Clinical Practice Guideline on Acupuncture for Post-stroke Spasticity

Je-Shin Kim; Seung-Won Shin; Eui-Ju Lee; Byung-Cheul Shin; Myeong-Soo Lee; Sung-Min Lim; Dong-Woo Nam; Sang-Kwan Moon; Kim, Je-Shin; Shin, Seung-Won; Lee, Eui-Ju; Shin, Byung-Cheul; Lee, Myeong-Soo; Lim, Sung-Min; Nam, Dong-Woo; Moon, Sang-Kwan

doi:10.13048/jkm.15001

JKM > Volume 36(1); 2015 > Article

Kim, Shin, Lee, Shin, Lee, Lim, Nam, and Moon: Clinical Practice Guideline on Acupuncture for Post-stroke Spasticity

Original Article

The Journal of Korean Oriental Medicine 2015; 36(1): 1-8.

DOI: https://doi.org/10.13048/jkm.15001

Clinical Practice Guideline on Acupuncture for Post-stroke Spasticity

Je-Shin Kim¹, Seung-Won Shin¹, Eui-Ju Lee¹, Byung-Cheul Shin², Myeong-Soo Lee³, Sung-Min Lim⁴, Dong-Woo Nam⁵, Sang-Kwan Moon⁶

¹Dept. of Sasang Constitutional Medicine, Kyung Hee Uiversity Korean Medicine Hospital

²Dept. of Korean Physical Medicine Rehabilitation, School of Korean Medicine, Pusan National University

³Korean Institute of Oriental Medicine

⁴Department of Clinical Research on Rehabilitation, Korean National Rehabilitation Research Institute

⁵Dept. of Acupuncture & Moxibustion Medicine, Kyung Hee Uiversity Korean Medicine Hospital

⁶Dept. of Korean Internal Medicine, Kyung Hee Uiversity Korean Medicine Hospital

Correspondence to: 이의주 (Eui-Ju Lee), 서울 동대문구 경희대로 23 경희대학교한방병원 사상체질과, Tel: +82-2-958-9232, Fax: +82-2-958-9234, E-mail: drsasang@hanmail.net

Received November 23, 2014 Revised March 13, 2015 Accepted March 17, 2015

Abstract

Objectives:

This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with post-stroke spasticity.

Methods:

Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on post-stroke spasticity, compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine.

Results & Conclusions:

One systematic review and 7 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of electroacupuncture treatment for post-stroke spasticity. However, it did not show any sufficient evidence to treat the patients with post-stroke spasticity with the sole acupuncture. The moderate evidence was presented that over 3 times of the electroacupuncture treatments with 1–100 Hz frequency should be performed every week on the acupoints, such as LI11, LI10, TE5, LI4, ST36, GB34, ST40, or LR3, for 20–30 minutes. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. Finally, there was a moderate evidence to support safety of acupuncture treatment for post-stroke spasticity.

Keywords: Acupuncture, stroke, spasticity, Clinical practice guideline

감사의 글

This research was supported by a grant of rehabilitation R&D project (12-D-02, 2014006) from the Korean National Rehabilitation Center.

Fig. 1.

Flow Chart of the Trial Selection Process.

RCT: Randomized Controlled Trial; SR: Systematic Review.

Table 1.

Level of Evidence.

수준	내용
I a	잘 수행된 무작위 대조 임상연구의 메타분석 및 체계적 문헌고찰로부터 얻어진 근거
I b	적어도 하나의 무작위 대조 임상연구로부터 얻어진 근거
II a	무작위 없이 적어도 하나의 잘 디자인된 대조군 연구 및 코호트 연구로부터 얻어진 근거
II b	적어도 하나의 잘 디자인된 관찰연구로부터 얻어진 근거
III	역사적 중요 문헌에 게재된 치료법으로 전문가 합의에 의한 근거
IV	연속증례연구 등 그 외의 연구로부터 얻어진 근거
V	전문가의 의견 또는 임상경험 전문가로부터 얻어진 근거

Table 2.

Grade of Recommendation.

등급		내용	근거수준
A	매우권고	적어도 한 개 이상의 무작위 대조 임상연구 또는 메타분석에 의한 근거가 있는 경우 매우 권고함	Ia, Ib
B	권고	무작위 대조 임상연구가 아니라도 잘 수행된 연구디자인에 의한 근거이거나 역사적으로 중요 문헌에 의한 것이면 권고함.	IIa, IIb, III
C	선택적권고	근거 자료가 부족하더라도 전문가 합의가 있을 경우 선택적으로 권고함	IV, V
GPP		임상진료지침 개발그룹의 임상적 경험에 근거하였을 경우 권고함

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