebral ischemia/ or cerebrovascular accident/ or stroke/

2. (stroke or poststroke or post-stroke or cerebrovasc$ or brain vasc$ or cerebral vasc$ or cva$ or apoplex$ or SAH).tw.

3. ((brain$ or cerebr$ or cerebell$ or intracran$ or intracerebral) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$)).tw.

4. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracranial or subarachnoid) adj5 (haemorrhage$ or hemorrhage$ or haematoma$ or hematoma$ or bleed$)).tw.

5. hemiplegia/

6. (hemipleg$ or hemipar$ or paresis or paretic).tw.

7. brain injuries/

8. or/1-7

9. acupuncture/ or acupuncture therapy/ or acupoints/ or neiguan/ or acupuncture analgesia/ or ear acupuncture/ or electroacupuncture/ or meridians/ or needling/ or scalp acupuncture/

10. (acupuncture$ or electroacupuncture or electro-acupuncture or acupoint$ or meridians or needling).tw.

11. ((meridian or non-meridian or trigger) adj10 point$).tw.

12. 9 or 10 or 11

13. 8 and 12

Appendix 7. CBM search strategy

#1 中风

#2 卒中

#3 脑血管

#4 脑*塞

#5 脑*血

#6 脑*栓

#7 蛛网膜下腔出血

#8 主题词="中风/全部副主题/全部树"

#9 主题词="脑血管意外/全部副主题/全部树"

#10 主题词="垂体卒中/全部副主题"

#11 主题词="梗塞, 大脑中动脉/全部副主题"

#12 主题词="梗塞, 大脑前动脉/全部副主题"

#13 主题词="梗塞, 大脑后动脉/全部副主题"

#14 主题词= "中风后遗症/全部副主题"

#15 主题词= "中风先兆症/全部副主题"

#16 主题词=="蛛网膜下腔出血/全部副主题/全部树"

#17 #1 or #2 or #3 or #4 or #5 or #6 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15

#18 随机

#19 盲法

#20 单盲

#21 双盲

#22 三盲

#23 安慰剂

#24 主题词="随机对照试验 [文献类型 ]"

#25 主题词="随机分配"

#26 主题词="随机对照试验/全部副主题"

#27 #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26

#28 针

#29 电针

#30 长针

#31 芒针

#32 皮下针

#33 火针

#34 头针

#35 手捻针

#36 巨针

#37 头皮针

#38 体针

#39 温针

#40 透刺

#41 巨刺

#42 针法

#43 刺法

#44 眼针

#45 磁极针

#46 毫针

#47 谬刺

#48 皮内针

#49 鑱针

#50 园针

#51 鍉针

#52 锋针

#53 铍针

#54 圆利针

#55 大针

#56 #28 or #29 or #30 or #31 or #32 or #33 or #34 or #35 or #36 or #37 or #38 or #39 or #40 or #41 or #42 or #43 or #44 or #45 or #46 or #47 or #48 or #49 or #50 or #51 or #52 or #52 or #53 or #54 or #55

Appendix 8. CNKI search strategy

(主题=中风 OR 主题=卒中 OR 主题=脑血管 OR 主题=脑梗塞 OR 主题=脑梗死 OR 主题=脑血栓 OR 主题=脑栓塞 OR 主题=脑出血 OR 主题=脑溢血 OR 主题=蛛网膜下腔出血) AND (主题=随机 OR 主题=盲法 OR 主题=单盲 OR 主题=双盲 OR 主题=三盲 OR 主题=安慰剂) AND (主题=针灸 OR 主题=针刺 OR 主题=电针 OR 主题=芒针 OR 主题=皮下针 OR 主题=火针 OR 主题=头针 OR 主题=手捻针 OR 主题=针刀 OR 主题=长针 OR 主题=巨针 OR 主题=头皮针 OR 主题=体针 OR 主题=温针 OR 主题=透刺 OR 主题=巨刺 OR 主题=针法 OR 主题=刺法 OR 主题=眼针 OR 主题=磁极针 OR 主题=毫针 OR 主题=谬刺 OR 主题=皮内针 OR 主题=鑱针 OR 主题=园针 OR 主题=鍉针 OR 主题=锋针 OR 主题=铍针 OR 主题=圆利针 OR 主题=大针)

Appendix 9. VIP search strategy

(U=中风+U=卒中+U=脑血管+U=脑梗塞+U=脑梗死+U=脑血栓+U=脑栓塞+U=脑出血+U=脑溢血+U=蛛网膜下腔出血)*(U=随机+U=盲法+U=安慰剂)*(U=针灸+U=针刺+U=电针+U=针法+U=刺法+U=磁极针)*全部期刊*年=2005-2015

Appendix 10. Wanfang search strategy

((中风 or 卒中 or 脑血管* or 脑梗* or 脑*栓 or 脑栓* or 脑*血 or 蛛网膜下腔出血) and ((((("随机") or ("盲法")) or ("单盲")) or ("双盲")) or ("安慰剂"))) and ((((("针灸") or ("针法")) or ("针刺")) or ("电针")) and ("刺法"))

Appendix 11. Risk of bias assessment tool

Potential source of bias Assessment criteria

Random sequence generation

Selection bias (biased allocation to interventions) due to inadequate generation of a randomised sequence

Low risk of bias: Random number table; computer random number generator; coin tossing; shuffling cards or envelopes; throwing dice; drawing of lots; minimization (minimization may be implemented without a random element, and this is considered to be equivalent to being random).
High risk of bias: Sequence generated by odd or even date of birth; date (or day) of admission; sequence generated by hospital or clinic record number; allocation by judgement of the clinician; by preference of the participant; based on the results of a laboratory test or a series of tests; by availability of the intervention.
Unclear: Insufficient information about the sequence generation process to permit judgement.

Allocation concealment

Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment

Low risk of bias: Randomisation method described that would not allow investigator/participant to know or influence intervention group before eligible participant entered in the study (e.g. central allocation, including telephone, web-based, and pharmacy-controlled, randomisation; sequentially numbered drug containers of identical appearance; sequentially numbered, opaque, sealed envelopes).
High risk of bias: Using an open random allocation schedule (e.g. a list of random numbers); assignment envelopes were used without appropriate safeguards (e.g. if envelopes were unsealed or non-opaque or not sequentially numbered); alternation or rotation; date of birth; case record number; any other explicitly unconcealed procedure.
Unclear: Randomisation stated but no information on method used is available.

Blinding of participants and personnel

Performance bias due to knowledge of the allocated interventions by participants and personnel during the study

Low risk of bias: No blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced by lack of blinding; blinding of participants and key study personnel ensured, and unlikely that the blinding could have been broken.
High risk of bias: No blinding or incomplete blinding, and the outcome is likely to be influenced by lack of blinding; blinding of key study participants and personnel attempted, but likely that the blinding could have been broken, and the outcome is likely to be influenced by lack of blinding.
Unclear: Insufficient information to permit judgement

Blinding of outcome assessment

Detection bias due to knowledge of the allocated interventions by outcome assessors.

Low risk of bias: No blinding of outcome assessment, but the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding; blinding of outcome assessment ensured, and unlikely that the blinding could have been broken.
High risk of bias: No blinding of outcome assessment, and the outcome measurement is likely to be influenced by lack of blinding; blinding of outcome assessment, but likely that the blinding could have been broken, and the outcome measurement is likely to be influenced by lack of blinding.
Unclear: Insufficient information to permit judgement

Incomplete outcome data

Attrition bias due to amount, nature or handling of incomplete outcome data.

Low risk of bias: No missing outcome data; reasons for missing outcome data unlikely to be related to true outcome (for survival data, censoring unlikely to be introducing bias); missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups; for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk not enough to have a clinically relevant impact on the intervention effect estimate; for continuous outcome data, plausible effect size (difference in means or standardized difference in means) among missing outcomes not enough to have a clinically relevant impact on observed effect size; missing data have been imputed using appropriate methods.
High risk of bias: Reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across intervention groups; for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk enough to induce clinically relevant bias in intervention effect estimate; for continuous outcome data, plausible effect size (difference in means or standardized difference in means) among missing outcomes enough to induce clinically relevant bias in observed effect size; ‘as-treated’ analysis done with substantial departure of the intervention received from that assigned at randomisation; potentially inappropriate application of simple imputation.
Unclear: Insufficient information to permit judgement

Selective reporting

Reporting bias due to selective outcome reporting

Low risk of bias: The study protocol is available and all of the study’s pre-specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre-specified way; the study protocol is not available but it is clear that the published reports include all expected outcomes, including those that were pre-specified (convincing text of this nature may be uncommon).
High risk of bias: Not all of the study’s pre-specified primary outcomes have been reported; one or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. subscales) that were not pre-specified; one or more reported primary outcomes were not pre-specified (unless clear justification for their reporting is provided, such as an unexpected adverse effect); one or more outcomes of interest in the review are reported incompletely so that they cannot be entered in a meta-analysis; the study report fails to include results for a key outcome that would be expected to have been reported for such a study.
Unclear: Insufficient information to permit judgement

Other bias

Bias due to problems not covered elsewhere in the table

Low risk of bias: The study appears to be free of other sources of bias.
High risk of bias: Had a potential source of bias related to the specific study design used; stopped early due to some data-dependent process (including a formal-stopping rule); had extreme baseline imbalance; has been claimed to have been fraudulent; had some other problem.
Unclear: Insufficient information to assess whether an important risk of bias exists; insufficient rationale or evidence that an identified problem will introduce bias.

