Abstract
To evaluate the evidence supporting the effectiveness of acupuncture treatment for SCI and its complications, we conducted search across 19 electronic databases to find all of the randomized controlled trials (RCTs) that used acupuncture as a treatment for SCI and its complications. The methodological quality of each RCT was assessed using the Cochrane risk of bias tool and the PEDro scale. Sixteen RCTs, including 2 high-quality RCTs, met our inclusion criteria (8 for functional recovery from SCI, 6 for bladder dysfunction, and 2 for pain control). The meta-analysis showed positive results for the use of acupuncture combined with conventional treatments for the functional recovery in terms of motor ASIA scores and total FIM scores when compared to conventional treatments alone. Positive results were also obtained for the treatment of bladder dysfunction, in terms of the total efficacy rate, when comparing acupuncture to conventional treatments. However, 2 RCTs for pain control reported conflicting results. Our systematic review found encouraging albeit limited evidence for functional recovery, bladder dysfunction, and pain in SCI. However, to obtain stronger evidence without the drawbacks of trial design and the quality of studies, we recommend sham-controlled RCTs or comparative effectiveness research for each condition to test the effectiveness of acupuncture.
Highlights
Spinal cord injury (SCI) affects approximately 900 to 1,000 individuals per million in the general population, and it is estimated that there are 12,000 new cases of SCI every year in the United States [1]
The outcome measures we considered were neurologic status or score, functional ability outcomes, activities of daily living, scores related to the efficacy rate, and outcome measures related to the complications of SCI
Eight trials studied functional recovery in SCI (5 in traumatic SCI [4,5,6, 8, 10], 1 in nontraumatic SCI [7], and 2 were not reported [3, 9]), 6 trials studied bladder dysfunction secondary to SCI (1 in traumatic SCI [13], 1 in mixed SCI [15], and 4 were not reported [11, 12, 14, 16]), and 2 trials studied the use of acupuncture for pain control in SCI (2 trials did not report SCI type) [17, 18]
Summary
Spinal cord injury (SCI) affects approximately 900 to 1,000 individuals per million in the general population, and it is estimated that there are 12,000 new cases of SCI every year in the United States [1]. 80% of the individuals who experience SCI are male, and, since 2000, the average age at injury has increased to 39.5 years, with 11.5% of those injured greater than 60 years of age [2] These statistics indicate that SCI may be a significant social and economic burden for patients and their families. There are a variety of treatments used for the secondary complications of SCI, such as intermittent catheterization for bladder dysfunction, analgesics for pain, and others [25] These treatments tend to be administered over long periods of time, and because of the potential complications of treatment, there has been an increased interest in alternative medical treatments, including acupuncture and other related therapies (moxibustion and acupressure) [26]. Many studies [28, 29] have analyzed the use of acupuncture for these types of problems; these studies report a variety of outcomes regarding level of function, pain, and quality of life
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