Efficacy and safety of dissimilar acupuncture intervention time-points in treating stroke: a systematic review and network meta-analysis.

Abstract

Impairment of motor function and activities of daily living is very common in post-stroke patients. Acupuncture has been used in stroke for a long time. Although growing evidence supports the beneficial effects of acupuncture, there is still no clear conclusion on the optimal intervention time-point for acupuncture in stroke. Thus, we tried to assess the efficacy and safety of dissimilar acupuncture intervention time-points by network meta-analysis (NMA). A retrieval was performed in several databases from beginning to October 2020. We only enrolled randomized controlled trials (RCTs) testing acupuncture for stroke, and the outcome indicators measured were Fugl-Meyer assessment (FMA) score, Barthel Index (BI), and adverse events. Thirty-eight trials involving 3,836 participants were included in this NMA, the vast majority of which had a low or unclear risk of selection bias, detection bias, reporting bias, attrition bias, but had a high risk of performance bias. The results showed as following: (I) acupuncture treatment (Acu) is significantly more effective than non-acupuncture treatment (Non-Acu) with a good safety. (II) In terms of FMA, acupuncture within 48 h post-stroke (Acu I) was superior to acupuncture within 2-15 d post-stroke (Acu II) [standard mean difference (SMD): 7.17; 95% confidence interval (CI), 1.11 to 13.22], acupuncture within 16-30 d post-stroke (Acu III) (SMD: 20.73; 95% CI, 13.68 to 27.78), acupuncture within 1 month to half a year post-stroke (Acu IV) (SMD: 26.95; 95% CI, 14.88 to 39.02). As for BI, Acu I was the optimal time-point, comparing with Acu III (SMD: 15.18; 95% CI, 8.97 to 21.39) and Acu IV (SMD: 22.88; 95% CI, 11.07 to 34.69). (III) Results of ranking indicated that Acu was better than Non-Acu at a similar stage in improving FMA and BI, while Acu I was the optimal intervention time-point, followed by Acu II. Although the credibility of our conclusions is low, our NMA indicates that acupuncture can be beneficial for stroke survivors with good safety. In terms of improvement in FMA score and BI, the soon use of acupuncture the better the efficacy. The optimal acupuncture intervention time-point for stroke is within 48 h post-stroke, and the significant validity period lasts until 15 days after onset.