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acupuncture:evaluation:neuro-psychiatrie:07. syndrome epaule-main post-avc [19 May 2022 07:49] Nguyen Johan Page name changed from acupuncture:evaluation:neuro-psychiatrie:07. algodystrophie post-avc to acupuncture:evaluation:neuro-psychiatrie:07. syndrome epaule-main post-avc |
acupuncture:evaluation:neuro-psychiatrie:07. syndrome epaule-main post-avc [23 May 2025 16:34] (Version actuelle) Nguyen Johan [1.1. Generic Acupuncture] |
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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 | | + | |
| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
| + | === Shi 2025 === | ||
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| + | Shi J, Chen F, Liu Y, Bian M, Sun X, Rong R, Liu S. Acupuncture versus rehabilitation for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis of randomized controlled trials. Front Neurol. 2025 Apr 2;16:1488767. https://doi.org/10.3389/fneur.2025.1488767 | ||
| + | ^Backgound| Shoulder-hand syndrome (SHS) is one of the common sequelae after stroke, which not only hinders the recovery of patients, but also increases the economic burden of the family. In the absence of effective treatment measures, acupuncture treatment has been widely used in China to treat post-stroke shoulder-hand syndrome, but the details are unclear. Therefore, this review aims to evaluate the true efficacy of acupuncture in patients with SHS.| | ||
| + | ^Methods| We searched eight databases [PubMed, Embase, Web of Science, Cochrane library, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, the China National Knowledge Infrastructure (CNKI) database, and Wan fang database] from its inception to March 2025, randomized controlled trials (RCTs) of SHS acupuncture treatment combined with rehabilitation (Rehab). Two investigators independently used pre-designed forms to extract valid data from eligible randomized controlled trials. Meta-analysis was implemented through the Rev. Man software (version 5.4). The strength of the evidence obtained was implemented using the GRADE profiler software. Adverse events (AEs) were collected by reading the full text and used to evaluate the safety of acupuncture treatment.| | ||
| + | ^Results| **Forty-seven studies, involving 4,129 participants**, met the eligibility criteria, and were included in the review. Overall meta-analysis showed that combined acupuncture rehabilitation significantly improved motor function (upper-limb Fugl-Meyer Assessment (FMA): 41 studies, mean difference (MD) 9.50, 95% confidence interval (CI) [8.47, 10.53]) and pain reduction (visual analog score (VAS): 37 studies, MD: -1.49, 95% CI [-1.66, -1.33]). It also improved activities of daily living (ADL) compared to rehabilitation alone (ADL: 17 studies, MD: 11.94, 95% CI [8.26, 13.63]). There was no significant difference in the occurrence of adverse events (AEs) between acupuncture treatment combined with Rehab and Rehab alone (p > 0.05). The certainty of the evidence was rated low level because of flaws in the study design and considerable heterogeneity among the included studies.| | ||
| + | ^Conclusion| This review found that acupuncture treatment combined with Rehab treatment may have a positive promoting effect on improving motor function, reducing pain, and improving daily living ability in SHS patients. However, due to the existing methodological quality issues, our findings should be treated with caution. Future high-quality studies are urgently needed to validate our findings.| | ||
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| + | === Zhan 2023 === | ||
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| + | Zhan J, Luo Y, Mao W, Zhu L, Xu F, Wang Y, Chen H, Zhan L. Efficacy of acupuncture versus rehabilitation therapy on post-stroke shoulder pain: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2023 Jul 21;102(29):e34266. https://doi.org/10.1097/MD.0000000000034266 | ||
| + | ^Background| Acupuncture and rehabilitation therapy (RT) have been widely used for post-stroke shoulder pain (PSSP), but the efficacy of acupuncture versus RT remains unclear. Our aim was to assess the efficacy of acupuncture versus RT for PSSP.| | ||
