post-stroke constipation
Constipation post-AVC
| ☆☆☆ | 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 |
1.1. Generic Acupuncture
1.1.1. Sun 2023
Sun T, Wang K, Li L, Yan M, Zou L, Zhang M, Yang S, Wu J, Liu J. Efficacy and safety of acupuncture in post-stroke constipation: a systematic review and meta-analysis. Front Neurosci. 2023 Sep 26;17:1275452. https://doi.org/10.3389/fnins.2023.1275452
| Background and objective | Post-stroke constipation ( PSC ) is a common complication of strokes that seriously affects the recovery and quality of life of patients, and effective treatments are needed. Acupuncture is a viable treatment option, but current evidence is insufficient to support its efficacy and safety. This study aims to evaluate the efficacy and safety of acupuncture in the treatment of PSC . |
| Methods | A systematic search of eight databases was conducted to identify PSC-related randomized clinical trials from the inception of each database through May 2023. Methodological quality assessment was conducted by RoB 2.0, meta-analysis was conducted by RevMan 5.3 and Stata 15.1, and evidence quality was evaluated by GRADE. Moreover, reporting quality of acupuncture interventions was assessed using the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). |
| Results | Thirty RCTs involving 2,220 patients were identified. We found that acupuncture was superior to conventional treatment (CT) in improving total responder rate [risk ratio (RR): 1.16, 95% confidence interval (CI): 1.09 to 1.25, p < 0.0001], decreasing constipation symptom scores [standardized mean difference (SMD): -0.65, 95% CI: -0.83 to -0.46, p < 0.00001], increasing serum P substance (SP) levels (SMD: 1.92, 95% CI: 0.47 to 3.36, p = 0.009), reducing the time to first bowel movement (BM) (SMD: -1.19, 95% CI: -2.13 to -0.25, p = 0.01), and lowing serum vasoactive intestinal peptide (VIP) levels (SMD: -2.11, 95% CI: -3.83 to -0.38, p = 0.02). Furthermore, acupuncture plus CT was superior regarding total responder rate (RR: 1.26, 95% CI: 1.17 to 1.35, p < 0.00001), serum SP levels (SMD: 2.00, 95% CI: 1.65-2.35, p < 0.00001), time to first BM (SMD: -2.08, 95% CI: -2.44 to -1.71, p < 0.00001), and serum VIP levels (SMD: -1.71, 95% CI: -2.24 to -1.18, p < 0.00001). However, regarding Bristol Stool Scale (BSS) score, acupuncture plus CT was superior to CT (SMD: -2.48, 95% CI: -3.22 to -1.73, p < 0.00001), while there was no statistically significant difference between acupuncture and CT (SMD: 0.28, 95% CI: -0.02 to 0.58, p = 0.07). Acupuncture causes fewer AEs than CT (RR: 0.13, 95% CI: 0.06 to 0.26, p < 0.00001), though there was no statistically significant difference between acupuncture plus CT vs. CT (RR: 1.30, 95% CI: 0.60 to 2.84, p = 0.51). |
| Conclusion | Acupuncture may be an effective and safe therapy for PSC . However, given the inferior quality of clinical data, additional well-designed RCTs are required to confirm these findings. |
1.1.2. Yang 2014 ☆☆
Yang JP, Liu JY, Gu HY, Lv WL, Zhao H, Li GP. [Randomized controlled trials of acupuncture and moxibustion for post-stroke constipation: a meta analysis]. Zhongguo Zhen Jiu. 2014 Aug;34(8):833-6.[167989]
| Purpose | The clinical efficacy of acupuncture and moxibustion for post-stroke constipation was systematically reviewed. |
| Methods | By computerized and manual retrieval of clinical research literature regarding acupuncture and moxibustion for post-stroke constipation, the randomized control trials (RCTs) that met the inclusive criteria were collected. Cochrane systematic review method was used and Revmen 5.2 software was adopted to perform this Meta analysis. |
| Results | Totally 8 articles were included, involving 610 cases of post-stroke constipation. As a result, the total effective rate and cured rate of acupuncture and moxibustion for post-stroke constipation were significantly superior to those of the control group [total effective rate: OR = 2.10, 95% CI (1.25, 3.54), Z = 2.78, P = 0.005; cured rate: OR = 2.37, 95% CI (1.57, 3.58), Z = 4.10, P < 0.0001]. |
| Conclusion | This result indicated that acupuncture was effective for post-stroke constipation and had some advantages compared with other therapies. |
1.2. Special Acupuncture Techniques
1.2.1. Scalp acupuncture
1.2.1.1. Jiang 2023
Jiang W, Jiang X, Yu T, Gao Y, Sun Y. Efficacy and safety of scalp acupuncture for poststroke depression: A meta-analysis and systematic review. Medicine (Baltimore). 2023 Aug 4;102(31):e34561. https://doi.org/10.1097/MD.0000000000034561
| Background | Poststroke depression (PSD) is a common clinical poststroke complication that adversely affects cognitive and physical function rehabilitation. Scalp acupuncture (SA) can significantly improve somatic dysfunction and emotional disorder in stroke patients. This meta-analysis aims to evaluate the effectiveness and safety of SA in the treatment of PSD. |
| Methods | We conducted a comprehensive search of multiple electronic databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Internet, China Science and Technology Journal Database, Wan Fang Data Knowledge Service Platform, and China Biology Medicine databases until December 20, 2022, to identify randomized controlled trials investigating the efficacy of SA in the treatment of PSD. Two independent researchers screened the literature, extracted data, and assessed the risk of bias in the included studies based on the inclusion and exclusion criteria. We performed a meta-analysis of the eligible literature using RevMan 5.4.1 and Stata 15.0 software. |
