Clinical Practice Guideline on Acupuncture for Post-stroke Spasticity

Article information

J Korean Med. 2015;36(1):1-8

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

Je-Shin Kim ¹, Seung-Won Shin ¹, Eui-Ju Lee ¹^,, Byung-Cheul Shin ², Myeong-Soo Lee ³, Sung-Min Lim ⁴, Dong-Woo Nam ⁵, Sang-Kwan Moon ⁶

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 2014 November 23; Revised 2015 March 13; Accepted 2015 March 17.

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

Fig. 1.

Flow Chart of the Trial Selection Process.

RCT: Randomized Controlled Trial; SR: Systematic Review.

Table 1.

Level of Evidence.

Table 2.

Grade of Recommendation.

감사의 글

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

References

1. Francisco GE, McGuire JR. Poststroke spasticity management. Stroke; a journal of cerebral circulation 2012;43(11):3132–6.

2. Kim YH, Han TR, Jung HY, Chun MH, Lee JM, Kim DY, et al. Clinical Practice Guideline for Stroke Rehabilitation in Korea. Brain & Neuro Rehabilitation 2009;2(1):1–38.

3. VA/DOD Clinical practice guideline for the management of stroke rehabilitation. Journal of rehabilitation research and development 2010;47(9):1–43.

4. Lee MS. Recommendations for Development of Clinical Practice Guideline in Korean Medicine (PRIDE-CPG-KM). Korea Institute of Oriental Medicine 2013;

5. 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):672–82.

6. Moon SK, Whang YK, Park SU, Ko CN, Kim YS, Bae HS, et al. Antispastic effect of electroacupuncture and moxibustion in stroke patients. The American journal of Chinese medicine 2003;31(3):467–74.

7. Lee SW, Yun JM, Son JW, Kang BG, Park SM, Yun HJ, et al. The Effect of Electroacupuncture on Upper-Extremity Spasticity of Stroke Patients. Journal of Korean oriental internal medicine 2007;28(3):492.

8. Gong WJ, Zhang T, Cui LH. Effects of Electroacupuncture at Zusanli (ST36) on Lower Limbs Motor Function in Patients with Stroke during Spasm Period:A Clinical Research. Chinese Journal of Rehabilitation Theory and Practice 2008;14(11):1057–8.

9. Li L, Yang WX, Hu FJ. Clinical Effect of Electric Acupuncture and Baclofen on Recovery of Spasticity. Chinese Journal of Rehabilitation 2007;22(5):319–20.

10. Zong T. Influence of Du Acupoint Electrical Stimulation on Limb Spasticity after Cerebral Infarction and Motor Function. Liaoning Journal of Traditional Chinese Medicine 2012;39(7):1391–3.

11. Park DS, Choi DY, Lee JD, Kim YS, Nam SS, Lee SH, et al. The Acupuncture and Moxibustion Medicine. Jipmoondang 2012;601

12. Fink M, Rollnik JD, Bijak M, Borstadt C, Dauper J, Guergueltcheva V, et al. Needle acupuncture in chronic poststroke leg spasticity. Archives of physical medicine and rehabilitation 2004;85(4):667–72.

13. Dong XL, Feng XM, Zhu H. Evaluation of the effects of acupuncture for the treatment of hemipleyis in patients with stroke by Fugl-Meyer. Chinese Journal of Clinical Rehabilitation 2003;7(19):2711–2.

14. Zhang ZM, L FC, Pi ZK, Fan XY, Chen HQ, Zhang J. Observation on clinical therapeutic effect of acupuncture on upper limb spasticity in the patient of poststroke. Chinese Acupuncture & Moxibustion 2008;28(4):257–60.

15. Wu HM, Tang JL, Lin XP, Lau JTF, Leung PC, Woo J, et al. Acupuncture for stroke rehabilitation. Cochrane Database of Systematic Reviews 2006;(3):CD004131.

16. Zhao JG, Cao CH, Liu CZ, Han BJ, Zhang J, Li ZG, et al. Effect of acupuncture treatment on spastic states of stroke patients. Journal of the neurological sciences 2009;276(1–2):143–7.

17. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. The American journal of medicine 2001;110(6):481–5.

18. Kim SY, Ji SM, Lee SJ, Lee YJ, Park JE, Nam MH, et al. Guidance for development of clinical practice guidelines. National Evidence-based Healthcare Collaborating Agency 2011;:20–77.

19. Yoon BW, Hong KS, Kwon SU, Lee SH, Ko SB, Choi HY. Clinical Practice Guidelines for Stroke. Clinical Research Center for Stroke 2013;

20. Rah UW, Kim YH, Ohn SH, Chun MH, Kim MW, Yoo WK, et al. Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012. Brain & Neuro Rehabilitation 2014;7(1(suupl.1)):S1–S75.

Article information Continued