What's new

DateEventDescription
12 January 2016New citation required but conclusions have not changedCompared with the 2006 version of this review, a substantial amount of new information has been included, but there is no change to the main conclusions in this updated review.
12 January 2016New search has been performedWe have updated the searches to July 2015. We included 26 new trials (1889 participants) in this version. There are now 31 trials, with 2257 participants, included in this updated review.

History

Protocol first published: Issue 2, 2003
Review first published: Issue 3, 2006

DateEventDescription
20 October 2008AmendedContact details updated
15 July 2008AmendedConverted to new review format.

Contributions of authors

Wu HM: developing the search strategy, assessment of studies, data extraction, data entry, data analysis, writing of protocol and review.
Yang A: developing the search strategy, assessment of studies, data extraction, data entry, data analysis, writing of review.
Tang JL: data analysis, resolution of disagreements, writing protocol and review.
Xu Li: assessment of studies, data extraction, data entry, suggestions and corrections.
Yang M: data extraction, suggestions and corrections.
Liu GJ: data analysis, suggestions and corrections.

Declarations of interest

Ai Yang: none known.
Hong Mei Wu: none known.
Jin-Ling Tang: none known.
Li Xu: none known.
Ming Yang: none known.
Guan J Liu: none known.

Sources of support

Internal sources

  • Hong Kong Branch of Chinese Cochrane Center, China.

  • Department of Community & Family Medicine, Chinese University of Hong Kong, China.

  • Chinese Cochrane Center, West China Hospital, Si Chuan University, China.

External sources

  • Hong Kong Croucher Foundation, China.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Bao 2012

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 60 (30/30)
Demographics: aged 50-73 years, 67% male
Type of stroke: ischaemic only
Diagnosis: WHO definition and all confirmed by CT
Severity on entry: not stated
Time from stroke onset: 3-12 months
Setting: inpatient and outpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + WM versus WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints. Numbers of points used: 4 scalp acupoints and 3 body acupoints

    • Depths of insertion: not stated

    • Deqi elicited: yes

    • Needle stimulation: manual

    • Needle retention time: 50 minutes

    • Needle type: hua tuo brand

  • Treatment regimen

    • Number of treatment sessions: 56 sessions

    • Frequency of treatment: 7 sessions/week

    • Total course: 8 weeks

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of cognitive function (MMSE, MoCA)

  • Improvement of independence (Barthel index)

  • FU: 8 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Chou 2009

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: 5

ParticipantsCountry: UK
Number of participants included: 33 (17/16)
Demographics: aged 59-90 years, 48% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: CT/MRI
Severity on entry: unclear
Time from stroke onset: 13-33 months
Setting: inpatient
Comparability: comorbidity and past history similar
Interventions

Comparison: real acupuncture + PT versus sham acupuncture + PT

Acupuncture treatment

  • Acupuncture rationale: stated

  • Needling details

    • Points used: body acupoints

    • Numbers of points used: 2 acupoints

    • Depths of insertion: 0.03 inch

    • Deqi elicited: yes

    • Needle stimulation: electrical

    • Needle retention time: 20 minutes

    • Needle type: the needles were 1 inch long

  • Treatment regimen

    • Number of treatment sessions: 16 sessions

    • Frequency of treatment: 2/week

    • Total course: 8 weeks

  • Practitioner background: has been practicing Traditional Chinese Medicine for many years after graduating from medical school (China Medical University, Taichung, Taiwan)

  • Co-intervention: PT

Control interventions: sham acupuncture + PT

Outcomes
  • Improvement of cognitive function (LOTCA-G)

  • Quality of life (SF-36, SS-QOL)

  • FU: 8 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Low risk

Treatment: 3 participants could not finish the treatment protocol

Control: 2 participants decided not to receive rehabilitation

Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Dai 1997

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 136 (46/45/45)
Demographics: aged 48-86 years, 75% male
Type of stroke: ischaemic only
Diagnosis: WHO definition and all confirmed by CT
Severity on entry: mild to severe
Time from stroke onset: 3-14 months
Setting: unclear
Comparability: unclear
Interventions

3 arms:

  • acupuncture + WM

  • acupuncture only

  • WM only

Comparison eligible: acupuncture + WM versus WM only

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details:

    • points used: both body and scalp (three temporal points) acupoints

    • Numbers of points used: 5-11 points

    • Depths of insertion: 1.5-2.0 inches

    • Deqi elicited: yes

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: stainless steel, gauge 26-30#, length 2.0-2.6 inches

  • Treatment regimen:

    • Number of treatment sessions: 30 sessions

    • Frequency of treatment: 1 session/day

    • Total course: 30 days

  • Practitioner background: not stated

  • Co-intervention:

    • aspirin 25 mg qd orally

Control interventions: WM: aspirin 25 mg qd orally

OutcomesNumber of participants with improvement in global neurological deficit (CSRS 1 score decrease > 18%) at the end of treatment
FU: 30 days
Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Gao 2014a

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: none

ParticipantsCountry: China
Number of patients included: 60 (30/30)
Demographics: 50% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 3-6 months
Setting: outpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + WM versus WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 1 scalp acupoint and 5 body acupoints

    • Depths of insertion: 0.66-1.05 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: hua tuo brand, length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 24 sessions

    • Frequency of treatment: 6 sessions/week

    • Total course: 4 weeks

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of depression (HAMD)

  • Improvement of neurological function (MESS and SSS)

  • TCM syndrome scoring criteria

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on the allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Low riskNo participants lost to follow-up
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Guo 2011

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 95 (32/31/32)
Demographics: aged 40-65 years, 61% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-6 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

3 arms:

  • acupuncture only

  • WM only

  • acupuncture + WM

Comparison eligible: acupuncture + WM versus WM only

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 4 scalp acupoints and 2 body acupoints

    • Depths of insertion: not stated

    • Deqi elicited: not stated

    • Needle stimulation: manual and electrical

    • Needle retention time: 30 minutes

    • Needle type: not stated

  • Treatment regimen

    • Number of treatment sessions: 30 sessions

    • Frequency of treatment: 5 sessions/week

    • Total course: 6 weeks

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of depression (HAMD)

  • Improvement of neurological function (Clinical Neurological Function Defect Scale)

  • FU: 6 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Guo 2012

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 60 (30/30)
Demographics: aged 38 to 73 years, 68% male
Type of stroke: unclear
Diagnosis: unclear
Severity on entry: not stated
Time from stroke onset: 3 months to 5 years
Setting: inpatient
Comparability: comorbidity and past history similar
Interventions

Comparison: acupuncture + OT versus OT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: body acupoints

    • Numbers of points used: 1 acupoint

    • Depths of insertion: 0.28-0.55 inch

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: not stated

    • Needle type: the needles were 1.57 inches long

  • Treatment regimen

    • Number of treatment sessions: 6-12 sessions

    • Frequency of treatment: 6/week

    • Total course: 1-2 weeks

  • Practitioner background: not stated

  • Co-intervention: OT

Control interventions: OT

OutcomesNumber of participants with improvement in swallowing function (water drinking test)
Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Huang 2008a

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 90 (30/30/30)
Demographics: 67% male
Type of stroke: ischaemic only
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-3 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

3 arms:

  • acupuncture only

  • PT only

  • acupuncture + PT

Comparison eligible: acupuncture + PT versus PT only

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: scalp acupoints

    • Numbers of points used: 3 points

    • Depths of insertion: 0.98-1.38 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: the needles were 1.57 inches long

  • Treatment regimen

    • Number of treatment sessions: 24 sessions

    • Frequency of treatment: 6 sessions/week

    • Total course: 4 weeks

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Neurological function (MESS and SSS)

  • Independence (Barthel Index)

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNo information provided
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Ke 2015

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 80 (40/40)
Demographics: aged 61-83 years, 55% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition
Severity on entry: not stated
Time from stroke onset: 2-18 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + PT versus PT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: body acupoints

    • Numbers of points used: 27 body acupoints

    • Depths of insertion: 0.66-5.25 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: 30-40 minutes

