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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Available from: Eric A. Macklin
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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.
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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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    • "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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