Acupuncture therapy for post-stroke spastic paralysis: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Han , LI Juan , LI Yuxi , YE Jing , ZHONG Dongling , ZHANG Ya , XIAO Qiwei , WANG Xu , REN Yulan ,  LIANG Fanrong

Chengdu University of TCM, Chengdu, 610075, P.R.China;

Corresponding?author：

LIANG Fanrong, Email: acuresearch@126.com

Keywords：

Post-stroke spastic paralysis; Acupuncture therapy; Overview of systematic reviews; AMSTAR 2; GRADE

DOI：

10.7507/1672-2531.201903078

Video：

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Objectives To evaluate the quality of methodology and evidence of the exiting systematic reviews (SRs) of acupuncture therapy for post-stroke spastic paralysis.Methods CNKI, CBM, The Cochrane Library, PubMed and EMbase databases were electronically searched to collect SRs of acupuncture therapy for post-stroke spastic paralysis from inception to December 16^th, 2018. Two reviewers independently screened literature, extracted data, and evaluated the quality of methodology and evidence by AMSTAR 2 scale and GRADE system.Results A total of 7 SRs were included. The results showed that acupuncture therapy had obvious advantages in treating post-stroke spastic paralysis without obvious adverse reactions. The results of AMSTAR 2 scale showed that the failure of key items 2 and 7 resulted in extremely low methodological quality. The results of GRADE system showed that 46.15% of which were low-level evidence quality, 42.31% were medium, 11.54% were extremely low, and no evidence quality were high.Conclusions Current evidence shows that acupuncture and moxibustion therapy is effective in treating spastic paralysis after stroke, however, the quality of the SRs is low. The studies are required to be standardized and combined with the characteristics of TCM to obtain high quality evidence in the future.

Citation： YANG Han, LI Juan, LI Yuxi, YE Jing, ZHONG Dongling, ZHANG Ya, XIAO Qiwei, WANG Xu, REN Yulan, LIANG Fanrong. Acupuncture therapy for post-stroke spastic paralysis: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1233-1239. doi: 10.7507/1672-2531.201903078 Copy