    • Needle type: not stated

  • Treatment regimen

    • Number of treatment sessions: 30 sessions

    • Frequency of treatment: 7 sessions/week

    • Total course: 30 days

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of syndrome (TCM syndrome scoring criteria)

  • Improvement of independence (Barthel Index)

  • FU: 30 days

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Li 1997a

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 112 (42/20/50)
Demographics: aged 24-76 years
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition and all confirmed by CT or MRI
Severity on entry: not stated
Time from stroke onset: 1 month to 8.5 years
Setting: inpatients
Comparability: comorbidity and past history similar
Interventions

3 arms:

  • acupuncture + PT and OT

  • acupuncture only

  • PT and OT

Comparison eligible: acupuncture + PT and OT versus PT and OT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 10-12 points

    • Depths of insertion: not stated

    • Deqi elicited: unclear

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: not stated

  • Treatment regimen

    • Number of treatment sessions: 72 sessions

    • Frequency of treatment: 6 sessions/week

    • Total course: 3 months

  • Practitioner background: not stated

  • Co-intervention: baseline medication, PT and OT

Control interventions: baseline medication plus PT and OT

OutcomesNumber of participants with improvement in global neurological deficit (CSRS 1 score) at the end of treatment
FU: 3 months
Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Li 2010a

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: none
ITT analysis: not stated
Losses to FU: 4

ParticipantsCountry: China
Number of participants included: 46 (24/22)
Demographics: aged 47-79 years, 59% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-36 months
Setting: outpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + WM versus WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 5 scalp acupoints and 6 body acupoints

    • Depths of insertion: 0.66-1.5 inches

    • Deqi elicited: yes

    • Needle stimulation: manual and electrical

    • Needle retention time: 30 minutes

    • Needle type: gauge 30#, length 1.97 inches

  • Treatment regimen

    • Number of treatment sessions: 60 sessions

    • Frequency of treatment: 5 sessions/week

    • Total course: 12 weeks

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of cognitive function (MMSE HDS-R)

  • Improvement of independence (Barthel Index)

  • Adverse events

  • FU: 12 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Low risk

Treatment: 1 participant could not finish the treatment protocol

Control: 3 participants could not finish the control protocol

Selective reporting (reporting bias)Unclear riskSome patient-related outcomes were not reported, such as information on quality of life or all-cause mortality
Other biasUnclear riskNo information provided

Li 2011a

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 62 (31/31)
Demographics: 54% male
Type of stroke: unclear
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 6-20 months
Setting: outpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + WM versus WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: body acupoints

    • Numbers of points used: 7 body acupoints

    • Depths of insertion: 0.39-1.05 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: not stated

    • Needle type: stainless steel needle gauge 28#, length 1.31 inches

  • Treatment regimen

    • Number of treatment sessions: 28 sessions

    • Frequency of treatment: 7 sessions/week

    • Total course: 4 weeks

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of cognitive function (MMSE)

  • Improvement of independence (ADL)

  • FU: 4 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Li 2013a

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 60 (20/20/20)
Demographics: aged 40-75 years
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-3 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

3 arms:

  • acupuncture only

  • PT only

  • acupuncture + PT

Comparison eligible: acupuncture + PT versus PT only

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: body acupoints

    • Numbers of points used: 12 points

    • Depths of insertion: not stated

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: 30 minute

    • Needle type: not stated

  • Treatment regimen

    • Number of treatment sessions: not stated

    • Frequency of treatment: 7 sessions/week

    • Total course: not stated

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of motor function (Fugl-Meyer Assessment)

  • Improvement of pain (Visual Analogue Score)

  • Improvement of independence (ADL)

  • FU: not stated

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Liu 2013a

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 50 (25/25)
Demographics: aged 35-74 years, 68% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition and all confirmed by CT
Severity on entry: not stated
Time from stroke onset: 3-12 months
Setting: inpatient
Comparability: no significant difference in age, comorbidity, or time post onset
Interventions

Comparison: acupuncture + daily OT versus daily OT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: scalp acupoints

    • Numbers of points used: 2 scalp acupoints

    • Depths of insertion: 1.05-1.31/0.66 inches

    • Deqi elicited: yes

    • Needle stimulation: manual and electrical stimulation

    • Needle retention time: 90 minutes

    • Needle type: hua tuo brand, length 0.98 inches

  • Treatment regimen

    • Number of treatment sessions: 24 sessions

    • Frequency of treatment: 6 sessions/week

    • Total course: 4 weeks

  • Practitioner background: not stated

  • Co-intervention: OT

Control interventions: OT

Outcomes
  • Improvement of cognitive function (MMSE)

  • Independence (ADL)

  • FU: 24 days

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Lun 1999

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 109 (61/48)
Demographics: aged 35-75 years, 60% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition and all confirmed by CT before entry
Severity on entry: not stated
Time from stroke onset: 2 months to 5 years
Setting: unclear
Comparability: unclear
Interventions

Comparison: acupuncture + TCM versus TCM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: scalp acupoints

    • Numbers of points used: 5 points

    • Depths of insertion: 2-2.6 inches

    • Deqi elicited: yes

    • Needle stimulation: manual

    • Needle retention time: 30 minute

    • Needle type: stainless steel needle, gauge 28-30#, length 2.6 inches

  • Treatment regimen

    • Number of treatment sessions: 30 sessions

    • Frequency of treatment: 1/day

    • Total course: 45 days

  • Practitioner background: not stated

  • Co-intervention: baseline TCM

Control interventions: TCM

OutcomesNumber of participants with improvement in global neurological deficit (CSRS 2) at the end of treatment
FU: 45 days
Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Naeser 1992

Methods

RCT
Method of randomisation: not stated
Blinding: participants blinded

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: USA
Number of participants included: 16 (10/6)
Demographics: aged 44-74 years
Type of stroke: ischaemic only
Diagnosis: all confirmed by CT
Severity on entry: moderate
Time from stroke onset: 1-3 months
Setting: inpatients
Comparability: no significant difference in age or time post onset
Interventions

Comparison: real acupuncture + daily PT versus sham acupuncture + daily PT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 11 body acupoints; numbers of scalp acupoints unclear

    • Depths of insertion: unclear

    • Deqi elicited: unclear

    • Needle stimulation: electrical stimulation with frequency 1-2 Hz and amplitude unknown

    • Needle retention time: 20 minutes

    • Needle type: gauge 34#, length and material unknown

  • Treatment regimen

    • Number of treatment sessions: 20 sessions

    • Frequency of treatment: 5 sessions/week

    • Total course: 4 weeks

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions

  • Sham

  • Acupuncture + PT

OutcomesNumber of participants with improvement in motor function (BMIT) within 5 days after completing treatment
FU: 35 days
Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Low riskQuote: "The sham acupuncture was done only on the non-paralyzed upper extremity and lower extremity. The patients were told that in China acupuncture is used on the non-paralysed side to treat the paralysed side. They were further told that the stimulation was low level, and they would not feel anything"
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Sun 2013a

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: 1
ITT analysis: not stated
Losses to FU: 7

ParticipantsCountry: China
Number of participants included: 71 (36/35)
Demographics: aged 51-72 years, 56% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition
Severity on entry: not stated
Time from stroke onset: 3-9 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + OT + WM versus OT + WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 7 scalp acupoints and 5 body acupoints

    • Depths of insertion: 0.26-1.97 inches

    • Deqi elicited: yes

    • Needle stimulation: manual and electrical

    • Needle retention time: 30 minutes

    • Needle type: hua tuo brand, length 1.31-1.97 inches

  • Treatment regimen

    • Number of treatment sessions: 45 sessions

    • Frequency of treatment: 1 session/day

    • Total course: 45 days

  • Practitioner background: not stated

  • Co-intervention: OT + WM

Control interventions: OT + WM

Outcomes
  • Improvement of symptoms of turbid phlegm obstructing orifices

  • Improvement of cognitive function (MMSE)

  • Improvement of independence (ADL)

  • Improvement of neurological function (NDFS)

  • Improvement of quality of life (MOS, SF-36)

  • Adverse event: itchiness of the skin at the acupoint in one participant in the acupuncture group

  • FU: 45 days

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Low risk4 participants could not finish the treatment protocol, 3 participants lost to follow-up
Selective reporting (reporting bias)Unclear riskSome patient-related outcomes were not reported, such as information on quality of life or all-cause mortality
Other biasUnclear riskNo information provided

Sun 2015

Methods

RCT
Method of randomisation: randomisation by using envelopes
Blinding: not stated

Adverse effects: none
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 93 (31/31/31)
Demographics: aged 60-95 years, 47% male
Type of stroke: unclear
Diagnosis: WHO definition
Severity on entry: not stated
Time from stroke onset: 9-46 months
Setting: inpatient and outpatient
Comparability: no significant difference in age, comorbidity, or time post onset
Interventions