| + | ^Methods| Six databases including PubMed, Cochrane Library, China National Knowledge Infrastructure, Chinese biological medicine database, Chinese Scientific Journal Database, and WAN FANG were searched from their inception to March 2022. Randomized controlled trials (RCTs) comparing acupuncture with RT on PSSP were included. Primary outcome was shoulder pain. Secondary outcomes were upper limb motor function, activities of daily living (ADL), and adverse events (AEs). We used RevMan Version 5.3 to pool data. We conducted data synthesis of all outcomes using the random effects model. The methodological quality of all studies was assessed by 2 independent reviewers using the risk of bias (ROB) assessment tool. We also performed subgroup analysis and sensitivity analysis. We assessed the publication bias using the Egger test and funnel plots.| | ||
| + | ^Results| **Eighteen studies** were included in qualitative synthesis, fifteen (83%) studies with 978 patients were included in meta-analysis (MA) because of the outcomes of 3 studies were inappropriate. Nine (50%) studies were considered as moderate to high quality according to ROB assessment tool. The effectiveness of acupuncture for patients with PSSP was similar to that of RT on shoulder pain alleviation (standardized mean difference [SMD]: -0.41, 95% confidence interval [CI]: -0.91 to 0.08, P = .10), improvement of upper limb motor function (weighted mean difference [WMD]: 0.80, 95% CI: -1.19 to 2.79, P = .43), and ADL (WMD: -0.83, 95% CI: -3.17 to 1.51, P = .49). Two (11%) studied reported no acupuncture-related AEs, and fourteen (78%) studies did not mention AEs resulting from acupuncture.| | ||
| + | ^Conclusions| Acupuncture is similar to RT in relieving shoulder pain, improving upper limb motor function and ADL in patients with PSSP. Either acupuncture or RT might be the optimal treatment of PSSP. More well-designed RCTs of this topic are needed in the future. | | ||
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| + | === Zhan 2022 ☆ === | ||
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| + | Zhan J, Wei X, Tao C, Yan X, Zhang P, Chen R, Dong Y, Chen H, Liu J, Lu L. Effectiveness of acupuncture combined with rehabilitation training vs. rehabilitation training alone for post-stroke shoulder pain: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2022 Oct 4;9:947285. https://doi.org/10.3389/fmed.2022.947285 | ||
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| + | ^Background|Post-stroke shoulder pain (PSSP) is characterized by shoulder pain on the hemiplegic side, which can limit physical activity in patients with stroke. Acupuncture combined with rehabilitation training (AR) has been widely used in PSSP, but the evidence of its effectiveness is still unclear.| | ||
| + | ^Objective|The study aimed to evaluate the effect and safety of AR vs. rehabilitation training (RT) alone on PSSP.| | ||
| + | ^Methods| e searched PubMed, the Cochrane Library, the Chinese Biological Medicine Database (CBM), the Chinese Scientific Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and the WAN FANG database for relevant studies from their inception to February 2022. Only randomized controlled trials (RCTs) comparing the effect of AR with RT alone on PSSP were considered. The primary outcome was shoulder pain. Secondary outcomes included upper limb motor function, activities of daily living (ADL), shoulder range of motion (ROM), and adverse events (AEs). Subgroup analysis and sensitivity analysis were also conducted. Quality assessment was implemented based on Cochrane risk of bias (ROB) criteria, which consist of seven items. When more than four items in a study were judged as low ROB, the overall quality of this study was co**nsidered low risk.| | ||
| + | ^Results|A total of **40 studies **were included in the qualitative analysis, and 35 (87.5%) studies with **2,554 patients were included in the meta-analysis. Of the 40 studies, 14 (35.0%) were of moderate-to-high quality. The meta-analysis results showed that AR is better than RT alone in reducing shoulder pain (MD -1.32, 95% CI -1.58 to -1.07), improving upper limb motor function (MD 6.81, 95% CI 4.95-8.67), ADL (MD 11.17, 95% CI 9.44-12.91), and shoulder ROM (internal rotation: MD 10.48, 95% CI 8.14-12.83; backward extension: MD 7.82, 95% CI 6.00-9.64; anteflexion: MD 12.88, 95% CI 5.47-20.29; external rotation: MD 11.40, 95% CI 6.17-16.64; abduction: MD 16.96, 95% CI 8.61-25.31) without obvious AEs.| | ||
| + | ^Conclusion|AR may be better than RT alone for the improvement of shoulder pain, upper limb motor function, ADL, and shoulder ROM, without obvious AEs in patients with PSSP. However, considering the clinical and statistical heterogeneity, our findings need to be interpreted with caution. More rigorous RCTs in this area should be conducted in the future.| | ||
| === Liu 2019 ☆=== | === Liu 2019 ☆=== | ||
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| ==== Special Acupuncture Techniques ==== | ==== Special Acupuncture Techniques ==== | ||
