Différences
Ci-dessous, les différences entre deux révisions de la page.
| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
|
acupuncture:evaluation:neuro-psychiatrie:07. spasticite de l hemiplegique [11 Mar 2022 15:47] Nguyen Johan [1.1. Generic Acupuncture] |
acupuncture:evaluation:neuro-psychiatrie:07. spasticite de l hemiplegique [17 Oct 2025 13:32] (Version actuelle) Nguyen Johan [1.2.5. Zhang 2017 (technique des méridiens tendino-musculaires) ☆] |
||
|---|---|---|---|
| Ligne 6: | Ligne 6: | ||
| ===== Systematic Reviews and Meta-Analysis===== | ===== Systematic Reviews and Meta-Analysis===== | ||
| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | ||
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | ||
| - | | ☆ | Limited evidence for effectiveness of acupuncture | | ||
| - | | Ø | No evidence or insufficient evidence | | ||
| Ligne 17: | Ligne 13: | ||
| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
| + | === Tian 2025 === | ||
| + | |||
| + | Tian Y, Yan X, Wang H, Dang C, Sun Y. Efficacy of acupuncture therapy for spastic paralysis in post-stroke patients: a systematic review and meta-analysis. Int J Neurosci. 2025 Feb;135(2):180-187. https://doi.org/10.1080/00207454.2023.2292955 | ||
| + | ^Backgound| Despite the potentially good efficacy of acupuncture therapy in the management of post-stroke spastic paralysis demonstrated in previous studies, further verification through meta-analysis can be conducive to eliminating the inconclusive of treatment outcomes in prior findings. This systematic review and meta-analysis were thus performed to comprehensively investigate the effects of acupuncture on the daily living abilities, upper and lower limb motor function, and related functional indices of post-stroke patients with spastic paralysis.| | ||
| + | ^Methods| We conducted a computer search to collect data from PubMed, PEDro, Clinical SportDiscus, and Scopus. The inclusion criteria followed the Population-Intervention-Comparison-Outcome (PICO) principle. Literature screening, data extraction, and quality assessment of the research articles were performed by two independent investigators. Standard mean difference and 95% confidence intervals of the data were analyzed using either a random-effects model or a fixed-effects model.| | ||
| + | ^Results| Acupuncture therapy appeared to be effective in mitigating the limb pain of post-stroke patients with spastic paralysis (RR = -0.04, 95% CI: -0.26, 0.17), ameliorating their daily life ability (RR = 4.66, 95% CI: -0.74, 10.05), and improving their hand function (RR = 0.65, 95% CI: 0.40, 0.90) and lower limb function (RR = 0.35, 95% CI: 0.09, 0.62).| | ||
| + | ^Conclusion| Acupuncture therapy provides more pronounced improvement in the daily life ability and limb motor function of post-stroke patients with spastic paralysis than conventional treatment regimens. Thus, acupuncture therapy can be a viable treatment option for the management of spastic paralysis following stroke.| | ||
| === Javier-Ormazábal 2022 === | === Javier-Ormazábal 2022 === | ||
| Ligne 27: | Ligne 30: | ||
| ^Conclusion|Treatment with invasive physiotherapy, combined with conventional physiotherapy, seems to have positive effects in reducing spasticity, although more studies are needed to improve the heterogeneity of the interventions and to assess their long-term effectiveness.| | ^Conclusion|Treatment with invasive physiotherapy, combined with conventional physiotherapy, seems to have positive effects in reducing spasticity, although more studies are needed to improve the heterogeneity of the interventions and to assess their long-term effectiveness.| | ||
| + | === Liao 2022 (Upper Limb) RETRACTED === | ||
| + | * <color #ed1c24>Retracted</color>: Analysis of the Efficacy of Acupuncture Combined with Rehabilitation Training in the Treatment of Upper Limb Spasm after Stroke: A Systematic Review and Meta-Analysis. Biomed Res Int. 2023 Dec 29;2023:9802958. https://doi.org/10.1155/2023/9802958 | ||