3 arms:

  • acupuncture only

  • WM only

  • acupuncture + WM

Comparison eligible: acupuncture + WM versus WM only

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 6 body acupoints, 3 scalp acupoints

    • Depths of insertion: not stated

    • Deqi elicited: yes

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: hua tuo brand, length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 120 sessions

    • Frequency of treatment: 5 sessions/week

    • Total course: 24 weeks

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of depression (HAMD)

  • Adverse event

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using envelopes assorted in a random manner
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskSome patient-related outcomes were not reported, such as information on quality of life or all-cause mortality
Other biasUnclear riskNo information provided

Wang 2001

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 90 (34/30/26)
Demographics: aged 39-75 years, 56% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition and all confirmed by CT
Severity on entry: not stated
Time from stroke onset: 2 months to 5 years
Setting: unclear
Comparability: unclear
Interventions

3 arms:

  • acupuncture + TCM

  • acupuncture only

  • TCM only

Comparison eligible: acupuncture + TCM versus TCM only

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: body acupoints

    • Numbers of points used: 6-10 points

    • Depths of insertion: not stated

    • Deqi elicited: yes

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: not stated

  • Treatment regimen

    • Number of treatment sessions: 60 sessions

    • Frequency of treatment: 10 sessions/13 days

    • Total course: 78 days

  • Practitioner background: not stated

  • Co-intervention: TCM

Control interventions: TCM

Outcomes
  • Number of participants with improvement in global neurological deficit (CSRS 2) at the end of treatment

  • FU: 78 days

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Wang 2011a

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 85 (43/42)
Demographics: aged 40-80 years, 65% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 33-192 days
Setting: inpatient and outpatient
Comparability: no significant difference in age, comorbidity, or time post onset
Interventions

Comparison: acupuncture + PT + OT versus PT + OT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: body acupoints

    • Numbers of points used: 10 acupoints

    • Depths of insertion: 0.08-0.2 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: not stated

    • Needle type: not stated

  • Treatment regimen

    • Number of treatment sessions: 10 sessions

    • Frequency of treatment: 3-4 sessions/week

    • Total course: 3 weeks

  • Practitioner background: not stated

  • Co-intervention: PT + OT

Control interventions: PT + OT

Outcomes
  • Improvement of motor function (Fugl-Meyer Assessment)

  • Improvement of pain (Visual Analogue Scale)

  • FU: 3 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Wang 2012

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 60 (30/30)
Demographics: aged 43-77 years, 65% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition and all confirmed by CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-6 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + PT versus PT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: scalp acupoints

    • Numbers of points used: 4 points

    • Depths of insertion: 0.98-1.38 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: stainless steel needle, gauge 30#, length 1.97 inches

  • Treatment regimen

    • Number of treatment sessions: 45 sessions

    • Frequency of treatment: 15 sessions/month

    • Total course: 3 months

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of motor function (Motor Assessment Scale)

  • Improvement of independence (modified Barthel Index)

  • FU: 3 months

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Wu 2008

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 160 (40/40/40/40)
Demographics: aged 40-69 years, 63% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-6 months
Setting: inpatient and outpatient
Comparability: no significant difference in age, comorbidity, or time post onset
Interventions

4 arms:

  • PT + OT

  • acupuncture + PT + OT

  • WM + PT + OT

  • acupuncture + WM + PT + OT

Comparisons eligible:

  • acupuncture + PT + OT versus PT + OT

  • acupuncture + WM + PT + OT versus WM + PT + OT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 2 scalp acupoints and 2 body acupoints

    • Depths of insertion: not stated

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: not stated

    • Needle type: not stated

  • Treatment regimen

    • Number of treatment sessions: 56 sessions

    • Frequency of treatment: 7 sessions/week

    • Total course: 8 weeks

  • Practitioner background: not stated

  • Co-intervention: PT + OT/WM + PT + OT

Control interventions: PT + OT/WM + PT + OT

Outcomes
  • Improvement of depression (HAMD)

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Wu 2011a

Methods

RCT
Method of randomisation: randomisation by using random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 60 (30/30)
Demographics: aged 41-76 years, 55% male
Type of stroke: ischaemic only
Diagnosis: confirmed by CT/MRI
Severity on entry: not stated
Time from stroke onset: 1 month to 8 years
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + daily PT versus daily PT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 5 scalp acupoints and 16 body acupoints

    • Depths of insertion: not stated

    • Deqi elicited: yes

    • Needle stimulation: electrical

    • Needle retention time: 30 minutes

    • Needle type: hua tuo brand, length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 84 sessions

    • Frequency of treatment: 7 sessions/week

    • Total course: 12 weeks

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of spasticity (Ashworth)

  • Improvement of motor function (Fugl-Meyer Assessment)

  • Improvement of independence (Barthel Index)

  • FU: 12 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Wu 2013a

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 90 (30/30/30)
Demographics: 45-80 years, 57% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition and all confirmed by CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-3 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

3 arms:

  • routine acupuncture + OT + WM

  • acupuncture kinesitherapy simultaneously + OT + WM

  • OT + WM

Comparisons eligible:

  • routine acupuncture + OT + WM versus OT + WM

  • acupuncture kinesitherapy simultaneously + OT + WM versus OT + WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: scalp acupoints

    • Numbers of points used: 7 points

    • Depths of insertion: 0.66-1.57 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 30 sessions

    • Frequency of treatment: 5 sessions/week

    • Total course: 6 weeks

  • Practitioner background: not stated

  • Co-intervention: OT + WM

Control interventions: OT + WM

Outcomes
  • Improvement of swallowing function (Water drinking test)

  • FU: 6 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Xu 2013

Methods

RCT
Method of randomisation: not stated
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 140 (70/70)
Demographics: 45-75 years, 47% male
Type of stroke: unclear
Diagnosis: WHO definition and all confirmed by CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-12 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + WM versus WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 4 scalp acupoints and 16 body acupoints

    • Depths of insertion: 1.18-1.97 inches

    • Deqi elicited: yes

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: stainless steel needle, length 1.97 inches

  • Treatment regimen

    • Number of treatment sessions: 80 sessions

    • Frequency of treatment: 2 sessions/day

    • Total course: 40 days

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of swallowing function (Water drinking test)

  • FU: 40 days

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Yao 2014

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 90 (30/30/30)
Demographics: 54% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition and all confirmed by CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-12 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison eligible:

  • routine acupuncture + PT versus PT only

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 15 points

    • Depths of insertion: not stated

    • Deqi elicited: yes

    • Needle stimulation: manual and electrical

    • Needle retention time: 30 minutes

    • Needle type: stainless steel needle, length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 24 sessions

    • Frequency of treatment: 3 sessions/week

    • Total course: 8 weeks

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of motor function (Fugl-Meyer Motor Assessment)

  • Improvement of neurological function (Neurological Deficit Score)

  • Improvement of independence (Barthel Index)

  • Improvement of pain (Visual Analogue Score)

  • FU: 8 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Zhan 2014

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: none

ParticipantsCountry: China
Number of participants included: 130 (65/65)
Demographics: aged 45-75 years, 59% male
Type of stroke: unclear
Diagnosis: WHO definition
Severity on entry: not stated
Time from stroke onset: 2-11 months
Setting: inpatient and outpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + PT versus PT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: body acupoints

    • Numbers of points used: 8 points

    • Depths of insertion: not stated

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: 15-20 minutes

    • Needle type: not stated

  • Treatment regimen

    • Number of treatment sessions: 6 sessions

    • Frequency of treatment: 6 sessions/week

    • Total course: 1 week

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of independence (Barthel Index)

  • FU: 1 week

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Low riskNo participants withdrew or were lost to follow-up
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Zhang 2013a

Methods

RCT
Method of randomisation: closed envelopes
Blinding: Investigators, participants, not blinded
Adverse effects: not stated

ITT analysis: none
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 90 (30/30/30)
Demographics: 43-75 years, 54% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition and all confirmed by CT/MRI
Severity on entry: not stated
Time from stroke onset: 6-19 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

3 arms:

  • acupuncture only

  • WM only

  • acupuncture + WM

Comparison eligible: acupuncture + WM versus WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: scalp acupoints

    • Numbers of points used: 4 acupoints

    • Depths of insertion: 0.66-1.05 inches

    • Deqi elicited: yes

    • Needle stimulation: manual and electrical

    • Needle retention time: 30 minutes

    • Needle type: hua tuo brand, length 0.98 inches

  • Treatment regimen

    • Number of treatment sessions: 30 sessions

    • Frequency of treatment: 5 sessions/week

    • Total course: 6 weeks

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of depression (Hamilton Depression Scale)

  • Improvement of sleep (Rhone Planck Sleepiness Scale)

