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| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:neuro-psychiatrie:07. spasticite de l hemiplegique [22 Sep 2022 07:01] Nguyen Johan [1.1.1. Javier-Ormazábal 2022] |
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) ☆] |
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| ===== 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 | | ||
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| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
| + | === Tian 2025 === | ||
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| + | 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 === | ||
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| ^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) === | + | === Liao 2022 (Upper Limb) RETRACTED === |
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| + | * <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. | ||
| - | 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.| | ^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.| | ^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.| | ||
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| ==== Special Acupuncture Techniques ==== | ==== Special Acupuncture Techniques ==== | ||
| + | === Comparison of Acupuncture techniques === | ||
| + | == Zhu 2024 == | ||
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| + | 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 === | ||
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| ^ 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 === | ||
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| + | 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 | ||
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| + | ^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 ===== | ===== Overviews of Systematic Reviews ===== | ||
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| + | ==== American Academy of Physical Medicine and Rehabilitation (AAPM&R, USA) 2024 ⊕ ==== | ||
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| + | 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 | ||
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| + | |//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.| | ||
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| + | ==== Department of Veterans Affairs and Department of Defense (VA/DoD, USA) 2024 Ø ==== | ||
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| + | 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 | ||
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| + | | 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)| | ||