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| + | === Comparison of Acupuncture techniques === | ||
| + | == Huang 2023 == | ||
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| + | Huang T, Yao H, Huang J, Wang N, Zhou C, Huang X, Tan X, Li Y, Jie Y, Wang X, Yang Y, Liang Y, Yue S, Mao Y, Lai S, Zheng J, He Y. Effectiveness of acupuncture for pain relief in shoulder-hand syndrome after stroke: a systematic evaluation and Bayesian network meta-analysis. Front Neurol. 2023 Nov 17;14:1268626. https://doi.org/10.3389/fneur.2023.1268626 | ||
| + | ^Background| Shoulder-hand syndrome (SHS) is a common complication after stroke, and SHS-induced pain significantly hampers patients' overall recovery. As an alternative therapy for pain relief, acupuncture has certain advantages in alleviating pain caused by SHS after stroke. However, choosing the best treatment plan from a variety of acupuncture options is still a serious challenge in clinical practice. Therefore, we conducted this Bayesian network meta-analysis to comprehensively compare the effectiveness of various acupuncture treatment methods.| | ||
| + | ^Methods| We systematically searched for randomized controlled trials (RCTs) of acupuncture treatment in patients with post-stroke SHS published in PubMed, Embase, Cochrane, and Web of Science until 9 March 2023. We used the Cochrane bias risk assessment tool to assess the bias risk in the included original studies.| | ||
| + | ^Results| A total of **50 RCTs involving 3,999 subjects** were included, comprising 19 types of effective acupuncture interventions. Compared to single rehabilitation training, the top three interventions for VAS improvement were floating needle [VAS = -2.54 (95% CI: -4.37 to -0.69)], rehabilitation + catgut embedding [VAS = -2.51 (95% CI: -4.33 to -0.68)], and other multi-needle acupuncture combinations [VAS = -2.32 (95% CI: -3.68 to -0.94)]. The top three interventions for improving the Fugl-Meyer score were eye acupuncture [Meyer = 15.73 (95% CI: 3.4627.95)], other multi-needle acupuncture combinations [Meyer = 12.22 (95% CI: 5.1919.34)], and traditional western medicine + acupuncture + traditional Chinese medicine [Meyer = 11.96 (95% CI: -0.59 to 24.63)].| | ||
| + | ^Conclusion| Multiple acupuncture methods are significantly effective in improving pain and upper limb motor function in post-stroke SHS, with relatively few adverse events; thus, acupuncture can be promoted.| | ||
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| ^Results| A total of **7 studies** were included, involving**504 patients** with stroke shoulder-hand syndrome. Meta-analysis showed that compared with the control group, Chinese materia medica iontophoresis combined with acupuncture can improve the total clinical efficiency by 22% [RR=1. 22, 95% CI (1. 11, 1. 35), Z=3. 94, P<0. 000 1], relieve pain [MD=-1. 55, 95% CI (-2. 08, -1. 02), Z=5. 72, P<0. 000 01], enhance the motor function of the affected limbs [MD=6. 01, 95%CI (5. 15, 6. 87), Z=13. 73, P<0. 000 01], and improve patients' ability of daily activities [MD=9. 07, 95% CI (5. 95, 12. 19), Z=5. 69, P<0. 000 01].| | ^Results| A total of **7 studies** were included, involving**504 patients** with stroke shoulder-hand syndrome. Meta-analysis showed that compared with the control group, Chinese materia medica iontophoresis combined with acupuncture can improve the total clinical efficiency by 22% [RR=1. 22, 95% CI (1. 11, 1. 35), Z=3. 94, P<0. 000 1], relieve pain [MD=-1. 55, 95% CI (-2. 08, -1. 02), Z=5. 72, P<0. 000 01], enhance the motor function of the affected limbs [MD=6. 01, 95%CI (5. 15, 6. 87), Z=13. 73, P<0. 000 01], and improve patients' ability of daily activities [MD=9. 07, 95% CI (5. 95, 12. 19), Z=5. 69, P<0. 000 01].| | ||
| ^Conclusion| Chinese materia medica iontophoresis combined with acupuncture for the treatment of shoulder-hand syndrome has a significant effect, can effectively relive pain, improve patient's motor function and quality of life, and is conducive to the promotion and application of featured technology of traditional Chinese medicine.| | ^Conclusion| Chinese materia medica iontophoresis combined with acupuncture for the treatment of shoulder-hand syndrome has a significant effect, can effectively relive pain, improve patient's motor function and quality of life, and is conducive to the promotion and application of featured technology of traditional Chinese medicine.| | ||
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| + | ===== Overviews of Systematic Reviews ===== | ||
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| + | ==== Lei 2022 ==== | ||
