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Spasticité de l'hémiplégique : évaluation de l'acupuncture
1. Lim 2015
Lim SM, Yoo J, Lee E, Kim HJ, Shin S, Han G, Ahn HS. Acupuncture for spasticity after stroke: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2015. [177749].
| Objective | The aim of this systematic review was to determine how effective acupuncture or electroacupuncture (acupuncture with electrical stimulation) is in treating poststroke patients with spasticity. |
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| Methods | We searched publications in Medline, EMBASE, and the Cochrane Library in English, 19 accredited journals in Korean, and the China Integrated Knowledge Resources Database in Chinese through to July 30, 2013. We included randomized controlled trials (RCTs) with no language restrictions that compared the effects of acupuncture or electroacupuncture with usual care or placebo acupuncture. The two investigators assessed the risk of bias and statistical analyses were performed. |
| Results | Three RCTs in English, 1 in Korean, and 1 in Chinese were included. Assessments were performed primarily with the Modified Ashworth Scale (MAS). Meta-analysis showed that acupuncture or electroacupuncture significantly decreased spasticity after stroke. A subgroup analysis showed that acupuncture significantly decreased wrist, knee, and elbow spasticity in poststroke patients. Heterogeneity could be explained by the differences in control, acupoints, and the duration after stroke occurrence. |
| Conclusion | In conclusion, acupuncture could be effective in decreasing spasticity after stroke, but long-term studies are needed to determine the longevity of treatment effects. |
2. Park 2014
Park SW, Yi SH, Lee JA, Hwang PW, Yoo HC, Kang KS. Acupuncture for the treatment of spasticity after stroke: a meta-analysis of randomized controlled trials. J Altern Complement Med. 2014. 20(9):672-682. [174937].
| Objectives | Acupuncture has been suggested as a treatment for spasticity in patients with stroke. The available literature was reviewed in an effort to assess its efficacy in this situation. |
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| Methods | Randomized trials assessing the effects of acupuncture for the treatment of spasticity after stroke were identified by searching the Cochrane Library, PubMed, ProQuest, EBSCOhost, SCOPUS, CINAHL, EMBASE, Alternative Medicine Database, and Chinese and Korean medical literature databases. Two reviewers independently extracted data on study characteristics, patient characteristics, and spasticity outcomes. |
| Results | Eight trials with 399 patients met all the inclusion criteria. Compared with controls without acupuncture, acupuncture had no effect on improving clinical outcomes (as measured by validated instruments such as the Modified Ashworth Scale) or physiologic outcomes (assessed by measures such as the H-reflex/M-response [H/M] ratio at the end of the treatment period). H/M ratios did decrease significantly immediately after the first acupuncture treatment. Methodologic quality of all evaluated trials was considered inadequate. |
| Conclusions | The effect of acupuncture for spasticity in patients with stroke remains uncertain, primarily because of the poor quality of the available studies. Larger and more methodologically sound trials are needed to definitively confirm or refute any effect of acupuncture as a treatment for spasticity after stroke. |
3. Li Ning 2009
Li Ning, Zhao Yu, Wang Cheng-Wei. [Meta -analysis of study on limb spasm after stroke treated by acupuncture and moxibustion from 2000 to 2008]. Journal of Clinical Acupuncture and Moxibustion. 2009. 25(12):4. [172500].