| + | * Liao Y, Liu F, Yang J, Ma Q, Li J, Chen Y, Wu J. Analysis of the Efficacy of Acupuncture Combined with Rehabilitation Training in the Treatment of Upper Limb Spasm after Stroke: A Systematic Review and Meta-Analysis. Biomed Res Int. 2022 Aug 9;2022:8663356. https://doi.org/10.1155/2022/8663356. | ||
| + | |||
| + | ^Objective|Systematic evaluation of the efficacy of acupuncture combined with cognitive rehabilitation training in the treatment of upper limb spasm after cerebral apoplexy.| | ||
| + | ^Methods|The data of CNKI, CBM, CQVIP, Wanfang, and the libraries of Pubmed and Cochrane were searched by computer, and the related literatures about acupuncture combined with cognitive rehabilitation training in the treatment of cognitive dysfunction after stroke were searched. The search time is from January 1, 1995 to January 1, 2022. All data segments were independently analyzed and extracted by two evaluators. After evaluating the quality of the methodology, meta-analysis was carried out by using the RevMan5.4 software.| | ||
| + | ^Results|Finally, **11 studies** were included, with a total of **789 subjects**. The results of meta-analysis indicated that acupuncture combined with cognitive rehabilitation training was superior to simple cognitive rehabilitation training or drugs in the following aspects, the difference exhibited statistically significant, the total effective rate (RR = 1.58, 95% CI), latency of P300 (MD = -18.46, 95% CI), amplitude of P300 (MD = 1.23, 95% CI (0.82), P < 0.00001, 95% CI (0.31)), and activity of daily living (ADL), respectively, were significantly higher compared to the control group (P < 0.00001), and the difference was statistically significant (P < 0.05). Based on the results of systematic evaluation, the GRADE system recommendation classification method is used to evaluate the quality of evidence. The results show that the level of evidence is low and the intensity of recommendation is weak.| | ||
| + | ^Conclusion| The results of this meta-analysis suggest that the curative effect of acupuncture combined with cognitive rehabilitation training is better compared to simple cognitive rehabilitation training or drugs. However, due to the low quality of the original literature, it needs to be confirmed by multicenter, high-quality, large-sample randomized blind controlled trials in the future.| | ||
| + | |||
| + | === Xue 2022 === | ||
| + | |||
| + | |||
| + | Xue C, Jiang C, Zhu Y, Liu X, Zhong D, Li Y, Zhang H, Tang W, She J, Xie C, Li J, Feng Y, Jin R. Effectiveness and safety of acupuncture for post-stroke spasticity: A systematic review and meta-analysis. Front Neurol. 2022 Aug 17;13:942597. https://doi.org/10.3389/fneur.2022.942597. | ||
| + | ^Objective|This systematic review and meta-analysis aimed to comprehensively evaluate the effectiveness and safety of acupuncture for post-stroke spasticity.| | ||
| + | ^Methods| Nine electronic databases were searched from their inception to 6 June 2022, to identify randomized-controlled trials (RCTs) that investigated the effectiveness and safety of acupuncture for post-stroke spasticity. Two reviewers independently screened the studies, extracted the data, assessed the risk of bias. The reporting quality of interventions in controlled trials of acupuncture was evaluated using Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The RevMan 5.4 and R 4.2.0 software were used for statistical analysis.| | ||
| + | ^Results|A total of **88 eligible studies** were included, involving** 6,431 individuals**. The pooled data demonstrated that acupuncture combined with conventional rehabilitation (CR) was superior to CR in reducing the Modified Ashworth Scale (MAS) score (standardized mean difference [SMD] = -0.73; 95% CI = -0.83 to -0.63; I 2 = 65%; low certainty of evidence). The favorable results were also observed in comparisons of acupuncture vs. CR (SMD = -0.22, 95% CI = -0.36 to -0.07; I 2 = 49%; moderate certainty of evidence). Subgroup analysis showed that acupuncture treatment with a frequency of once or twice a day was more effective than CR. In addition, the antispasmodic effect of acupuncture treatment increased with more sessions. Four studies explicitly reported slight acupuncture-related adverse events.| | ||