  • Adverse event

  • FU: 6 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using closed envelopes
Allocation concealment (selection bias)Low riskRandomisation by using closed envelopes
Blinding (performance bias and detection bias)
All outcomes
High riskQuote: "unable to blind to participants and operators"
Blinding of participants and personnel (performance bias)
All outcomes
High riskQuote: "unable to blind to participants and operators"
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskDetails not given
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskSome patient-related outcomes were not reported, such as information on quality of life or all-cause mortality
Other biasUnclear riskNo information provided

Zhang 2015

Methods

RCT
Method of randomisation: random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: not stated

ParticipantsCountry: China
Number of participants included: 90 (30/30/30)
Demographics: 66% male
Type of stroke: ischaemic only
Diagnosis: CT/MRI
Severity on entry: not stated
Time from stroke onset: 2-6 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

3 arms:

  • acupuncture only

  • PT only

  • acupuncture + PT

Comparison eligible: acupuncture + PT versus PT only

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: scalp acupoints

    • Numbers of points used: 3 points

    • Depths of insertion: 0.98-1.18 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 24 sessions

    • Frequency of treatment: 6 sessions/week

    • Total course: 4 weeks

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of neurological function (Modified Edinburgh And Scandinavia Stroke Scale)

  • Improvement of independence (Barthel Index)

  • FU: 4 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Zheng 2014

Methods

RCT
Method of randomisation: randomisation by using random number table
Blinding: not stated

Adverse effects: not stated
ITT analysis: not stated
Losses to FU: none

ParticipantsCountry: China
Number of participants included: 60 (30/30)
Demographics: aged 51-79 years, 60% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition
Severity on entry: not stated
Time from stroke onset: 1-6 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + WM versus WM

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 2 scalp acupoints and 5 body acupoints

    • Depths of insertion: 0.39-1.97 inches

    • Deqi elicited: yes

    • Needle stimulation: manual

    • Needle retention time: 30 minutes

    • Needle type: hua tuo brand, length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 48 sessions

    • Frequency of treatment: 6 sessions/week

    • Total course: 8 weeks

  • Practitioner background: not stated

  • Co-intervention: WM

Control interventions: WM

Outcomes
  • Improvement of cognitive function (MMSE, MoCA)

  • Improvement of independence (Barthel Index)

  • FU: 8 weeks

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using random number table
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Low riskQuote: "No participants lost to follow-up"
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Zhou 2014

Methods

RCT
Method of randomisation: closed envelopes
Blinding: Investigators but not participants blinded
Adverse effects: 20

ITT analysis: not stated
Losses to FU: none

ParticipantsCountry: China
Number of participants included: 147 (75/72)
Demographics: aged 35-80 years, 54% male
Type of stroke: ischaemic only
Diagnosis: WHO definition and all confirmed by CT/MRI
Severity on entry: not stated
Time from stroke onset: 1-3 months
Setting: inpatient
Comparability: no significant difference in age or time post onset
Interventions

Comparison: acupuncture + daily PT versus daily PT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 8 scalp acupoints and 9 body acupoints

    • Depths of insertion: 1.18-1.38 inches

    • Deqi elicited: not stated

    • Needle stimulation: manual and electrical

    • Needle retention time: 6-8 hours/30 minutes

    • Needle type: hua tuo brand, length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 40 sessions

    • Frequency of treatment: 5 sessions/week

    • Total course: 8 weeks

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of depression (HAMD)

  • Improvement of neurological function (NIHSS)

  • Improvement of independence (Barthel Index)

  • Improvement of motor function (Fugl-Meyer scale)

  • Adverse event: bleeding, haematoma, and pain

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandomisation by using closed envelopes
Allocation concealment (selection bias)Low riskRandomisation by using closed envelopes
Blinding (performance bias and detection bias)
All outcomes
Low riskInvestigators blinded
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskDetails not given
Blinding of outcome assessment (detection bias)
All outcomes
Low riskOutcome assessors blinded
Incomplete outcome data (attrition bias)
All outcomes
Low risk

Treatment: no participants lost to follow-up

Control: 3 participants lost to follow-up

Selective reporting (reporting bias)Unclear riskSome patient-related outcomes were not reported, such as information on quality of life or all-cause mortality
Other biasUnclear riskNo information provided

Zhu 2007

  1. a

    BMIT: Boston Motor Inventory Test
    CSRS 1: Chinese Stroke Recovery Scale based on the revised diagnostic criteria of acute cerebral infarction formulated by the second National Academic Symposium on Cerebrovascular Diseases of the Chinese Medical Association in 1986, which is similar to the Revised Scandinavian Stroke Scale (RSSS)
    CSRS 2: Chinese Stroke Recovery Scale based on principles of traditional Chinese medicine
    CT: computerised tomography
    FU: follow-up
    HAMD: Hamilton Depression Scale
    ITT: intention-to-treat
    LOTCA: Loewenstein Occupational Therapy Cognitive Assessment
    MESS: modified Edinburgh Stroke Scale
    MMSE: Mini Mental State Examination
    MoCA: Montreal Cognitive Assessment Scale
    MRI: magnetic resonance imaging
    OT: occupational therapy
    PT: physical therapy
    qd: once per day
    RCT: randomised controlled trial
    SF-36: 36-Item Short Form Health Survey
    SS-QOL: Stroke Specific Quality of Life Scale
    SSS: Scandinavian Stroke Scale
    TCM: Traditional Chinese Medicine
    WHO: World Health Organization
    WM: Western medicine

MethodsRCT
Method of randomisation: not stated
Blinding: not stated
ITT analysis: not stated
Losses to FU: not stated
ParticipantsCountry: China
Number of participants included: 60 (30/30)
Demographics: aged 45-69 years, 53% male
Type of stroke: both ischaemic and haemorrhagic strokes
Diagnosis: WHO definition
Severity on entry: not stated
Time from stroke onset: 1-6 months
Setting: inpatient
Comparability: no significant difference in age, comorbidity, or time post onset
Interventions

Comparison: acupuncture + PT versus PT

Acupuncture treatment

  • Acupuncture rationale: not stated

  • Needling details

    • Points used: both body and scalp acupoints

    • Numbers of points used: 2 scalp acupoints and 4 body acupoints

    • Depths of insertion: 1.57 inches

    • Deqi elicited: yes

    • Needle stimulation: manual and electrical stimulation

    • Needle retention time: 30 minutes

    • Needle type: length 1.57 inches

  • Treatment regimen

    • Number of treatment sessions: 24 sessions

    • Frequency of treatment: 6 sessions/week

    • Total course: 4 weeks

  • Practitioner background: not stated

  • Co-intervention: PT

Control interventions: PT

Outcomes
  • Improvement of neurological function (Modified Edinburgh Stroke Scale and Scandinavian Stroke Scale)

Notes-
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskThe method of random sequence generation was not reported
Allocation concealment (selection bias)Unclear riskInformation on allocation concealment was not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInformation on blinding was not reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInformation on blinding was not reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInformation on attrition was not reported
Selective reporting (reporting bias)Unclear riskFree of selective reporting bias was assessed as 'unclear' due to some clinically important outcomes unstated, such as quality of life, mortality and adverse events
Other biasUnclear riskNo information provided

Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion
  1. a

    ADL: activities of daily living
    MAS: Modified Ashworth Scale
    OT: occupational therapy
    PT: physical therapy
    TCM: Traditional Chinese Medicine
    WM: Western medicine

