Occupational therapy with or without combined acupuncture on upper limb pain and hand functions in children with spastic hemiplegic cerebral palsy: A three-arm randomized, placebo-controlled trial: 作业疗法合并或不合并针刺对痉挛型偏瘫脑瘫患儿上肢疼痛及手功能的干预研究:一个三臂随机安慰剂对照临床试验

Abstract

ObjectiveThis study is conducted to investigate the effects of occupational therapy (OT) with or without combined acupuncture for upper limb pain and hand functions among children with spastic hemiplegic cerebral palsy. MethodsA total of 90 patients who met the inclusion criteria were enrolled in a three-arm randomized, placebo-controlled trial, and were allocated to mono-occupational therapy (OT) group (patients= 30), OT combined with real-acupuncture (ORA) group (patients= 30), and OT combined with placebo-acupuncture (OPA) group (patients= 30), respectively. In addition to receiving the conventional OT program as the basic treatment for total 8 weeks, patients in ORA and OPA group also received corresponding acupuncture treatment 5 days per week for the first two weeks, 3 days per week for the next two weeks, 2 days per week for another two weeks, and 1 day per week for the last two weeks. Non-communicating children's pain checklist-revised scale (NCCPC-R) was used for assessing the upper limb pain among patients. Squeeze dynamometry, modified Ashworth scale (MAS), manual muscle testing (MMT), Jebsen-Taylor hand function test (JTHFT) and box and block test (BBT) were used for assessing various aspects of upper limb and hand functions among patients. Meanwhile, adverse effects were monitored and recorded. ResultsAfter 8-week treatment, NCCPC-R global scores witnessed a dramatic decline in ORA group (P < 0.05), but not in either OPA (P > 0.05) or OT group (P > 0.05). Dramatic increases were identified in both squeeze dynamometry scores and MMT scores in all three groups (all P < 0.05). Furthermore, the increases of ORA group were more significant than those of another two groups (both P < 0.05). There were no significant changes in MAS global scores in each group (all P > 0.05). The BBT global scores of all three groups significantly increased (all P < 0.05) after treatment. Among them, the increase of the ORA group was more than that of the other two groups (P < 0.05). The 8-week treatment also had a significant impact on several sub-tests of JTFHT in each group. No significant adverse event was reported. ConclusionORA is a potential and promising alternative therapy for mitigating upper limb pain as well as improving both upper limb and hand functions among children with spastic hemiplegic cerebral palsy.