| + | ^Conclusion| Acupuncture could be recommended as adjuvant therapy for spasticity after stroke. However, due to the high risk of bias and heterogeneity of the included studies, the effectiveness of acupuncture for post-stroke spasticity remains to be confirmed.| | ||
| Ligne 85: | Ligne 105: | ||
| ==== Special Acupuncture Techniques ==== | ==== Special Acupuncture Techniques ==== | ||
| + | === Comparison of Acupuncture techniques === | ||
| + | == Zhu 2024 == | ||
| + | |||
| + | Zhu GC, Chen KM, Belcastro F. Comparing the effects of different acupoint-stimulating therapies in mitigating post-stroke spasticity and motor dysfunction in older stroke survivors: A network meta-analysis of randomized trials. Maturitas. 2024 Sep;187:108040. https://doi.org/10.1016/j.maturitas.2024.108040 | ||
| + | ^Background| Acupoint-stimulating therapies have often been used to manage stroke-related spasticity and motor dysfunction. However, the effects of different acupoint-stimulating therapies in older stroke survivors have been unclear.| | ||
| + | ^Methods| This systematic review and network meta-analysis compared the effects of different acupoint-stimulating therapies in managing spasticity and motor dysfunction in older stroke survivors. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched 7 databases for studies published up to July 2023. Inclusion criteria were: (1) older adults with strokes; (2) treatments were acupoint-stimulating therapies; (3) a control group did not receive acupoint-stimulating therapy, or the study compared different acupoint-stimulating therapies; and (4) outcomes included spasticity and motor function. Methodological quality was assessed with Risk-of-bias tool for randomized trials version 2, while R and Metainsight were used to conduct the network meta-analysis| | ||
| + | ^Results| We analyzed **27 studies** and the results showed that non-invasive electroacupuncture and warm acupuncture were more effective in reducing spasticity than conventional acupuncture (standardized mean difference and 95 % confidence intervals = 1.35/1.19 [0.57; 2.13/0.54; 1.83]) and invasive electroacupuncture (standardized mean difference and 95 % confidence intervals = 0.96/0.80 [0.12; 1.80/0.08; 1.51]). Conventional acupuncture and invasive electroacupuncture were effective in improving motor function (standardized mean difference and 95 % confidence intervals = 0.99/1.41 [0.42; 1.56/0.54; 2.28]). However, there was significant inconsistency for the effects of invasive electroacupuncture between studies. | | ||
| + | ^Conclusions|Our findings suggest that for older stroke survivors with spasticity, non-invasive electroacupuncture and warm acupuncture are appropriate, whereas conventional acupuncture is more appropriate for patients aiming for motor recover.| | ||
| === Fire needle === | === Fire needle === | ||
| Ligne 130: | Ligne 158: | ||
| ^Results| Totally, **13 papers were included, with 820 patients involved.** In reference to Cochrane Reviewers' Handbook 5.0.2, the randomized controlled trial (RCT) risk of bias was assessed and it was unclear for all of the 13 papers. The results of Meta-analysis showed that the clinical effect was improved with acupuncture at meridian sinew as compared with normal acupuncture technique[①total effective rate:OR=3.86, 95% CI (2.67,5.57), Z=7.20, P<0.00001; ②modified Ashworth spasm scale:OR=4.54, 95% CI (2.91,7.10), Z=6.64, P<0.00001; ③evaluation of limb motor function with Fugl-Meyer score:MD=4.18, 95% CI (-0.59,8.94), Z=1.72, P=0.09>0.05]. The publication bias of included papers was not obvious and therefore it could be neglected in the impact on the combined effect size. | | ^Results| Totally, **13 papers were included, with 820 patients involved.** In reference to Cochrane Reviewers' Handbook 5.0.2, the randomized controlled trial (RCT) risk of bias was assessed and it was unclear for all of the 13 papers. The results of Meta-analysis showed that the clinical effect was improved with acupuncture at meridian sinew as compared with normal acupuncture technique[①total effective rate:OR=3.86, 95% CI (2.67,5.57), Z=7.20, P<0.00001; ②modified Ashworth spasm scale:OR=4.54, 95% CI (2.91,7.10), Z=6.64, P<0.00001; ③evaluation of limb motor function with Fugl-Meyer score:MD=4.18, 95% CI (-0.59,8.94), Z=1.72, P=0.09>0.05]. The publication bias of included papers was not obvious and therefore it could be neglected in the impact on the combined effect size. | | ||