1.	Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2197-2223.
2.	Bousser MG. Stroke prevention: an update. Front Med, 2012, 6(1): 22-34.
3.	Wu P, Mills E, Moher D, et al. Acupuncture in post stroke rehabilitation: a systematic review and meta-analysis of randomized trials. Stroke, 2010, 41(4): e171-e179.
4.	Sui HL, Wong YO, Chu MK, et al. Abstract 3506: acupuncture in managing of spasticity of post stroke survivor: a systematic review. Stroke, 2012, 43(2): A3506.
5.	Zorowitz RD, Gillard PJ, Brainin M. Post stroke spasticity: sequelae and burden on stroke survivors and caregivers. Neurology, 2013, 80(3 Suppl 2): S45-S52.
6.	Sommerfeld DK, Eek EU, Svensson AK, et al. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke, 2004, 35(1): 134-139.
7.	Demetrios M, Khan F, Turner-Stokes L, et al. Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity. Cochrane Database Syst Rev, 2013, (6): CD009689.
8.	Francisco GE, McGuire JR. Post stroke spasticity management. Stroke, 2012, 43(11): 3132-3136.
9.	Ng SS, Hui-Chan CW. Contribution of ankle dorsiflex or strength to walking endurance in people with spastic hemiplegia after stroke. Arch Phys Med Rehabil, 2012, 93(6): 1046-1051.
10.	Lundstr?m E, Smits A, Borg J, et al. Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event. Stroke, 2010, 41(2): 319-324.
11.	Zhuang L, He J, Zhuang X, et al. Quality of reporting on randomized controlled trials of acupuncture for stroke rehabilitation. BMC Complement Altern Med, 2014, 14: 151.
12.	祁麗麗, 陳文華, 褚立希. 互動式頭針結合 PNF 技術對缺血性卒中痙攣性偏癱上肢功能的影響. 中國針灸, 2018, 38(3): 234-238.
13.	Stevenson VL. Rehabilitation in practice: Spasticity management. Clin Rehabil, 2010, 24(4): 293-304.
14.	Barzel A, Ketels G, Tetzlaff B, et al. Enhancing activities of daily living of chronic stroke patients in primary health care by modified constraint-induced movement therapy (HOMECIMT): study protocol for a cluster randomized controlled trial. Trials, 2013, 14: 334.
15.	梁繁榮, 吳曦, 李瑛, 等. 循證針灸學. 北京: 人民衛生出版社, 2009.
16.	劉鳴. 系統評價、Meta-分析設計與實施方法. 北京: 人民衛生出版社, 2011.
17.	熊俊, 杜元灝. 關于國內針灸系統評價/Meta 分析方法學質量的思考. 針刺研究, 2011, (1): 72-75.
18.	熊俊, 陳日新, 李萬瑤. 針灸治療頸椎病系統評價/Meta 分析文獻質量多元評價研究. 中華中醫藥雜志, 2012, 27(4): 1064-1068.
19.	陶歡, 楊樂天, 平安, 等. 隨機或非隨機防治性研究系統評價的質量評價工具AMSTAR 2解讀. 中國循證醫學雜志, 2018, 18(1): 101-108.
20.	曾憲濤, 冷衛東, 李勝, 等. 如何正確理解及使用 GRADE 系統. 中國循證醫學雜志, 2011, 11(9): 985-990.
21.	Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
22.	Cai Y, Zhang CS, Liu S, et al. Electro acupuncture for post stroke spasticity: a systematic review and meta-analysis. Arch Phys Med Rehabil, 2017, 98(12): 2578-2589.
23.	葉濤, 朱路文, 唐強. 針刺結合康復訓練治療腦卒中后肢體痙攣的 Meta 分析. 中國康復醫學雜志, 2017, (3): 318-324.
24.	嚴曉藝, 賈麗燕, 張云皎, 等. 針刺治療腦卒中后肌痙攣的系統綜述與 Meta 分析. 北京中醫藥大學學報, 2017, 40(1): 52-58.
25.	汪偉, 柴鐵劬, 王春, 等. 針刺治療腦卒中后痙攣性癱瘓療效比較的系統評價與 Meta 分析. 成都中醫藥大學學報, 2016, 39(3): 117-122.
26.	于川, 申斌, 許世聞. 針灸治療中風后痙攣癱瘓的系統評價. 中醫臨床研究, 2016, 8(22): 12-15.
27.	李翊. 針灸治療中風后痙攣性癱瘓的系統評價與 Meta 分析. 黑龍江: 黑龍江中醫藥大學, 2017.
28.	張瑜. 經筋刺法治療腦卒中后痙攣性癱瘓的系統評價與 Meta 分析. 遼寧: 遼寧中醫藥大學, 2016.
29.	Wei YX, Zhao X, Zhang BC. Synergistic effect of moxibustion and rehabilitation training in functional recovery of post-stroke spastic hemiplegia. Complement Ther Med, 2016, 26: 55-60.
30.	張自茂, 馮崇廉, 皮周凱, 等. 針刺治療腦卒中后上肢痙攣療效觀察. 中國針灸, 2008, 28(4): 257-260.
31.	王秀娟, 劉強, 林翠茹, 等. 頭體針結合治療中風后上肢痙攣療效觀察. 上海針灸雜志, 2013, 32(8): 630-632.
32.	祁營洲, 傅立新, 熊俊, 等. 針刺治療中風后痙攣性癱瘓的系統評價. 中國針灸, 2009, 29(8): 683-688.
33.	Macpherson H, Altman DG, Hammerschlag R, et al. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement. J Evid Based Med, 2010, 3(3): 140-155.
34.	Tarsilla M. Cochrane Handbook for Systematic Reviews of Interventions. Naunyn Schmiedebergs Arch Exp Pathol Pharmakol, 2011, 5(2): S38.

1. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2197-2223.
2. Bousser MG. Stroke prevention: an update. Front Med, 2012, 6(1): 22-34.
3. Wu P, Mills E, Moher D, et al. Acupuncture in post stroke rehabilitation: a systematic review and meta-analysis of randomized trials. Stroke, 2010, 41(4): e171-e179.
4. Sui HL, Wong YO, Chu MK, et al. Abstract 3506: acupuncture in managing of spasticity of post stroke survivor: a systematic review. Stroke, 2012, 43(2): A3506.
5. Zorowitz RD, Gillard PJ, Brainin M. Post stroke spasticity: sequelae and burden on stroke survivors and caregivers. Neurology, 2013, 80(3 Suppl 2): S45-S52.
6. Sommerfeld DK, Eek EU, Svensson AK, et al. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke, 2004, 35(1): 134-139.
7. Demetrios M, Khan F, Turner-Stokes L, et al. Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity. Cochrane Database Syst Rev, 2013, (6): CD009689.
8. Francisco GE, McGuire JR. Post stroke spasticity management. Stroke, 2012, 43(11): 3132-3136.
9. Ng SS, Hui-Chan CW. Contribution of ankle dorsiflex or strength to walking endurance in people with spastic hemiplegia after stroke. Arch Phys Med Rehabil, 2012, 93(6): 1046-1051.
10. Lundstr?m E, Smits A, Borg J, et al. Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event. Stroke, 2010, 41(2): 319-324.
11. Zhuang L, He J, Zhuang X, et al. Quality of reporting on randomized controlled trials of acupuncture for stroke rehabilitation. BMC Complement Altern Med, 2014, 14: 151.
12. 祁麗麗, 陳文華, 褚立希. 互動式頭針結合 PNF 技術對缺血性卒中痙攣性偏癱上肢功能的影響. 中國針灸, 2018, 38(3): 234-238.
13. Stevenson VL. Rehabilitation in practice: Spasticity management. Clin Rehabil, 2010, 24(4): 293-304.
14. Barzel A, Ketels G, Tetzlaff B, et al. Enhancing activities of daily living of chronic stroke patients in primary health care by modified constraint-induced movement therapy (HOMECIMT): study protocol for a cluster randomized controlled trial. Trials, 2013, 14: 334.
15. 梁繁榮, 吳曦, 李瑛, 等. 循證針灸學. 北京: 人民衛生出版社, 2009.
16. 劉鳴. 系統評價、Meta-分析設計與實施方法. 北京: 人民衛生出版社, 2011.
17. 熊俊, 杜元灝. 關于國內針灸系統評價/Meta 分析方法學質量的思考. 針刺研究, 2011, (1): 72-75.
18. 熊俊, 陳日新, 李萬瑤. 針灸治療頸椎病系統評價/Meta 分析文獻質量多元評價研究. 中華中醫藥雜志, 2012, 27(4): 1064-1068.
19. 陶歡, 楊樂天, 平安, 等. 隨機或非隨機防治性研究系統評價的質量評價工具AMSTAR 2解讀. 中國循證醫學雜志, 2018, 18(1): 101-108.
20. 曾憲濤, 冷衛東, 李勝, 等. 如何正確理解及使用 GRADE 系統. 中國循證醫學雜志, 2011, 11(9): 985-990.
21. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
22. Cai Y, Zhang CS, Liu S, et al. Electro acupuncture for post stroke spasticity: a systematic review and meta-analysis. Arch Phys Med Rehabil, 2017, 98(12): 2578-2589.
23. 葉濤, 朱路文, 唐強. 針刺結合康復訓練治療腦卒中后肢體痙攣的 Meta 分析. 中國康復醫學雜志, 2017, (3): 318-324.
24. 嚴曉藝, 賈麗燕, 張云皎, 等. 針刺治療腦卒中后肌痙攣的系統綜述與 Meta 分析. 北京中醫藥大學學報, 2017, 40(1): 52-58.
25. 汪偉, 柴鐵劬, 王春, 等. 針刺治療腦卒中后痙攣性癱瘓療效比較的系統評價與 Meta 分析. 成都中醫藥大學學報, 2016, 39(3): 117-122.
26. 于川, 申斌, 許世聞. 針灸治療中風后痙攣癱瘓的系統評價. 中醫臨床研究, 2016, 8(22): 12-15.
27. 李翊. 針灸治療中風后痙攣性癱瘓的系統評價與 Meta 分析. 黑龍江: 黑龍江中醫藥大學, 2017.
28. 張瑜. 經筋刺法治療腦卒中后痙攣性癱瘓的系統評價與 Meta 分析. 遼寧: 遼寧中醫藥大學, 2016.
29. Wei YX, Zhao X, Zhang BC. Synergistic effect of moxibustion and rehabilitation training in functional recovery of post-stroke spastic hemiplegia. Complement Ther Med, 2016, 26: 55-60.
30. 張自茂, 馮崇廉, 皮周凱, 等. 針刺治療腦卒中后上肢痙攣療效觀察. 中國針灸, 2008, 28(4): 257-260.
31. 王秀娟, 劉強, 林翠茹, 等. 頭體針結合治療中風后上肢痙攣療效觀察. 上海針灸雜志, 2013, 32(8): 630-632.
32. 祁營洲, 傅立新, 熊俊, 等. 針刺治療中風后痙攣性癱瘓的系統評價. 中國針灸, 2009, 29(8): 683-688.
33. Macpherson H, Altman DG, Hammerschlag R, et al. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement. J Evid Based Med, 2010, 3(3): 140-155.
34. Tarsilla M. Cochrane Handbook for Systematic Reviews of Interventions. Naunyn Schmiedebergs Arch Exp Pathol Pharmakol, 2011, 5(2): S38.

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