An Effectiveness Study Comparing Acupuncture, Physiotherapy, and Their Combination in Poststroke Rehabilitation: A Multicentered, Randomized, Controlled Clinical Trial

摘要

Context - Stroke is a leading cause of death and disability worldwide, being the third leading cause of death in the United States and the second and third most common causes of death in Chinese cities and rural areas, respectively. Evaluation of different rehabilitative modalities appears necessary to optimize treatment.Objectives - To compare acupuncture and physiotherapy for effectiveness and reliability in treating hemiplegic patients after stroke.Design - The research team designed a multicentered, three-arm, randomized controlled trial. Power calculations revealed a targeted sample size of 310 participants. Setting: The study took place at seven in-patient hospitals in China.Participants - The research team screened a total of 310 patients. Of that number, 274 completed the study, 15 did not meet the inclusion/exclusion criteria, and 21 dropped out. Adverse events were rare (less than 1%), mild, and temporary. Intervention - The research team randomly divided participants into three groups that all received conventional care as needed—including psychological counseling, standard nursing care, and daily medical evaluation plus (1) acupuncture, (2) physiotherapy, or (3) acupuncture plus physiotherapy. Theparticipants received treatments once a day, 6 days a week for 4 weeks.Outcome Measures - The research team evaluated all patients at baseline, after 2 weeks, and after 4 weeks using the Fugl-Meyer Assessment of Physical Performance (EMA), a modifiedBarthel Index (BI), and the Neurologic Defect Scale (NDS).Results - No significant differences existed between the three groups at baseline. Compared to baseline, participants in all groups improved their FMA, BI, and NDS scores by the end of week 2 (P< .05) and further improved by the end of week 4 (P<.05) The study found no statistically significant differences in outcomes between the three groups after treatment (P> .05). Conclusion - Acupuncture plus conventional care was similar in effectiveness to physiotherapy treatment plus conventional care for poststroke rehabilitation. The study found no synergis-tic effects for the combination of acupuncture and physiotherapy in addition to conventional care; that combination of treatments was no more effective than either treatment by itself. The effectiveness and lack of adverse events associated with acupuncture in this study suggest that it may represent an additional treatment option for stroke patients.