| ^ Conclusions|**Acupuncture at meridian sinew is effective in the treatment of spastic paralysis after stroke**. The total clinical effect and the improvement in muscular tone with acupuncture at meridian sinew are better than those with normal acupuncture technique. The quality of the included literature is not high generally. Hence, it is necessary to have more clinical studies with high-quality and strict design. | | ^ Conclusions|**Acupuncture at meridian sinew is effective in the treatment of spastic paralysis after stroke**. The total clinical effect and the improvement in muscular tone with acupuncture at meridian sinew are better than those with normal acupuncture technique. The quality of the included literature is not high generally. Hence, it is necessary to have more clinical studies with high-quality and strict design. | | ||
| + | |||
| + | ==== Mechanistic systematic reviews==== | ||
| + | |||
| + | === You 2025 === | ||
| + | |||
| + | |||
| + | You L, Hu M, Li J, Tan J, Guo F, Kong Y. The mechanism of electroacupuncture treatment for post-stroke spasticity: A systematic review and meta-analysis. Behav Brain Res. 2025 Oct 14:115873. https://doi.org/10.1016/j.bbr.2025.115873 | ||
| + | |||
| + | ^Objective|To assess whether electroacupuncture (EA) is an effective treatment for post-stroke spasticity (PSS) and to examine the mechanisms by which it modulates PSS, combining clinical and mechanistic evidence to clarify its therapeutic value and biological basis.| | ||
| + | ^Methods|Databases searched included PubMed, Web of Science, Embase, Medline, and SinoMed. Study quality was assessed using the SYRCLE bias risk assessment tool and CAMARADES checklist. Meta-analyses were performed with Stata 15.0 and Rstudio. Primary outcomes were Zea Longa and Modified Ashworth Scale (MAS) scores; secondary outcomes included Bederson score, electrophysiological measures, cerebral infarction and edema, and biomarkers such as IL-6, TNF-α, MDA, GABA, Glu, GABA-T, GAD67, BDNF, TrkB, GPX4, GSH, and related mRNA indicators.| | ||
| + | ^Results|Twenty animal studies (n = 388) were included, with quality scores ranging from 4 to 8 (mean 6.1). Meta-analysis showed significant improvement in Zea Longa score (MD = –1.05, 95% CI –1.30 to –0.80, P < 0.001) and MAS score (MD = –1.06, 95% CI –1.43 to –0.69, P < 0.001). EA significantly enhanced neurological recovery, reduced limb spasticity, improved balance, and decreased infarct size and edema. It downregulated IL-6, TNF-α, MDA, Glu, and GABA-T, while upregulating GSH, GABA, GAD67, BDNF, TrkB, GPX4, SLC7A11, and their corresponding mRNA levels. Publication bias was detected for MAS, and protocol heterogeneity (waveform, acupoints, duration) contributed to variability.| | ||
| + | ^Conclusion|EA alleviates PSS through modulation of neurotransmitters, suppression of microglia-mediated neuroinflammation, reduction of oxidative stress, and enhancement of synaptic plasticity and neuronal development. These findings support EA’s therapeutic potential for PSS, warranting further high-quality mechanistic and clinical studies.| | ||
| + | ===== Overviews of Systematic Reviews ===== | ||
| + | |||
| + | |||
| + | ==== Choi 2022 ==== | ||
| + | |||
| + | Choi TY, Jun JH, Lee HW, Yun JM, Joo MC, Lee MS. Traditional Chinese Medicine Interventions in the Rehabilitation of Cognitive and Motor Function in Patients With Stroke: An Overview and Evidence Map. Front Neurol. 2022 May 17;13:885095. https://doi.org/10.3389/fneur.2022.885095 | ||
