Spasticité de l'hémiplégique : évaluation de l'acupuncture

Articles connexes: - spasticité - conduites thérapeutiques - pathologie - acupuncture expérimentale - qigong -

1. Systematic Reviews and Meta-Analysis

1.1. Acupuncture générique

1.1.1. Rodriguez-Mansilla 2016

Rodriguez-Mansilla J, Espejo-Antúnez L, Bustamante-López AI. [Effectiveness of acupuncture in spasticity of the post-stroke patient. Systematic review]. Aten Primaria. 2016;48(4):226-34. [182168].

Objective	To determine the effectiveness of acupuncture for reducing spasticity in post-stroke patients.
Methods	DESIGN: Literature review. DATA SOURCE: The literature search was performed using scientific databases from January 2000 to January 2013. SELECTION OF STUDIES: Out of the 110 studies that were found, nine random and controlled trials were included. Inclusion criteria were based on clinical trials in which participants were over 18 years old, who were suffering with post-stroke spasticity, and one of the experimental groups was treated with acupuncture. DATA EXTRACTION: The variables were the passive resistance to stretching of the affected limb, and the degree of personal dependence. The variables were assessed by the Modified Ashworth Scale and Barthel Index.
Methods	The search was performed in the PUBMED, COCHRANE Library, PEDro, Dialnet, CSIC, CINAHL, databases. Search terms included the combination of keywords “acupuncture”; “muscle spasticity”; “stroke”.
Results	Passive resistance to stretching, the degree of personal dependence, and motor function of the affected limb showed statistically significant improvements in at least one study included; however, these improvements are not clinically relevant changes. Passive resistance improved in the elbow, ankle, knee, and wrist. An increased joint range was observed, except for the elbow, forearm, and thumb. Improved of the patient dependency was also observed.
Conclusions	Although improvements relative to the reduction of spasticity are shown, the results have failed to demonstrate the effectiveness of the technique for this ailment. It would take a greater number of studies to calculate the size of the reported effects with homogeneous procedures in the design as well as in the duration, frequency, and measurement tools.

1.1.2. 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.
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.

1.1.3. 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.
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.

1.1.4. 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.
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.

1.1.5. 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.
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.

1.1.6. 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

1.2. Special acupuncture techniques

1.2.1. Yang 2018 (moxibustion sur aiguille)

Yang L, Tan JY, Ma H, Zhao H, Lai J, Chen JX, Suen LKP. Warm-needle moxibustion for spasticity after stroke: A systematic review of randomized controlled trials. Int J Nurs Stud. 2018;:129-138. [115380].

Background	Spasticity is a common post-stroke complication, and it results in substantial deterioration in the quality of life of patients. Although potential positive effects of warm-needle moxibustion on spasticity after stroke have been observed, evidence on its definitive effect remains uncertain.
Objectives	This study aimed to summarize clinical evidence pertaining to therapeutic effects and safety of warm-needle moxibustion for treating spasticity after stroke. DESIGN: Randomized controlled trials were reviewed systematically on the basis of the Cochrane Handbook for Systematic Reviews of Interventions. The report follows the PRISMA statement.
Methods	Ten electronic databases (PubMed, CENTRAL, EMBASE, AMED, CINAHL, Web of Science, CBM, CNKI, WanFang, and VIP) were explored, and articles were retrieved manually from two Chinese journals (The Journal of Traditional Chinese Medicine and Zhong Guo Zhen Jiu) through retrospective search. Randomized controlled trials with warm-needle moxibustion as treatment intervention for patients with limb spasm after stroke were included in this review. The risk of bias assessment tool was utilized in accordance with Cochrane Handbook 5.1.0. All included studies reported spasm effect as primary outcome. Effect size was estimated using relative risk, standardized mean difference, or mean difference with a corresponding 95% confidence interval. Review Manager 5.3 was utilized for meta-analysis.
Results	Twelve randomized controlled trials with certain methodological flaws and risk of bias were included, and they involved a total of 878 participants. Warm-needle moxibustion was found to be superior to electroacupuncture or acupuncture in reducing spasm and in promoting motor function and daily living activities. Pooled results for spasm effect and motor function were significant when warm-needle moxibustion was compared with electroacupuncture or acupuncture. A comparison of daily living activities indicated significant differences between warm-needle moxibustion and electroacupuncture. However, no difference was observed between warm-needle moxibustion and acupuncture.
Conclusions	Warm-needle moxibustion may be a promising intervention to reduce limb spasm as well as improve motor function and daily living activities for stroke patients with spasticity. However, evidence was not conclusive. Rigorously designed randomized controlled trials with sample sizes larger than that in the included trials should be conducted for verification.

