Screening of optimized acupuncture therapeutic schemes through orthogonal design in the treatment of post-stroke shoulder-hand syndrome

Abstract

Objective To optimize the treatment schemes of acupuncture in the treatment of post-stroke shoulder-hand syndrome. Methods Ninety eligible patients with post-stroke shoulder-hand syndrome visiting the Rehabilitation Department or Acupuncture Department of Pudong New Area Traditional Chinese Medicine Hospital and Longhua Hospital were divided into nine groups by using the random number table, with ten patients in each group. Then four factors were set up: adopting acupoint selection (A), needle retaining time (B), treatment frequency (C), and course of treatment (D) as well as three levels by the orthogonal experimental design and nine typical treatment protocols were selected for our study: 1. Scalp acupuncture combined with yang meridians, retaining the needles for ten minutes, treating once every other day for two weeks; 2. Scalp acupuncture combined with yang meridians, retaining the needles for twenty minutes, treating once every day for four weeks; 3. Scalp acupuncture combined with yang meridians, retaining the needles for thirty minutes, treating twice every day for eight weeks; 4. Scalp acupuncture combined with yin meridians, retaining the needles for ten minutes, treating once every day for eight weeks; 5. Scalp acupuncture combined with yin meridians, retaining the needles for twenty minutes, treating twice every day for two weeks; 6. Scalp acupuncture combined with yin meridians, retaining the needles for thirty minutes, treating once every other day for four weeks; 7. Scalp acupuncture combined with yang meridians and yin meridians, retaining the needles for ten minutes, treating twice every day for four weeks; 8. Scalp acupuncture combined with yang meridians and yin meridians, retaining the needles for twenty minutes, treating once every day for eight weeks; 9. Scalp acupuncture combined with yang meridians and yin meridians, retaining the needles for thirty minutes, treating once every day for two weeks; Each group was scored by using the Visual analogue scale (VAS), Fugl-Meyer upper-extremity score and modified Barthel index (BI) score before and after the treatment. Baseline data were analyzed by variance analysis and rank test, while VAS scale, Fugl-Meyer scale and Barthel scale were analyzed by range analysis and variance analysis of the orthogonal experimental design. Results The baseline data like age, course of the disease, VAS scale, Fugl-Meyer scale and Barthel scale before treatment were no statistical significance. For the improvement of VAS scale, A, C, D were the significant factors(F=7.382, 3.742, 15.775, all P<0.05). The best treatment scheme was the scalp acupuncture combined with yang meridians and yin meridians, retaining the needles for twenty minutes, and treating once every other day for eight weeks. For the improvement of FMA scale, A, B, D were the significant factors(F=5.629, 11.006, 32.305, all P<0.01). The best treatment scheme was the scalp acupuncture combined with yang meridians and yin meridians, retaining the needles for twenty minutes, and treating once every other day for four weeks. For the improvement of BI scale, B, D were the significant factors(F=6.269, 19.919, all P<0.01). The best treatment scheme was the scalp acupuncture combined with yang meridians and yin meridians, retaining the needles for twenty minutes, treating once every other day for four weeks. According to clinical experience, treatment for longer time has better curative effect. Conclusion Selecting the scalp acupuncture combined with yang meridians and yin meridians, retaining the needles for 20min, and treating once every other day for eight weeks is the best scheme for the treatment of post-stroke shoulder-hand syndrome, which can effectively ease the pain degree of low limbs, improve the motor function of upper-extremity and patients′ daily activities. Key words: Acupuncture therapy; Stroke; Reflex sympathetic dystrophy; Clinical protocols; Orthogonal design