| + | ^ Objective | Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aim of this evidence map is to provide a synopsis of the best clinical practices and interventions in stroke rehabilitative care and to identify areas with a paucity of evidence to guide future research. | | ||
| + | ^ Methods | PubMed, EMBASE, CDSR, six Korean databases, and two Chinese databases were searched for SRs evaluating the effectiveness of any stroke rehabilitation intervention through October 2021. The quality of the SRs was assessed using AMSTAR 2. A bubble plot was used to graphically display clinical topics, the number of articles, the number of patients included, confidence, and effectiveness. | | ||
| + | ^ Results | In total, ninety-five SRs were identified; however, after methodological analysis, only 48 had sufficient quality to be included. In total, forty-eight SRs were included in the evidence mapping. The overall search identified SRs from 2015 to 2021. A total of four SRs focused on post-stroke cognitive impairment, whereas the other forty-four SRs focused on post-stroke motor function. In total, nineteen different traditional Chinese medicine (TCM) intervention modalities were included. Acupuncture was the most commonly used treatment. Overall, the quality of the included SRs was low or very low. Most SRs concluded that TCM interventions may have potential benefits in stroke rehabilitation. The results were more promising when acupuncture was used for shoulder-hand syndrome. | | ||
| + | ^ Conclusions | However, the identified reviews cautioned that firm conclusions cannot be drawn. The evidence map provides a visual overview of the research volume and content involving TCM interventions in stroke rehabilitation. Evidence mapping can facilitate the process of knowledge translation from scientific findings to researchers and policymakers and possibly reduce waste in research. | | ||
| + | | | Spaticity, hand spasms, spastic hemiplegia. | | ||
| + | |||
| + | ===== Clinical Practice Guidelines ===== | ||
| + | | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | ||
| + | |||
| + | |||
| + | ==== American Academy of Physical Medicine and Rehabilitation (AAPM&R, USA) 2024 ⊕ ==== | ||
| + | |||
| + | Verduzco-Gutierrez M, Raghavan P, Pruente J, Moon D, List CM, Hornyak JE, Gul F, Deshpande S, Biffl S, Al Lawati Z, Alfaro A. AAPM&R consensus guidance on spasticity assessment and management. PM R. 2024 Aug;16(8):864-887. https://doi.org/10.1002/pmrj.13211 | ||
| + | |||
| + | |//Acupuncture, including electro-acupuncture.// Moderate level evidence for electro-acupuncture combined with conventional routine care (pharmacological and rehabilitation) in reduction in upper-limb and lower-limb spasticity, improved overall motor function, activities of daily living. It is proposed that acupuncture works by decreasing the pain-spasm cycle, spinal motor neuron regulation, and neurochemical regulation, though exact mechanisms are not clear.| | ||
| + | |||
| + | ==== Department of Veterans Affairs and Department of Defense (VA/DoD, USA) 2024 Ø ==== | ||
| + | |||
| + | |||
| + | VA/DoD Clinical Practice Guideline for Management of Stroke Rehabilitation. Department of Veterans Affairs and Department of Defense. Washington, DC: U.S. Government Printing Office. 2024. https://www.healthquality.va.gov/guidelines/Rehab/stroke/VADoD-2024-Stroke-Rehab-CPG-Full-CPG_final_508.pdf | ||
| + | |||
| + | | 25. There is insufficient evidence to recommend for or against the use of acupuncture or dry needling for **spasticity management**. (Neither for nor against / Reviewed, New-added)| | ||
| + | |||
| + | |||
| + | ==== Stroke Foundation (Australia, New-Zealand) 2022 ∅ ==== | ||
| + | |||
| + | Australian and New Zealand Clinical Guidelines for Stroke Management. Chapter 6: Managing complications. https://app.magicapp.org/#/guideline/WE8wOn | ||
| + | |||
| + | | For stroke survivors with **spasticity**, acupuncture should not be used for treatment of spasticity in routine practice other than as part of a research study. (Lim et al 2015) [Weak recommendation against]. | | ||
