Clinical Practice Guideline for acupuncture in Post-stroke urinary retention

Ji-Won Lee; Eui-Ju Lee; Byung-Cheul Shin; Myeong-Soo Lee; Sung-Min Lim; Chung-Sik Cho; Sang-Kwan Moon; Lee, Ji-Won; Lee, Eui-Ju; Shin, Byung-Cheul; Lee, Myeong-Soo; Lim, Sung-Min; Cho, Chung-Sik; Moon, Sang-Kwan

doi:10.13048/jkm.16001

JKM > Volume 37(1); 2016 > Article

Lee, Lee, Shin, Lee, Lim, Cho, and Moon: Clinical Practice Guideline for acupuncture in Post-stroke urinary retention

Original Article

The Journal of Korean Oriental Medicine 2016; 37(1): 1-9.

Published online: March 31, 2016

DOI: https://doi.org/10.13048/jkm.16001

Clinical Practice Guideline for acupuncture in Post-stroke urinary retention

Ji-Won Lee¹, Eui-Ju Lee², Byung-Cheul Shin³, Myeong-Soo Lee⁴, Sung-Min Lim⁵, Chung-Sik Cho⁶, Sang-Kwan Moon⁷

¹Department of Clinical Korean Medicine, Graduate School, Kyung Hee University

²Dept. of Sasang Constitutional Medicine, School of Korean Medicine, Kyung Hee University Korean Medicine Hospital

³Dept. of Rehabilitation Medicine of Korean Medicine, Korean Medicine Hospital, Yangsan, Pusan National University

⁴Clinical Research Division, Korean Institute of Oriental Medicine

⁵Department of Clinical Research on Rehabilitation, Korean National Rehabilitation Research Institute

⁶Dept. of Internal Medicine, College of Korean Medicine, Daejeon University

⁷Dept. of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital

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

Received November 19, 2015 Revised March 14, 2016 Accepted March 18, 2016

Abstract

Objectives:

Objectives : This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with Post-stroke Urinary Retention; PSUR.

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 PSUR 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:

4 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of acupuncture treatment for PSUR. The moderate evidence was presented that over 3 times a week of the acupuncture should be performed over 4 weeks on the acupoints, such as SP6, CV3, CV6, CV4, SP9, BL28, BL23, BL22, KI3 or BL67, for 15–30 minutes. 20–140Hz frequency and 10–20 minutes of treatment is suggested if electro-acupuncture treatment is performed with. 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 PSUR.

Keywords: Acupuncture, Stroke, Urinary dysfunction, Urinary retention, Clinical practice guideline

Table 1.

Quality 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	I a, I b
B	권고	무작위 대조 임상연구가 아니라도 잘 수행된 연구디자인에 의한 근거이거나 역사적으로 중요 문헌에 의한 것이면 권고함.	II a, II b, III
C	선택적권고	근거 자료가 부족하더라도 전문가 합의가 있을 경우 선택적으로 권고함	IV, V
	GPP	임상진료지침 개발그룹의 임상적 경험에 근거하였을 경우 권고함

Table 3.

Summary of Randomized Controlled Trials of Acupuncture for Urinary Retention after Stroke

Author (year) Country	Sample Size (Analyzed)	Intervention Group			Control Group
Author (year) Country	Sample Size (Analyzed)	N (Analyzed)	Range of age (Mean±SD)	Types of treatment	N (Analyzed)	Range of age (Mean±SD)	Types of treatment
Chen et al. (2000) China	64 (64)	39 (39)	55∼78 (63±NR)	WA + PT	25 (25)	46∼72 (61.5±NR)	PT
Gong et al. (2003) China	60 (60)	30 (30)	55∼70 (NR) NSR	SA + Ginger-salt-indirect moxibustion	30 (30)	55∼70 (NR) NSR	Ginger-salt-indirect moxibustion
Wang et al. (2009) China	142 (142)	74 (74)	39∼72 (55.6±8.4) NSR	EA + PT	68 (68)	39∼72 (55.6±8.4) NSR	PT
Zeng et al. (2012) China	60 (60)	30 (30)	50∼80 (67.66±6.78)	EA + PT	30 (30)	50∼80 (69.38±5.38)	PT

AT(acupuncture therapy); CT(conventional therapy); EA(electro-acupuncture); FFVB(the first filling volume of bladder); MA(manual acupuncture); MUFR(maximum urine flow rate); MVBC(maximum volume of bladder capacity); NR(not reported); NSR(not separately reported by the group); PT(physical therapy); RUV(residual urine volume); SA(scalp acupuncture); UDT(urodynamic testing); WA(warm therapy)

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