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Sommaire
Spasticité de l'hémiplégique : évaluation de l'acupuncture
1. Revues systématiques et méta-analyses
1.1. Li 2016 ☆
Li Hong-Liang, Xue Zhi-Hui, Chen Guo, Xiang Juan, Li Fei, Li Tie-Lang. [Systematic review of acupuncture plus rehabilitation for post-stroke spasm]. Shanghai Journal of Acupuncture and Moxibustion. 2016;5:612-617. [187055].
| Objectives | To systematically review the therapeutic efficacy of acupuncture plus rehabilitation in treating post-stroke spasm and to summarize the commonly-used acupoints. |
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| Methods | The randomized controlled trials and quasi-randomized trials of acupuncture plus rehabilitation for post-stroke spasm published from January 1 of 2005 to December 31 of 2014 in China were retrieved from CNKI, WanFang database, and VIP database, etc. by using computer. The eligible studies were recruited for review. |
| Results | Totally 15 studies were enrolled. The Meta-analysis showed that the most commonly used acupoints in acupuncture treatment for post-stroke spasm were Quchi (LI 11), Jianyu (LI 15), Hegu ( LI 4 ), Tianjing (TE 10), Waiguan (TE 5), Zusanli (ST 36), Sanyinjiao ( SP 6 ), Chize (LU 5), and so on. Compared to the controls, acupuncture plus rehabilitation had significantly better effective rate [OR=3. 13, 95%CI (2. 00, 4. 89), P<0. 00001], recovery rate [OR=2. 42, 95%CI (1. 53, 3. 83), P=0. 0002], MAS score [MD=﹣0. 48, 95%CI (﹣0. 62, ﹣0. 35), P<0. 00001], FMA score [MD=5. 58, 95%CI (4. 96, 6. 20), P<0. 00001], and NDS score [SMD=﹣0. 68, 95%CI (﹣0. 91, ﹣0. 44), P<0. 00001]. |
| Conclusions | Acupuncture plus rehabilitation can effectively mitigate the post-stroke spasm and is worth promoting in clinic; more high-quality researches are expected as the quality of the currently recruited trials is not so satisfactory. |
1.2. 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. |
1.3. 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. |
2. Qi 2009 ∼
Qi YZ, Fu LX, Xiong J, Wang ZL, Mou J, Lu YM.. [Systematic Evaluation of Acupuncture for Treatment of Post-Stroke Spastic Paralysis]. Chinese Acupuncture And Moxibustion. 2009;29(8):683-8. [154652]
| Objectives | To evaluate the effects of acupuncture on post-stroke spastic paralysis. |
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| Methods | A systematic evaluation including all the relavant randomized controlled trials (RCTs) or quasi-RCTs of acupuncture and moxibustion for treatment of post-stroke spastic paralysis were carried out according to the method recommended by the Cochrane Collaboration. |
| Results | Nine hundred and seventy-eight patients being included in fourteen papers met the enrolled criteria. However, their methodological quality was relatively poor. Meta-analysis of nine trials indicated that there was no significant difference between the treatment groups and the control groups in Ashworth scores, Carr-Shepherd scores, nerve defect scores and hip adductor tension scores. Whereas the Fugel-Meyer scores in one trial and the Barthel scores in three trials were better in the treatment groups than those of the control group. |
| Conclusions | A reliable conclusion can not be drawn from the present data because of the defects in methodological quality and insufficient numbers of trials, especially lack the long-term terminal outcomes, although it appears a tendency that acupuncture can improve the conditions of post-stroke spastic paralysis. Therefore, it is necessary to perform more multi-central RCTs of high quality in future. |
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] 摘 要：目的：了解针灸治疗中风后肢体痉孪研究现状和发展水平、推断研究热点、推测学科发展。方 法：检索《中国期刊全文数据库》C]NK工）2000~ 2008 年 月间的针灸治疗中风后肢体痉孪研究的全部文 献，采用文献计量学方法对文献从发表时间分布、基金资助研究情况、文献研究类型、期刊分布、省份分 布、大学单位分布和穴位处方、刺灸方案、随机对照研究的标准符合率等方面进行统计分析。 结果：2000 - 2008年月间 数据库共收录针灸治疗中风后艘体痉孪研究文献'; 107 篇，文献研究呈 逐年上升趋势，其中 篇文献报道受基金资助；临床研究篇，综述等其他研究篇，无实验基础研 究；文献报道以《针灸临床杂志》等种主要针灸杂志为主；产文地区主要为广东省、黑龙江省及天津市； 张针灸处方中，上月支穴位以“肩骼、合谷、曲池、手三里、尺泽”等为主，下月支穴位以“阳陵泉、三阴交、足 三里、血海、委中”等为主；刺灸方法以传统毫针与电针为主，共计张处方提及；篇随机对照研究文 献的标准符合率较低。结论：中风后肢体痉孪的针灸研究目前正在吸引着针灸界更多的关 注。针灸穴位选取、规范化的刺灸方法实施、提高临床研究的报告质量是未来临床研究的重点。 关键词：中风后肢体痉孪；文敞计量学；针灸
