Abstract
Objectives To systematically assess the efficacy of acupuncture combined with rehabilitation on unilateral neglect after stroke. Methods The Cochrane Library, PubMed, Excerpt Medical Database (EMBASE), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (CBM), and Wan Fang databases were searched online for randomised controlled trials (RCTs) of acupuncture and its effects on unilateral neglect after stroke from their inception to September 2019. RCTs on acupuncture combined with rehabilitation in the experimental group for unilateral neglect compared with rehabilitation alone or rehabilitation plus sham acupuncture in the control group were included. Two authors separately screened the literature, extracted the data, and evaluated the quality of the included studies. Review Manager 5.3 software was used for the data analysis. Results A total of 542 patients from nine RCTs were included. The meta-analysis showed that the experimental groups could significantly improve Fugl–Meyer Assessment (FMA) (MD = 11.54, 95% CI [9.54, 13.54], P < 0.00001) and the ability of daily living (SMD = 1.35, 95% CI [0.64, 2.07], P < 0.00001) and the ability of daily living (SMD = 1.35, 95% CI [0.64, 2.07], P < 0.00001) when compared with the control groups. However, there was no significant difference in the drop of Catherine Bergego Scale (CBS) and Behavioural Inattention Test-conventional (BIT-C) between the two groups. Conclusions Acupuncture combined with rehabilitation was more effective in improving the motor function and the ability of daily living. Because of the limitations regarding the quantity and quality of the studies in this meta-analysis, high-quality and well-designed RCTs are necessary to validate the above conclusions.
Highlights
Worldwide, stroke is responsible for increasingly high rates of mortality and disability [1]
Inclusion and Exclusion Criteria. e relevant articles were selected according to following criteria: (1) the included studies were randomised controlled trials (RCTs) studying acupuncture for treating unilateral neglect after stroke; (2) the included participants had to be clinically diagnosed with unilateral neglect, and stroke was confirmed by computerized tomographic scan or magnetic resonance imaging; (3) studies in which the experimental group were given acupuncture combined with rehabilitation, while the control group underwent rehabilitation alone or rehabilitation plus sham acupuncture; (4) the primary outcome measures included Catherine Bergego Scale (CBS), Behavioural Inattention Test-conventional (BIT-C), Fugl–Meyer assessment (FMA), Barthel Index (BI), or Modified Barthel Index (MBI); (5) the secondary outcome was an analysis of adverse events (AEs) as a way to assess safety; and (6) full text should be accessible
Duplicate data n = 1 Data were incomplete n = 1 Rehabilitation was not used in the control group n = 1 RTMS was used in the experiment group n = 1 Control group with acupuncture n = 2 No specific outcome measures n = 8
Summary
Stroke is responsible for increasingly high rates of mortality and disability [1]. E presence of unilateral neglect significantly delays the recovery of hemiparesis, and patients often experience more problems with the activities of daily living (ADL) [4]. The outcome can directly evaluate the degree of unilateral neglect, such as the Catherine Bergego Scale (CBS) and Behavioural Inattention Test-conventional (BIT-C) [6]. These outcomes of motor function and activities of daily living are heavily influenced by unilateral neglect and can indirectly reflect the degree of this neglect, such as when measured by the Fugl–Meyer assessment (FMA), Modified Barthel Index (MBI), Barthel Index (BI), and Functional Independence Measure (FIM) [7, 8]
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