Electroacupuncture with rehabilitation training for limb spasticity reduction in post-stroke patients: A systematic review and meta-analysis

ABSTRACT

Objective

To assess the effectiveness of electroacupuncture (EA) with rehabilitation training in reducing limb spasticity in post-stroke patients.

Methods

A systematic review was performed by electronically searching six databases (Medline/Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure, Database for Chinese Technical Periodicals, and Wanfang Data) for randomized controlled trials (RCTs) on EA with rehabilitation training for limb spasticity reduction in post-stroke patients from 1 January 2009 to 1 January 2019. A meta-analysis was performed using SAS 9.3 and RevMan 5.3 software after bibliography screening, data extraction, and risk of bias assessment using the Cochrane handbook. The primary outcome was spasticity.

Results

A total of 31 RCTs (including 2488 participants) were included. Except for Cai et al.’s study, the quality of other RCTs was not high. All studies performed a descriptive analysis, and 29 RCTs conducted a meta-analysis. The odds ratio (OR) for marked efficiency was 2.35 (95% confidence interval [CI] 1.68–3.27, Z = 5.03, P < .00001). The OR for Modified Ashworth Scale (MAS) classification was 2.42 (95% CI 1.89–3.10, Z = 7.03; P < .00001). The weighted mean difference (WMD) for MAS score was −0.68 (95% CI −0.79 – −0.56, Z = 11.24, P < .00001). The WMD for clinical spasticity index score was −1.50 (95% CI −2.28 – −0.72, Z = 3.79, P = .0002).

Conclusion

EA with rehabilitation training could be a good strategy for reducing limb spasticity after stroke and is better than EA alone or rehabilitation training alone. However, its effectiveness remains to be further verified by large-sample and high-quality RCTs.

KEYWORDS:

• Stroke
• electroacupuncture
• rehabilitation
• spasticity
• hypertonia

Acknowledgments

Jiyao Zhang and Luwen Zhu contributed to the initiation and design of this review, analysis and interpretation of data, writing of the manuscript and amendments to the drafts, and final approval of the version to be published. Qiang Tang  contributed to the analysis and interpretation of the data, critical review of the draft for important intellectual content, and final approval of the version to be published. Jiyao Zhang  and Luwen Zhu contributed equally to this work.

Disclosure of interest

The authors report no conflict of interests.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this review.