Bai 2007The trial included people with stroke less than 1 month since onset
Bai 2011The trial included people with stroke less than 1 month since onset
Bai 2013The trial included people with stroke less than 1 month since onset although the median time to post-stroke was more than 1 month
Bao 2008The duration of stroke since onset was not stated in the trial
Bao 2010The duration of stroke since onset was not clear
Bao 2012aThe trial included people with stroke less than 1 month since onset
Cai 2010The trial included people with stroke less than 1 month since onset
Calabro 2011Abstract only; clarification of randomisation and intervention sought but not obtained
Cao 2010aThe trial included people with stroke less than 1 month since onset
Cao 2010bNot RCT
Chang 2010The trial included people with stroke less than 1 month since onset
Chao 2009The trial included people with stroke less than one month since onset
Chau 2009It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Che 2002The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Chen 2000Confounded; the trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Chen 2007The trial included people with stroke less than 1 month since onset
Chen 2008aThe duration of stroke since onset was not clear
Chen 2008bStroke population not randomised to treatment: quasi-randomisation of particpants (based on administrative procedure) to 1 of 2 groups
Chen 2009The trial included people with stroke less than 1 month since onset
Chen 2010aThe trial included people with stroke less than 1 month since onset
Chen 2010bThe duration of stroke since onset was not clear
Chen 2012aThe trial included people with stroke less than 1 month since onset
Chen 2012bThe trial included people with stroke less than 1 month since onset
Chen 2013The trial included people with acute stroke (less than 1 month since onset)
Chen 2014The trial included people with stroke less than 1 month since onset
Cheng 2006The duration of stroke since onset was not stated in the trial
Cheng 2007The duration of stroke since onset was not stated in the trial
Cheng 2011It was not possible to include data from this trial in the analysis. Stroke population not randomised to treatment: quasi-randomisation of particpants (based on administrative procedure) to 1 of 2 groups
Chow 2006Abstract only; clarification of randomisation and intervention sought but not obtained
Chu 2007The trial included people with stroke less than 1 month since onset
Chu 2009The trial included people with stroke less than 1 month since onset
Cui 1992It was not possible to include data from this trial in the analysis; this confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Ding 2000It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Dong 2007aThe trial included people with acute stroke (less than 1 month since onset)
Dong 2007bThe duration of stroke since onset was not clear
Dong 2008aThe trial included people with acute stroke (less than 1 month since onset)
Dong 2008bThe trial included people with acute stroke (less than 1 month since onset)
Dong 2009The trial included people with stroke less than 1 month since onset
Du 2013The duration of stroke since onset was not stated in the trial
Duan 2010The trial included people with stroke less than 1 month since onset
Duan 2014The duration of stroke since onset was not clear
Fang 2009The duration of stroke since onset was not stated in the trial
Feng 1996aIt was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Feng 1996bIt was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Feng 2011The trial included people with stroke less than 1 month since onset
Fink 2004It was not possible to include data from this trial in the analysis. MAS scores (as a clinical measure of spasticity) were assessed before and after the treatment period but mean change of neurological score after the treatment period was not available
Fu 2010The trial included people with stroke less than 1 month since onset
Fu 2013The trial included people with stroke less than 1 month since onset
Fu 2014The trial included people with stroke less than 1 month since onset
Gao 2001It was not possible to include data from this trial in the analysis. This confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Gao 2008The duration of stroke since onset was not stated in the trial
Gao 2011The duration of stroke since onset was not clear
Gao 2014bThe trial included people with stroke less than 1 month since onset
Gong 2008The trial included people with stroke less than 1 month since onset
Gu 2007The trial included people with acute stroke (less than 1 month since onset)
Gu 2009The trial included people with stroke less than 1 month since onset
Guan 2009aIt was not possible to include data from this trial in the analysis. Stroke population not randomised to treatment: quasi-randomisation of particpants (based on administrative procedure) to 1 of 2 groups
Guan 2009bQuasi-randomised study
Guan 2013The trial included people with stroke less than 1 month since onset
Guo 1999The trial aimed to assess effects of acupuncture only compared with PT and OT
Guo 2006aThe trial included people with stroke less than 1 month since onset
Guo 2006bThe trial included people with stroke less than 1 month since onset
Guo 2013The trial included people with stroke less than 1 month since onset
Han 2008The trial included people with stroke less than 1 month since onset
Han 2010The trial included people with stroke less than 1 month since onset
Han 2011The trial included people with stroke less than 1 month since onset
Han 2012The duration of stroke since onset was not stated in the trial
Han 2014Quasi-randomised study
Hang 2014The trial included people with stroke less than 1 month since onset
He 2008The trial included people with stroke less than 1 month since onset
Hegyi 2012The trial included people with stroke less than 1 month since onset
Hong 2013The duration of stroke since onset was not clear
Hou 1998The trial aimed to assess the effects of the combination of acupuncture, oxygen and herbs compared with acupuncture or oxygen respectively
Hsing 2012The trial aimed to assess effects of electrical acupuncture compared with routine acupuncture
Hu 2011The duration of stroke since onset was not stated in the trial
Hu 2012The trial included people with stroke less than 1 month since onset
Huang 2002It was not possible to include data from this trial in the analysis; this confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Huang 2008bThe duration of stroke since onset was not clear
Huang 2008cThe duration of stroke since onset was not clear
Huang 2011The trial included people with stroke less than 1 month since onset
Huang 2012The trial included people with stroke less than 1 month since onset
Huang 2014The duration of stroke since onset was not clear
Jia 2012The trial included people with stroke less than 1 month since onset
Jiang 1998It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Jiang 2000It was not possible to include data from this trial in the analysis; this confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Jiang 2006The trial included people with stroke less than 1 month since onset
Jiang 2009The trial included people with stroke less than 1 month since onset
Jiang 2010The duration of stroke since onset was not stated in the trial
Jiang 2011aThe duration of stroke since onset was not clear
Jiang 2011bThe trial included people with stroke less than 1 month since onset
Jiang 2012The trial included people with stroke less than 1 month since onset
Jiang 2013The trial included people with stroke less than 1 month since onset
Jin 1993It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Jin 2010aQuasi-randomised study
Jin 2010bThe duration of stroke since onset was not stated in the trial
Kang 2011The trial included people with stroke less than 1 month since onset
Kang 2013The trial included people with stroke less than 1 month since onset
Kjendahl 1997The trial included people with stroke less than 1 month since onset although the median time to post-stroke was more than 1 month
Lai 1997aIt was not possible to include data from this trial in the analysis; this confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Lai 1997bThe trial aimed to assess the effects of electrical acupuncture compared with manual acupuncture. Acupoints were the same between the 2 groups
Lai 1998The trial aimed to assess the effects of electrical acupuncture compared with manual acupuncture. Acupoints were the same between 2 groups
Lai 2004It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Lai 2011The duration of stroke since onset was not clear
Lang 2013The trial included people with stroke less than 1 month since onset
Lao 2013The trial included people with stroke less than 1 month since onset
Lee 2007The full-text with English or Chinese language was not available
Lee 2009The duration of stroke since onset was not stated in the trial
Lei 2013The trial included people with stroke less than 1 month since onset
Li 1993It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Li 1994aIt was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Li 1994bIt was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Li 1997bNo outcome measures of interest were available in the trial, which aimed to assess the effects of acupuncture on the change of intellectual disturbance in people with vascular dementia caused by cerebrovascular disease
Li 2006aThe trial included people with stroke less than 1 month since onset
Li 2006bThe trial included people with stroke less than 1 month since onset
Li 2006cThe trial included people with stroke less than 1 month since onset
Li 2006dThe trial included people with stroke less than 1 month since onset
Li 2006eThe trial included people with stroke less than 1 month since onset
Li 2008aThe trial included people with acute stroke (less than 1 month since onset)
Li 2008bThe duration of stroke since onset was not clear
Li 2008cThe trial included people with stroke less than 1 month since onset
Li 2008dThe trial included people with stroke less than 1 month since onset
Li 2009aThe trial included people with stroke less than 1 month since onset
Li 2009bThe trial included people with stroke less than 1 month since onset
Li 2010bThe trial included people with stroke less than 1 month since onset
Li 2010cThe trial aimed to assess the effects of the combination of acupuncture and PT compared with PT. The duration of stroke since onset was not stated in the trial
Li 2011bThe trial included people with stroke less than 1 month since onset
Li 2011cThe trial included people with stroke less than 1 month since onset
Li 2011dThe trial included people with acute stroke (less than 1 month since onset)
Li 2012aThe duration of stroke since onset was not stated in the trial
Li 2012bThe duration of stroke since onset was not stated in the trial
Li 2012cThe trial included people with stroke less than 1 month since onset
Li 2012dQuasi-randomised study
Li 2012eThe duration of stroke since onset was not clear
Li 2012fThe trial included people with stroke less than 1 month since onset although the median time to post-stroke was more than 1 month
Li 2012gThe duration of stroke since onset was not stated in the trial
Li 2013bThe trial included people with stroke less than 1 month since onset. Stroke population not randomised to treatment: quasi-randomisation of particpants (based on administrative procedure) to 1 of 2 groups
Li 2013cThe trial included people with stroke less than 1 month since onset
Li 2014The trial included people with stroke less than 1 month since onset
Li 2015The trial included people with stroke less than 1 month since onset
Liang 1993It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Liang 2010Quasi-randomised study
Liang 2012The trial included people with stroke less than 1 month since onset
Liao 2006aThe duration of stroke since onset was not clear
Liao 2006bThe duration of stroke since onset was not stated in the trial
Liao 2013The trial included people with stroke less than 1 month since onset
Liao 2014The duration of stroke since onset was not clear
Lim 2014Review
Lin 2010aThe trial included people with stroke less than 1 month since onset
Lin 2010bThe duration of stroke since onset was not stated in the trial
Lin 2012The duration of stroke since onset was not clear
Lin 2013The trial included people with stroke less than 1 month since onset
Liu 1998It was not possible to include data from this trial in the analysis. ADL was assessed before and after the treatment period but the number of participants who were independent after the treatment period was not available. The trial primarily aimed to assess the effects of acupuncture on the intellectual disturbance in people with vascular dementia due to stroke
Liu 2004aThe trial included people with stroke less than 1 month since onset (that is, acute stroke)
Liu 2004bConfounded (acupuncture plus 1 type of Chinese herbs versus another type of Chinese herbs
Liu 2006The trial included people with acute stroke (less than 1 month since onset)
Liu 2008aThe trial included people with stroke less than 1 month since onset
Liu 2008bNon-randomised controlled study
Liu 2009The trial included people with stroke less than 1 month since onset
Liu 2010aThe trial included people with stroke less than 1 month since onset
Liu 2010bThe trial included people with stroke less than 1 month since onset
Liu 2011aThe duration of stroke since onset was not stated in the trial
Liu 2011bThe trial included people with stroke less than 1 month since onset
Liu 2012aThe trial included people with stroke less than 1 month since onset
Liu 2012bThe duration of stroke since onset was not clear
Liu 2012cThe trial included people with stroke less than 1 month since onset
Liu 2013cThe trial included people with stroke less than 1 month since onset
Liu 2013dThe duration of stroke since onset was not clear
Liu 2013eThe duration of stroke since onset was not stated in the trial
Liu 2013fThe duration of stroke since onset was not stated in the trial
Liu 2014bThe trial included people with stroke less than 1 month since onset
Liu 2015The duration of stroke since onset was not clear
Long 2013The duration of stroke since onset was not stated in the trial
Lu 2010The trial included people with stroke less than 1 month since onset
Lu 2011aThe trial included people with stroke less than 1 month since onset
Lu 2011bThe duration of stroke since onset was not stated in the trial
Luo 2007The trial included people with stroke less than 1 month since onset
Luo 2008The trial included people with stroke less than 1 month since onset
Luo 2012The duration of stroke since onset was not stated in the trial
Lv 2009The trial included people with stroke less than 1 month since onset
Lv 2014The trial included people with stroke less than 1 month since onset
Ma 2011aThe trial included people with acute stroke (less than 1 month since onset)
