Acupuncture for Upper-Extremity Rehabilitation in Chronic Stroke: A Randomized Sham-Controlled Study

Harvard University, Cambridge, Massachusetts, United States
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 12/2005; 86(12):2248-55. DOI: 10.1016/j.apmr.2005.07.287
Source: PubMed


To compare the effects of traditional Chinese acupuncture with sham acupuncture on upper-extremity (UE) function and quality of life (QOL) in patients with chronic hemiparesis from stroke.
A prospective, sham-controlled, randomized controlled trial (RCT).
Patients recruited through a hospital stroke rehabilitation program.
Thirty-three subjects who incurred a stroke 0.8 to 24 years previously and had moderate to severe UE functional impairment.
Active acupuncture tailored to traditional Chinese medicine diagnoses, including electroacupuncture, or sham acupuncture. Up to 20 treatment sessions (mean, 16.9) over a mean of 10.5 weeks.
UE motor function, spasticity, grip strength, range of motion (ROM), activities of daily living, QOL, and mood. All outcomes were measured at baseline and after treatment.
Intention-to-treat (ITT) analyses found no statistically significant differences in outcomes between active and sham acupuncture groups. Analyses of protocol-compliant subjects revealed significant improvement in wrist spasticity (P<.01) and both wrist (P<.01) and shoulder (P<.01) ROM in the active acupuncture group, and improvement trends in UE motor function (P=.09) and digit ROM (P=.06).
Based on ITT analyses, we conclude that acupuncture does not improve UE function or QOL in patients with chronic stroke symptoms. However, gains in UE function observed in protocol-compliant subjects suggest traditional Chinese acupuncture may help patients with chronic stroke symptoms. These results must be interpreted cautiously because of small sample sizes and multiple, unadjusted, post hoc comparisons. A larger, more definitive RCT using a similar design is feasible and warranted.

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    • "Previous studies found that 10.4%, 28.4%, and 62.5% of the general population have used TCM services in the previous month, year, and six years in Taiwan, respectively [13, 16, 21]. After stroke chronic symptoms such as spasticity, changed muscle tone, motor neuron excitability, and ankle plantar flexor spasticity can improve after TCM treatment, particularly acupuncture [22–26]. Our previous studies also proved the medical effectiveness of acupuncture [27, 28]. "
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    ABSTRACT: . The use of complementary and alternative medicine in critical illness is increasing worldwide. This study investigates how traditional Chinese medicine (TCM) is used in stroke patients. Methods . Using Taiwan National Health Insurance reimbursement claims, we compared the annual use of TCM between stroke patients and general population, identifying 15,330 patients with a new onset of stroke in 2000–2009. The sociodemographic status and medical comorbidities between stroke patients receiving TCM services and those without using the service were compared. Results . The use of TCM was higher in stroke patients than in the general population, 27.9% versus 25.4% in 2000 and 32.7% versus 27.8% in 2009, respectively, and grew consistently from 2000 to 2009. Among stroke patients, women, younger patients, white-collar employees, higher-income residents, and those living in areas with more TCM physicians were more likely to use TCM. Stroke patients using rehabilitation services were more likely to have more TCM visits (OR = 2.28, 95% CI = 1.96–2.66) and higher expenditure on TCM (OR = 2.67, 95% CI = 2.29–3.12) compared with stroke patients without rehabilitation. Conclusion . TCM is popular and well accepted in Taiwan. Patients with stroke have a higher TCM utilization rate than people without stroke.
    Evidence-based Complementary and Alternative Medicine 12/2012; 2012(6):387164. DOI:10.1155/2012/387164 · 1.88 Impact Factor
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    • "Patients usually lie still for 20–30 minutes or more, at which point, the practitioner returns to remove the " needles. " Variations on this ritual template have been used in acupuncture clinical trials in North America (Huang, Nir, Chen, Schnyer, & Manber, 2006; Wayne, et al., 2005), Australia(Smith, Coyle, & Norman, 2006) , Europe (Andersen D, et al., 2010; Kleinhenz, et al., 1999) (K. Streitberger, et al., 2004) (Kristen, et al., 2010) and Asia (Tsang, et al., 2007) (So, et al., 2009). "
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    ABSTRACT: Evidence that placebo acupuncture is an effective treatment for chronic pain presents a puzzle: how do placebo needles appearing to patients to penetrate the body, but instead sitting on the skin's surface in the manner of a tactile stimulus, evoke a healing response? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations (including warmth, tingling or flowing sensations) suggest an embodied healing mechanism. In this qualitative study, we asked a subset of patients in a singleblind randomized trial in irritable bowel syndrome to describe their treatment experiences while undergoing placebo treament. Analysis focused on patients' unprompted descriptions of any enhanced touch sensations (e.g., warmth, tingling) and any significance patients assigned to the sensations. We found in 5/6 cases, patients associated sensations including "warmth" and "tingling" with treatment efficacy. The conclusion offers a "neurophenomenological" account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices, possibly underlying the phenomenology of placebo acupuncture.
    Consciousness and Cognition 03/2011; 20(3):784-91. DOI:10.1016/j.concog.2010.12.009 · 2.31 Impact Factor
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    • "Twenty-six articles (33%) offered no discernible physiologic rationale for how acupuncture might work (Table 1). Indications with no rationale include addiction [42], auditory hallucinosis [35], breech presentation [13], chronic fatigue syndrome [49], chronic sinusitis [70], depression [67], irritable bowel syndrome [29], mental fatigue [32], overactive bladder syndrome [27] and stroke rehabilitation [62,80,82]. "
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    ABSTRACT: Scientific interest in acupuncture has led numerous investigators to conduct clinical trials to test the efficacy of acupuncture for various conditions, but the mechanisms underlying acupuncture are poorly understood. The author conducted a PubMed search to obtain a fair sample of acupuncture clinical trials published in English in 2005. Each article was reviewed for a physiologic rationale, as well as study objectives and outcomes, experimental and control interventions, country of origin, funding sources and journal type. Seventy-nine acupuncture clinical trials were identified. Twenty-six studies (33%) offered no physiologic rationale. Fifty-three studies (67%) posited a physiologic basis for acupuncture: 33 (62% of 53) proposed neurochemical mechanisms, 2 (4%) segmental nervous system effects, 6 (11%) autonomic nervous system regulation, 3 (6%) local effects, 5 (9%) effects on brain function and 5 (9%) other effects. No rationale was proposed for stroke; otherwise having a rationale was not associated with objective, positive or negative findings, means of intervention, country of origin, funding source or journal type. The dominant explanation for how acupuncture might work involves neurochemical responses and is not reported to be dependent on treatment objective, specific points, means or method of stimulation. Many acupuncture trials fail to offer a meaningful rationale, but proposing a rationale can help investigators to develop and test a causal hypothesis, choose an appropriate control and rule out placebo effects. Acupuncture may stimulate self-regulatory processes independent of the treatment objective, points, means or methods used; this would account for acupuncture's reported benefits in so many disparate pathologic conditions.
    BMC Complementary and Alternative Medicine 02/2006; 6(1):25. DOI:10.1186/1472-6882-6-25 · 2.02 Impact Factor
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