| Results | This study comprised a total of 14 randomized controlled trials, 10 of which used SA and 4 of which used SA in combination with electroacupuncture therapy. The results of the meta-analysis revealed that the effective rate of the SA group was significantly higher than that of the Western medicine group (relative risk = 1.09, 95% confidence interval (CI) [1.02, 1.16], P = .008). Moreover, compared to the Western medicine group, the SA group demonstrated significant improvements in Hamilton depression scale scores (mean difference = -2.29, 95% CI [-3.88, -0.70], P = .005) and neurological function deficit scores (mean difference = -3.06, 95% CI [-5.91, -0.21], P = .04). Additionally, the SA group has a lower incidence of adverse events than the western medicine group (relative risk = 0.12, 95% CI [0.05, 0.29], P < .00001). |
| Conclusion | SA has superior efficacy and safety compared to Western medicine for PSD. These findings suggest that SA could be a promising alternative treatment for the assessed condition. Due to the limited number and quality of the included literature, the above conclusions must be confirmed by additional high-quality research. |
1.2.2. Catgut Embedding
1.2.2.1. Guo 2022
Guo M, Le X, Qin-Yu W, Ye M, Sheng-Qiang Z, Yao X, Da-Hua W, Bai-Yan L. Effectiveness and Safety of Acupoint Catgut Embedding for the Treatment of Poststroke Constipation: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2022 Jul 5;2022:8080297. https://doi.org/10.1155/2022/8080297.
| Objectives | Acupoint catgut embedding therapy has shown effectiveness in treating functional constipation; however, relevant, high-quality clinical evidence is scarce. This study aimed to systematically assess the effectiveness and safety of acupoint catgut embedding in treating poststroke constipation. |
| Methods | Correlative randomized controlled trials were identified through a comprehensive literature search of PubMed, Cochrane Library/Cochrane Central Register of Controlled Trials, Web of Science, Embase, China National Knowledge Internet, Chinese Biomedical Literature Database, Wanfang, and VIP databases from inception until February 2022. Meta-analysis was performed using RevMan 5.3 software. |
| Results | Fifteen trials involving 1084 patients were identified. The meta-analysis revealed that the acupoint catgut embedding group was significantly superior to the non-catgut embedding group with regard to the efficacy rate (RR = 1.27, 95% CI (1.19, 1.37), P < 0.05), the first defecation time (MD = -3.08, 95% CI (-4.53, -1.63), P < 0.05), the defecation sensation score (MD = -0.44, 95% CI (-0.61, -0.26), P < 0.05), the degree of difficulty in defecation (MD = -0.73, 95% CI (-1.10, -0.37), P < 0.05), the PAC-QOL scale score (MD = -10.06, 95% CI (-13.47, -6.64), P < 0.05), and the symptom integral (MD = -3.15, 95% CI (-3.60, -2.71), P < 0.05). However, there was no significant difference in the stool property score (MD = 0.06, 95% CI (-0.39, 0.50), P > 0.05) as well as the incidence of adverse reactions (RD = 0.01, 95% CI (-0.01, 0.03), P > 0.05) between the two groups. |
| Conclusions | The results showed that acupoint catgut embedding is probably an effective and safe acupuncture treatment strategy for poststroke constipation. Nevertheless, more rigorously designed, standardized, large-sample, and multicenter randomized controlled designs are warranted to further verify the findings of this study. |
1.2.3. Electroacupuncture
1.2.3.1. Wang 2018
Wang De-Long, Wang Qi , Xiang Dong-Guo , et al. [RCTs Meta- analysis of Electro- acupuncture Treating Post- stroke Constipation]. Journal of Clinical Acupuncture and Moxibustion. 2018;34(3):62. [188707].
| Objective | To evaluate the clinical efficacy of electro - acupuncture in the treatment of post - stoke constipation, to analyze the current research status, and to provide reference for its clinical application. |
| Methods | RCTs of electro - acupuncture treating post - stoke constipation were retrieved from CNKI, Wanfang Data, vIP, Pubmed, Embase, and Cochrane from the establishment of the database to Aug. 2017. The literatures were screened by two reviewers according to the inclusion - exclusion criteria, and the methodological quality was assessed by Cochrane score. Software Review manager 5. 3 was used for Meta - analysis. |
| Results | A total of 11 literatures were included in the study with 703 patients involved. The results of Meta - analysis showed that there were significant differences between the electro - acupuncture group and the control group in terms of the total efficacy [ RR = 1. 20, 95 % CI( 1. 1 1, 1. 30), P< 0. 00001], effective rate [ RR:: 2. 03, 95 % CI( 1. 50, 2. 73), P< 0. 00001]. |
| Conclusion | Electro - acupuncture has a good therapeutic effect on constipation after stroke. However, the study needs more support with high - quality researches due to the limits of the number and quality of the included literatures. |