Ma 2011bThe trial included people with stroke less than 1 month since onset
Ma 2013The trial included people with stroke less than 1 month since onset
Mou 2010The trial included people with stroke less than 1 month since onset
Mu 2007The duration of stroke since onset was not stated in the trial
Mukherjee 2006Abstract only; clarification of randomisation and intervention sought but not obtained
Muo 2001It was not possible to include data from this trial in the analysis. This confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Ni 2011The trial included people with stroke less than 1 month since onset
Nie 2011The trial included people with stroke less than 1 month since onset
Nie 2013The duration of stroke since onset was not stated in the trial
Pan 2013The duration of stroke since onset was not stated in the trial
Pang 2010Not RCT
Peng 2007aThe trial aimed to assess the effects of the combination of acupuncture, PT and WM compared with WM. The duration of stroke since onset was not stated in the trial
Peng 2009The trial included people with stroke less than 1 month since onset
Peng 2015The duration of stroke since onset was not stated in the trial
Qi 2000It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Qi 2013The trial included people with stroke less than 1 month since onset
Qi 2013aThe trial included people with stroke less than 1 month since onset
Qiao 2012Abstract only; clarification of randomisation and intervention sought but not obtained
Qiu 2011Quasi-randomised study
Qu 1991It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Ran 2013The trial included people with stroke less than 1 month since onset
Ren 2009The duration of stroke since onset was not stated in the trial
Ren 2010The trial included people with acute stroke (less than 1 month since onset)
Ren 2012The trial included people with stroke less than 1 month since onset
Sallstrom 1996The median time to post-stroke was more than 1 month, but the trial included people with acute stroke (that is, less than 1 month)
Salom-Moreno 2014The duration of stroke since onset was not stated in the trial
Schaechter 2007The duration of stroke since onset was not stated in the trial
Seo 2013The trial aimed to assess the effects of ouhyul herbal acupuncture point injection compared with normal saline acupuncture point injection
Shang 2008Quasi-randomised study
Shao 2012The duration of stroke since onset was not clear
Shen 2008The trial included people with stroke less than 1 month since onset
Shen 2009The trial included people with stroke less than 1 month since onset
Sheng 2011The trial included people with stroke less than 1 month since onset
Sheng 2013The duration of stroke since onset was not clear
Shi 2007The trial aimed to assess the effects of combination of acupuncture, PT and WM compared with WM
Shi 2007aThe trial included people with stroke less than 1 month since onset
Song 2010Not stroke
Sui 2001It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Sun 2008Abstract only; clarification of randomisation and intervention sought but not obtained
Sun 2010The duration of stroke since onset was not clear
Sun 2011Not RCT
Sun 2013bThe duration of stroke since onset was not stated in the trial
Sun 2014The trial included people with stroke less than 1 month since onset
Suo 2008The trial aimed to assess the effects of combination of sham acupuncture and PT compared with acupuncture only
Tang 2005The trial included people with stroke less than 1 month since onset
Tang 2012The trial included people with stroke less than 1 month since onset
Tang 2013The trial included people with stroke less than 1 month since onset
Tang 2013aThe trial aimed to assess the effects of combination of acupuncture and WM compared with combination of WM and PT
Tian 2014The trial included people with stroke less than 1 month since onset
Tong 1997It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Tong 2013The trial included people with stroke less than 1 month since onset
Tong 2014The trial included people with stroke less than 1 month since onset
Wan 2013The duration of stroke since onset was not clear in the trial
Wang 2004Randomisation was not stated; the trial included people with acute stroke (less than 1 month since onset)
Wang 2006The trial included people with stroke less than 1 month since onset
Wang 2007The trial included people with stroke less than 1 month since onset
Wang 2008The trial included people with stroke less than 1 month since onset
Wang 2008aThe trial included people with stroke less than 1 month since onset
Wang 2008bThe trial included people with acute stroke (less than 1 month since onset)
Wang 2009Quasi-randomised study
Wang 2010aThe duration of stroke since onset was not clear
Wang 2010bThe duration of stroke since onset was not clear
Wang 2011bThe trial included people with stroke less than 1 month since onset
Wang 2011cThe trial included people with stroke less than 1 month since onset
Wang 2011dThe duration of stroke since onset was not clear
Wang 2011eThe trial included people with stroke less than 1 month since onset
Wang 2011fThe duration of stroke since onset was not clear
Wang 2011gThe trial included people with stroke less than 1 month since onset
Wang 2011hThe trial included people with stroke less than 1 month since onset
Wang 2011iThe trial included people with stroke less than 1 month since onset
Wang 2011jThe trial included people with stroke less than 1 month since onset
Wang 2013The duration of stroke since onset was not stated in the trial
Wang 2014aThe trial aimed to assess the effects of acupuncture compared with transcutaneous electrical acupoint stimulation
Wang 2014bThe duration of stroke since onset was not stated in the trial
Wei 2005The trial included people with ischaemic stroke less than 1 month since onset (that is, acute stroke). Data for participants with haemorraghic stroke more than 150 days were not separated from data for participants with ischaemic stroke
Wei 2009The trial included people with stroke less than 1 month since onset
Wenli 2007The trial included people with stroke less than 1 month since onset
Wong 2013Abstract only; clarification of randomisation and intervention sought but not obtained
Wu 1999Data on pre-planned outcome measures of interest were not available from the trial, which aimed to assess the effects of acupuncture on urinary incontinence in people with stroke
Wu 2009aThe trial included people with stroke less than 1 month since onset
Wu 2009bThe trial aimed to assess the effects of three different forms of acupuncture
Wu 2010The trial included people with acute stroke (less than 1 month since onset)
Wu 2011The trial included people with stroke less than 1 month since onset
Wu 2012The duration of stroke since onset was not clear
Wu 2012aThe trial included people with acute stroke (less than 1 month since onset)
Wu 2013bThe trial included people with acute stroke (less than 1 month since onset)
Wu 2014aThe trial included people with acute stroke (less than 1 month since onset)
Wu 2014bThe duration of stroke since onset was not clear
Xia 2008The trial included people with stroke less than 1 month since onset
Xia 2010The trial included people with stroke less than 1 month since onset
Xiao 1996It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Xiao 2006The trial included people with stroke less than 1 month since onset
Xiao 2008The trial included people with acute stroke (less than 1 month since onset)
Xiao 2011The trial included people with acute stroke (less than 1 month since onset)
Xie 2010The trial included people with stroke less than 1 month since onset
Xie 2012The trial included people with stroke less than 1 month since onset
Xie 2013Quasi-randomised study
Xing 2007The trial included people with stroke less than 1 month since onset
Xu 2009aThe duration of stroke since onset was not stated in the trial
Xu 2009bThe duration of stroke since onset was not stated in the trial
Xu 2010The trial included people with acute stroke (less than 1 month since onset)
Xu 2013aThe trial included people with stroke less than 1 month since onset
Xu 2014The duration of stroke since onset was not clear
Yan 2010The duration of stroke since onset was not clear
Yan 2011The trial included people with stroke less than 1 month since onset
Yang 2006The duration of stroke since onset was not clear
Yang 2007aQuasi-randomised study
Yang 2007bThe trial included people with stroke less than 1 month since onset
Yang 2007cThe trial included people with stroke less than 1 month since onset
Yang 2008The trial aimed to assess the effects of electrical acupuncture compared with routine acupuncture
Yang 2009The duration of stroke since onset was not clear
Yang 2010The trial included people with stroke less than 1 month since onset
Yang 2011aThe trial included people with stroke less than 1 month since onset
Yang 2011bThe duration of stroke since onset was not clear
Yang 2011cThe duration of stroke since onset was not clear
Yang 2012The trial included people with stroke less than 1 month since onset
Yang 2014The duration of stroke since onset was not clear
Yang 2014aThe duration of stroke since onset was not clear
Yang 2015The trial included people with stroke less than 1 month since onset
Yao 2006The duration of stroke since onset was not stated in the trial
Yao 2013aThe trial included people with stroke less than 1 month since onset
Yao 2013bThe trial included people with acute stroke (less than 1 month since onset)
Yin 2013aThe trial included people with acute stroke (less than 1 month since onset)
Yin 2013bThe trial included people with stroke less than 1 month since onset
Yin 2014The duration of stroke since onset was not clear
You 2011The trial included people with stroke less than 1 month since onset
You 2014The trial included people with stroke less than 1 month since onset
Yu 2002It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups. The trial was also confounded; it aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Yu 2007The trial included people with stroke less than 1 month since onset
Yu 2009The trial included people with stroke less than 1 month since onset
Yu 2011Abstract only; clarification of randomisation and intervention sought but not obtained
Yuan 2010The trial included people with stroke less than 1 month since onset
Zeng 2010The trial included people with stroke less than 1 month since onset
Zhang 1988It was not possible to include data from this trial in the analysis. This confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Zhang 1997It was not possible to include data from this trial in the analysis. This confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Zhang 2002aThe trial aimed to assess the effects of magnetic acupuncture compared with routine acupuncture. Acupoints were similar between the 2 groups
Zhang 2002bThe duration of stroke since onset was not stated in the trial; it was not possible to include data from this trial in the analysis. This confounded trial aimed to assess effects of acupuncture only compared with drug therapy (such as WM or TCM)
Zhang 2007aThe trial included people with stroke less than 1 month since onset
Zhang 2007bThe trial aimed to assess the effects of the combination of acupuncture, buyang huanwu decoction and routine treatment compared with routine treatment
Zhang 2008The trial included people with stroke less than 1 month since onset
Zhang 2009bThe trial included people with stroke less than 1 month since onset
Zhang 2009cThe duration of stroke since onset was not stated in the trial
Zhang 2010aThe trial aimed to assess the effects of basic therapy, rehabilitation, acupuncture, TCM, and massage therapy compared with basic treatment and rehabilitation treatment
Zhang 2010bThe trial included people with acute stroke (less than 1 month since onset)
Zhang 2010cThe trial included people with acute stroke (less than 1 month since onset)
Zhang 2010dThe trial included people with stroke less than 1 month since onset
Zhang 2010eThe duration of stroke since onset was not clear
Zhang 2010fThe trial included people with acute stroke (less than 1 month since onset)
Zhang 2011aThe trial included people with stroke less than 1 month since onset
Zhang 2011bThe duration of stroke since onset was not stated in the trial
Zhang 2011cThe duration of stroke since onset was not stated in the trial
Zhang 2011dThe trial included people with stroke less than 1 month since onset
Zhang 2011eThe duration of stroke since onset was not clear
Zhang 2012bThe trial included people with stroke less than 1 month since onset
Zhang 2012cThe trial included people with stroke less than 1 month since onset
Zhang 2012dThe trial included people with stroke less than 1 month since onset
Zhang 2012eThe trial included people with stroke less than 1 month since onset
Zhang 2013bThe trial included people with stroke less than 1 month since onset
Zhang 2014bAbstract only; clarification of randomisation and intervention sought but not obtained
Zhang 2014cThe duration of stroke since onset was not clear
Zhang 2014dThe trial included people with stroke less than 1 month since onset
Zhao 2008The duration of stroke since onset was not stated in the trial
Zhao 2009The trial aimed to assess the effects of deep acupuncture compared with routine acupuncture. Acupoints were the same between 2 groups
Zhao 2010The duration of stroke since onset was not stated in the trial
Zhao 2011aThe duration of stroke since onset was not clear
Zhao 2011bThe trial included people with acute stroke (less than 1 month since onset)
Zhao 2014aThe trial included people with stroke less than 1 month since onset
Zhao 2014bThe duration of stroke since onset was not stated in the trial
Zheng 1996The trial aimed to assess the effects of combination of body and scalp acupuncture compared with body acupuncture only or scalp acupuncture only
Zheng 2000Confounded (acupuncture plus Chinese herbs versus WM only)
Zheng 2011bThe trial aimed to assess the effects of different forms of acupuncture
Zheng 2011cThe trial included people with stroke less than 1 month since onset
Zhong 2014The trial included people with stroke less than 1 month since onset
Zhou 1995It was not possible to include data from this trial in the analysis. The trial aimed to assess effects of 2 methods of acupuncture on subacute or chronic stroke. Acupoints were different between the 2 groups
Zhou 2008The trial aimed to assess the effects of combination of acupuncture, PT and WM compared with WM. The duration of stroke since onset was not stated in the trial
Zhu 2010aThe duration of stroke since onset was not stated in the trial
Zhu 2010bThe duration of stroke since onset was not stated in the trial
Zhu 2011Abstract only; clarification of randomisation and intervention sought but not obtained
Zhu 2012aThe trial included people with stroke less than 1 month since onset
Zhu 2012bThe duration of stroke since onset was not stated in the trial
Zhuang 2012The trial included people with stroke less than 1 month since onset

