Efficacy and safety of acupuncture combined with rehabilitation training for poststroke cognitive impairment: A systematic review and meta-analysis

Peiyuan Zhuo; Lianhong Huang; Miaoran Lin; Jie Chen; Yaling Dai; Minguang Yang; Huawei Lin; Jingfang Zhu; Jia Huang; Weilin Liu; Jing Tao

doi:10.1016/j.jstrokecerebrovasdis.2023.107231

Efficacy and safety of acupuncture combined with rehabilitation training for poststroke cognitive impairment: A systematic review and meta-analysis

J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107231. doi: 10.1016/j.jstrokecerebrovasdis.2023.107231. Epub 2023 Jul 18.

Authors

Peiyuan Zhuo¹, Lianhong Huang², Miaoran Lin¹, Jie Chen², Yaling Dai¹, Minguang Yang¹, Huawei Lin¹, Jingfang Zhu¹, Jia Huang³, Weilin Liu¹, Jing Tao⁴

Affiliations

¹ Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
² Department of Rehabilitation Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian China.
³ College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
⁴ Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China; College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China. Electronic address: taojing01@fjtcm.edu.cn.

PMID: 37473532
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107231

Abstract

Background: Accumulated evidence has proven that both acupuncture and rehabilitation therapy are beneficial for stroke sequelae. However, there is no systematic review to identify the efficacy and safety of acupuncture combined with rehabilitation training for poststroke cognitive impairment (PSCI). Therefore, the aim of this study was to assess the efficacy and safety of acupuncture combined with rehabilitation therapy for patients with PSCI.

Methods: We searched nine databases, including PubMed, Embase, Scopus, Web of Science, EBSCO, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang, from their inception to September 2022. Randomized controlled trials (RCTs) examining the effect of acupuncture combined with rehabilitation on PSCI were included. The primary outcomes were the Mini-Mental State Examination (MMSE) score, Montreal Cognitive Assessment (MoCA) score, Modified Barthel Index (MBI) score, and Fugl-Meyer Assessment (FMA) score. The quality of the methodology was evaluated by Cochrane's risk of bias tool. Meta-analyses were performed by Revman 5.3 software.

Results: A total of 18 RCTs involving 1654 patients were included. The overall methodological quality of the included studies was low. Pooled results demonstrated that acupuncture combined with rehabilitation could significantly improve the clinical efficacy of PSCI (OR=3.23, 95% CI: 2.13 to 4.89), MMSE score (MD= 2.85, 95% CI: 2.56 to 3.15), MoCA score (MD= 2.18, 95% CI: 1.38 to 2.97), MBI score (MD= 9.23, 95% CI: 5.62 to 12.84), and FMA score (MD=5.72, 95% CI: 3.48 to 7.96).

Conclusions: Acupuncture combined with rehabilitation may produce better outcomes than rehabilitation alone in the treatment of PSCI. However, the safety of combined interventions is still unclear. Therefore, research with more rigorous study designs and RCTs with larger sample sizes is still needed.

Keywords: Acupuncture; Cognitive impairment; Poststroke; Rehabilitation training.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Acupuncture Therapy* / adverse effects
Acupuncture Therapy* / methods
Cognitive Dysfunction* / diagnosis
Cognitive Dysfunction* / etiology
Cognitive Dysfunction* / therapy
Humans
Research Design
Stroke* / complications
Stroke* / diagnosis
Stroke* / therapy
Treatment Outcome