1.2.2. Cai 2017 (electroacupuncture)

Cai Y, Zhang CS, Liu S, Wen Z, Zhang AL, Guo X, Lu C, Xue CC. Electroacupuncture for Poststroke Spasticity: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2017;98(12):2578-2589. [42608].

Objective	To evaluate the effects and safety of electroacupuncture (EA) for stroke patients with spasticity.
Methods	DATA SOURCES: Five English databases (PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database) and 4 Chinese databases (Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Chongqing VIP Database, Wanfang Database) were searched from their inception to September 2016. STUDY SELECTION: Randomized controlled trials were included if they measured spasticity with the Modified Ashworth Scale (MAS) in stroke patients and investigated the add-on effects of electroacupuncture to routine pharmacotherapy and rehabilitation therapies. DATA EXTRACTION: Information on patients, study design, treatment details and outcomes assessing spasticity severity, motor function, and activities of daily living was extracted.
Data synthesis	In total, 22 trials involving 1425 participants met the search criteria and were included. The estimated add-on effects of EA to reduce spasticity in the upper limbs as measured by the MAS (standardized mean difference [SMD]=-.57; 95% confidence interval [CI], -.84 to -.29), and to improve overall motor function as measured by the Fugl-Meyer Assessment of Sensorimotor Recovery (mean difference [MD]=10.60; 95% CI, 8.67-12.53) were significant. Significant add-on effects of EA were also shown for spasticity in the lower limbs, lower-limb motor function, and activities of daily living ([SMD=-.88; 95% CI, -1.42 to -.35;], [MD=4.42; 95% CI, .06-8.78], and [MD=6.85; 95% CI, 3.64-10.05], respectively), although with high heterogeneity. For upper-limb motor function, no significant add-on effects of EA were found.
Conclusions	EA combined with conventional routine care has the potential of reducing spasticity in the upper and lower limbs and improving overall and lower extremity motor function and activities of daily living for patients with spasticity, within 180 days poststroke. Further studies of high methodological and reporting quality are needed to confirm the effects and safety of EA, and to explore the adequate and optimal protocol of EA for poststroke spasticity, incorporating a group of comprehensive outcome measures in different populations.

1.2.3. Zhang 2017 (technique des méridiens tendino-musculaires) ☆

Zhang Y, Ma TM, Bai ZH, Sun BW, Zhao HY. [Meta-analysis on the Therapeutic Effect of Acupuncture at Meridian Sinew for Spastic Paralysis After Stroke]. Zhen Ci Yan Jiu. 2017; 42(2): 178-82. [184444].

Objective	To review systematically the clinical effects of spastic paralysis after stroke treated with acupuncture at meridian sinew (“Jingjin”, musculotendon).
Methods	“Meridian sinew” “stroke” and “spasm” were taken as the key words to retrieve from the Chinese National Knowledge Infrastracture Database (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database (VIP), Chinese Biomedical Library (CBM), Wanfang Data, PubMed and the Cochrane Library. The Cochrane“risk of bias” tool was used to conduct the methodological quality evaluation to the literature. RevMan 5.3 software was adopted for Meta-analysis.
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.

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