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| + | Lei S, Dai F, Xue F, Hu G, Zhang Y, Xu X, Wang R, Zhang X, Cong D, Wang Y. Acupuncture for shoulder-hand syndrome after stroke: An overview of systematic reviews. Medicine (Baltimore). 2022 Nov 18;101(46):e31847. https://doi.org/10.1097/MD.0000000000031847. | ||
| + | ^Background|To provide evidence, this review evaluated the methodological quality, risk of bias, and reporting quality of SRs/MAs in the treatment of shoulder-hand syndrome after stroke with acupuncture.| | ||
| + | ^Methods|Systematic reviews and Meta analyses (SRs/MAs) of acupuncture for shoulder and hand syndromes after stroke were retrieved from 6 databases from inception to May 1, 2022. Two reviewers independently screened the literature and extracted the data, then used Assessment of Multiple Systematic Reviews-2 (AMSTAR-2), Bias Risk in Systematic Review (ROBIS), and Preferred Report Item for Systematic review and Meta-analysis (PRISMA), Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess methodological quality, risk of bias, quality of reporting, and quality of evidence.| | ||
| + | ^Results| We included **7 SRs/Mas**, of which all SRs/MAs had very low AMSTAR-2 assessment quality and one study had a very low assessment bias risk. According to the PRISMA checklist, Protocol and registration, Synthesis of results, Summary of evidence, Conclusions and Funding were the main reporting limitations. GRADE evaluation showed a total of 37 results, but no high-quality evidence results, 6 results (16.22%) of the evidence quality were moderate, and supported acupuncture combined with exercise rehabilitation and drug therapy was better than exercise joint drug rehabilitation and rehabilitation, we also found that the result of limitations were the main factors that influence the evidence of low quality, followed by imprecision, inconsistency, and publication bias.| | ||
| + | ^Conclusions| Acupuncture is a relatively safe and effective adjuvant therapy for shoulder and hand syndromes after stroke. However, because of the low quality of SRs/MAs evidence supporting these findings, high-quality randomized controlled trials should be conducted, and the quality of relevant SRs should be improved to provide evidence for clinical application.| | ||
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| ===== Clinical Practice Guidelines ===== | ===== Clinical Practice Guidelines ===== | ||
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| | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | ||
| + | ==== Spanish Society of Neurorehabilitation (SSN, Spain) 2025 ⊕==== | ||
| + | Juárez-Belaúnde A, Colomer C, Dorado R, Laxe S, Miguens X, Ferri J, Rodríguez R, Pérez T, López C, Ríos M, González C, Pelayo R, Bernabeu M, Noé E, Gómez A, Quemada I. Guidelines: Basic principles of pain management in acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation. Neurologia (Engl Ed). 2025 Apr 10:S2173-5808(25)00028-8. https://doi.org/10.1016/j.nrleng.2025.04.005 | ||
| + | |Hemiplegic Shoulder Pain (HSP) after Stroke. \\ -**ICCPN**: Acupuncture may be helpful. Grade of recommendation: Moderate (B). \\ - **AHA/ASA**: The usefulness of acupuncture as a coadjuvant treatment for HSP is unclear. Grade of recommendation: Moderate (B). \\ - **UEMS-PRMS**: Management of HSP may include subacromial or glenohumeral corticosteroid injection, suprascapular nerve block, electrical stimulation of shoulder muscles, botulinum toxin injections targeting the subscapular and/or pectoral muscles, shoulder orthoses, oral anti-inflammatory drugs, massage, gentle mobilisation of the shoulder muscles, and acupuncture. Grade of recommendation: Low (IV). \\ - **IMSERSO**: Combination treatment with aromatherapy and acupressure is recommended to treat pain in HSP. Grade of recommendation: High (A).| | ||
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| + | ==== Brazilian Academy of Neurology 2022 Ø==== | ||
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| + | Minelli C, Bazan R, Pedatella MTA, Neves LO, Cacho RO, Magalhães SCSA, Luvizutto GJ, Moro CHC, Lange MC, Modolo GP, Lopes BC, Pinheiro EL, Souza JT, Rodrigues GR, Fabio SRC, Prado GFD, Carlos K, Teixeira JJM, Barreira CMA, Castro RS, Quinan TDL, Damasceno E, Almeida KJ, Pontes-Neto OM, Dalio MTRP, Camilo MR, Tosin MHS, Oliveira BC, Oliveira BGRB, Carvalho JJF, Martins SCO. Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I. Arq Neuropsiquiatr. 2022 Jun;80(6):634-652. https://doi.org/10.1590/0004-282X-ANP-2021-0354 | ||
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| + | | //Painful shoulder// : Acupuncture, as an adjunctive treatment, has an uncertain value. (Recommendation IIb-B)|. | ||