Characteristics of ongoing studies [ordered by study ID]

Fu 2011

Trial name or titleRandomised, controlled Phase III trial to evaluate the efficacy and safety of comprehensive acupuncture treatment programmes for post-stroke motor rehabilitation
MethodsRandomised parallel controlled trial
ParticipantsPeople with haemorrhagic or ischaemic stroke
InterventionsAcupuncture + rehabilitation training
Outcomes
  • BOSS

  • Fugl-Meyer Motor Assessment

Starting date1 January 2011
Contact informationShanghai Municipal Health Bureau
NotesRecruiting status:completed

Liu 2013b

Trial name or titleAcupuncture based on five elements body characteristics in the treatment of people with post-stroke depression
MethodsRandomised parallel controlled trial
ParticipantsPeople with post-stroke depression
Interventions
  • Five pedestrian body dialectical acupuncture

  • Conventional acupuncture

Outcomes
  • HAMD

  • ADL

  • Neurologic function score

Starting date1 July 2013
Contact informationThe First Affiliated Hospital of Guangxi Traditional Chinese Medicine University
NotesRecruiting status

Xie 2006

Trial name or titleRandomised controlled study on the acupuncture for dysphagia in convalescence phase of apoplexy
MethodsParallel RCT
ParticipantsPeople with dysphagia in the convalescent phase of apoplexy
InterventionsAcupuncture with swallowing training
Outcomes
  • Mortality

  • Improvement

  • Neurological function scale

  • Length of hospitalisation

  • Nutrition status

  • Quality of life

  • TCM outcomes

  • Rate of Lung Infection

  • Loss of follow-up, and withdraw

  • Adverse events

Starting date1 October 2006
Contact informationDepartment of Acupuncture, Huguosi TCM Hospital attached to the Beijing University of TCM
NotesDate last refreshed: 7 February 2015

Zhong 2010

  1. a

    ADL: activities of daily living
    BOSS: Burden of Stroke Scale
    fMRI: functional magnetic resonance imaging
    HAMD: Hamilton Depression Scale
    TCM: traditional Chinese medicine

Trial name or titleThe research of linguistic functional recovery mechanism based on fMRI after electroacupuncture at acupoints Tongli (HT5) and Xuanzhong (GB39) curing basal ganglia aphasia after stroke
MethodsRandomised parallel controlled trial
ParticipantsPeople who have explicit syndrome of aphasia, presenting within ischaemic stroke only in basal ganglia
InterventionsElectroacupuncture
Outcomes
  • Linguistic functional evaluation after 30 days' and 60 days' therapy

  • fMRI after 30 days' and 60 days' therapy

Starting date1 January 2010
Contact informationState Administration of Traditional Chinese Medicine
NotesRecruiting status:completed