Acupuncture for spinal cord injury and its complications: a systematic review and meta-analysis of randomized controlled trials

Abstract

To evaluate the evidence supporting the effectiveness of acupuncture treatment for SCI and its complications, we conducted search across 19 electronic databases to find all of the randomized controlled trials (RCTs) that used acupuncture as a treatment for SCI and its complications. The methodological quality of each RCT was assessed using the Cochrane risk of bias tool and the PEDro scale. Sixteen RCTs, including 2 high-quality RCTs, met our inclusion criteria (8 for functional recovery from SCI, 6 for bladder dysfunction, and 2 for pain control). The meta-analysis showed positive results for the use of acupuncture combined with conventional treatments for the functional recovery in terms of motor ASIA scores and total FIM scores when compared to conventional treatments alone. Positive results were also obtained for the treatment of bladder dysfunction, in terms of the total efficacy rate, when comparing acupuncture to conventional treatments. However, 2 RCTs for pain control reported conflicting results. Our systematic review found encouraging albeit limited evidence for functional recovery, bladder dysfunction, and pain in SCI. However, to obtain stronger evidence without the drawbacks of trial design and the quality of studies, we recommend sham-controlled RCTs or comparative effectiveness research for each condition to test the effectiveness of acupuncture.

Figure 1

A flow chart describing the trial selection process. AT: acupuncture; CDSR: The Cochrane Database of Systematic Review; CENTRAL: The Cochrane Central Register of Controlled Trials; CNKI: China National Knowledge Infrastructure; CT: clinical trial; DB: database; KSI: Korean Studies Information; KISTI: Korea Institute of Science Technology Information; KNAL: Korean National Assembly Library; KTKP: Korean Traditional Knowledge Portal; RCT: randomized clinical trial; SCI: spinal cord injury.

Figure 2

The meta-analysis of acupuncture for spinal cord injury and its complications. ASIA: American Spinal Injury Association; AT: acupuncture; FIM: functional independence measure; Tx: treatment.