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Study of acupuncture for stroke rehabilitation

from :Cochrane

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.


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 thousands of years and is increasingly practiced in most of Western countries especially in USA,UK,Canada,Australia,France,German. However, it remains uncertain whether the existing evidence is sufficiently reliable to recommend the routine use of acupuncture.


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.

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. No serious side effects were reported and there was no information on the effects of acupuncture on death or the need for institutional care.

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 limited by 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.

One case in South Africa :

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